Hypokalaemic Paralysis Associated with COVID-19 Infection
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SARS-CoV-2 is a positive strand RNA virus that causes severe respiratory syndrome in humans. In December, 2019, an outbreak of a novel coronavirus SARS-CoV-2, previously 2019-nCoV started in Wuhan, China, and has since become a global threat to human health. 2019-nCoV infection may be associated with cellular immune deficiency, respiratory injury, coagulation activation, myocardial injury, hepatic injury, and kidney injury.

A 56-year-old male patient presented to emergency department in the hospital with complains of fever 2 days, weakness in bilateral lower limbs for 1 day. There was no history of nausea, vomiting, diarrhoea, shortness of breath, chest pain, loss of consciousness, abnormal body movement or bowel or bladder involvement. Patient had no co-morbidities like diabetes mellitus, Thyroid dysfunction. There was no history of diuretics, laxatives or insulin intake.

In the emergency room, patient was conscious, alert and oriented to time place and person. His vitals included pulse- 90/min, blood pressure- 136/86mmhg, respiratory rate- 22/min, SpO2 of 98% at room air and temperature of 98.8°F. General physical examination was unremarkable. Neurological examination revealed GCS of 15/15, no cranial nerve involvement. Motor examination revealed flaccid paralysis of both lower limbs with normal bulk, Hypotonia and power of grade 1 while upper limbs muscle power was normal (grade 5). There was no sensory involvement in any limbs. Deep tendon reflexes were attenuated (1+) but symmetrical in all limbs. Cerebellar and meningeal signs were negative. There was no focal tenderness over spine. The abdominal, respiratory and cardiovascular examinations were unremarkable.

NCCT head was unremarkable. ABG revealed severe hypokalemia with K+ of 2.05 mmol/L while rest was within normal limits. The initial laboratory investigations were done which confirmed hypokalemia with serum K+ level of 2.0 mEq/L. ECG revealed T- wave flattening seen in leads II, III, aVR, aVL, aVF and U waves are seen in lead V2 and V3. Chest x-ray PA-view was within normal limits.

Patient was managed with intravenous and oral potassium replacement and his neurological symptoms were improving. After 24 hours he had gained power of 3/5 in both lower limbs which improved to grade 5/5 over next 24 hours. Patient’s urine sodium and potassium were not done as therapy was deemed urgent. Serum aldosterone and renin level were found to be normal. Thyroid profile including thyroid stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4) levels were within normal range. His nasal and throat swab for COVID-19 RT-PCR came out to be positive. His serial potassium level was 3.0 then 3.4mEq/L by next 8 hours and 24 hours respectively.

Patient was diagnosed as a case of hypokalaemic paralysis associated with COVID-19 and was managed with oral potassium supplements, multivitamins, hydroxychloroquine, favipiravir and ivermectin. Patient improved and was discharged after negative RT-PCR for COVID-19 on day 10.

Source: https://www.japi.org/x2748474/hypokalaemic-paralysis-associated-with-covid-19-infection
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