Erosive Gastritis as a Trigger for Hypokalemic Paralysis in a Genetically Predisposed Patient

To the Editor,

Hypokalemic paralysis is a rare neuromuscular emergency characterized by sudden, reversible muscle weakness due to low potassium levels in the blood.^[1] Although hypokalemic paralysis due to gastrointestinal potassium loss is well-documented, the role of erosive gastritis as a trigger is seldom reported, especially in patients with a familial predisposition. We aim to emphasize this link based on a recent clinical case.^{[1 ,2]}

An 18-year-old female with type 1 diabetes mellitus experienced recurrent vomiting over 2 days, leading to a sudden onset of muscle weakness in her limbs and facial drooping. She had no history of diarrhea, kidney disease, or medication use. A family history of episodic electrolyte imbalances in a close relative suggested a genetic vulnerability. Upon examination, she was hemodynamically stable, with limb muscle strength rated 3/5–4/5. Laboratory test results showed severe hypokalemia (serum potassium 2.1 mEq/L) and electrocardiographic changes typical of hypokalemia, while her kidney function was normal.

An upper gastrointestinal endoscopy revealed redness and erosions in the gastric body and antrum, indicative of erosive gastritis [Figure 1], and tests for Helicobacter pylori were negative. The patient was treated with intravenous and oral potassium supplements, antiemetics, and proton-pump inhibitors. Her serum potassium levels returned to normal, and her muscle weakness completely resolved within a week, with no recurrence during short-term follow-up.^[3]

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Figure 1:

Endoscopic view of the gastric mucosa showing mucosal erythema and inflammation.

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This case highlights the interaction between genetic predisposition and secondary triggers in hypokalemic paralysis.^[2,4] In individuals with a familial tendency, even temporary gastrointestinal potassium losses from vomiting can lead to severe paralytic episodes. While gastrointestinal causes such as gastroenteritis and persistent vomiting have been previously noted, erosive gastritis remains an uncommon and underrecognized trigger.^[2]

Early identification of the underlying gastrointestinal issue, along with prompt correction of electrolyte imbalances, is crucial to prevent complications and recurrence.^[1,4] Clinicians should be vigilant for atypical gastrointestinal causes when assessing young patients with hypokalemic paralysis, particularly if there is a suggestive family history.