Clinical features and recovery pattern of secondary hypokalaemic paralysis.
Creatine kinase
Hypokalaemic non-periodic paralysis
Hypomagnesaemia
Paradoxical hypokalaemia
Rebound hypokalaemia
Secondary hypokalaemic paralysis
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
27
04
2023
accepted:
31
07
2023
revised:
30
07
2023
medline:
23
10
2023
pubmed:
5
8
2023
entrez:
4
8
2023
Statut:
ppublish
Résumé
Information regarding frequency, details of neurological signs and recovery patterns of patients with secondary hypokalaemic paralysis (HP) is limited. This study aimed to analyse the frequency, aetiology, clinical features and recovery patterns of patients with secondary HP. The clinical and laboratory records of 18 consecutive patients with secondary HP aged ≥ 18 years admitted to our hospital between April 2011 and March 2022 were reviewed. Patients with inherited hypokalaemic periodic paralysis were excluded. Of the 18 patients, 16 had a common aetiology: chronic alcoholism, diarrhoea or an imbalanced diet. Initial symptoms, such as fatigue, were often atypical. Three patients had prominent asymmetric limb weakness and four had predominant upper limb weakness. On admission, the mean serum potassium and creatine kinase (CK) levels of the patients were 1.90 mmol/L and 4488 U/mL, respectively. Ten patients (56%) had decreased potassium levels after admission, despite potassium replacement treatment (rebound hypokalaemia). Twelve patients presented with increased CK levels even after 2-5 days (delayed hyperCKaemia). Low serum magnesium levels significantly correlated with rebound hypokalaemia. Secondary HP can be caused by a variety of conditions, but mainly occurs due to lifestyle conditions/disorders. Secondary HP often presents with atypical symptoms, and the initial symptoms can be non-specific. Rebound hypokalaemia and delayed hyperCKaemia are common in secondary HP, despite potassium replacement. As such, careful serial monitoring is needed for patients with secondary HP.
Identifiants
pubmed: 37542171
doi: 10.1007/s00415-023-11923-8
pii: 10.1007/s00415-023-11923-8
doi:
Substances chimiques
Potassium
RWP5GA015D
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5571-5577Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Ahlawat SK, Sachdev A (1999) Hypokalaemic paralysis. Postgrad Med J 75:193–197. https://doi.org/10.1136/pgmj.75.882.193
doi: 10.1136/pgmj.75.882.193
pubmed: 10715756
pmcid: 1741179
Lin SH, Lin YF, Chen DT, Chu P, Hsu CW, Halperin ML (2004) Laboratory tests to determine the cause of hypokalemia and paralysis. Arch Intern Med 164:1561–1566. https://doi.org/10.1001/archinte.164.14.1561
doi: 10.1001/archinte.164.14.1561
pubmed: 15277290
Sung CC, Cheng CJ, Chiang WF, Chau T, Hsu YJ, Yang SS, Lin SH (2015) Etiologic and therapeutic analysis in patients with hypokalemic nonperiodic paralysis. Am J Med 128:289-296.e1. https://doi.org/10.1016/j.amjmed.2014.09.027
doi: 10.1016/j.amjmed.2014.09.027
pubmed: 25447623
Hiraga A, Kamitsukasa I, Kojima K, Kuwabara S (2012) Clinical features and recovery patterns of acquired non-thyrotoxic hypokalemic paralysis. J Neurol Sci 313:42–45. https://doi.org/10.1016/j.jns.2011.09.034
doi: 10.1016/j.jns.2011.09.034
pubmed: 22000401
Halperin ML, Kamel KS (1998) Potassium. Lancet 352:135–140. https://doi.org/10.1016/S0140-6736(98)85044-7
doi: 10.1016/S0140-6736(98)85044-7
pubmed: 9672294
Lin SH, Lin YF, Halperin ML (2001) Hypokalaemia and paralysis. QJM 94:133–139. https://doi.org/10.1093/qjmed/94.3.133
doi: 10.1093/qjmed/94.3.133
pubmed: 11259688
Maurya PK, Kalita J, Misra UK (2010) Spectrum of hypokalaemic periodic paralysis in a tertiary care centre in India. Postgrad Med J 86:692–695. https://doi.org/10.1136/pgmj.2010.104026
doi: 10.1136/pgmj.2010.104026
pubmed: 20935343
Wi JK, Lee HJ, Kim EY, Cho JH, Chin SO, Rhee SY, Moon JY, Lee SH, Jeong KH, Ihm CG, Lee TW (2012) Etiology of hypokalemic paralysis in Korea: data from a single center. Electrolyte Blood Press 10:18–25. https://doi.org/10.5049/EBP.2012.10.1.18
doi: 10.5049/EBP.2012.10.1.18
pubmed: 23508689
pmcid: 3597914
Kayal AK, Goswami M, Das M, Jain R (2013) Clinical and biochemical spectrum of hypokalemic paralysis in North: East India. Ann Indian Acad Neurol 16:211–217. https://doi.org/10.4103/0972-2327.112469
