Hypokalemic periodic paralysis is a condition that causes episodes of extreme muscle weakness typically beginning in childhood or adolescence. Most often, these episodes involve a temporary inability to move muscles in the arms and legs. Attacks cause severe weakness or paralysis that usually lasts from hours to days. Some people may have episodes almost every day, while others experience them weekly, monthly, or only rarely. Attacks can occur without warning or can be triggered by factors such as rest after exercise, a viral illness, or certain medications. Often, a large, carbohydrate-rich meal or vigorous exercise in the evening can trigger an attack upon waking the following morning.
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Hypokalemic periodic paralysis hypoPP is a disorder that causes occasional episodes of muscle weakness and sometimes a lower than normal level of potassium in the blood. The medical name for low potassium level is hypokalemia. HypoPP is one of a group of genetic disorders that includes hyperkalemic periodic paralysis and thyrotoxic periodic paralysis.
HypoPP is congenital. This means it is present at birth. In most cases, it is passed down through families inherited as an autosomal dominant disorder.
In other words, only one parent needs to pass the gene related to this condition on to their child in order for the child to be affected. Unlike other forms of periodic paralysis, people with hypoPP have normal thyroid function.
But they have a very low blood level of potassium during episodes of weakness. This results from potassium moving from the blood into muscle cells in an abnormal way. Risk factors include having other family members with periodic paralysis.
The risk is slightly higher in Asian men who also have thyroid disorders. Symptoms include attacks of muscle weakness or loss of muscle movement paralysis that come and go. There is normal muscle strength between attacks. Attacks usually begin in the teen years, but they can occur before age How often the attacks occur varies.
Some people have attacks every day. Others have them once a year. During attacks the person remains alert. Another symptom may include eyelid myotonia a condition in which after opening and closing the eyes, they cannot be opened for a short time.
The health care provider may suspect hypoPP based on a family history of the disorder. Other clues to the disorder are muscle weakness symptoms that come and go with normal or low results of a potassium test. Between attacks, a physical examination shows nothing abnormal.
Before an attack, there may be leg stiffness or heaviness in the legs. During an attack of muscle weakness, blood potassium level is low. This confirms the diagnosis. There is no decrease in total body potassium. Blood potassium level is normal between attacks. During an attack, muscle reflexes are decreased or absent.
And muscles go limp rather than staying stiff. Muscle groups near the body, such as the shoulders and hips, are involved more often than the arms and legs. Muscle weakness that involves the breathing or swallowing muscles is an emergency situation.
Dangerous irregular heartbeats heart arrhythmias may also occur during attacks. Any of these must be treated right away. Potassium given during an attack may stop the attack. Potassium can be taken by mouth. But if weakness is severe, potassium may need to be given through a vein IV.
A medicine called acetazolamide may be prescribed to prevent attacks. Your provider may tell you to also take potassium supplements because acetazolamide may cause your body to lose potassium. HypoPP responds well to treatment. Treatment may prevent, and even reverse, progressive muscle weakness. Although muscle strength starts out normal between attacks, repeated attacks may eventually cause worsening and permanent muscle weakness between attacks.
Call your provider if you or your child has muscle weakness that comes and goes, especially if you have family members who have periodic paralysis. Go to the emergency room or call the local emergency number such as if you or your child faints has trouble breathing, speaking, or swallowing.
HypoPP cannot be prevented. Because it can be inherited, genetic counseling may be advised for couples at risk of the disorder. Treatment prevents attacks of weakness.
Doing mild exercise when these symptoms start may help prevent a full-blown attack. Amato AA. Disorders of skeletal muscle. Bradley's Neurology in Clinical Practice. Philadelphia, PA: Elsevier; chap Channelopathies: episodic and electrical disorders of nervous system. Tilton AH. Acute neuromuscular diseases and disorders. Pediatric Critical Care. Review provided by VeriMed Healthcare Network.
Editorial team. Hypokalemic periodic paralysis. HypoPP is the most common form of periodic paralysis. It affects males more often.
In some cases, the condition may be the result of a genetic problem that is not inherited. Exams and Tests. The goals of treatment are relief of symptoms and prevention of further attacks. Taking potassium supplements may help prevent muscle weakness.
Eating a low-carbohydrate diet may help decrease symptoms. If acetazolamide does not work for you, other medicines may be prescribed. Outlook Prognosis.
Possible Complications. Health problems that may be due to this condition include: Kidney stones a side effect of acetazolamide Irregular heartbeat during attacks Difficulty breathing , speaking, or swallowing during attacks rare Muscle weakness that worsens over time.
When to Contact a Medical Professional. Alternative Names. Paralysis Read more. Potassium Read more.
Hypokalemic Periodic Paralysis FAQ
This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. No other genes have yet been found to cause HOKPP, suggesting that other, unidentified genes may be responsible for the condition. The resources below provide information about treatment options for this condition.
Hypokalemic Periodic Paralysis: a case report and review of the literature
Hypokalemic periodic paralysis hypoKPP , also known as familial hypokalemic periodic paralysis FHPP ,  is a rare, autosomal dominant channelopathy characterized by muscle weakness or paralysis when there is a fall in potassium levels in the blood. Not in all cases. Many levels stay the same and should not be used as a guideline for diagnosis of an episode. Individuals with this mutation, attacks sometimes begin in adolescence and most commonly occur with individual triggers such as rest after strenuous exercise attacks during exercise are rare , high carbohydrate meals, meals with high sodium content, sudden changes in temperature, and even excitement, noise, flashing lights cold temperatures and stress. Weakness may be mild and limited to certain muscle groups, or more severe full-body paralysis. During an attack reflexes may be decreased or absent.