Chronic Fluoride Toxicity FROM Dietary Rock Salt AS A Cause OF Hypokalemic Periodic Paralysis IN A Rural Teen FROM Salem, Tamil Nadu

Abstract

Background:

Hypokalemic periodic paralysis (HPP) is a rare but potentially reversible neuromuscular disorder characterized by episodic muscle weakness seen with hypokalemia (low serum potassium levels). While most cases are genetic or secondary to renal or endocrine dysfunctions, the environmental origins of chronic exposure to fluoride have been reported in the literature but are less recognized, especially in populations residing in rural, endemic areas.

Case Presentation: A 17-year-old female from a rural village in Salem, Tamil Nadu, presented with recurrent events of flaccid weakness in her limbs that occurred repeatedly when she woke in the early morning, more frequently happens during the summer. She demonstrated hypokalemia and metabolic alkalosis on routine laboratory tests. A comprehensive dietary history arrived at the level of acute and chronic exposure through regularly consuming "Kal uppu" (locally mined rock salt) as it is a common food item used in her community. To confirm exposure, dietary items and food and water sources were assessed and demonstrated excessive fluoride exposure that was consistent with fluoride-induced HPP.

Conclusions: This case illustrates that environmental and cultural aspects may play a role in choosing a diagnostic differential. Chronic fluoride ingestion, as a result of non-commercial rock salt, may have contributed to subtle systemic toxicity, in this case, hypokalemic periodic paralysis. Therefore, raising public health awareness regarding, and limiting interventions, for dietary sources of fluoride is critical in rural and endemic areas.