2.  B.E.  32, female  Married with four children  Roman Catholic  from Laguna

3.  The patient is a diagnosed case of hypokalemic periodic paralysis since 1997 c/o private MD. The patient is non-hypertensive and non-diabetic.

4.  Generalized body weakness

5.  12 yrs PTC, the patient started to have sudden onset of generalized body weakness described as “nawawalan ng lakas ang buong katawan”, (-)seizures, (-)fever, (-)headache, (-) vomiting, (-) loss of consciousness, (-) DOB. Consulted a private MD and was diagnosed to have HPP. Patient was maintained on Kalium BID.

6.  Since being diagnosed with HPP, the patient has been having intermittent bouts of generalized body weakness, usually upon waking up, lasting for 1-2 days. The patient has been hospitalized 2x for IV infusion of K.

7.  2 weeks PTC, the patient had another episode of generalized body weakness now lasting for 3-4 days with note of increase frequency of attacks (weekly). Patient self medicated with Kalium tablets with resolution of symptom after 4 days. Persistence of intermittent episodes of HPP prompted consult

8. Gen: (-)weight loss, (-)fever, (-) chills, (-)pallor CNS: (-)headache, (-)seizures, (-)vomiting HEENT: (-)blurring of vision, (-)difficulty of swallowing Respiratory: (-)cough/colds, (-)chest pain, (-)orthopnea, (-)paroxysmal nocturnal dyspnea, (-)hemoptysis CVS: (-)chest pain, (-)palpitations, (-)easy fatigability GIT: (-)vomiting, (-)constipation, (-)hematochezia, (-) melena, (-) abdominal pain GUT: (-) dysuria, (-) hematuria, (-) urgency, (-)frequency MSS: (-)limitation of movement, (-)pain on exertion Hema: (-)easy bruising, (-)bleeding tendencies Endo: (-) polyuria, (-)polydipsia, (-)polyphagia

9.  (-) DM, HPN, asthma, seizures  (-) previous surgeries  (-) known allergies to food and drugs

10.  (-) similar illnesses  (+) DM - father  (-) HPN, goiter, kidney disease, liver disease

11. DM 3235 46 37 5958

12.  HS graduate, previously worked as a saleslady, currently unemployed  Patient’s husband is a jeepney driver, non- promiscious  Lives with husband and 2 children  Non-smoker, non-alcoholic beverage drinker

13.  Menarche at 12 yo  Regular menstrual cycle lasting for 4-5days consuming 2-3 pads per day, (-) dysmenorrhea  G2P2(2002) all via SVD c/o midwife with no note fetomaternal complications

14.  Alert, awake, coherent, ambulatory, not in cardiorespiratory distress  BP: 110/ 80 HR 88 RR 20 Temp 36.8  HEENT: Anicteric sclera, pink conjunctivae, (-) cervical lymphadenopathy, (-) tonsillopharyngeal congestion, (-) anterior neck mass, (-) neck vein engorgement  CHEST: Equal chest expansion, clear breath sounds, (-) rales, (-) rhonchi, (-) wheezes

15.  HEART: Adynamic precordium, distinct heart sounds, normal rate regular rhythm, (-) murmurs  ABDOMEN: Flabby, normoactive bowel sounds, soft, non-tender, (-) distended abdominal veins, liver edge palpated 7 cm MCL, spleen not palpated  EXT: Pink nailbeds, full and equal pulses, CRT < 2 sec, (-) edema, (-)cyanosis, (-)clubbing

16.  Neuro Examinations: CN I – intact CN II- pupils 3mm EBRTL CN III, IV, VI – EOMS full and intact, brisk corneals CN V – can smile CN VII – no facial asymmetry CN VIII – intact CN IX, X – uvula midline, good gag CN XI – good shoulder shrug CN XII – tongue midline  MMTs: 5/5 on all extremities  Sensory: 100% on all extremities  Reflexes: ++  (-) dysdiadochokinesia, dysmetria  (-) nystagmus, ataxia  (-) clonus, babinksi

17.  Hypokalemic Periodic Paralysis

18.  Diagnostics: Serum K > other tests that should have been ordered: ECG, blood chemistry, CBC, urinalysis,  Therapeutics: Kalium durules TID  Advised to increase intake of K-rich food such as banana and watermelon  TCB once with results

19.  Are there any meds that can prevent the recurrence of the weakness?

20.  Among adults with hypokalemic periodic paralysis, is acetazolamide effective in preventing episodes of weakness?  P: adult patients with HPP  I: acetazolamide  O: prevention of HPP  M: RCT

21. Thank You!