Hey guys. I’m Siobhan, a 3rd-year medical resident. Today I’m gonna be telling you about Alex. Alex is a 28 year old man who works as an engineer and he’s never had any medical problems before. He’s known for always having a cup of coffee in his hand and he works really long hours. It was a regular Tuesday night. Alex finished work, went to the gym, came home, had some dinner and then by 10 o’clock he was getting ready for bed feeling tired, but normal. 5 hours later he woke up suddenly, unable to move his arms or legs. Alex was paralyzed! Alex was paralyzed. He couldn’t move his arms or his legs. He wasn’t in any pain and he could breathe normally. And other than this extreme sense of panic, he actually felt like himself. As fear flooded his body, Alex cried out for help and his roommate came in within a few seconds. After trying to lift him off the bed and failing, he called 911. At the emergency department Alex was quickly triage and then seen by the emergency doctor who asked him a lot of questions. Alex told her that this had never happened to him before or anyone else in his family. He doesn’t take any medications, he doesn’t use any recreational drugs. He doesn’t have any chest pain and shortness of breath or dizziness. He just couldn’t move his arms or his legs. The emergency physician examined him and found that he was tachycardic with a heart rate of around 110. His blood pressure was fine and he didn’t have a fever. On close examination of his muscles, she found that it was his proximal muscles: the ones closest to his core, that were weak. So his shoulders, elbows, hips and knees had 0 out of 5 strength. Meaning that when he tried to move them there wasn’t even a flicker of movement and the deep tendon reflexes weren’t present. But when she went to examine his wrists in his hands, he had 5 out of 5 strength, completely normal and luckily his sensation was completely intact. Okay, so we’ve got a previously healthy 28 year old man who’s presenting with acute onset paralysis of his proximal muscles. With such an unusual presentation and an unclear diagnosis, these are the moments we are weaned to step back and look broadly to consider all possible diagnoses so that we don’t miss anything. So what I always do is break things down into large categories, so that I can organize my thinking. So acute onset weakness: It can be a muscle problem, a nerve problem, a problem with the connection between the muscles and the nerves called a neuromuscular Junction or it could be an electrolyte abnormality. Now we need some more information to figure out which of these options is most likely. So the emergency physician ordered some bloodwork, an ECG to look at the electrical activity of the heart and a CT scan of the brain. The results are back and it’s shocking. Alex’s potassium is dangerously low at 1.6 mEQ per liter. It’s so abnormal that repeat bloodwork was sent right away, just to make sure it wasn’t a lab error, but sure enough it came back the same. So it looks like a slam-dunk, we have a cause for his paralysis. Such low levels of potassium is extremely concerning because it can cause a deadly heart rhythm. So the next step is to be replacing his potassium giving him some to drink, some through the IV and also giving him magnesium which helps with the absorption. So you’re probably getting the sense that potassium is pretty important, but I want you to understand how important potassium is in your body. It helps regulate fluid, muscle contractions including your heartbeat and being able to send signals down your nerves. And of all this potassium most of it, 98% of it is inside the cell. And the little bit that’s outside the cell inside the blood needs to be really tightly regulated, because too much or too little could be deadly. Your kidneys do a lot of the regulation, but there are also pumps on the outside of the cell membrane that help shift potassium in and one of those is called the sodium potassium ATPase pump. And on that note, Alex’s potassium is rechecked to make sure that it’s coming up into the normal range, but shockingly his potassium is still dangerously low. So there’s a trick in medicine: for every 10 mEQ of potassium you give someone, you expect their blood value to go up by 0.1. Now Alex received 360 mEQ of potassium, that’s a massive amount. Now you would expect his potassium to go from 1.6 all the way up to 5.2. But did that happen? No, it went from 1.6 to 1.9. Something is really not right. It’s not adding up, something else is going on. So we need to step back and try to figure this out. Alright, let’s break this down. Hypokalemia can be caused by not eating enough potassium, if somehow you’re losing potassium by either vomiting, diarrhea or if you have a condition that makes you pee out a whole bunch of potassium, if you have low magnesium or if your body