Celiac crisis with hypokalemic paralysis in a young lady.

Celiac crisis presents as severe acute diarrhea with life-threatening metabolic derangement in a patient with celiac disease. We report a 30-year-old lady who was admitted with one-month history of worsening small bowel-type diarrhea. She developed acute quadriparesis due to refractory hypokalemia. Celiac disease was diagnosed on the basis of positive serology and histological features. She improved with aggressive correction of hypokalemia and gluten-free diet. Celiac crisis is a rare presentation of this heterogeneous disease in adulthood.

Thyrotoxic periodic paralysis in mexican mestizo patients: a clinical, biochemical and HLA-Serological study

Background. Thyrotoxic periodic paralysis (TPP) is characterized by episodes of neuromuscular weakness occurring in the context of hypokalemia and hyperthyroidism and has been predominantly described in Oriental populations. Whereas it is uncommon in Caucasians and Blacks, TPP does occur in individuals of Native American descent. The objective was to analyze the clinical, biochemical, and HLA characteristics of group of Mexican mestizo patients with TPP. Methods. The sample was comprised of 14 men with TPP diagnosed since january 1990, based on one or more episodes of flaccid paralysis, accompanied by hypokalemia and occurring in the context of clinical and biochemical hyperthyroidism. Eight were available HLA testing. Results. Hyperthyroidsm was diagnosed before the development of periodic paralysis in five of the patients, whereas in six it occurred afterward. The severity of paralysis did not correlate with the degree of either hypokalemia or hyperthyroidism. An increased frequency of HLA-DR3 was found in Graves' patients without paralysis but not in those with paralysis, as compared to the general population. Conclusions. TPP is more common than previously thoought in Mexicans, in whom it behaves as in other Native American groups. The lack of HLA-DR3 association in Graves' patients with TPP is interesting, but at the moment has no pathophysiological implications

Normokalaemic periodic paralysis as the presenting manifestation of hyperthyroidism.

We report a 50 year old male admitted with complaints of episodic weakness. During the attack of paralysis there was no hypokalaemia. There were no clinical signs of thyrotoxicosis, but since thyroid function tests revealed hyperthyroidism, he was treated as a case of thyrotoxic periodic paralysis, with no recurrence of symptoms over 6 months.

Plasma thiocyanate and free radicals in jaaraparesis

Tropical Spastic Paraparesis (TSP) in West African contries is countries is caused by combination of excess cyanide from the ingestion of Cassava and a deficiency of the sulphur-containing amino-acids required to detosify the cyanide. Free radical damage to long axons has also been reported to results in damage similar to that seen in Jamaican TSP. To investigate the possibility that these mechanisms may be responsible for Jamican TSP, venous blood from non-smoking blood donors and 22 patients with TSP were analysed for thiocyanate, superoxide dismutase and glutahione. Serum thiocyanate is an index of cyanide exposure. Superoxide dismutase protects against free radical damage, and glutathione in addition to rotecting against free radical damage is ana important sulphur-containing peptiae. Levels of thiocyanate in the patients with TSP were similar to those in control patients. Glutathione was elevated in all the patients, and superoxide dimutase activity was normal. The low levels of thiocyanate suggest that cyanide toxicity is not the primary cause of Jamaican TSP and, in any event, sufficient amounts of sulphur-containing amino-acids are present to detoxify cyanide. Free radical mechanisms ara also unlikely to be responsible for damage to the neurons in thes patients