Hypokalemic periodic paralysis: Difference between revisions
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==Background== | |||
*Autosomal dominant channelopathy<ref>June-Bum Kim, MD, PhD. Channelopathies. Korean J Pediatr. 2014 Jan;57(1):1-18 [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935107/ Full Text]</ref> | *Autosomal dominant channelopathy<ref>June-Bum Kim, MD, PhD. Channelopathies. Korean J Pediatr. 2014 Jan;57(1):1-18 [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935107/ Full Text]</ref> | ||
*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. | *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. | ||
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*Most first attacks happen by age 16 | *Most first attacks happen by age 16 | ||
==Differential Diagnosis== | |||
*[[Guillan Barre]] - Deep tendon reflexes spared, CN 7 spared | *[[Guillan Barre]] - Deep tendon reflexes spared, CN 7 spared | ||
*[[Thyrotoxic Periodic Paralysis]] - Distinguished by thyroid studies | *[[Thyrotoxic Periodic Paralysis]] - Distinguished by thyroid studies | ||
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*[[ALS]] | *[[ALS]] | ||
==Treatment== | |||
*Replace potassium appropriately - do not try to correct to normal level as once the muscles release potassium you will likely overcorrect | *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 | *Long Term Treatment: Should be initiated by PMD | ||
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** Medications to increase potassium: Acetazolomide, Spironolactone, Potassium tablets, | ** Medications to increase potassium: Acetazolomide, Spironolactone, Potassium tablets, | ||
==Disposition== | |||
Can be discharged from ED after potassium repletion and resolution of symptoms. | Can be discharged from ED after potassium repletion and resolution of symptoms. | ||
==See Also== | |||
==Sources== | |||
<references/> | <references/> | ||
Revision as of 15:10, 16 January 2015
Background
- Autosomal dominant channelopathy[1]
- 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.