is shifting potassium into the cells using that sodium potassium ATPase pump that we were talking about earlier. We really need to figure out which one of these processes is happening. Meanwhile an urgent blood work result comes back showing that Alex has high levels of thyroid hormone in its blood. This is really unexpected. This is called hyperthyroidism. So your thyroid is an organ just about here on your neck and it’s involved in regulating metabolism and affects almost every organ system in your body. When I think of hyperthyroidism I think of everything extra, so extra oil in your hair, extra nervous, extra tremor. You might be sweating more, your heart is racing, you’re having extra bowel movements, weight loss from high metabolism and you might actually feel hot all the time. With these test results the doctors went back to Alex and asked him about these specific symptoms. They found out that he actually had felt like he had a little bit of a tremor and sometimes he would feel like his heart was racing and he would always be wearing a t-shirt when other people were wearing sweaters. But he’d always thought this was just related to the amount of coffee that he was drinking all the time. 2 Hours later Alex started to move and then soon after that he was up and walking like everything was normal. So quickly his blood work was repeated. Potassium was completely normal and even his ECG changes had gone away, he just still had a bit of a fast heart rate. So this fits with the idea of an intracellular potassium shift. So all the supplements that were giving just kept shifting into the cells and in the blood the level was still low and just like that his level just normalized. So the question is: what is causing all this potassium to shift into the cells? Alright, back to the drawing board. And this is what medicine is all about, rethinking things if they don’t quite fit together. Okay, so major triggers for potassium to shift into cells. Well, Alex wasn’t taking any medications. Alkalosis and refeeding syndrome, we would have seen that on the blood work. Exercise, head injury, adrenaline, a heart attack. It just doesn’t fit with the story! And when he came in, he didn’t have hypothermia But this! Hypokalemic periodic paralysis, that sounds about right. And there is a sub type called thyrotoxic periodic paralysis. So this fit perfectly: thyrotoxic periodic paralysis. Alex came in with high thyroid levels and paralysis, it explains everything. So the question is: what is it? And how do we treat Alex? So to be honest, it’s a condition we don’t fully understand. We know it more typically happens to men of Asian descent who are in their 30s and it’s extremely rare. So all the people who have high thyroid in North America, only 0.1 to 0.2 percent of them will ever get periodic paralysis. Scientists have discovered that people with these conditions tend to have more of those sodium potassium pumps on the outside of their cells compared to the general population. So they’re more easily able to shift potassium into their cells and we also know some of the triggers: high thyroid levels, high carbohydrate meal which means high level of insulin in the body and then high intense exercise. So this makes sense, putting the pieces of Alex’s story together. So he was living with symptoms of hyperthyroidism, the fast heart rate and a bit of a tremor. He thought it was to do with coffee. Then on Tuesday night he exercised and he had a big carb load in his meal before going to sleep. While he was sleeping, potassium was shifted into his cells and he woke up paralyzed. So the good news is that by treating the underlying cause, the hyperthyroidism, we can prevent Alex from ever having these terrifying episodes of paralysis in the future. So he had some more testing done and he was diagnosed with Graves disease, which is one of the most common causes of hyperthyroidism and he was given treatment with 2 medications. The first one is called propranolol and that helps with the fast heart rate and the tremor. And the second one is called methimazole and that prevents him from making too much of the thyroid hormone. And I’m so happy to tell you guys that since treatment Alex had no other episodes of this and he’s been feeling so much better. So let’s just take a moment and realize how amazing our bodies are. Right now you’ve got thyroid hormone going through your body, your cells are shifting potassium in and out, your kidneys are fighting to keep the right amount of potassium in your body. It’s incredible! So anyway, I hope you guys enjoyed it. Let me know: had you ever even heard of periodic paralysis syndromes? Did you know what I was talking about already? I would love to hear! Anyway, don’t forget to subscribe and if you want to see more like this, I’ll be seeing you in the next video. So bye for now!

