Flashback to the hypokalemic episode

For those of you readers that remember me going to the ER in November paralyzed, I typed up the incident in better detail which follows. If you'd like to see the blood work done during that time, comment or contact me and tell me why you'd like to see it, if it seems like a valid reason I'll gladly email it to you.

 

November 4th, feel slight muscle fatigue in legs, feels like I had a 'charlie horse' in both legs the night before but hadn't woken from them.

November 5th, sometime before 4am I wake up. Paralyzed. 90-95%, I manage to get from my back to my stomach with considerable effort, confused and assuming sleep paralysis. No matter what I do I can't do more than slightly prop myself up an inch or so from mattress, I can't lift my arm high enough (18 inches or so) to hit the back light on my alarm clock to see the time so I estimate over the course of 15 minutes I manage to get my legs over the edge of the bed and can get propped up towards a sitting position to about a 40 degree angle. Thinking if I can just sit up maybe whatever is wrong will stop, pinched nerve or perhaps my time perception is way off and this has been seconds, I even thought it's carbon monoxide I have to get up I have to move move move move. While trying to sit up I get enough of my weight leaning off the bed that I just slide right off the bed and land in an odd pile on the floor, I try with every ounce of effort to get up for several seconds and realize something is very, very wrong.

At this point I've got the brain fog of 'combat cocktail' and immediately go to work trying to focus myself and assess the situation. I go through the president's last names, conjugate some latin verbs, say the preamble to the constitution all of this out loud. Ok, I've decided it's unlikely that I've had a stroke, my memory is working fine and I'm not lethargic so carbon monoxide is out. I then mentally lose it (not a panic just omg wtf I'm out of ideas this is so weird are you sure this is not a dream?!), somewhere in going through things in my head locked-in syndrome starts flashing over and over in my mind and I just flat out lose it having the first panic attack of my life. I calm myself down realizing that isn't going to help a damn bit and begin to shout as loud as I can over and over "help, someone please help, I need help, help, help" and similar things pausing only to listen for my mother or half-brother (long story, half is 40 mom is 60, medical issues for mom, money issues for brother, living together during a down economy to help each other etc). Eventually the dog comes in, sniffs me and goes back to my mom's room whining and between the two of us she wakes up and comes in. After a good 5 minutes of telling her, from a weird position in the floor in my underwear, that I can't move call 911 she finally leaves... to use the bathroom and do her hair before calling 911 *grumble*.

6 firefighters and 2 emt's show up. EMT's were women, the biggest of the two probably weighing in at a whopping 130lbs (I'm 268 6'0 in the ER) and the firefighters are all 5'5ish guys. They all crowd into my tiny 10x9 room and start asking me what's wrong, pawing through my crap, telling me to get up. Finally 2 try to get me up off the floor "sir you have to help us, sir you have to get up" over and over, till one not helping goes "guys I don't think he can" finally 3 of them get me to my knees, at which point 2 release me and I go face first into the floor with absolutely no ability to stop myself. Ultimately took all 6 to get me into their roller chair thing and all 8 to get me off of it and onto the gurney at which point they leave me sitting outside of the ambulance (highest it got that day was 19F, by this time I've had someone place my phone in my hands and I can do nothing more than mash the home button to see the time and it's around 4:40 so it's probably 10F or worse outside) in the middle of the road, in my underwear for a good 5 minutes arguing with my mom on what hospital to take me to before loading me.

We are at the ER less than 10 minutes later after a grand inquisition over and over asking me if I use drugs, insisting that I must use illegal drugs, demanding to know what illegal drugs I'm on then telling the ER they think it's a stroke because I can't touch my nose with my fingertips blah blah. I go straight into a room and the 2 EMT's start yelling at me "sir you have to slide over to the bed, you can do this, sir move to the bed" at this point I've probably said I'm paralyzed 200 times in the hour or so I've been awake. Finally they get every nurse from the ER and they sheet-slide me over to the bed... oh yeah, did I mention it was an OBGYN bed.

Nurses immediately start taking blood (all in all I counted 27 individual tubes taken during my 37 hour hospital visit), they one by one start asking me the drug questions again, try another stroke test with nose touching, shift change at 5am. New nurses, drug questions one by one, stroke test, blood blood blood. just before 9am I finally see a doctor (I think Dougie Howser was older) "we believe you are hypokalemic and are going to give you some potassium". Little after 9 nurse gives me 2 massive potassium pills, 2 packets of oral potassium solution and says they'll be back in a minute to give me IV potassium. About 9:30 they give me the line for the IV, hang the bag (about 5 inches tall, 4 or so wide and about 2 inches thick full) yellowish fluid and she says "we can't give this to you straight I'll be back in a minute and we will get it started" just before 11 a nurse I've never seen comes in and checks the bag "this isn't plugged in!" It wasn't plugged in at the wall, she plugs it in waits for it to start dripping leaves the room... few seconds pass "HOLY FFUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU " you get the picture, worst pain I've ever experienced in my life. Straight IV potassium solution pumping into my arm, I can literally feel it moving up my arm, to my shoulder, then it gets to my chest and of course, I can't move to push the call button... finally the pain just kinda dulls (I imagine from my body dumping every chemical it knows of to help me ignore it) and they come in and I start complaining (note, I'm not a baby to pain) and yet another new nurse looks at the bag and looks at me and goes "oh I'm so sorry we are supposed to give that to you with something". 15 minutes into the drip I'm able to move my feet and wave my hands violently (and keep doing until I can move more just out of fear if I stop I won't be able to move again). About 1 the drip has been done an they send something from the physical therapy department down to test my motor function and have me take a few dozen steps, I feel perfectly fine at this point 100% mobility.


