Hypokalemic periodic paralysis: Difference between revisions
No edit summary |
Vincent Chan (talk | contribs) No edit summary |
||
Line 5: | Line 5: | ||
*Attacks can last several hours to several days | *Attacks can last several hours to several days | ||
*Most first attacks happen by age 16 | *Most first attacks happen by age 16 | ||
*There is no decrease in total body potassium. Blood potassium level is normal between attacks.<ref>Mount DB, Zandi-Nejad K. Disorders of potassium balance. In Taal MW, Chertow GM, Marsden PA, et al., eds. Brenner and Rector’s The Kidney. 9th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 17.</ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Line 14: | Line 15: | ||
*Spinal Impingement/[[Epidural Abscess]] | *Spinal Impingement/[[Epidural Abscess]] | ||
*[[ALS]] | *[[ALS]] | ||
*[[NMS]] | |||
*[[Serotonin Syndrome]] | |||
==Physical Exam== | |||
*Reflexes are decreased or absent<ref name="Chinnery">Chinnery PF. Muscle diseases. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 429.</ref> | |||
*Shoulders and hips, are involved more often than the arms and legs.<ref name="Chinnery"></ref> | |||
*There is flaccid paralysis rather than hypertonia | |||
*There should not be myoclonus or spasticity | |||
==Treatment== | ==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 | *Long Term Treatment: | ||
**Should be initiated by primary physician but often includes eating a low carbohydrate diet and avoiding alcohol | |||
** Medications to increase potassium: | **Medications to increase potassium: [[Acetazolamide]], [[Spironolactone]], Potassium tablets, | ||
==Disposition== | ==Disposition== | ||
*Can be discharged from ED after potassium repletion and resolution of symptoms. | |||
==See Also== | ==See Also== |
Revision as of 15:23, 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
- There is no decrease in total body potassium. Blood potassium level is normal between attacks.[2]
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
- NMS
- Serotonin Syndrome
Physical Exam
- Reflexes are decreased or absent[3]
- Shoulders and hips, are involved more often than the arms and legs.[3]
- There is flaccid paralysis rather than hypertonia
- There should not be myoclonus or spasticity
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 primary physician but often includes eating a low carbohydrate diet and avoiding alcohol
- Medications to increase potassium: Acetazolamide, Spironolactone, Potassium tablets,
Disposition
- Can be discharged from ED after potassium repletion and resolution of symptoms.
See Also
Sources
- ↑ June-Bum Kim, MD, PhD. Channelopathies. Korean J Pediatr. 2014 Jan;57(1):1-18 Full Text
- ↑ Mount DB, Zandi-Nejad K. Disorders of potassium balance. In Taal MW, Chertow GM, Marsden PA, et al., eds. Brenner and Rector’s The Kidney. 9th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 17.
- ↑ 3.0 3.1 Chinnery PF. Muscle diseases. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 429.