A young man with gradual onset extremity paralysis in all 4 limbs

This case comes fromJon B. Cole, one of our EM faculty and unparalleled toxicologist, and director of the Minnesota Poison Control Center.  @jonbcole2  https://twitter.com/jonbcole2Here is his incredible list of publications for early career, with h-index of 18 and i10 index of 33!CaseA young man was brought to the ED by friends with a complaint of progressive weakness to the point of extremity paralysis on arrival.  He spoke no English and spoke a language for which only a phone interpreter was available.  He was awake, alert, and oriented, but had 1/5 strength in all 4 extremities, such that they needed to hold the phone to his ear for him.  He was areflexic.Ventilations were rapid and shallow, but adequate.He denied head or neck trauma, or neck pain.  He did say that something like this had happened before in his home country.The emergency physician suspected the diagnosis and rapidly obtained a 12-lead ECG before any other test could be obtained:And the diagnosis was made.  What is it?Large U-waves confirm the diagnosis of hypokalemic periodic paralysis (HPP).  The K returned at 1.4 mEq/L and K was given po and IV.  The patient was admitted to the ICU.Mg was normal and phosphate was very low.p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Arial; background-color: #fefefe}The potassium was repleted in the ICU to a total of 170 mEq with resolution of symptoms (this could be hazardous!).  He was monitored overni...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs