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Periodic Paralysis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Periodic paralysis (PP): Disorder of muscle metabolism usually inherited that leads to flaccid extremity weakness. Exacerbated by hyperkalemia, hypokalemia, thyrotoxicosis

  • Primary: Fa...

Diagnosis

Signs and Symptoms

History

  • Intermittent weakness:

    • Can be isolated

    • Rapid onset

    • Common for attacks to recur and for weakness to persist between attacks

    • Frequency from single isolated to daily attack...

Treatment

Pre-Hospital

  • Supportive:

    • ABC, IV, O2, monitor

Initial Stabilization/Therapy

  • Supportive care

  • HyperPP:

  • HypoPP:

    • Potassium...

Follow-Up

Disposition

  • HypoPP or HyperPP:

    • Lifestyle modifications:

      • Avoid triggers: Ethanol, prolonged exercise, high potassium foods, fasting

  • ThryoPP:

    • Depends on severity of underlying disease, if asymptoma...

Pearls and Pitfalls

  • Admit Andersen–Tawil patients and all PP patients who remain symptomatic.

  • Use caution with volatile anesthetics and depolarizing muscle relaxants in patients with all forms of PP

Additional Reading

  • Alkaabi  JM, Mushtaq  A, Al-Maskari  FN, et al. Hypokalemic periodic paralysis: A case series, review of the literature and update of management. Eur J Emerg Med.  2010;17(1):4...

Codes

ICD9

359.3 Periodic paralysis 

ICD10

G72.3 Periodic paralysis 

SNOMED

  • 267607008 Familial periodic paralysis (disorder)

  • 7409003 Secondary periodic paralysis (disorder)

  • 278513006 Hyperkalemic periodic pa...

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