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Cited by 167Potassium and Related DisordersIon Transport and Channel RegulationCardiac electrophysiology and arrhythmias

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.·2004·Archives of Internal Medicine
DOI 10.1001/archinte.164.14.1561
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Abstract

BACKGROUND: Hypokalemia and paralysis may be due to a short-term shift of potassium into cells in hypokalemic periodic paralysis (HPP) or due to a large deficit of potassium in non-HPP. Failure to make a distinction between HPP and non-HPP may lead to improper management. Therefore, we evaluated the diagnostic value of spot urine tests in patients with hypokalemia and paralysis during 3 years. METHODS: Before therapy, the urine potassium concentration, potassium-creatinine ratio, and transtubular potassium concentration gradient were determined in a second voided urine sample. RESULTS: Forty-three patients with hypokalemia and paralysis were identified: 30 had HPP and 13 had non-HPP. There was no significant difference in the plasma potassium or bicarbonate concentrations and in the pH of arterial blood between the 2 groups. All but 2 patients in the non-HPP group had urine potassium concentration values less than 20 mmol/L. Although the potassium concentration was significantly lower in the HPP group, there was some overlap. In contrast, the transtubular potassium concentration gradient and potassium-creatinine ratio differentiated patients with HPP vs non-HPP. Although only a mean +/- SD of 63 +/- 36 mmol of potassium chloride was administered in the patients with HPP, rebound hyperkalemia (>5 mmol/L) occurred in 19 (63%) of these 30 patients. CONCLUSIONS: Calculating the transtubular potassium concentration gradient and potassium-creatinine ratio provided a simple and reliable test to distinguish HPP from non-HPP. Minimal potassium chloride supplementation should be given to avoid rebound hyperkalemia in patients with HPP.

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  • Reported precipitating factors of TPP include high carbohydrate ingestion, strenuous exercise, trauma, acute upper respiratory tract infection, high-salt diet, emotional stress, exposure to cold, alcohol ingestion, menstruation, and use of drugs such as corticosteroids, epinephrine, acetazolamide, and non-steroidal anti-inflammatory drugs.

    “The precipitating factors of TPP reported in the literature included high carbohydrate ingestion, strenuous exercise, trauma, acute upper respiratory tract infection (URI), high-salt diet, emotional stress, exposure to cold, alcohol ingestion, menstruation, and use of drugs such as corticosteroids, epinephrine, acetazolamide, and non-steroidal anti-inflammatory drugs (2, 3, 14, 22, 23, 24).”

    From A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants (2013) · cites this paper as [2]

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Authors
Lin, S.-H., Lin, Y.-F., Chen, D.-T., Chu, P., Hsu, C.-W., & Halperin, M. L.
Affiliations
  • Tri-Service General Hospital (TW)
  • National Defense Medical Center (TW)
  • University of Alabama at Birmingham (US)
  • University of Toronto (CA)
ORCID
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2004-07-26
Volume
164
Issue
14
Pages
1561
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinte.164.14.1561
OpenAlex
W2128467090
Cited by
167
References
34
Citations by year
2026: 6 · 2025: 8 · 2024: 6 · 2023: 11 · 2022: 8 · 2021: 8 · 2020: 14 · 2019: 8 · 2018: 9 · 2017: 9 · 2016: 2 · 2015: 6 · 2014: 5 · 2013: 9 · 2012: 15
FWCI
5.53
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Ion Transport and Channel Regulation
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
hypokalemic periodic paralysis, hypokalemia, paralysis, potassium chloride supplementation, differential diagnosis
MeSH terms
Adult, Creatinine, Diagnosis, Differential, Female, Humans, Hydrogen-Ion Concentration, Hypokalemia, Male, Potassium, Potassium Chloride, Paralysis, Hyperkalemic Periodic

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