It occurs due to shift of potassium into the cells from extracellular space. Recurrent episodes of weakness in between the attacks may be experienced by some patients, otherwise patient usually has complete recovery. 5 Rarely patient can develop quadriparesis which needs to be differentiated from Guillian-Barre syndrome, transverse myelitis and spinal cord compression. Deep tendon reflexes are markedly diminished with hypotonia. Attacks may have correlation with seasonal variation that frequent attacks occur in summer months, which may be due to increased outdoor activity and consumption of sweet drinks in the summer. Precipitating factors of HPP include high carbohydrate diet, high salt intake, trauma, surgery, rest after sternous unaccustomed exercise, cold exposure, alcohol, emotional stress and drug like diuretics, estrogen, laxatives, steroids, amphotericin B etc. Sensory functions, bowel and bladder were not affected. 4 The muscular weakness may range from mild weakness to total flaccid paralysis. 3 Typical HPP attack is characterised by transient episode of muscular weakness usually involving lower limbs. 2 Some authors have reported HPP in a young boy of 14 years. HPP usually affects young Asian males in their 3 rd decade of life. No further episodes of hypokalemia or paralysis were noted. He was managed with methimazole and propranolol, and IV potassium chloride. An iodide 123 thyroid uptake nuclear medicine scan showed a 2 hour thyroid uptake of 20% (normal less than 8%) and a 24 hour uptake of 50% (normal less than 33%) consistent with hyperthyroidism. Serum potassium was 2.5 meq/L, X-ray chest was normal. Laboratory findings including blood sugar, renal profile, liver function tests, creatinine phosphokinase, sodium, calcium and magnesium were within normal limits. Heart and lung examination was non contributory. There was no sensory deficit.Ĭranial nerves revealed no abnormality. Power was normal in both upper limbs but 2/5 in both lower limbs with hypotonia. Deep tendon reflexes were diminished while planter response was flexor bilaterally. neck examination revealed diffuse thyromegaly with a bruit on auscultation. On examination he was anxious, BP 130/80 mmHg, Pulse rate 90/min, respiratory rate 16/minutes. The patient reported palpitation, heat intolerance, excessive sweating, irritability, tremors of both hands, weight loss. He woke up in the morning to find that he was unable to move, walk and stand up. A 22 year old patient, non alcoholic, non diabetic, vegetarian presented with complaints of sudden onset symmetrical weakness of lower limb muscles predominantly proximal group.
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