Hypokalemic Periodic Paralysis in Pregnancy: A Case Report

Myopathy is a disorder of skeletal muscles and has a rare occurrence in pregnancy. It may present with numbness/weakness. The occurrence of isolated weakness involving all the limbs is alarming to the patient and the diagnosis can be challenging to the Obstetrician. We present a case of hypokalaemic paralysis in pregnancy.

A 32-year-old grand multipara presented at 31 weeks gestation with numbness in all limbs for nine days and one-day history of weakness in all limbs. She had a similar episode in her last pregnancy with complete resolution by the end of puerperium. On examination, she was conscious with a Glasgow Coma Scale score was 15/15, had no signs of meningeal irritation, and no cranial nerve palsy. She had normal muscle bulk; the power of 4/5 in both upper limbs and 3/5 in both lower limbs. There was no clearly defined sensory level. Planter reflex was flexor symmetrically. A review of other systems was unremarkable. Her PCV was 35% and random blood glucose was 4.2mmol/l. Serum biochemistry showed severe hypokalaemia of 1.8mmol/l with normal levels of sodium and chloride. Urinary potassium level was normal. She had parenteral correction of potassium with complete resolution of weakness, and she was maintained on oral potassium supplements. She had an uneventful delivery at 37 weeks gestation.

Measuring the serum level of potassium should be part of the initial workup when evaluating pregnant women presenting with muscle weakness. Multidisciplinary management leads to early diagnosis, prompt management, and a good prognosis.