Abstract
Background: Hypokalemia of clinical significance, severe enough to cause paralysis
and cardiac dysrhythmias, is an uncommon life-threatening medical disorder. Hypokalemic
periodic paralysis (HPP), where an abrupt intracellular shift of potassium has occurred,
must be distinguished from hypokalemic non-periodic paralysis (non-HPP), where a total
body potassium deficit exists. The challenge for emergency physicians is to swiftly
and accurately differentiate disease etiology and institute prompt treatment. Aggressive
potassium repletion, required in non-HPP etiologies, may predispose HPP patients to
dangerous and potentially fatal rebound hyperkalemia as the intracellular potassium
shift resolves. Objectives: Describe the process by which HPP and non-HPP can be differentiated
on clinical and laboratory grounds leading to appropriate resuscitation from severe
and clinically relevant hypokalemia. Chronic diarrhea syndromes and possibly normal
alkaline phosphatase levels alert the clinician to the potential for non-HPP. Case
Report: A case of HIV/AIDS-associated isospora belli diarrheal illness with severe hypokalemia of the non-HPP type is presented. Historical,
laboratory, and clinical findings, which assisted in the differentiation from HPP,
are emphasized. Clinical progression and treatment strategies, as well as electrocardiogram
findings with T-U-P fusion waves, are described in detail. Conclusion: The history,
especially the time course of disease, is essential in differentiating HPP and non-HPP,
allowing treatment to proceed without overcorrection and rebound hyperkalemia. Although
other infectious diseases have been linked to non-HPP, to our knowledge this is the
first report linking non-HPP to isospora belli diarrheal illness.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A simple and rapid approach to hypokalemic paralysis.Am J Emerg Med. 2003; 21: 487-491
- Electrocardiographic manifestations in patients with thyrotoxic periodic paralysis.Am J Med Sci. 2003; 326: 128-132
- Effects of potassium supplementation on the recovery of thyrotoxic periodic paralysis.Am J Emerg Med. 2004; 22: 544-547
- Laboratory tests to determine the cause of hypokalemia and paralysis.Arch Intern Med. 2004; 164: 1561-1566
- An approach to the patient with severe hypokalaemia: the potassium quiz.QJM. 2005; 98: 305-316
- Clinical review: thyrotoxic periodic paralysis: a diagnostic challenge.J Clin Endocrinol Metab. 2006; 91: 2490-2495
- Hypokalaemia and paralysis.QJM. 2001; 94: 133-139
- Hypokalemia.N Engl J Med. 1998; 339: 451-458
- Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes.Arch Intern Med. 1999; 159: 601-606
- The pitfalls of potassium replacement in thyrotoxic periodic paralysis: a case report and review of the literature.J Emerg Med. 2004; 26: 157-161
- Thyrotoxic periodic paralysis and intravenous propranolol in the emergency setting.J Emerg Med. 2000; 18: 199-202
- Treatment of hypokalemia.N Engl J Med. 1999; 340 (author reply 155. Erratum in: N Engl J Med 1999;340:663): 154-155
- Hypokalaemic paralysis.Postgrad Med J. 1999; 75: 193-197
- Iatrogenic worsening of hypokalemia and neuromuscular paralysis associated with the use of glucose solutions for potassium replacement in a young woman with licorice intoxication and furosemide abuse.Acad Emerg Med. 1999; 6: 960-964
- Decrease in serum potassium concentrations and appearance of cardiac dysrhythmias during infusion of potassium with glucose in potassium-depleted patients.N Engl J Med. 1962; 266: 228-233
- Hypophosphatemia in the emergency department therapeutics.Am J Emerg Med. 2000; 18: 457-461
- Hypokalemic myopathy induced by Giardia lamblia.N Engl J Med. 1993; 329: 210-211
- Hypokalemic myopathy induced by Giardia lamblia.N Engl J Med. 1994; 330: 66-67
Article info
Publication history
Published online: November 10, 2008
Accepted:
May 1,
2008
Received in revised form:
April 23,
2008
Received:
March 11,
2008
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
