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Clinical Profile in Hypokalemic Periodic Paralysis Cases

Year 2014, Volume: 11 Issue: 1, 6 - 9, 01.03.2014
https://doi.org/10.15197/sabad.1.11.02

Abstract

The present article was aimed to study demographic and clinical pattern, periodicity and precipitating events for hypokalemic paralysis and to assess the response to treatment both during acute attacks and as prophylaxis in comparison with available literature. Forty patients with hypokalemic paralysis were admitted in Narayana Medical College and Hospital during the last two years, in all the medical units and neurology wards. Patients were assessed clinically, with symptomatology and precipitating factors were evaluated. There were total 40 patients in the present study. Younger more including male gender. Mean age was 30.95 years. Common precipitating factor were diarrhea, fever, strenuous activity, following dextrose administration, in patients with diabetic ketoacidosis, however in majority of the cases we could not identify the precipitating factors. Most common electrocardiographic change on ECG was U' wave (36 cases) followed by flat 'T' wave (14 patients) and ECG was normal in 4 patients. Hypokalemic paralysis was predominantly seen in younger males. Vomiting, diarrhea were important precipitating factors. The response to oral potassium chloride supplementation was good as only few patients requiring intravenous potassium chloride. The approach to hypokalemic paralysis patient includes a vigorous search for the underlying etiology and potassium replacement therapy.

