Hypokalemic periodic paralysis
Background
- Autosomal dominant channelopathy
* Symptoms include muscle weakness or paralysis with associated hypokalemia (though potassium levels can be normal), sometimes painful
though often painless. Weakness can be from hand to leg to complete paralysis.
* Triggered by strenuous exercise, high carbohydrate meal, high sodium meals, sudden changes in temperature or emotional stress
* Attacks can last several hours to several days
* Most first attacks happen by age 16
Differential Diagnosis
* Guillan Barre - Deep tendon reflexes spared, CN 7 spared
* Thyrotoxic Periodic Paralysis - Distinguished by thyroid studies
* Multiple Sclerosis
* Myasthenia Gravis
* Conversion Disorder
* Spinal Impingement/Epidural Abscess
* ALS
Treatment
* Replace potassium appropriately - do not try to correct to normal level as once the muscles release potassium you will likely overcorrect
* Long Term Treatment: Should be initiated by PMD
* Avoid exacerbating factors
* Medications to increase potassium: Acetazolomide, Spironolactone, Potassium tablets,
Disposition
Can be discharged from ED after potassium repletion and resolution of symptoms.
See Also
Authors