Journal of the Neurological Sciences 344 (2014) 238
Contents lists available at ScienceDirect
Journal of the Neurological Sciences journal homepage: www.elsevier.com/locate/jns
Letter to the Editor Dengue-associated hypokalemic paralysis Keywords: Dengue Hypokalemia Paralysis
Sir, The recent article on “Dengue-associated hypokalemic paralysis” is very interesting [1]. Malhotra and Garg noted that “curious is the fact that only 35 patients had manifest-paralysis when more than twothirds affected with the dengue virus exhibit hypokalemia; whether this indicates a genetically mediated channel disorder or an incidental association remains to be seen [1].” Indeed, Garg et al. has recently reported in another journal that “Dengue virus infection was the second leading cause of hypokalemic paralysis [2].” Hence, it seems that Garg et al. might believe that dengue is the cause of paralysis rather than a coincidence. It is no doubt that hypokalemia can be seen in a number of dengue patients [3]. However, the magnitude of hypokalemia in most cases might be mild and does not contribute to the paralysis. In addition, the prevalence rates of hypokalemia are variable in different reports. Some reports might show high prevalence, up to two-thirds of all infected cases [3], while the others show low prevalence (about 14–17% [4]). Hence, dengue-associated hypokalemic paralysis should be an important neurological complication of severe dengue [5]. Finally, it should also be noted that not all dengue patients who develop quadriparesis are due to hypokalemia. Some rare causes of quadriparesis in dengue patients such as hematoma induced compressive myelopathy can also be seen.
http://dx.doi.org/10.1016/j.jns.2014.06.040 0022-510X/© 2014 Elsevier B.V. All rights reserved.
Conflict of interest There is no conflict of interest.
References [1] Malhotra HS, Garg RK. Dengue-associated hypokalemic paralysis: causal or incidental? J Neurol Sci 2014;340:19–25. [2] Garg RK, Malhotra HS, Verma R, Sharma P, Singh MK. Etiological spectrum of hypokalemic paralysis: a retrospective analysis of 29 patients. Ann Indian Acad Neurol 2013 Jul;16(3):365–70. [3] Ying RS, Tang XP, Zhang FC, Cai WP, Chen YQ, Wang J, et al. Clinical characteristics of the patients with dengue fever seen from 2002 to 2006 in Guangzhou. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi Jun 2007;21(2):123–5. [4] Lumpaopong A, Kaewplang P, Watanaveeradej V, Thirakhupt P, Chamnanvanakij S, Srisuwan K, et al. Electrolyte disturbances and abnormal urine analysis in children with dengue infection. Southeast Asian J Trop Med Public Health Jan 2010;41(1):72–6. [5] Verma SP, Himanshu D, Tripathi AK, Vaish AK, Jain N. An atypical case of dengue haemorrhagic fever presenting as quadriparesis due to compressive myelopathy. BMJ Case Rep Mar 25, 2011. http://dx.doi.org/10.1136/bcr.10.2010.3421 [pii: bcr1020103421].
Beuy Joob* Sanitation Medical Academic Center, Bangkok Thailand *Corresponding author. Tel.: +66 24658292. E-mail address: [email protected]. Viroj Wiwanitkit Hainan Medical University, China Joseph Ayobabalola University, Nigeria Faculty of Medicine, University of Nis, Serbia 1 April 2014
Contents lists available at ScienceDirect
Journal of the Neurological Sciences journal homepage: www.elsevier.com/locate/jns
Letter to the Editor Dengue-associated hypokalemic paralysis Keywords: Dengue Hypokalemia Paralysis
Sir, The recent article on “Dengue-associated hypokalemic paralysis” is very interesting [1]. Malhotra and Garg noted that “curious is the fact that only 35 patients had manifest-paralysis when more than twothirds affected with the dengue virus exhibit hypokalemia; whether this indicates a genetically mediated channel disorder or an incidental association remains to be seen [1].” Indeed, Garg et al. has recently reported in another journal that “Dengue virus infection was the second leading cause of hypokalemic paralysis [2].” Hence, it seems that Garg et al. might believe that dengue is the cause of paralysis rather than a coincidence. It is no doubt that hypokalemia can be seen in a number of dengue patients [3]. However, the magnitude of hypokalemia in most cases might be mild and does not contribute to the paralysis. In addition, the prevalence rates of hypokalemia are variable in different reports. Some reports might show high prevalence, up to two-thirds of all infected cases [3], while the others show low prevalence (about 14–17% [4]). Hence, dengue-associated hypokalemic paralysis should be an important neurological complication of severe dengue [5]. Finally, it should also be noted that not all dengue patients who develop quadriparesis are due to hypokalemia. Some rare causes of quadriparesis in dengue patients such as hematoma induced compressive myelopathy can also be seen.
http://dx.doi.org/10.1016/j.jns.2014.06.040 0022-510X/© 2014 Elsevier B.V. All rights reserved.
Conflict of interest There is no conflict of interest.
References [1] Malhotra HS, Garg RK. Dengue-associated hypokalemic paralysis: causal or incidental? J Neurol Sci 2014;340:19–25. [2] Garg RK, Malhotra HS, Verma R, Sharma P, Singh MK. Etiological spectrum of hypokalemic paralysis: a retrospective analysis of 29 patients. Ann Indian Acad Neurol 2013 Jul;16(3):365–70. [3] Ying RS, Tang XP, Zhang FC, Cai WP, Chen YQ, Wang J, et al. Clinical characteristics of the patients with dengue fever seen from 2002 to 2006 in Guangzhou. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi Jun 2007;21(2):123–5. [4] Lumpaopong A, Kaewplang P, Watanaveeradej V, Thirakhupt P, Chamnanvanakij S, Srisuwan K, et al. Electrolyte disturbances and abnormal urine analysis in children with dengue infection. Southeast Asian J Trop Med Public Health Jan 2010;41(1):72–6. [5] Verma SP, Himanshu D, Tripathi AK, Vaish AK, Jain N. An atypical case of dengue haemorrhagic fever presenting as quadriparesis due to compressive myelopathy. BMJ Case Rep Mar 25, 2011. http://dx.doi.org/10.1136/bcr.10.2010.3421 [pii: bcr1020103421].
Beuy Joob* Sanitation Medical Academic Center, Bangkok Thailand *Corresponding author. Tel.: +66 24658292. E-mail address: [email protected]. Viroj Wiwanitkit Hainan Medical University, China Joseph Ayobabalola University, Nigeria Faculty of Medicine, University of Nis, Serbia 1 April 2014