100 thoughts on “28 YEAR OLD PARALYZED IN HIS SLEEP!! Real Medical Case

  1. Love this type of video! As a vet student it helps me understand some of my classes haha
    I also love how passionate you are 🙂

  2. The more I learn about molecular bio the more I question myself if we were all engineered! Plus watching this video even adds to it.

  3. Recently just had a patient who has deiatbetic ulcers on the legs, the skin is actually crystallizing causing the wound bed to slough off. Have you ever seen this? The patient is on dialysis for kidney failure and is suffering from decreased hemoglobin because the crystallization has reached the bone marrow and decreasing the circulating RBCs.

  4. I feel like my sister might have this!
    She gets random episodes and theres times she cant feel her legs and she always feeling hot. she was on thyroid medication but got tooken off. She gets pain on her legs every now and then and some of her blood work showed that she has very low potassium as well…she is being sent to see a endocrinologist as of now, my sister is only 15

  5. This is so great! I used to live for this show called “Mystery Diagnosis” and this was like that. This is helpful for nursing school 😉

  6. You are so passionate about medicine, it's contagious! Not a prospective medical student but I absolutely love your videos 🙂

  7. I said this on your last video like this please do more like this I absolutely love it and find it very educational you explain things very well! I’m pre med and I work in the OR in a hospital so this stuff is always interesting to me!!!

  8. this has absolutely nothing to do with the content of the video, but what is the dish at 0:23? It looks freaking delicious

  9. Actually had a really weird thing happened when I was 21 years old. I had just worked a 16-hour shift between bartending and serving. Went to sleep. And when I woke up I cannot move my legs at all I had no feeling in the bottom part of my body. I went to the emergency room and found that I could move my upper body but I had lots of pain about where my lungs are. After some questions and some work they had decided that I may need surgery. But I'm very anti surgery unless absolutely need it. So I went to a chiropractor. And I cried and cried and cried and cried because I didn't have medical insurance you know good old America. The chiropractor agreed to give me an x-ray and they would waive the fee of that first x-ray. What they found on that x-ray is that I had had five pinched nerves one of them being my sciatic nerve. This was caused by an accident I had when I was 18 years old where a car came out of the Road the wrong way and hit my side of the car the passenger side. When I was at the hospital at 18 I asked them to check me for whiplash and they said that because of how fast the car was going that I probably didn't have it and they didn't do any x-rays upon the time. Fast forward to a few years later when I was having these issues and the chiropractor said that the way my spine looked that I absolutely had whiplash at some point and that's when I remember that car accident and so I could pinpoint when that was. It was an absolutely crazy experience I suffered loss of feeling in my left leg for about a year-and-a-half and had tons of Pain still to this day because of that. So it's important when you go to the hospital for an accident to make sure that they get you an x-ray because you need to have it on file just in case.

  10. I loved this video! These are my favorite. I have never heard of this condition. I know of Graves’ disease. But never knew paralysis could occur. So scary! I have the opposite of graves- hashimoto’s disease. I hope that is not a thing with hashi.

  11. I knew immediately what you were talking about because I’ve lived it for 18 years with my wife and now my son for the last 2 1/2 years

  12. I have an important question? If you did consider a musical path for a career, how did you decide between medical and music? I can’t decide, I’m stuck.

  13. This was a great video to watch, and I guessed it as you started as it almost matched the symptoms I had back in 2002 at 32yo. I had been feeling weakness all week, woke up one day and struggled to push myself out of bed before finally losing all weakness when I was sitting checking emails.

    I was stuck for about 4 hours yelling for help until i managed to drag myself to the phone and call 000. My potassium was 2.5, weakness response for entire body was 0 by the time I hit hospital but was walking around in about 6 hours after potassium drink and iv.

    My cause was that I had just moved in to a new place, had no fridge so had been eating like 8 sausages, a loaf of white bread and tomato sauce a day for about a week.

    Thanks for this video, it explained some things to me that had not been mentioned at the time or since so was very interesting. Given I'm on injectables now and going to the gym again I'll be more aware even though I've had no replaces since….but I've also been ensuring I get about 3000mg of potassium a day from foods.

  14. Thats so scary, but so amazed at what medicine allows us to be capable of. I am currently in the middle of applications for college, and your videos have proved to be a major source of stress relief. Thank you Siobhan! You are an inspiration:)

  15. Wooooooooow, if I woke up paralyzed, I would surely die because I live alone and no one checks on me. I would most certainly die of dehydration lol. Horrible. Hes lucky he lived with someone!

  16. I love your style of presentation. It's clear, easy to follow and you make me want to learn more about how the body works.

  17. I have hyperthyroidism and I weight 98 pounds and was in 4th grade and was 5"2 tall I experienced insomnia sweating and tremors eventually I lost control of my legs and I ate so much food and was oblivious of my condition once I was put on the meds I had massive weight gain and I kept my old eating habits I realized I needed to change in 5th grade once I weighed more than my 17 yr old brother (5"7) I kept fighting and now I'm in 6th grade at the weight 165 and 5"6 and 3/4 in tall sry if its kinda off subject but I guess it has something to do with this. 🙂

  18. Im currently getting my Doctorate of Dapo4D, Im an expert on the 3rd dimension and above. His spine was actually going into the 4th dimension this is why he was in pain.

