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Hypokalemic Paralysis as a Presenting Symptom of Dengue Fever: A Case Series

Received: 20 June 2022     Accepted: 18 July 2022     Published: 24 August 2022
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Abstract

Dengue virus is one of the leading causes of viral hemorrhagic fever, especially in tropics countries like India. It can manifest from being asymptomatic to life-threatening complications. Although it is considered a non-neurotropic virus, there has been increasing evidence of neurological complications associated with the dengue virus. It is one of the leading causes of death in tropical and subtropical regions. The neurological involvements include Acute Disseminated Encephalomyelitis, Transverse Myelitis, Guillan-Barre Syndrome and Encephalitis. Here, we wished to investigate an unusual increase in cases of quadriparesis following fever. We report 3 such cases of acute onset proximal and distal symmetric pure motor reversible flaccid quadriparesis due to hypokalemia in dengue fever patients, who recovered completely on treatment. Thus, recognition and early treatment for hypokalemia in such patients must be undertaken to avoid complications.

Published in American Journal of Internal Medicine (Volume 10, Issue 4)
DOI 10.11648/j.ajim.20221004.12
Page(s) 83-85
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Dengue Fever, Hypokalemia, Quadriparesis

References
[1] Carod-Artal FJ, Wichmann O, Farrar J, Gascón J. Neurological complications of dengue virus infection. The Lancet Neurology. 2013 Sep 1; 12 (9): 906-19.
[2] Prabhat N, Ray S, Chakravarty K, Kathuria H, Saravana S, Singh D, Rebello A, Lakhanpal V, Goyal MK, Lal V. Atypical neurological manifestations of dengue fever: a case series and mini review. Postgraduate Medical Journal. 2020 Dec 1; 96 (1142): 759-65.
[3] World Health, O., Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. 2009, Geneva: World Health Organization. 1-147.
[4] Jha S, Ansari MK. Dengue infection causing acute hypokalemic quadriparesis. Neurology India. 2010 Jul 1; 58 (4): 592.
[5] Kumar N. Hypokalemic Quadriparesis Associated with Dengue: A Case Series. Vol. 04, Journal of Advanced Research in Medicine. Advanced Research Publications; 2018. p. 8-10.
[6] Kumar A, Rao CR, Pandit V, Shetty S, et al. Clinical manifestations and trend of dengue cases admitted in a tertiary care hospital, Udupi district, Karnataka. Indian J Community Med 2010; 35: 386-90.
[7] Koshy JM, Joseph DM, John M, Mani A, Malhotra N, Abraham GM, Pandian J. Spectrum of neurological manifestations in dengue virus infection in Northwest India. Tropical doctor. 2012 Oct; 42 (4): 191-4.
[8] Jain RS, Handa R, Prakash S, Nagpal K, Gupta P. Acute hypokalemic quadriparesis: an atypical neurological manifestation of dengue virus. J Neurovirol. 2014 Feb 1; 20 (1): 103-4.
[9] Hira HS, Kaur A, Shukla A. Acute neuromuscular weakness associated with dengue infection. Journal of neurosciences in rural practice. 2012 Jan; 3 (01): 36-9.
[10] Mount DB. Fluid and electrolyte disturbances. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill Companies; 2012. pp. 341-59.
[11] Jha, S., & Ansari, M. K. (2010). Dengue infection causing acute hypokalemic quadriparesis. Neurology India, 58 (4), 592-594.
[12] Ghacha R, Sinha AK. Acute renal failure due to rhabdomyolysis caused by hypokalemia. Saudi Journal of Kidney Diseases and Transplantation. 2001 Apr 1; 12 (2): 187.
[13] Knochel JP. Neuromuscular manifestations of electrolyte disorders. The American journal of medicine. 1982 Mar 1; 72 (3): 521-35.
[14] Verma R, Holla VV, Kumar V, Jain A, Husain N, Malhotra KP, Garg RK, Malhotra HS, Sharma PK, Kumar N. A study of acute muscle dysfunction with particular reference to dengue myopathy. Annals of Indian Academy of Neurology. 2017 Jan; 20 (1): 13.
[15] Sejersted, O. M., & Sjøgaard, G. (2000). Dynamics and consequences of potassium shifts in skeletal muscle and heart during exercise. Physiological Reviews, 80 (4), 1411-1481.
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  • APA Style

