Hypokalemic periodic paralysis
Revision as of 13:12, 16 January 2015 by Ostermayer (talk | contribs)
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.