# Hyperinsulinemic State and Hypokalemic Quadriparesis in Tropical Fever: Is There a Link?

## TL;DR

A patient with tropical fever and low potassium levels developed sudden muscle weakness, possibly linked to high insulin levels caused by the infection.

## Contribution

This case suggests a novel link between hyperinsulinemia, dengue infection, and hypokalemic paralysis.

## Key findings

- A 48-year-old male with prediabetes and obesity developed acute quadriparesis during tropical fever.
- Low serum potassium and elevated C peptide levels indicated hyperinsulinemia-induced transcellular potassium shift.
- Dengue NS1 positivity without classic symptoms suggests a unique pathophysiological mechanism for paralysis.

## Abstract

It is rare for quadriparesis to manifest as a symptom of tropical illnesses. With a history of only one fever episode one week prior, our patient, a 48-year-old male with obesity and prediabetes, who was also known to have ankylosing spondylitis, presented with acute onset flaccid quadriparesis. He did not exhibit any additional symptoms of dengue, such as bleeding tendencies, petechial rashes, thrombocytopenia, or febrile episodes. Upon examination, it was discovered that he had extremely low serum potassium levels and was dengue non-specific antigen 1 (NS1) positive. His hyperinsulinemia, as seen by elevated C peptide levels, most likely caused a transcellular shift that was then triggered by the dengue infection, leading to hypokalemic paralysis.