Periodic Paralysis

 

 

Background 

 

  • Due to hereditary skeletal muscle ion channelopathies

  • Hyperkalemic periodic paralysis:

    • Episodes of myotonia & muscle weakness that may last for several hours

    • Weakness can occur during rest after strenuous exercise, infusion of potassium, metabolic acidosis, or hypothermia

    • The hyperkalemia is transient & occurs only at the time of weakness

    • Acute attacks can be fatal because of cardiac dysrhythmias or respiratory failure

    • A chronic myopathy frequently develops in older patients

    • Treatment consists of a low potassium diet & the administration of thiazide diuretics

  • Hypokalemic periodic paralysis:

    • Paralysis can be produced by a ↓ in serum potassium levels caused by strenuous exercise, infusion of glucose and insulin, or ingestion of carbohydrates & sodium rich food

    • Paralysis usually affects the limbs and trunk, but spares the diaphragm. Chronic muscle weakness occurs in most patients as they age

 

 

Considerations 

 

  • Risk of periodic paralysis attacks, with potential for respiratory failure & cardiac dysrhythmias 

  • Avoid triggers of attacks: 

    • Hyperkalemic Periodic Paralysis (attacks when K >5.5) 

      • K infusion 

      • Metabolic acidosis 

      • Hypothermia 

    • Hypokalemic Periodic Paralysis (attacks when K <3.0):

      • Glucose/insulin infusion & other K lowering shift drugs 

      • ↓ K 

      • Hypothermia 

      • Carbohydrate load 

  • Sensitivity to NDMRs: use ↓ dose, continuous monitoring with twitch monitor 

  • Avoid succinylcholine (due to ↑ K) in hyperkalemic periodic paralysis (ok with hypokalemic periodic paralysis) 

  • Frequent electrolyte monitoring esp. K

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