A study of hypokalemic paralysis - etiology, clinical profile and outcome.

Chandramohan, G (2011) A study of hypokalemic paralysis - etiology, clinical profile and outcome. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Acute flaccid paralysis is a potentially reversible medical emergency and has a wide differential diagnosis that includes neurologic, metabolic and infectious etiologies. Acute hypokalemic paralysis (HP) constitutes a group of heterogenous disorders that present with acute muscular weakness and can at times be potentially life threatening. Complications secondary to hypokalemia such as a cardiac arrhythmia or respiratory failure lead to morbidity and mortality. Although there are many potential causes of hypokalemia, there are far fewer entities in the differential diagnosis of hypokalemic paralysis. Hypokalemia and paralysis can be divided into 2 types, hypokalemic periodic paralysis (HPP) where there is short-term shift of potassium into cells and non- HPP resulting from a large deficit of potassium due to various etiologies. The differential diagnosis in a patient with HP can be challenging due to heterogeneity of its etiologies, but it is important to make the diagnosis promptly because different therapies are required for each type and identifying causes that are reversible are important. Presence of a positive family history and recurrent episodes in a patient can be helpful in making a diagnosis of HPP , but HPP and non-HPP are almost indistinguishable and there is diagnostic difficulty. Familial periodic paralysis has been reported as the most common cause of hypokalemic paralysis in Caucasians. Thyrotoxic hypokalemic paralysis (TPP) is common in the Asian (oriental) population. The etiology of hypokalemic paralysis is likely to depend on ethnicity, vigor of the investigation, and the setting of the medical practice. In this study an attempt has been made to analyze the various etiologies of HP that appears to be common in our region. We have also analyzed the metabolic profile that will aid in diagnosis and outcome of patients with hypokalemic paralysis. AIM : To analyze the clinical presentation, etiology, and outcome of patients presenting with hypokalemic paralysis. CONCLUSIONS : 1. The commonest causes for hypokalemic paralysis (HP) in our study were sporadic periodic paralysis (SPP) and renal tubular acidosis (RTA). 2. Among the patients with hypokalemic paralysis, 57% of them were due to secondary causes. Presence of acidosis or alkalosis in arterial blood gas analysis suggests a renal cause for Hypokalemic paralysis. 3. Spot urine K+/Cr ratio helps to distinguish the diagnostic categories of HPP (Hypokalemic paralysis due to K+ shifts) with non-HPP (Hypokalemic paralysis due to K+ deficits) 4. There was a male predominance in Hypokalemic periodic paralysis (HPP). Sporadic periodic paralysis (SPP) was more common than familial periodic paralysis (FPP) in this study. 5. Male predominance was noted in Thyrotoxic periodic paralysis ( TPP). Absence of history of thyroid disease or clinical thyrotoxicosis does not exclude the diagnosis of TPP. So thyroid function tests should be done in all patients with HP. 6. Though much less potassium is needed during therapy of HPP (SPP, TPP), there is still a danger of rebound hyperkalemia. 7. Hypomagnesemia should be looked for and corrected along with the correction of hypokalemia in patients with metabolic alkalosis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: hypokalemic paralysis ; etiology ; clinical profile ; outcome.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 04:27
Last Modified: 11 Jul 2017 04:27
URI: http://repository-tnmgrmu.ac.in/id/eprint/1371

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