A 65 year old female was brought to ED by relative with complain of breathlessness since today morning exagrated since 30 mins a/w difficulty in speaking and drowsiness since 2 days, bilateral upper and lower limb weakness LL>UL, History of fever on and off since 2 months last episode of fever 15 days back, decreased food intake since 15 days generalised weakness since 1 month. Recently diagnosed with hypertension 2 month back. Patient was admitted in other hospital with diagnosis of typhoid fever. Airway- threatened, rr-gasping, spo2 86% RA, chest b/l air entry reduced on basal region, bp 130/80 pr 122 crt <3, GCS e3v2m5 pupil b/l rtl 3mm, rbs 216mg/dl, afebrile. Power lower limb 0/5, upper limb 2/5, reflexes absent. Single breath count 2,  wbc counts 41,000, K+ 0.8. Hrtc Thorax - BILATERAL PLEURAL EFFUSION (RIGHT > LEFT) WITH BILATERAL SUBSEGMENTAL ATELECTASIS, FIBROTIC BANDS IN BILATERAL LUNG FIELDS, PREDOMINANTLY IN BILATERAL LOWER LOBES, TINY CALCIFIED NODULE IN THE SUPERIOR SEGMENT OF THE LEFT LOWER LOBE. (this is the history of patient came to ed give differential diagnosis of this case first, the next make detailed long extensive case of hypokelamic periodic paralaysis - if you think history is not proper then you can alter history on your own and match it with diagnosis.)