Authors' reply

N Gupta¹, A Garg², P Chabbra³,  
¹ Department of Medicine, University College of Medical Sciences, Delhi; Department of Clinical Immunology and Rheumatology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
² Department of Medicine, University College of Medical Sciences, Delhi, India
³ Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India

Correspondence Address:
Dr. N Gupta
Department of Medicine, University College of Medical Sciences, Delhi; Department of Clinical Immunology and Rheumatology, Christian Medical College (CMC), Vellore, Tamil Nadu
India

Full Text

Sir,

Senthilkumaran et al.[1] have raised a query about the possibility of underlying channelopathies in dengue virus (DENV)-related hypokalemic quadriparesis and voiced a concern regarding differentiating it from Guillain-Barré syndrome. Hypokalemia in DENV infection is likely multifactorial. It is related to renal and GI loss, decreased intake, a transcellular shift (probably as a result of catecholamine and renin release due to stress) as also underlying channelopathy. The latter would need evidence from large studies and mutation analysis on muscle biopsy specimens. Differentiation between DENV-related hyopkalemic paralysis and Guillian Barre syndrome can be done on the basis of history. We agree that the latter should be ruled out before labeling a patient with DENV-related hypokalemic paralysis. Most of the DENV patients have fever but the presence of fever excludes the diagnosis of Guillian Barre syndrome. Similarly, the onset of weakness (from day of fever), progression, presence or absence of deep tendon reflexes, neck muscle involvement, cranial nerve involvement, and electrophysiological findings can help in differentiating DENV-related hypokalemic paralysis from Guillian Barre syndrome.

Ray et al.[2] have raised concern regarding the multifactorial nature of hypokalemia and we do agree with them. Joob et al.[3] have addressed the use of nonsteroidal anti-inflammatory drugs (NSAIDs) as being a causal factor for hypokalemia. To the best of our knowledge paracetamol has not been reported to cause such problems and NSAID use was ruled out on history taking.

References