References

  • Soule BR, Simone NL. Hypokalemic Periodic Paralysis: a case report and review of the literature. Cases J 2008;1:256.
  • Ahlawat SK, Sachdev A. Hypokalaemic paralysis. Postgrad Med J 1999;75:193-7.
  • Fialho D, Hanna MG. Periodic paralysis. Handb Clin Neurol 2007;86:77-106.
  • Muralikrishna GS, Yasoda T, Subash S, Venkatesan S, Sayeed ZA, Rajagopalan RS. Familial hypokalemic peri- odic paralysis. J Assoc Physicians India 1983;31(5):316-8.
  • Fontaine B, Vale-Santos J, Jurkat-Rott K, et al. Mapping of the hypokalaemic periodic paralysis (HypoPP) locus to chromosome 1q31-32 in three European families. Nat Genet 1994;6:267-72.
  • Links TP, Smit AJ, Molenaar WM, Zwarts MJ, Oosterhuis HJ. Familial hypokalemic periodic paralysis. Clinical, diagnostic and therapeutic aspects. J Neurol Sci 1994;122:33-43.
  • Siler JN, Discavage WJ. Anesthetic management of hypo- kalemic periodic paralysis. Anesthesiology 1975;43:489- 90.
  • Machkhas H, Ashizawa T, Ptacek L. Familial periodic pa- ralyses. Curr Neurol 1996;16:65-92.
  • Biemond A, Daniels AP. Familial periodic paralysis and its transition into spinal muscular dystrophy. Brain 1934;57:91.
  • River GL, Kushner DS, Armstrong SH Jr, Dubin A, Slodki SJ, Cutting HO. Renal tubular acidosis with hypokalemia and muscular paralysis. Metabolism 1960;9:1118-32.
  • Rowbottom SJ, Ray DC, Brown DT. Hypokalemic paralysis associated with renal tubular acidosis. Critical Care Med 1987;15:1067-8.
  • Gamakaranage C, Rodrigo C, Jayasinghe S, Rajapakse S. Hypokalemic paralysis associated with cystic disease of the kidney: case report. BMC Nephrology 2011;12:16.
  • Stedwell RE, Allen KM, Binder LS. Hypokalemic paralyses: a review of the etiologies, pathophysiology, presentation, and therapy. Am J Emerg Med 1992;10:143-8.
  • Cannon SC. Pathomechanisms in channelopathies of skel- etal muscle and brain. Annu Rev Neurosci 2006;29:387- 415.
  • Lehmann-Horn F, Jurkat-Rott K, Rüdel R. Periodic paraly- sis: understanding channelopathies. Curr Neurol Neurosci Rep 2002;2(1):61-9.
  • Phakdeekitcharoen B, Ruangraksa C, Radinahamed P. Hypokalaemia and paralysis in the Thai population. Nephrol Dial Transplant 2004;19(8):2013-8
  • Johnsen T. Familial periodic paralysis with hypokalaemia. Experimental and clinical investigations. Danish Med Bull 1981;28:1-27.
  • Kantola IM, Tarssanen LT. Diagnosis of familial hypoka- lemic periodic paralysis: role of the potassium exercise test. Neurology 1992;42:2158-61.
  • Rao SD, Rekha S, Chandrasekhara MK. Hypokalemic pa- ralysis. Indian Pediatrics 1991;28:425-8.
  • Dandge V, Pagarkar W, Agarwal M, Dharnidharka V, Rathi S. Primary hypokalemic periodic paralysis. Indian Pediatrics 1994;31:326.
  • Fenichel GM. Flaccid limb weakness in childhood. Clinical Pediatric Neurology, 2nd edn Philadelphia, WB Saunders Co 1993:192-3.
  • Levitt JO. Practical aspects in the management of hypo- kalemic periodic paralysis. J Transl Med 2008;6:18.
  • Grob D, Johns RJ, Liljestrand A. Potassium movement in patients with familial periodic paralysis: relationship to the defect in muscle function. Am J Med 1957;23:356-75.
  • Sternberg D, Tabti N, Hainque B, Fontaine B. Hypokalemic periodic paralysis. Gene reviews. Seattle, WA: University of Washington 2002.
  • Denney JL. Familial Periodic Paralysis. Calif Med1954;81:284.
  • Riggs JE. Periodic paralysis. Clin Neuropharmac 1989;12:249-57.
  • Jurkat-Rott K, Lerche H, Lehmann-Horn F. Skeletal muscle channelopathies. J Neurol 2002;249:1493-1502.
  • Lin S-H, Lin Y-F, Chen D-T, Chu P, Hsu C-W, Halperin ML. Laboratory tests to determine the cause of hypokalemia and paralysis. Arch Int Med 2004;164:1561-6.
  • Danowski TS, Elkinton JR, Burrows BA, Winkler AW. Exchanges of sodium and potassium in familial periodic paralysis. J Clin Invest 1948;27(1):65-73.
  • Rudel R, Lehmann-Horn F, Ricker K, Kuther G. Hypokalemic periodic paralysis: in vitro investigation of muscle fiber membrane parameters. Muscle Nerve 1984;7:110-20.
  • Kelley DE, Gharib H, Kennedy FP, Duda RJ, McManis PG. Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings. Arch Int Med 1989;149:2597-600.

Clinical Profile in Hypokalemic Periodic Paralysis Cases

Year 2014, Volume: 11 Issue: 1, 6 - 9, 01.03.2014
https://doi.org/10.15197/sabad.1.11.02

Abstract

Bu makale hipokalemik paralizide demografi, klinik tipler, yineleme sıklığı ve presipite eden faktörlerin değerlendirilmesi ve hem akut ataklar sırasındaki tedavinin ve hem de profilaksinin etkinliğinin mevcut bilgilerle kıyaslanması amacını gütmektedir. Son iki yıl içerisinde Narayana Tıp Koleji'ne ve Hastanesine; tüm tıbbi birimler ve nöroloji servisine toplam 40 hipokalemik paralizili hasta başvurmuştur. Hastalar semptomatoloji ve presipite eden faktörler açısından klnik olarak değerlendirilmişlerdir. Erkekler ve genç yaştakiler daha fazladır. Ortalama yaş 30.95 dir. Sık presipite eden faktörler ishal, ateş, ağır egzersiz ve diyabetik ketoasidozda dekstroz infüzyonudur, bununla birlikte çoğu olguda böyle bir faktör tespit edilememiştir. En sık EKG bulgusu U dalgasıdır (36 olgu), sonra düz T dalgasıdır (14 olgu), 4 hastada ise EKG normaldir. Hipokalemik paralizi başlıca genç bayanlarda görülmüştür. Kusma ve diyare önemli presipite eden faktörlerdir. Oral potasyum klorüre cevap iyidir sadece az sayıda hastada intravenöz potasyum klorür gerekmiştir. Hipokalemik paraliziye yaklaşım altta yatan etyoloji açısından detaylı araştırma ve potasyum replasmanıdır

