Thirty-three-year-old, Hyderabad-based Ravi (name changed) — like many others around him — loved jalebi with rabdi.
But unlike others, whenever he used to eat jalebi with rabdi, his arms and legs would become weak, making him bed-bound and paralysed for several hours.
When he faced this problem at a wedding function, he explained it away as food poisoning. And even when both the rabdi and jalebi were made at home, he faced the same issue.
A visit to the doctor
Hoping to find out why he alone faced this odd reaction to two of Hyderabad’s favourites, Ravi visited a doctor at a hospital in Hyderabad.
“I suspected a medical problem and asked him to return to the hospital a few hours after eating the rabdi-jalebi combination. After he returned, on examination, he had developed weakness in the arms and legs. He was unable to get up from squatting position. He couldn’t raise his arms,” said Apollo Hospital neurologist Dr Sudhir Kumar in a tweet.
3.After listening to Ravi, I suspected a medical problem and asked him to return to hospital a few hours after having rabdi-jalebi (after informed consent).
On exam, he had developed weakness of legs & arms. He was unable to get up from squatting position. He couldn't raise arms.
— Dr Sudhir Kumar MD DM (@hyderabaddoctor) March 28, 2023
Dr Sudhir Kumar explained that his speech and swallowing were normal. He had no muscle pain. He had no numbness and had normal bladder control.
“I ordered a blood test. The serum potassium was reported as 2.8 mEq/L (normal value 3.5-5 mEq/L). The clinical diagnosis at this stage was hypokalemic periodic paralysis (HPP),” said Dr Sudhir Kumar.
Hypokalemic periodic paralysis (HPP) is a rare genetic disorder that affects the muscles and causes episodes of muscle weakness or paralysis. It is called “hypokalemic” because the episodes are associated with low levels of potassium in the blood.
He added that having foods rich in carbohydrates (starchy foods) can reduce potassium levels in people prone to hypokalemic periodic paralysis. “This is due to insulin surge post-meal, resulting in increased potassium uptake in cells, thus decreasing serum potassium levels,” said Dr Kumar.
The doctor treated him with potassium supplements and he showed signs of recovery. “However, the job was only half done. We still needed to find out the cause of HPP,” he noted.
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The final diagnosis
On further examination, the doctor found out that Ravi had a high pulse rate (110/minute), prominent eyeballs (bulging eyes with a staring look), and a swelling in front of neck (goitre).
“The diagnosis was obvious now. I ordered a thyroid profile, which showed high T3 and T4 levels with low TSH. A final diagnosis of hyperthyroidism with hypokalemic periodic paralysis was made,” said the doctor.
Hyperthyroidism is a condition in which the thyroid gland produces too much thyroid hormone, leading to an overactive metabolism.
In some cases, hyperthyroidism can cause HPP. This is because high levels of thyroid hormone can increase the amount of potassium that is taken up by the cells, leading to low levels of potassium in the blood. This, in turn, can trigger episodes of muscle weakness or paralysis in people with HPP.
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Is HPP treatable?
Treatment for hyperthyroidism with HPP may involve managing both conditions separately.
This may include medications to control thyroid hormone levels, as well as treatments to manage the symptoms of HPP, such as a low-carbohydrate diet or potassium supplements.
“Endocrinology opinion was taken for management of hyperthyroidism. He responded well to treatment. He could now enjoy his rabdi-jalebi without the fear of getting paralysed,” said Dr Sudhir Kumar.