Electrocardiography revealed prominent u- ... Electrocardiographic evidence of U
waves in a ... Practical Electrocardiography BI Waverly Pvt Ltd, New.
IMAGES IN CLINICAL MEDICINE
Acute Onset Distal Motor Weakness following a Heavy Meal Parvez Kumar*, S Dwivedi*
A 24 years old male presented with weakness of both upper and lower limbs for 24 hours duration. Weakness started on getting up from sleep following a heavy meal. The patient was normotensive, non-diabetic, and without any preceding headache, vomiting, altered sensorium, gastro-intestinal upset, or viral illness. On examination, pulse was 90/minute, regular, blood pressure – 130/80 mm of Hg CNS examination revealed normal higher mental functions with intact cranial nerves.
On investigation, total leucocyte count was 7,900/cubic mm, random blood sugar, urea and serum creatinine were 106 mg/dl, 36 mg/ dl, and 0.9 mg/dl respectively. Electrocardiography revealed prominent uwaves (Fig. 1). Serum sodium and potassium were 141 and 1.8 meq/litre respectively. In view of low serum potassium patient was given potassium orally. Patient completely recovered after 8 hours following oral potassium supplementation. His follow-up
There was grade I-II/V strength in all groups of muscles of elbow, wrist, knee, and ankle while grade V/V at shoulder and hip joints. All sensory modalities were intact. Chest, cardiovascular, and abdominal examination was unremarkable
electrocardiogram (Fig. 2) was normal with serum potassium level of 3.8 meq/litre.
* Department of Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Comments Electrocardiographic evidence of U waves in a patient with acute onset areflexic motor weakness suggests hypokalaemic paralysis. It usually occurs following a heavy meal or
exercise. Gastrointestinal and renal losses of potassium, thyrotoxicosis, and barium carbonate ingestion are well known causes of secondary hypokalaemic paralysis 1,2 . Hypokalaemia can be controlled by oral or intravenous potassium supplementation3. Serum potassium level during the episode of motor weakness is usually less than 3 meq/litre 4. Hypokalaemia induced motor weakness may be induced by injection of insulin, epinephrine, fluorohydrocortisone, or glucose 5 . The characteristic ECG change is prominent Uwaves with reversal in amplitude of T and U waves6. Normal U wave is in same direction as the T-wave but 10% of it’s amplitude. In the present case clinical suspicion of hypokalaemia was made on the basis of U-wave, which reversed completely along with abolition of symptoms following correction of potassium level. Such paralysis are usually areflexic and flaccid.
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Agarwal AK, Ahlawat SK, Wadhwa S et al. Periodic paralysis secondary to gastrointestinal potassium loss. J Assoc Phys Ind 1994; 42: 261-2.
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Aminoff MJ. Nervous System. In: Tierney LM, Mcphee SJ, Papadakis MA (ed). Current Medical Diagnosis and Treatment, Lange Medical book, Prentice Hall international Inc, Stamford 1996; 35: 858-914.
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Walton J. Disorders of Muscle. In: Brain’s Diseases of Nervous System. Oxford Medical Publications, Oxford 1993; 10: 656.
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Rowland LP. Familial Periodic Paralysis. In: Merritt’s Textbook of Neurology, The Williams & Wilkins Co., USA 1995; 9: 781.
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Wagner GS. Electrolyte Abnormalities. In: Marriott’s Practical Electrocardiography BI Waverly Pvt Ltd, New Delhi 1994; 9: 180.
Journal, Indian Academy of Clinical Medicine
Vol. 2, No. 3
July-September 2001