References

  • Soule BR, Simone NL. Hypokalemic Periodic Paralysis: a case report and review of the literature. Cases J 2008;1:256.
  • Ahlawat SK, Sachdev A. Hypokalaemic paralysis. Postgrad Med J 1999;75:193-7.
  • Fialho D, Hanna MG. Periodic paralysis. Handb Clin Neurol 2007;86:77-106.
  • Muralikrishna GS, Yasoda T, Subash S, Venkatesan S, Sayeed ZA, Rajagopalan RS. Familial hypokalemic peri- odic paralysis. J Assoc Physicians India 1983;31(5):316-8.
  • Fontaine B, Vale-Santos J, Jurkat-Rott K, et al. Mapping of the hypokalaemic periodic paralysis (HypoPP) locus to chromosome 1q31-32 in three European families. Nat Genet 1994;6:267-72.
  • Links TP, Smit AJ, Molenaar WM, Zwarts MJ, Oosterhuis HJ. Familial hypokalemic periodic paralysis. Clinical, diagnostic and therapeutic aspects. J Neurol Sci 1994;122:33-43.
  • Siler JN, Discavage WJ. Anesthetic management of hypo- kalemic periodic paralysis. Anesthesiology 1975;43:489- 90.
  • Machkhas H, Ashizawa T, Ptacek L. Familial periodic pa- ralyses. Curr Neurol 1996;16:65-92.
  • Biemond A, Daniels AP. Familial periodic paralysis and its transition into spinal muscular dystrophy. Brain 1934;57:91.
  • River GL, Kushner DS, Armstrong SH Jr, Dubin A, Slodki SJ, Cutting HO. Renal tubular acidosis with hypokalemia and muscular paralysis. Metabolism 1960;9:1118-32.
  • Rowbottom SJ, Ray DC, Brown DT. Hypokalemic paralysis associated with renal tubular acidosis. Critical Care Med 1987;15:1067-8.
  • Gamakaranage C, Rodrigo C, Jayasinghe S, Rajapakse S. Hypokalemic paralysis associated with cystic disease of the kidney: case report. BMC Nephrology 2011;12:16.
  • Stedwell RE, Allen KM, Binder LS. Hypokalemic paralyses: a review of the etiologies, pathophysiology, presentation, and therapy. Am J Emerg Med 1992;10:143-8.
  • Cannon SC. Pathomechanisms in channelopathies of skel- etal muscle and brain. Annu Rev Neurosci 2006;29:387- 415.
  • Lehmann-Horn F, Jurkat-Rott K, Rüdel R. Periodic paraly- sis: understanding channelopathies. Curr Neurol Neurosci Rep 2002;2(1):61-9.
  • Phakdeekitcharoen B, Ruangraksa C, Radinahamed P. Hypokalaemia and paralysis in the Thai population. Nephrol Dial Transplant 2004;19(8):2013-8
  • Johnsen T. Familial periodic paralysis with hypokalaemia. Experimental and clinical investigations. Danish Med Bull 1981;28:1-27.
  • Kantola IM, Tarssanen LT. Diagnosis of familial hypoka- lemic periodic paralysis: role of the potassium exercise test. Neurology 1992;42:2158-61.
  • Rao SD, Rekha S, Chandrasekhara MK. Hypokalemic pa- ralysis. Indian Pediatrics 1991;28:425-8.
  • Dandge V, Pagarkar W, Agarwal M, Dharnidharka V, Rathi S. Primary hypokalemic periodic paralysis. Indian Pediatrics 1994;31:326.
  • Fenichel GM. Flaccid limb weakness in childhood. Clinical Pediatric Neurology, 2nd edn Philadelphia, WB Saunders Co 1993:192-3.
  • Levitt JO. Practical aspects in the management of hypo- kalemic periodic paralysis. J Transl Med 2008;6:18.
  • Grob D, Johns RJ, Liljestrand A. Potassium movement in patients with familial periodic paralysis: relationship to the defect in muscle function. Am J Med 1957;23:356-75.
  • Sternberg D, Tabti N, Hainque B, Fontaine B. Hypokalemic periodic paralysis. Gene reviews. Seattle, WA: University of Washington 2002.
  • Denney JL. Familial Periodic Paralysis. Calif Med1954;81:284.
  • Riggs JE. Periodic paralysis. Clin Neuropharmac 1989;12:249-57.
  • Jurkat-Rott K, Lerche H, Lehmann-Horn F. Skeletal muscle channelopathies. J Neurol 2002;249:1493-1502.
  • Lin S-H, Lin Y-F, Chen D-T, Chu P, Hsu C-W, Halperin ML. Laboratory tests to determine the cause of hypokalemia and paralysis. Arch Int Med 2004;164:1561-6.
  • Danowski TS, Elkinton JR, Burrows BA, Winkler AW. Exchanges of sodium and potassium in familial periodic paralysis. J Clin Invest 1948;27(1):65-73.
  • Rudel R, Lehmann-Horn F, Ricker K, Kuther G. Hypokalemic periodic paralysis: in vitro investigation of muscle fiber membrane parameters. Muscle Nerve 1984;7:110-20.
  • Kelley DE, Gharib H, Kennedy FP, Duda RJ, McManis PG. Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings. Arch Int Med 1989;149:2597-600.
There are 31 citations in total.

