Hypokalemia is an important metabolic cause of acute neuromuscular weakness, which can be life threatening if not treated on time, and frequently has secondary treatable causes. Our objective was to study the etiology, clinical and biochemical features in patients of hypokalemic paralysis. 48 patients who admitted with acute flaccid paralysis with hypokalemia from September 2012 to December 2015 were included in the study and investigated thoroughly. Secondary causes were detected in 33 patients, which include renal tubular acidosis (15), thyrotoxicosis (8), diabetes mellitus (3), alcoholism and dengue fever (2 each), hypothyroidism, acute gastroenteritis, acute pyrexia (1 each). Majority (73%) patients were presented in summer season. Thus, 69% patients had secondary and potentially treatable causes which may be indicated by areflexia, higher CPK levels and if patient taking longer time to recover and precipitated by summer season and rich carbohydrate diet inherent to this part of India.