1. Objective To highlight the surprisingly high incidence of this condition among the indigenous pregnant women from the Rejang basin of Sarawak and hopefully, to ignite interest in further research on this peculiar discovery. Methodology A retrospective cohort study was carried out over an eighteen month duration between 1 st May 2010 to 1 st November 2011, in the rural district Hospital of Kapit, Sarawak. Patients were identified based on case registry and relevant data were extracted systematically using a standardized proforma. Other causes of paralysis had been excluded. Onset of symptoms2.6 days (6hours-5days) Serum Potassium2.2 mmol/L (1.8-2.4mmol/L) Serum Creatinine46 umol/L (35-54umol/L) Creatinine Kinase947-5360 U/L (normal range <145U/L) ECG changesFlattened T waves (3/9 patients) Time to full ambulation36 hrs (16-90hrs after admission) Duration of admission3.5 days (2-6 days) Results Average potassium level was 2.2mmol/L at presentation. Interestingly, the majority of these women were less than twenty years of age, presented in the third trimester and proximal lower limb weakness was the predominant symptom.. All but one of the patients was of ethnic Iban descent. There were no identified familial trait of inheritance but it was difficult to quantify dietary consumptions, especially in relation to caffeine and clay intake. Conclusions Hypokalemic paralysis is estimated to affect 1:100,000 people, occurring more often in men than women. The reported incidence of hypokalaemic paralysis in this rural region is much higher among the indigenous population. Dietary habits, familial or genetic predisposition cannot be ruled out. Despite favourable outcomes, it may be associated with rare but serious maternal consequences. It warrants further detailed study into the possible aetiologies and progression of the condition, in order to better plan subsequent management. This is imperative as Kapit is a remote region with a predominantly indigenous population living far from healthcare facilities. References 1. Ahlawat S and Sachdev A. Hypokalemic paralysis. Postgrad Medical J 1999;75:193-197. 2. Appel CC and Myles TD. Caffeine-induced hypokalemic paralysis in pregnancy. Obstet Gyneco 2001 May;97 (5 Part 2):805-7. 3. Huerta-Alardín AL et al. Bench-to-bedside review: Rhabdomyolysis – an overview for clinicians 4. Muthukrishnan J et al. Pregnancy predisposes to rhabdomyolysis due to hypokalemia.. Saudi J Kidney Dis Transpl.2010 Nov;21(6):1127-8.. 5. Carminati G, Chena A, Orlando JM et al. Distal renal tubular acidosis with rhabdomyolysis as the presenting form in 4 pregnant women. Nefrologia; 2001;21(2): 204-8 6. Zainal D. Renal tubular acidosis in Kelantan, M’sia-A case review. Sing Med J 1994; Vol 35:303-305 7. http://www.endotext.org/female/female14/female14_2.htm (accessed 22/11/11) 8. Del Vecchio LR et al. Non-traumatic rhabdomyolysis: clinical and laboratory diagnosis, assessment of renal complications. Clin Ter 2002 Jan-Feb;153(1)31-44 9. Melli G et al. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore) 2005 Nov;84(6):377-85 10. www.kapitdc.sarawak.gov.my/pengenalan.html (accessed 22/11/11) 11. Soule BR and Simone NL. Hypokalemic Periodic Paralysis: a case report and review of the literature. Cases Journal 2008, 1:256. Where creatinine kinase levels were available, it was significantly raised to reflect hypokalemic rhabdomyolysis. Symptoms resolved with potassium correction and none of the patients with rhabdomyolysis developed myoglobinuria or renal failure. Of particular note, there were no recurrent symptoms in the course of the pregnancies with good maternal and fetal outcomes. Table-1 Clinical and biochemical findings of pregnant women presenting with hypokalmemic paralysis