ABSTRACT
A fifty-year-old male presented with weakness, difficulty in talking and breathing along with ascending paralysis. He gave prior history of excessive sweating in hot weather and had been administered many intravenous drips of dextrose solutions over the last three days. On clinical examination he was fully conscious, but was restless and tachycardiac. Motor power was 1/5, there was no obvious muscle wasting or fasciculation and the tendon reflexes along with abdominals and plantars were absent. Fundoscopy was unremarkable. Blood biochemistry revealed marked hypokalemia of 2.2 mmol along with an elevated blood and CSF sugar. Electrocardiography revealed flattened T waves and non-specific ST changes. His ventilation was supported and he was given I/V fluids with potassium supplementation and hyperglycaemia was managed with appropriate doses of insulin. The patient rapidly improved over the following few days with serum levels of potassium and ECG changes reverting to normal. The patient was discharged home in an ambulant state and he did not report back with any recurrence of symptoms