RT Journal Article
SR Electronic
T1 Child with acute weakness: don’t forget the salts
JF Archives of disease in childhood - Education & practice edition
JO Arch Dis Child Educ Pract Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 21
OP 23
DO 10.1136/archdischild-2019-318286
VO 107
IS 1
A1 Kathryn Boyle
A1 Ben McNaughten
A1 Andrew Thompson
A1 Stephen Mullen
YR 2022
UL http://ep.bmj.com/content/107/1/21.abstract
AB Case summary A 10-year-old boy presented with severe progressive generalised weakness on a background of 3 days of diarrhoea and vomiting. Vital signs were normal. Peripheral neurological examination revealed grade 1–2 power in all limbs, hypotonia and hyporeflexia. Sensation was fully intact. Cranial nerve examination and speech were normal. The ECG (figure 1) and initial venous blood gas (figure 2) are shown.Figure 1 ECG.Figure 2 Venous blood gas.Question 1 What abnormalities are present on the ECG?Peaked T waves, prolonged PR segment and loss of P waves?Shortening of the QT interval and Osborn waves (J waves)?T wave flattening/inversion, prominent U waves and long QU interval?Prolonged QT interval with multiple atrial and ventricular ectopics?Question 2 How would you manage this patient’s hypokalaemia?Question 3 What is the likely diagnosis?Conversion disorder.Myasthenia gravis.Periodic paralysis.Guillain-Barré syndrome.Botulism.Question 4 What interventions can be considered for long-term treatment of this condition? Answers can be found on page 2.