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Diagnostic Dilemma
Periodic Paralysis Vs Seizures
 
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Author: Ganga Chandramohan
Question
A 2 month old boy presented with a history of 2 episodes of shaking movements followed by eyes rolling back and becoming limp that occured hours apart. Also had diarrhea on that day. Physical exam was normal except for few hypopigmeneted macules over the eye brows. Baby was born SGA due to IUGR. Family history of epilepsy in grand mother and mother had one episode of seizure during adolescent. Laboratory data: CBC normal, potassium 5.9, CSF: WBC 7` {N4 percent,L50 percent, M46 percent}, RBC 46. Ammonia 37, Lactate 4.3, acetone and alcohol levels were negative. CXR- mild cardiomegaly, EEG-possible LVH, cardiac echo was normal. Head CT and MRI were normal. Patient`s serum potassium remained high between 5.4-5.9 and once it reached 7.2 that required Kayexalate. Serum Na 134-140, HCO3 was 19-21, BUN 2, Cr 0.3 mg, dl, Ca 9.9, Mg 2.1, Phos 6.4. Urine fractional excretion of K was 5.5.
HDNo. 3 patient had a ventricular fibrillation like reading from the monitor which was analyzed by the cardiologist and read it as artefact.

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