Hypokalemic periodic paralysis – the importance of patient education

Abstract

Hypokalemic periodic paralysis (HOKPP) is a rare neuromuscular disorder caused by altered transport of cellular potassium that leads to significant muscle weakness of the extremities. Paralytic attacks are induced by a drop in the serum potassium level and they have been associated with specific triggers. This case describes a 21-year-old male who has had recurrent presentations of acute paralytic attacks following vigorous physical activity. At presentation, this patient exhibited flaccid paralysis of all skeletal muscles below the neck, but was alert and oriented with stable vital signs. The patient was found to have a potassium level of 2.1 mmol/L and an EKG demonstrating U waves (characteristic of hypokalemia). The patient was treated with potassium supplementation with resolution of symptoms. The mainstay of prevention of long term permanent muscle weakness is avoidance of triggers that can lead to hypokalemia. Through education on disease process and lifestyle modifications, we were able to end the cycle of recurrent hospital readmissions and the subsequent financial burden this generated for the patient and his family.

The Role of Nutrition and Physical Activity as Trigger Factors of Paralytic Attacks in Primary Periodic Paralysis

“…Paralytic episodes in HypoPP are commonly reported to be triggered by high carbohydrate intake [9][10][11][12][13][14][15]. Even so, in the retrieved studies we did not identify any in-depth description of the meal composition like the amount and type of carbohydrates, or other sources of energy in the meals suspected to trigger a paralytic episode [9][10][11][12][13][14][15].…”

“…Paralytic episodes in HypoPP are commonly reported to be triggered by high carbohydrate intake [9][10][11][12][13][14][15]. Even so, in the retrieved studies we did not identify any in-depth description of the meal composition like the amount and type of carbohydrates, or other sources of energy in the meals suspected to trigger a paralytic episode [9][10][11][12][13][14][15]. Carbohydrate intake was typically described as either intake of sweets, sources of high amount of carbohydrates [9], carbohydrate-heavy meals [10][11][12][13][14] or high sugar intake [15].…”

“…Even so, in the retrieved studies we did not identify any in-depth description of the meal composition like the amount and type of carbohydrates, or other sources of energy in the meals suspected to trigger a paralytic episode [9][10][11][12][13][14][15]. Carbohydrate intake was typically described as either intake of sweets, sources of high amount of carbohydrates [9], carbohydrate-heavy meals [10][11][12][13][14] or high sugar intake [15]. Only a few studies gave some details on the type of carbohydrate-rich meal leading to paralysis [10,11,14], for details see Table 1.…”

“…A diet low in carbohydrate [11][12][13]16] and sodium [10], and avoidance of foods like pizza, pasta, candy [17] and large carbohydrate rich meals before bedtime [19] are recommended for individuals with HypoPP in several reports and reviews. A 2000 calorie diabetic diet has also been suggested based on one case-study [15].…”

“…varying from 30 mEq (2,25 g) to 60 mEq (4,50 g) potassium [13][14][15]. To relieve attacks, the potassium chloride dose given at onset differed slightly between case-report studies, from 15-20 mEq (1,125-1,5 g) oral potassium chloride supplement [14] to 1-2 tablets Sando K (12-24 mEq / 0.9-1.8 g potassium chloride) [11].…”