Hypokalaemic Periodic Paralysis
OVERVIEW
- rare channelopathy
CLINICAL FEATURES
- muscle weakness/paralysis with a matching fall in K+ levels
- starts in adolescence
- weakness may be mild -> full body paralysis
- may last hours/days
- recover suddenly
Triggers
- strenuous exercise followed by rest
- high carbohydrate meals
- meals with high Na+ content
- sudden changes in temperature
- excitement
- noise/flashing lights
INVESTIGATIONS
- hypokalaemia but not necessarily below normal
- elevated CK
- elevated transtubular potassium gradient
- ECG: sinus bradycardia, flattened T waves, U waves in II, V2, V3, V4 and ST depression
- provocation test with glucose load
MANAGEMENT
- IV K+
- prophylaxis for frequent attacks: acetazolamide, spironolactone
References and Links
LITFL
- CCC – Hyperkalaemia management
- CCC – Hyperkalaemia DDx
- CCC – Hypokalaemia
- CCC – Hypokalaemia Mind Map
- ECG Library – Hyperkalaemia
- ECG Library – Hypokalaemia
- Clinical Case – Hyperkalaemia
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC