CELL CASE

A 17-year-old sprinter consulted at the school clinic because of extreme weakness after
completing his track events. He said his legs had become “like rubber,” and he could hardly walk.
Eating, especially carbohydrates, triggered his weakness. After the most recent event, he was
unable to walk and had to be carried form the track on a stretcher.

Physical Examination findings at time of consultation:

Vital signs: Temp 37oC; PR 82/min; RR 20/min; BP 116/80 mmHg

Head and neck: Anicteric sclerae, pink conjunctivae, dry oral mucosa, no cervical
lymphadenopathy, (–) neck vein distention
Chest: Symmetrical expansion, clear breath sounds, (–) crackles or wheeze
Heart: Distinct heart sounds, normal rate, regular rhythm, (–) murmur
Abdomen: Soft abdomen, normoactive bowel sounds, non-tender
Extremities: Strong pulses, pinkish nail beds, (–) clubbing, (–) bipedal edema
Neuro: Awake, alert, with spontaneous movement, follows commands; normal mental status;
intact cranial nerves; (–) sensory deficits; Motor: 3/5 on all extremities, hyporeflexic in all
extremities; trunk and neck; (–) cerebellar signs; (–) Babinski

His physician ordered serum K levels, which was normal (4.5 mEq/L). However, because
he suspected a connection with K+, the measurement was repeated immediately after a treadmill
stress test. The results showed 2.2 mEq/L. He was advised to avoid carbohydrate-rich meal and
strenuous exercise. He was also given acetazolamide, which is a carbonic anhydrase inhibitor, to
help prevent attacks of weakness.

Learning Objectives for the Case on Cell Physiology:

1. Discuss the molecular bases of an action potential

a. Na+ ion and sodium channels
b. K+ ion and potassium channels
c. Components of an action potential
d. Explain absolute refractory period vs relative refractory period
2. Discuss the K+ equilibrium potential and its contribution to the resting membrane
potential. Explain the role of K+ in the pathophysiology of the disease.
3. Explain how the intake of carbohydrates and strenuous exercise precipitate an attack.
4. Discuss the different clinical manifestations and physical findings in relation to their
biomolecular bases.
5. Give the mechanism of action of acetazolamide. Explain how this drug can prevent
paralytic attack.
6. Make a concept map starting from the pathophysiologic abnormality. List down in
sequence all the physiologic consequences that have been disrupted down to the
presentation of the signs and symptoms to include all PE and lab findings of the case.