    Keshu Jindal, Bhatt Shrey Nandkishor, Sai Kiran, Urja Bhatt. (2022). Hypokalemic Paralysis as a Presenting Symptom of Dengue Fever: A Case Series. American Journal of Internal Medicine, 10(4), 83-85. https://doi.org/10.11648/j.ajim.20221004.12

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    ACS Style

    Keshu Jindal; Bhatt Shrey Nandkishor; Sai Kiran; Urja Bhatt. Hypokalemic Paralysis as a Presenting Symptom of Dengue Fever: A Case Series. Am. J. Intern. Med. 2022, 10(4), 83-85. doi: 10.11648/j.ajim.20221004.12

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    AMA Style

    Keshu Jindal, Bhatt Shrey Nandkishor, Sai Kiran, Urja Bhatt. Hypokalemic Paralysis as a Presenting Symptom of Dengue Fever: A Case Series. Am J Intern Med. 2022;10(4):83-85. doi: 10.11648/j.ajim.20221004.12

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  • @article{10.11648/j.ajim.20221004.12,
      author = {Keshu Jindal and Bhatt Shrey Nandkishor and Sai Kiran and Urja Bhatt},
      title = {Hypokalemic Paralysis as a Presenting Symptom of Dengue Fever: A Case Series},
      journal = {American Journal of Internal Medicine},
      volume = {10},
      number = {4},
      pages = {83-85},
      doi = {10.11648/j.ajim.20221004.12},
      url = {https://doi.org/10.11648/j.ajim.20221004.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20221004.12},
      abstract = {Dengue virus is one of the leading causes of viral hemorrhagic fever, especially in tropics countries like India. It can manifest from being asymptomatic to life-threatening complications. Although it is considered a non-neurotropic virus, there has been increasing evidence of neurological complications associated with the dengue virus. It is one of the leading causes of death in tropical and subtropical regions. The neurological involvements include Acute Disseminated Encephalomyelitis, Transverse Myelitis, Guillan-Barre Syndrome and Encephalitis. Here, we wished to investigate an unusual increase in cases of quadriparesis following fever. We report 3 such cases of acute onset proximal and distal symmetric pure motor reversible flaccid quadriparesis due to hypokalemia in dengue fever patients, who recovered completely on treatment. Thus, recognition and early treatment for hypokalemia in such patients must be undertaken to avoid complications.},
     year = {2022}
    }
    

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    AU  - Keshu Jindal
    AU  - Bhatt Shrey Nandkishor
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    AU  - Urja Bhatt
    Y1  - 2022/08/24
    PY  - 2022
    N1  - https://doi.org/10.11648/j.ajim.20221004.12
    DO  - 10.11648/j.ajim.20221004.12
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
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    EP  - 85
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20221004.12
    AB  - Dengue virus is one of the leading causes of viral hemorrhagic fever, especially in tropics countries like India. It can manifest from being asymptomatic to life-threatening complications. Although it is considered a non-neurotropic virus, there has been increasing evidence of neurological complications associated with the dengue virus. It is one of the leading causes of death in tropical and subtropical regions. The neurological involvements include Acute Disseminated Encephalomyelitis, Transverse Myelitis, Guillan-Barre Syndrome and Encephalitis. Here, we wished to investigate an unusual increase in cases of quadriparesis following fever. We report 3 such cases of acute onset proximal and distal symmetric pure motor reversible flaccid quadriparesis due to hypokalemia in dengue fever patients, who recovered completely on treatment. Thus, recognition and early treatment for hypokalemia in such patients must be undertaken to avoid complications.
    VL  - 10
    IS  - 4
    ER  - 

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Author Information
  • Department of Medicine, Atal Bihari Vajpayee Institute of Medical Science and Dr. RML Hospital, New Delhi, India

  • Department of Medicine, Atal Bihari Vajpayee Institute of Medical Science and Dr. RML Hospital, New Delhi, India

  • Department of Medicine, Atal Bihari Vajpayee Institute of Medical Science and Dr. RML Hospital, New Delhi, India

  • Department of Medicine, Gujarat Medical Education and Research Society Medical College and Hospital, Vadodra, India

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