The daily educational pearl – hypokalaemic periodic paralysis

Hypokalaemic periodic paralysis

= muscle weakness or paralysis with associated hypokalaemia

It can be:

– congenital – rare channelopathy

– secondary to

hyperthyroidism – also called thyrotoxic periodic paralysis

caffeine abuse


aldosteronism (primary / secondary / pseudo)

renal tubular acidosis

The attacks occur during the period of rest after strenuous exercise, after high carbohydrate or high sodium content meals. They can also be triggered by
sudden changes in temperature.

The weakness can be mild and limited to certain muscle groups, or severe, involving all the muscle groups.

The treatment in ED is K replacement, but be aware that on recovery there can be a sudden release of K from the muscle cells with hyperkalaemia. Very important for these patients though is prevention of recurrent attacks – so either treatment of the cause if it’s a secondary form, or acetazolamide / spironolactone for the congenital forms.

There is also a form of periodic paralysis associated with hyperkalaemia.