  19. I have Potassium (and Magnesium and Sodium 😆) deficiencies due to Secondary Hyperaldosteronism, which is fairly rare. I keep Potassium in my work locker, you know, for fun! I am actually an RN so my doc just writes my script for 10 mEq tablets, take 1-4 daily and I take whatever I feel like I need that day, usually 2-3 tablets. My Magnesium has always been weird, I take 2 grams, yes grams, daily and my level sometimes goes to 2 at the highest, but is sometimes at 1.5. My Sodium has been 127 before and my PCP called me to ask if I was okay because she was obviously concerned about my Neuro status 😶. I will say my Nephrologist has been stumped by where all my Magnesium and Sodium go to. He actually checked urine levels and the Magnesium levels were normal but my urine Sodium levels were high. He basically just said my kidneys were stupid and watch the Sodium they need pass on through 😆. Who knows. I just know, I forever crave salt due to my stupid kidneys! Oh and I scare Pharmacies anytime I fill my scripts there for the first time because I’m on 200 mg Spironolactone (has been as high as 400 mg), 30 mg Lisinopril (down from 40 mg), and Potassium. So of course all the Pharmacists think my Potassium is going to reach detrimental levels with that combo and I have to tell them that those meds keep just barely into normal range and they can call my doc to discuss. I’d like to see the warning that comes up in their system, haha. But yes, cases like this bring out what has become an electrolyte nerd in me!

  20. This is a reason why you have to wait in the ER. Like your kid has a broken arm, but at the same time a person just came into the ER who can't move. So please be patient with nurses and doctors cuz they have so much going on at the same time.

  21. College medical student here, enjoying your content and how you tell stories alot (and you also play violin!!) Thank you so much for making these vids and the channel xD!

  22. That happiness on your face while you explain the last bit….☺️☺️☺️that happiness is what I want to feel when I am a doctor…human body is a marvel…

  23. I really enjoyed the video! I didn’t understand everything because I’m only 14 years old but I want to be a doctor when I’m older. You inspire me so much. Thank you Siobhan.

  24. I love your passion and story telling ability. The way you present just captures the audience. Well done on another great video.

  25. i really feel like you’re going to make a wonderful doctor. the way you break things down, and genuinely are committed to the patient and getting to the bottom of their problem. it took me 18 years of constant doctors visits mistreatment and wrong diagnoses to finally correctly diagnose me with my condition. i mean this whole heartedly, we desperately need more doctors and people like you. 💗

  26. I want to be a pediatric surgeon when I’m older because I love to help people. Right now I’m 15 years old in a technical high school training to be a cna, then I’m going to college and med school to Pursue my dream

  27. MAgic of medcine your great volin md I would not mind having you as my doctor your great and Aswome at expliAning

  28. I love love your channel, you are so amazing!!! I feel like I learn so much from your videos, and your personality is to uplifting!!

  29. I was diagnosed with graves disease 8 years ago when i was 24 and my thyroid was removed when i was 26. I was NOT expecting a story about someone with a diagnosis like mine, when you were talking about the paralysis, but once you mentioned the thyroid, im not going to lie, i thought " here it comes" lol. On a random note Im hoping to get accepted into a nursing program for next semester and these stories make me want to start now 🤣 I love learning from real medical stories.

  30. Hi! Just started Medical school here in the UK (4 weeks into 5 years Medicine MBBCh)! Thanks for all the amazing videos! The human body is truly astounding!

  31. ❤️I love watching you and you are an inspiration because when I grow up to be older I’m gonna be a nurse and help people in need❤️

  32. I have hypokalemic periodic paralysis. My son has it too. It took forever to find out what was going on with us. It is rare but we have some good docs now. Thanks for the video.

  33. This happened to me when I was 7 years old I went to therapy for 2 years now I am 17 years old and I am walking as I was never paralyzed

  34. thank you so much for sharing the case! the structure/format you develop is so amazing! I have encountered 2 cases in my career before since I was working in an Endocrinology Department and it's China, we have a fabulous population.

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