This is the 3770th article of Da Medical Care
"Doctor, am I going to be paralyzed", the emergency room sent a young man wrapped in a quilt, Xiao Zhang, who is usually alive and likes to hike. During the day, I hiked with my donkey friends, felt tired, and went to bed early. Falling asleep and finding herself unable to move, a 120 was taken to the emergency room.
The emergency doctor patiently inquired, and after the examination, the preliminary judgment was "probably paralysis caused by hypokalemia"
01
What is hypokalmic periodic paralysis?
Hypokalmic periodic paralysis is characterized by episodic muscle weakness, decreased serum potassium, and rapid resolution of symptoms after potassium supplementation. Including primary and secondary, primary disease is often hereditary, the same family has several generations of disease; secondary is mostly caused by hyperthyroidism, hyperaldosteronism, renal failure and so on.
02
What causes it?
Most hypokalmic cyclic paralysis is a familial genetic disorder that is often induced by strenuous exercise, exertion, full meals, colds, mental stimulation, and other factors, such as insulin injections, epinephrine, or large amounts of glucose transfusion. Some patients have no obvious precipitating cause.
03
What are the manifestations?
Age of onset: more common in men aged 20 to 40 years
Prodromal symptoms: there may be limb numbness, pain, flushing, sweating, etc. before the onset of the disease
Main symptoms: often appear at night after a full meal or when getting up early in the morning, muscle paralysis, limb weakness, symmetrical limb weakness or complete paralysis, often the lower limbs are more serious than the upper limbs.
04
What tests do I need to do?
1. Blood test: normal serum potassium (K+) concentration is 3.5~5.5mmol/L, with an average of 4.2mmol/L. Serum potassium during seizures
2. Electrocardiogram: typical hypokalmic changes, manifested as U waves, T waves low or inverted.
3. Electromyography: when completely paralyzed, the motor potential disappears, and the electrical stimulation does not respond.
05
How is it treated?
1. Seizure period: potassium supplementation. Mild cases encourage the choice of diet and oral medication for potassium supplementation, and in severe cases, intravenous potassium supplementation is recommended.
Oral potassium supplementation: 10% potassium chloride is preferred and mixed into milk or juice to prevent gastrointestinal reactions.
Dietary potassium supplementation: Foods with high potassium content include meat, vegetables, fruits, and beans.
Intravenous potassium supplementation: according to the doctor's treatment plan.
2. Intermittent period: frequent seizures, supplement potassium salt during intermittent episodes, low sodium and high potassium diet.
06
How to prevent it?
The serum potassium of Xiao Zhang was only 2.3 mmol/L, and a combination of treatment was given, and oral plus intravenous potassium supplementation was given. After the treatment, Xiao Zhang began to gradually be able to raise his legs and move. He grabbed the nurse again and asked, "Will I still do this?" How to prevent it?
1. Improve self-protection: increase or decrease clothing in a timely manner according to seasonal changes and cold and warm conditions, so as to avoid being affected by wind and cold or inducing diseases due to excessive fatigue.
2. Maintain optimism: relieve psychological stress, know that the disease is mostly hereditary, and the number of attacks tends to decrease with age; after treatment, the effect is obvious.
3. Good eating habits: avoid high sugar and high carbohydrates, avoid drinking alcohol, eat less and eat more meals, and use more high potassium and low sodium foods.
High potassium foods such as tomatoes, potatoes, beans, spinach, mushrooms, seaweed, avocados, etc.
bibliography:
You Liming,Wu Ying. Nursing in Internal Medicine (6th Edition)[M].
Gao Fengli,Yang Qiong,Zhang Wei. Application of health education combined with dietary therapy in patients with hypokalmic cyclic paralysis[J].Clinical Medical Research and Practice,2018,3(06):149-150.DOI:10.19347/j.cnki.2096-1413.201806072.
Wang Jianghong,Zhang Rong. Care of patients with hypokalaemia with periodic paralysis[J].Chinese Journal of Maternal and Child Health,2016,27(S2):406-407.
Gao Hongqiong. Dietary maintenance of low potassium periodic paralysis[J].Chinese Journal of Health Nutrition,2016,26(2):341.
Author: Shanghai Pudong New Area Zhoupu Hospital
Department of Emergency Intensive Care Medicine
Lu Jiayun is in charge of nurse