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B.E. 32, femaleMarried with four childrenRoman Catholic from Laguna
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The patient is a diagnosed case of hypokalemic periodic paralysis since 1997 c/o private MD. The patient is non-hypertensive and non-diabetic.
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Generalized body weakness
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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.
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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.
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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
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Gen: (-)weight loss, (-)fever, (-) chills, (-)pallorCNS: (-)headache, (-)seizures, (-)vomiting HEENT: (-)blurring of vision, (-)difficulty of swallowingRespiratory: (-)cough/colds, (-)chest pain, (-)orthopnea, (-)paroxysmal nocturnal dyspnea, (-)hemoptysisCVS: (-)chest pain, (-)palpitations, (-)easy fatigabilityGIT: (-)vomiting, (-)constipation, (-)hematochezia, (-) melena, (-) abdominal painGUT: (-) dysuria, (-) hematuria, (-) urgency, (-)frequency MSS: (-)limitation of movement, (-)pain on exertionHema: (-)easy bruising, (-)bleeding tendenciesEndo: (-) polyuria, (-)polydipsia, (-)polyphagia
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(-) DM, HPN, asthma, seizures (-) previous surgeries (-) known allergies to food and drugs
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(-) similar illnesses (+) DM - father (-) HPN , goiter, kidney disease, liver
disease
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DM
3235
46
37
5958
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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
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Menarche at 12 yo Regular menstrual cycle lasting for
4-5days consuming 2-3 pads per day ,
(-) dysmenorrheaG2P2(2002) all via SVD c/o midwife
with no note fetomaternal complications
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Alert, awake, coherent, ambulatory, not in cardiorespiratory distress
BP: 110/ 80 HR 88 RR 20 Temp 36.8HEENT: Anicteric sclera, pink conjunctivae,
(-) cervical lymphadenopathy, (-) tonsillopharyngeal congestion, (-) anterior neck mass, (-) neck vein engorgement
CHEST: Equal chest expansion, clear breath sounds, (-) rales, (-) rhonchi, (-) wheezes
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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
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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
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Hypokalemic Periodic Paralysis
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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
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Are there any meds that can prevent the recurrence of the weakness?
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Among adults with hypokalemic periodic paralysis, is acetazolamide effective in preventing episodes of weakness?
P: adult patients with HPP I: acetazolamideO: prevention of HPPM: RCT
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Thank You!