Hypokalemic paralysis associated with dengue fever:Study from a tertiary centre in North India

ABSTRACT

Objective: Dengue associated hypokalemic paralysis (DHP) is an unusual neurological complication of dengue fever. This was a retrospective study of patients with DHP compared with idiopathic hypokalemic paralysis (IHP) seen in a tertiary centre in North India. Methods: Dengue was diagnosed by positive nonstructural protein (NS) 1 antigen and dengue-IgM antibody. Various clinical and laboratory parameters were compared between patients with DHP and IHP. Results: DHP was seen in 18 out of 489 (3.7%) dengue patients seen in the 4-years study period. Complications of bulbar weakness or respiratory failure developed in 6/18 (33.3%) of DHP patients. DHP patients with complications had higher hematocrit (p<0.001), lower platelet count (p=0.002), lower serum potassium (p=0.007) and higher creatinekinase (CK) (p<0.001) as compared to those without complications. When compared to IHP, DHP patients had fever at admission (p<0.001); myalgia (p<0.001); no past episodes (p=0.032); greater disability (p=0.02); lower serum potassium (p=0.0338); higher CK (p=0.001); and nerve conduction abnormalities (p=0.035). Conclusions: DHP should be suspected in patients who present with acute onset muscle weakness associated with fever. Predictors of complications in DHP include high hematocrit, low platelet count, low serum potassium and raised CK.