Dengue and Hypokalemic Paralysis: A Rare Association

Abstract

Dengue is one of the most common mosquito-borne viral illnesses in tropical areas, including Pakistan. Presentation varies from a self-limiting flu-like illness to life-threatening conditions like hemorrhagic shock and multi-organ dysfunction leading to death. In the absence of vomiting and diarrhea, electrolyte abnormalities are rare findings. Though Guillain-Barré syndrome is a known association of viral illnesses presenting with flaccid paralysis, there is a possibility for dengue to cause hypokalemia without apparent gut or renal losses. Dengue-associated hypokalemic paralysis is an underrecognized entity but has a favorable outcome. The clinician should suspect this in patients presenting with motor weakness in dengue-endemic areas. Neurological complications of dengue are reported frequently now, so early recognition of these neurological manifestations is needed for the successful recovery of patients. Here, we discuss a case of dengue-induced hypokalemia presenting with acute flaccid paralysis.

Keywords: acute hypokalemic paralysis; acute motor weakness; dengue fever/complications; dengue induced motor weakness; hypokalemia.

Figure 1. ECG of the patient before potassium chloride infusion showing ST segment depression, U wave, and prolonged QU interval

Figure 2. ECG after potassium chloride replacement