Brief Answer: Consultation/review with neurosurgeon needed Detailed Answer: Hi and thanks for the query, The clinical syndrome you describe deserves a very careful evaluation. To begin with, the fact that you got a past history of diabetes is a predisposing factor to develop some nerve abnormalities. This however does not explain this, when it comes to a sudden onset of paralysis. It might be very important to search for a possible cause at the level of the spinal nerves. Nerve supply to the upper limbs and the lower limbs are originate from the spinal cord. A proper clinical evaluation is required to determine the sites that might be affected most. This would be followed by a series of appropriate X rays, CT scans and MRI scans. Spinal TB, spinal tumors nor masses, degenerating diseases of the vertebral column are common conditions that must be considered in the evaluation of this condition. The history of spinal disease and surgery are factors that require a complete neurosurgical review, especially at the level of the spine. A tight blood glucose control also shall be potentially very beneficial. Thanks and kind regards as I wish you the best of health. Please, do feel free asking further questions in case of need. I would be honored making my modest contribution. DR Bain

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Brief Answer: Testing for Glomerular Filtration rate, Potassium Detailed Answer: Hi and thanks for the precisions. It is true that hyperkalemia or hypokalemia (fluctuations in blood Potassium concentration could present as such). However, I do think it is not very probable in this case for two reasons, explained already by the results of your blood chemistry. The paralysis in case of abnormal Potassium levels usually occurs when the levels of blood Potassium are very high (usually above 5mmol/l) or very low (less than 2mmol/l). Your chemistry is not in favor of this. Secondly, for this to be explained by high blood Potassium levels, maybe due to kidney dysfunction in your case, we expect big aberrations in serum BUN and Creatinine levels, which is not the case with you. Potassium is very important in Nerve impulse transmission process, reason why changes in its levels could affect the contraction of muscles. It is important to actually ascertain or check kidney function once again. Anemia with low erythropeotin levels is a classical sign, in general terms of advanced kidney disease. It is however abit paradoxal in your case, based on findings from blood chemistry, the Creatinine levels remain almost normal. I strongly suggest another blood chemistry, with proper evaluation of Creatinine levels, BUN and serum electrolytes again. An ultrasound to evaluate the sizes of the kidneys could be useful too in the evaluation process. I still think you would need a nuerosurgeon, to actually confront results from the blood chemistry and your clinical state. Doing an electromyogramme to analyze nerve conduction at the levels of the muscles could also be very useful. Anemia on its own can really not explain paralysis. But if kidney function is proven to be very deteriorated, with a significant reduction in Glomerular Filtration Rate (GFR), accompanied by a proven marked dysfunction or anomaly of blood Potassium levels, Fluctuations in blood Potassium could be incriminated. But for now, further investigation and confirmation of results, in my opinion, still need to be done. Kind regards Dr Bain

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