doi: 10.4103/0972-2327.112469
pubmed: 23956566
pmcid: 3724076
Kumar V, Armstrong L, Seshadri MS, Finny P (2014) Hypokalaemic periodic paralysis in rural northern India–most have secondary causes. Trop Doct 44:33–35. https://doi.org/10.1177/0049475513512643
doi: 10.1177/0049475513512643
pubmed: 24275360
Chandramohan G, Dineshkumar T, Arul R, Seenivasan M, Dhanapriya J, Sakthirajan R, Balasubramaniyan T, Gopalakrishnan N (2018) Spectrum of hypokalemic paralysis from a tertiary care center in India. Indian J Nephrol 28:365–369. https://doi.org/10.4103/ijn.IJN_225_17
doi: 10.4103/ijn.IJN_225_17
pubmed: 30270997
pmcid: 6146732
Thomas SM, Booth BE, Rao A (1999) Preponderance of hypokalaemia as a cause of acute onset quadriparesis in northern India/southern Nepal. Trop Doct 29:148–151. https://doi.org/10.1177/004947559902900308
doi: 10.1177/004947559902900308
pubmed: 10448237
Negrotto L, Barroso FA (2012) Focal hypokalemic paralysis: report of 2 cases and review of the literature. J Clin Neuromuscul Dis 14:21–27. https://doi.org/10.1097/CND.0b013e31825c5687
doi: 10.1097/CND.0b013e31825c5687
pubmed: 22922578
Liu X, Han K, Lu X (2022) Stroke-mimicking unilateral hypokalemic paralysis and literature review. Am J Emerg Med 58:349.e1-349.e3. https://doi.org/10.1016/j.ajem.2022.04.042
doi: 10.1016/j.ajem.2022.04.042
pubmed: 35527097
Kamel KS, Quaggin S, Scheich A, Halperin ML (1994) Disorders of potassium homeostasis: an approach based on pathophysiology. Am J Kidney Dis 24:597–613. https://doi.org/10.1016/s0272-6386(12)80220-4
doi: 10.1016/s0272-6386(12)80220-4
pubmed: 7942818
Lien YH (2015) Paradoxical hypokalemia: where has all the potassium gone? Am J Med 128:217–218. https://doi.org/10.1016/j.amjmed.2014.10.037
doi: 10.1016/j.amjmed.2014.10.037
pubmed: 25446305
Shayne P, Hart A (1994) Thyrotoxic periodic paralysis terminated with intravenous propranolol. Ann Emerg Med 24:736–740. https://doi.org/10.1016/s0196-0644(94)70286-1
doi: 10.1016/s0196-0644(94)70286-1
pubmed: 8092604
Shiang JC, Cheng CJ, Tsai MK, Hung YJ, Hsu YJ, Yang SS, Chu SJ, Lin SH (2009) Therapeutic analysis in Chinese patients with thyrotoxic periodic paralysis over 6 years. Eur J Endocrinol 161:911–916. https://doi.org/10.1530/EJE-09-0553
doi: 10.1530/EJE-09-0553
pubmed: 19755408
Rastegar A, Soleimani M (2001) Hypokalaemia and hyperkalaemia. Postgrad Med J 77:759–764. https://doi.org/10.1136/pmj.77.914.759
doi: 10.1136/pmj.77.914.759
pubmed: 11723313
Huang CL, Kuo E (2007) Mechanism of hypokalemia in magnesium deficiency. J Am Soc Nephrol 18:2649–2652. https://doi.org/10.1681/ASN.2007070792
doi: 10.1681/ASN.2007070792
pubmed: 17804670
Whang R, Flink EB, Dyckner T, Wester PO, Aikawa JK, Ryan MP (1985) Magnesium depletion as a cause of refractory potassium repletion. Arch Intern Med 145:1686–1689. https://doi.org/10.1001/archinte.1985.00360090162024
doi: 10.1001/archinte.1985.00360090162024
pubmed: 4026498
Pepin J, Shields C (2012) Advances in diagnosis and management of hypokalemic and hyperkalemic emergencies. Emerg Med Pract 14:1–17
pubmed: 22413702
Crop MJ, Hoorn EJ, Lindemans J, Zietse R (2007) Hypokalaemia and subsequent hyperkalaemia in hospitalized patients. Nephrol Dial Transplant 22:3471–3477. https://doi.org/10.1093/ndt/gfm471
doi: 10.1093/ndt/gfm471
pubmed: 17848395
Martin JB, Craig JW, Eckel RE, Munger J (1971) Hypokalemic myopathy in chronic alcoholism. Neurology 21:1160–1168. https://doi.org/10.1212/wnl.21.11.1160
doi: 10.1212/wnl.21.11.1160
pubmed: 5166222
Rubenstein AE, Wainapel SF (1977) Acute hypokalemic myopathy in alcoholism: a clinical entity. Arch Neurol 34:553–555. https://doi.org/10.1001/archneur.1977.00500210055009
doi: 10.1001/archneur.1977.00500210055009
pubmed: 889497
Ishikawa S, Saito T, Okada K, Atsumi T, Kuzuya T (1985) Hypokalemic myopathy associated with primary aldosteronism and glycyrrhizine-induced pseudoaldosteronism. Endocrinol Jpn 32:793–802. https://doi.org/10.1507/endocrj1954.32.793
doi: 10.1507/endocrj1954.32.793
pubmed: 3914413
Kruse JA, Carlson RW (1990) Rapid correction of hypokalemia using concentrated intravenous potassium chloride infusions. Arch Intern Med 150:613–617. https://doi.org/10.1001/archinte.1990.00390150101019
doi: 10.1001/archinte.1990.00390150101019
pubmed: 2310280