Hypokalemic Periodic Paralysis Syndrome.

Hypokalemic periodic paralysis (HPP) is a rare neuromuscular disorder characterized by recurrent episodes of acute muscle weakness or paralysis secondary to hypokalemia. Attacks are often triggered by metabolic or physiologic stressors and may require critical care management. We present two cases of HPP, highlighting challenges in management. A 22-year-old male and a 42-year-old male presented with severe hypokalemia and acute flaccid paralysis requiring intensive care unit admission due to profoundly low potassium levels. Both patients required aggressive repletion with symptom resolution. Despite continued outpatient management, both patients re-presented within one to two months with recurrent episodes requiring repeat hospitalization. HPP results from skeletal muscle ion channel dysfunction leading to episodic paralysis. Management is challenging due to the narrow therapeutic correction window and unpredictable recurrent attacks. These cases highlight the need for standardized protocols and long-term strategies to improve outcomes, along with reducing recurrence and complications.