Dengue-Associated Hypokalemic Paralysis (rare but significant): A Review of Neurological Manifestations and Treatment Considerations

Abstract

Dengue virus (DENV) infection, primarily transmitted by Aedes mosquitoes, has traditionally been considered a non-neurotropic virus, with neurological complications being relatively rare. However, in recent years, there has been an increasing recognition of various neurological manifestations associated with dengue infection. Among these, hypokalemic paralysis has emerged as a significant complication. This potentially life-threatening condition is characterized by acute onset muscle weakness or paralysis due to low serum potassium levels, which can complicate the clinical management of dengue patients. Understanding the pathophysiology, clinical features, and optimal management strategies for dengue-associated hypokalemic paralysis is crucial for improving patient outcomes. This review aims to synthesize the current literature on the association between dengue virus infection and hypokalemic paralysis, with a focus on its clinical presentation, pathophysiology, diagnostic challenges, and management strategies. By consolidating the findings from various studies, this review provides insights into how early recognition and treatment can improve patient recovery. A comprehensive literature search was performed using PubMed, Scopus, and Google Scholar databases. Case reports, case series, and observational studies published between 2000 and 2024 that documented neurological complications of dengue, particularly hypokalemic paralysis, were included. A total of 48 articles were reviewed, including 35 case reports, 9 case series, and 4 retrospective studies. The review revealed that hypokalemic paralysis is a rare yet significant complication of dengue infection. It predominantly affects adults aged 18-45 years, with rapid onset muscle weakness often starting in the lower limbs and potentially progressing to involve the upper limbs. The condition is characterized by normal sensory function and absent or diminished deep tendon reflexes. Laboratory findings consistently show serum potassium levels below 3.0 mmol/L, often in the range of 1.7 to 3.0 mmol/L. Electrocardiographic changes, such as flattened T-waves, prominent U-waves, and ST-segment depression, are commonly observed. The condition is typically reversible with prompt potassium supplementation, underscoring the importance of early intervention in preventing long-term complications. Hypokalemic paralysis, although rare, is a critical neurological complication of dengue virus infection that requires timely diagnosis and treatment. Early recognition, alongside corrective potassium supplementation, is essential for achieving full recovery. Given the increasing incidence of dengue in endemic regions, healthcare providers should maintain a high level of clinical awareness. Further research is needed to better understand the underlying mechanisms of dengue-associated hypokalemic paralysis and to refine management strategies. Moreover, improvements in early diagnostic techniques and standardized treatment protocols are necessary to optimize patient outcomes.