“I can’t move my legs,” the 26-year-old man advised his youthful brother, who towered above him as he lay sprawled on the ground. He’d been on his pc for hours, he defined, and when he tried to face up, he couldn’t. His legs regarded regular, felt regular, but they wouldn’t transfer.
At first, he figured his legs will need to have fallen asleep. He pulled himself up, leaning on his desk, and slowly straightened till he was standing. He might really feel the weight on his ft and knees. He let go of the desk and commanded his legs to maneuver. Instead, they buckled, and he landed on the ground with a thud.
His brother awkwardly pulled him onto the mattress. Then they waited. Surely this bizarre paralysis would disappear simply as all of a sudden because it got here. An hour handed, then two. I’m calling an ambulance, the youthful brother introduced lastly. Reluctantly, the elder agreed. He was embarrassed to be this helpless however fearful sufficient to need assist.
When the E.M.T.s arrived, they have been as confused as the brothers. The medics requested what the younger man had been as much as. Nothing dangerous, he assured them. For the previous few weeks he had been getting again into form. He modified his weight loss plan, lower out the junk and was ingesting a protein concoction that was supposed to assist him construct muscle. And he was understanding arduous every single day. He’d misplaced greater than 20 kilos, he added proudly.
Hearing about this excessive weight loss plan and train routine, the E.M.T.s advised the man he was most likely dehydrated. He wanted fluids and a few electrolytes. A few bottles of Gatorade and he would very possible really feel quite a bit higher. And if he didn’t, he might name once more.
With his brother’s assist, the man moved himself to a sitting place. He drank some water and Gatorade and waited to begin feeling higher. He fell asleep, nonetheless ready. By the following afternoon he was having hassle sitting upright. He was ingesting yet one more Gatorade when he observed that the bottle felt heavy. He realized with a begin that the weak spot had moved into his arms. Call the ambulance, he advised his brother. This can’t be dehydration.
A brand new set of E.M.T.s agreed. They hoisted the weakened man onto a stretcher, mounted the straps tightly and headed down the stairs. The man felt himself pitch ahead as the stretcher tilted down. Was he going to fall? He imagined himself tumbling down the stairs like a sack of potatoes, utterly unable to guard himself. The straps held him on the stretcher, however that feeling of helplessness terrified him.
A Quick Test Result
Dr. Getaw Worku Hassen was the emergency-medicine physician on obligation that night time at Metropolitan Hospital in Upper Manhattan. He requested the affected person if something like this had occurred earlier than. No, the affected person replied, although just lately his thighs had felt drained and weak at occasions. It by no means lasted lengthy, and he figured it was from understanding so arduous. The man requested if he might need had a stroke. Would he ever be capable to stroll once more? Hassen reassured him that his signs didn’t seem like a stroke. But, the physician acknowledged, he wasn’t positive what it did seem like.
On examination, the man’s coronary heart was racing at 110 beats a minute. And his blood stress was excessive. He couldn’t elevate both leg off the stretcher — not even an inch. His arms have been weak as properly. But his reflexes, sensation and the remainder of his nervous system appeared in any other case regular.
Hassen advised the man that they would wish to attend for the outcomes of his blood work and different assessments. He could be again when he knew extra. Moments later the physician was referred to as by the lab. One of the affected person’s electrolytes was dangerously low — his potassium.
The Cause Behind the Cause
Potassium might be the most essential electrolyte we measure routinely. It is crucial for each cell in the physique, and its motion out and in of cells is essential to a lot of the physique’s capabilities. Hassen instantly ordered potassium to be given each by mouth and intravenously. He wasn’t positive why this younger man had such a low stage of potassium however knew that if he didn’t get extra, he might die. Cells in the coronary heart depend upon the movement of potassium to work correctly. Either an excessive amount of or too little of it might trigger the coronary heart to develop a life-threatening arrhythmia.
The affected person was admitted to the intensive-care unit in order that his coronary heart might be monitored as the deficit was lowered. The affected person says he might really feel energy flowing again into his muscle groups nearly as quickly as he began getting the alternative electrolyte. By morning he felt robust sufficient to face. By midafternoon, he might stroll. The docs gave him potassium tablets to take every single day for the subsequent week and advised him to remain hydrated if he was going to maintain up this health routine. And, in fact, he ought to comply with up along with his common physician.
A number of days later, when Hassen returned to the hospital for his subsequent shift, he puzzled what had occurred to the man with the weakened legs. He noticed that his potassium had come again to a standard stage and that he had been discharged. These days, monetary pressures push docs caring for hospitalized sufferers to slender their focus to figuring out life-threatening situations and addressing these sufficient to stabilize the affected person. Patients are then despatched again to their primary-care docs to find out the hows and whys behind the situations that despatched them to the hospital in the first place. Hassen accepted this actuality, and but to him the actual pleasure of medication wasn’t simply figuring out and addressing the severe signs however determining the trigger behind the reason behind the symptom. This man’s weak spot was brought on by low potassium. But what made his potassium low?
A Striking Resemblance
Hassen reviewed the notes from the affected person’s in a single day keep. In the emergency division, he had been weak, his coronary heart racing, his blood stress excessive and his potassium low. When electrolytes have been repleted, his energy returned and his blood stress dropped. But his coronary heart continued to race. Heart charges are sometimes excessive in the E.R.: Patients are scared and generally sick, typically in ache. But this man’s coronary heart charge stayed excessive at the same time as all the pieces else bought higher. That struck Hassen as unusual.
And so Hassen turned to the web. He ultimately discovered a case report that bore a putting resemblance to his affected person: a younger man with weak legs, low potassium and a excessive coronary heart charge. That affected person turned out to have one thing Hassen had by no means heard of: thyrotoxic periodic paralysis, muscle weak spot the place the low potassium was being brought on by an extra of thyroid hormone.
The thyroid is a gland positioned in the neck that helps management the physique’s metabolic charge. Too a lot thyroid hormone causes the physique to race. Too little, and it slows to a crawl. Unchecked, both state will be deadly. Rarely, in some folks — normally younger, typically male — an excessive amount of thyroid hormone could make circulating potassium ranges drop and trigger weak spot.
Hassen referred to as the lab. He ordered assessments to test the stage of thyroid hormone in the pattern. It was very excessive. He referred to as the affected person and bought no reply, and he had no method to depart a message. He referred to as the quantity a dozen occasions over the course of the subsequent few weeks. Finally, perhaps unintentionally, the affected person picked up.
Hassen defined what he’d found. He gave the affected person the identify of an endocrinologist in the space. It turned out the younger man had what is called Graves’s illness. This is an autoimmune illness by which the affected person’s personal antibodies induce the thyroid gland to supply an excessive amount of hormone. It’s typically handled with radioactive iodine, which kills off some or most of the hormone-producing cells in the gland. This man, as an alternative, selected to take a drugs that interferes with the gland’s means to make thyroid hormone.
This analysis was made nearly 4 years in the past. The affected person gave up his intensive weight loss plan and train routine and is now making an attempt simply to remain in form and eat smarter — and to take his drugs every single day. Sometimes when he feels his thighs are drained or weak, he eats a banana or avocado to get the potassium that he thinks his physique is craving. He is set to by no means relive that sort of helplessness once more.
Lisa Sanders, M.D., is a contributing author for the journal. Her newest ebook is ‘‘Diagnosis: Solving the Most Baffling Medical Mysteries.’’ If you may have a solved case to share with Dr. Sanders, write her at [email protected]