Details

Primary Language English
Journal Section Original Articles
Authors

Amit Agrawal This is me

Publication Date March 1, 2014
Published in Issue Year 2014 Volume: 11 Issue: 1

Cite

APA Agrawal, A. (2014). Clinical Profile in Hypokalemic Periodic Paralysis Cases. European Journal of General Medicine, 11(1), 6-9. https://doi.org/10.15197/sabad.1.11.02
AMA Agrawal A. Clinical Profile in Hypokalemic Periodic Paralysis Cases. European Journal of General Medicine. March 2014;11(1):6-9. doi:10.15197/sabad.1.11.02
Chicago Agrawal, Amit. “Clinical Profile in Hypokalemic Periodic Paralysis Cases”. European Journal of General Medicine 11, no. 1 (March 2014): 6-9. https://doi.org/10.15197/sabad.1.11.02.
EndNote Agrawal A (March 1, 2014) Clinical Profile in Hypokalemic Periodic Paralysis Cases. European Journal of General Medicine 11 1 6–9.
IEEE A. Agrawal, “Clinical Profile in Hypokalemic Periodic Paralysis Cases”, European Journal of General Medicine, vol. 11, no. 1, pp. 6–9, 2014, doi: 10.15197/sabad.1.11.02.
ISNAD Agrawal, Amit. “Clinical Profile in Hypokalemic Periodic Paralysis Cases”. European Journal of General Medicine 11/1 (March 2014), 6-9. https://doi.org/10.15197/sabad.1.11.02.
JAMA Agrawal A. Clinical Profile in Hypokalemic Periodic Paralysis Cases. European Journal of General Medicine. 2014;11:6–9.
MLA Agrawal, Amit. “Clinical Profile in Hypokalemic Periodic Paralysis Cases”. European Journal of General Medicine, vol. 11, no. 1, 2014, pp. 6-9, doi:10.15197/sabad.1.11.02.
Vancouver Agrawal A. Clinical Profile in Hypokalemic Periodic Paralysis Cases. European Journal of General Medicine. 2014;11(1):6-9.