Morning Report: 11/25/2014

Dr. Freedman is back with Part 2 of his Morning Report!

Part 2:

 

Quick Case:

A 32 year-old gentleman, with no past medical history, presents with “I can’t move my legs.”   Serum potassium = 1.4mmol/L.

 

Diagnosis: Hypokalemic Periodic Paralysis

 

Background:

  • The periodic paralyses are a family of rare, dominantly-inherited disorders
  • Classified as primary or secondary. Thyrotoxic Periodic Paralysis is a cause.
  • Channel-opathy of Na, Ca, or K, with various mutations and phenotypes
  • 1 case per 100,000 for hypokalemic periodic paralysis

 

Presentation:

  • Majority present prior to 16 years of age
  • Symptoms may range from mild to severe and generalized
  • Predominantly affects proximal muscles, legs, extensors may be more affected than flexors
  • Myotonia: description of impaired muscle relaxation, ie. lid lag.

 

Workup:

  • Serum potassium will be low during an attack, but may be within normal
  • Check thyroid function
  • Patients often get labelled with conversion disorder
  • Urine electrolytes and potassium clearance may be of use (but not to us)

 

Treatment

  • For acute episodes, PO potassium supplementation is preferable to IV.
  • IV is reserved for PO intolerant, severe bulbar or respiratory weakness, or dysrhythmias
  • For those with recurrent attacks, acetazolamide or K-sparing diuretics have been used.

 

Plug: http://journals.lww.com/continuum/Pages/videogallery.asp

 

Happy Thanksgiving everyone! MR will return next week with more educational goodness!

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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