A child has diarrhea and this is followed up by generalized hypotonia and absent DTRs. There is no blood in the stools and this makes it less likely to a antibiotic needed bacterial diarrhea. This is presuming that there is no ongoing epidemic of cholera and that the stools don't resemble cholera. The absence of DTRs and the presence of Hypotonia all point to a Lower motor neuron lesion involving both upper and lower limbs. It is not clear if there is head lag as well. Thrombosis due to dehydration at the cervical level is a rare possibility and in the early stages may present with all signs of LMN lesions below the level of damage to the blood supply of the cord. More commonly would be simple, hypokalemia secondary to GE leading to generalized pseudoparalysis. This would be a notifiable case especially to the Acute Flaccid Paralysis surveillance team (AFP). But why the history of recurrent attacks of diarrhea. Is the child malnourished or has rickets? Is there polyuria or urine continued inspite of diarrhea? Could this child have an underlying renal tubular pathology predisposing the child to recurrent diarrheas, hypokalemia and acidosis. Is there hypokalemic paralysis precipitated by gastroenteritis with an underlying Renal Tubular Acidosis? Is the child acidotic, continuing to pass urine in excess to the loose stools? Is there malnutrition and evidence of widened wrist joints, double malleoli, short stature and rachitic rosary?
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