Laboratory Tests to Determine the Cause of Hypokalemia and Paralysis

Lin, Shih Hua; Lin, Yuh Feng; Chen, Dung Tsa; Chu, Pauling; Hsu, Chin Wang; Halperin, Mitchell L.

doi:10.1001/archinte.164.14.1561

Cited by 145 publications

(164 citation statements)

References 35 publications

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“…Nonfamilial HypoPP includes thyrotoxic periodic paralysis (TPP) and sporadic periodic paralysis (SPP), which are more common among Asians and Hispanics. 2 Although the incidence of TPP in Asian countries (2%) is approximately 10-20 times higher than the incidence in non-Asian ethnic populations (0.1%-0.2%), TPP is increasingly reported in Western countries because of globalization and immigration. 3 …”

mentioning

confidence: 98%

Mechanism of Thyrotoxic Periodic Paralysis

Lin

Huang

2012

Journal of the American Society of Nephrology

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The pathogenesis of thyrotoxic periodic paralysis has long been thought related to increased Na + -K + ATPase activity stimulated by thyroid hormone and/or hyperadrenergic activity and hyperinsulinemia. This mechanism alone, however, cannot adequately explain how hypokalemia occurs during acute attacks or the associated paradoxical depolarization of the resting membrane potential. Recent findings that loss of function mutations of the skeletal muscle-specific inward rectifying K + (Kir) channel, Kir2.6, associate with thyrotoxic periodic paralysis provide new insights into how reduced outward K + efflux in skeletal muscle, from either channel mutations or inhibition by hormones (adrenalin or insulin), can lead to a vicious cycle of hypokalemia and paradoxical depolarization, which in turn, inactivates Na + channels and causes muscle unexcitability and paralysis.

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mentioning

confidence: 98%

Mechanism of Thyrotoxic Periodic Paralysis

Lin

Huang

2012

Journal of the American Society of Nephrology

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128

121

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“…2 There are several causes for this disorder; hypoPP can be secondary to renal or gastrointestinal potassium loss. 3 In this occurrence, abnormal blood potassium levels are also observed between attacks, and muscle weakness fluctuates in parallel with blood potassium levels. Muscle weakness is thought to be directly related to the degree of muscle depolarization induced by hypokalemia.…”

Section: Hypokalemic Periodic Paralysis: a Muscle Disorder Causing Epmentioning

confidence: 96%

Hypokalemic Periodic Paralysis: A Model for a Clinical and Research Approach to a Rare Disorder

et al. 2007

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Summary:Rare diseases have attracted little attention in the past from physicians and researchers. The situation has recently changed for several reasons. First, patient associations have successfully advocated their cause to institutions and governments. They were able to argue that, taken together, rare diseases affect approximately 10% of the population in developed countries. Second, almost 80% of rare diseases are of genetic origin. Advances in genetics have enabled the identification of the causative genes. Unprecedented financial support has been dedicated to research on rare diseases, as well as to the development of referral centers aimed at improving the quality of care. This expenditure of resources is justified by the experience in cystic fibrosis, which demonstrated that improved care delivered by specialized referral centers resulted in a dramatic increase of life expectancy. Moreover, clinical referral centers offer the unique possibility of developing high quality clinical research studies, not otherwise possible because of the geographic dispersion of patients. This is the case in France where national referral centers for rare diseases were created, including one for muscle channelopathies. The aim of this center is to develop appropriate care, clinical research, and teaching on periodic paralysis and myotonia. In this review, we plan to demonstrate how research has improved our knowledge of hypokalemic periodic paralysis and the way we evaluate, advise, and treat patients. We also advocate for the establishment of international collaborations, which are mandatory for the follow-up of cohorts and conduct of definitive therapeutic trials in rare diseases.

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“…Para evaluar la pérdida renal es muy útil medir el potasio urinario siempre y cuando el paciente no esté bajo el influjo de diuréticos o de ahorradores de potasio (22,23); en nuestro caso esta prueba no fue útil ya que la paciente recibía previamente espironolactona (ahorrador de potasio). En la evaluación de la causa de una hipopotasemia, cuando no es evidente, es fundamental correlacionar el potasio con el equilibrio ácido-base del paciente y conocer además el estado de los otros iones: sodio, cloro, magnesio, calcio, fósforo, así como del lactato y el ácido úrico, además del uroanálisis.…”

Section: Figura 1 Evolución De Los Niveles Séricos De Potasiounclassified