They admit me shortly after, put me on a movement risk or whatever (bed was alarmed, if as much as my foot got over the edge of the bed alarms would sound... exactly the last thing a guy that woke up paralyzed wants... to be stuck in bed). Internalist, some sort of neuro doctor, nephroligst, endocrinologist and some other doctor end up coming through my room poking and prodding and looking at the various blood work. Nephroligst came several times and keeps saying "I don't know why I'm here, I don't think I can do anything for you, your kidneys are fine" finally the internalist comes back and tells me "We believe you have Hypokalemic Periodic Paralysis, it's a rare genetic disorder, honestly we had to google it". I got someone to bring me a tablet from home later that evening and started looking at all the information on this genetic disorder. Within 5 minutes of looking at the literature I was mad and decided they were full of ^!@$ and were wasting my time. Turns out this is a genetic disorder that affects something like 1 in 100k people, it presents in early teens and those that suffer generally have at least one attack a week from puberty on sometimes several. I'm 27 and have never had an attack, ever. I then decide something else caused my hpokalemia, likely poor diet and decided whenever they released me I'd go find a primary care and let them read the literature and see if they came to the same conclusion.

They wouldn't tell me my blood work results for anything, finally I get one of the nurses to tell me what my potassium was. When I came in my potassium was 2.2, she then confessed they kept coming into my room every few minutes to check on me because they (the nurses) were all afraid I was going to go into cardiac arrest because despite the 2 massive pills, the 2 oral packets, a third oral packet when first admitting me, the IV potassium and a fourth oral packet around 9pm the night I went in... my potassium wasn't responding how they were expecting... this is why I suspect the doctors thought it was hypokalemic periodic paralysis based on the literature (apparently to end an attack it takes a huge dose of potassium to stop an attack, this is the only rational reason I can see them deciding that was my diagnosis). By the 5th potassium was stable (but still a bit low, but well within 'healthy ranges') but I was severely dehydrated (so much so that attempts to draw blood the 2nd day were taking 3-5 sticks, with 30-90 seconds of probing with the needle just to get blood to come out, then it would take a good 2-3 minutes per tube to fill, it was oozing out like molasses after TWO blood thinner injections... side note, that stuff most use acetic acid as it stings like a mother for a good 2 minutes after the stomach injections). They finally let me go after about 37 hours and wanted me to go to the nephrologist for several more draws, the neuro doctor and the endocrinologist.

I went home election day and went straight to bed. Next day I get up, find a primary care in my network, she's a DO (which I liked) and come to find out was a pharmacist for like 15 years before becoming a DO so she's damn knowledgeable, and I cancelled all the blood work appointments the hospital scheduled as several of the bills were already available online through my insurance provider and I just could not (even with great coverage) afford all of those labs because they were billing them as "clinical consults" and crap instead of as blood work... insurance covered 92% of the bills in the end and I was still out like 1800 USD.

The DO had me in her exam room for THREE hours. First she had all the blood work and what not faxed over, while we waited for that she went over my body from head to toe for a good 10 minutes, read the paperwork then spent 2 and a half hours asking me questions. Medical history, family medical history, what exactly I ate in the days leading up (note hospital never once asked me a single damn thing about my food intake, not once, ever), asked me about each of my dozen plus tattoos and when I had them/how long they took to heal, what supplements I take etc. If the lady was 20 years younger, I would have proposed on the spot... she'd love this forum. I told her going in I thought the hospital was wrong on the diagnosis, after all the questions and exam she goes "I'll be honest, the hospital is full of shi* they don't know what they are talking about" and she agreed with me it was entirely due to my sodium intake overall and especially the 3 days before that caused it (I'll admit, I went overboard those 3 days, food is my drug sometimes... we estimated I had something like 200-300k mg in a 3 day period) and that diet was almost certainly the issue. I immediately reigned in my eating and haven't had a problem since.

BASICALLYThe 2.2 potassium and November 6th I tested at 152mmol/L for Sodium SerPl Qn.

Searching medical literature I found:

1 mEq/l sodium = 1 mmol/l sodium
Normal range for blood sodium levels is 135 to 145 milliequivalents per liter

”The diagnosis of hypernatremia was made at serum sodium (Na(+)) concentrations exceeding 150 mEq/L, and few people have been reported to survive concentrations greater than 160 mEq/L.” - A non-fatal case of sodium toxicity, Kupiec TC, J Anal Toxicol. 2004 Sep;28(6):526-8


Well, mine... on Nov 6th I tested at: Sodium SerPl Qn: 152 mmol/L so I was well into the start of the fatal range of sodium toxicity as well as severely hypokalemic. 

  This link has photos of my veins 4 days after, top photo is left arm, bottom photo is right, that pink is the chemical burn from the potassium