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Laboratory Tests to Determine the Cause of Hypokalemia and Paralysis
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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“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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Allegretti, A. S., Czawlytko, C. L., Stathatos, N., & Sadow, P. M. (2024) · New England Journal of Medicine · doi:10.1056/nejmcpc2312728 · Cited by 3
Unilateral paralysis associated with profound hypokalemia
Chiang, W., Yeh, F., & Lin, S. (2012) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2012.02.007 · Cited by 3
Self-citationClinical Profile in Hypokalemic Periodic Paralysis Cases
Kumar, M. R., Bharath, R., Rammohan, P., & Agrawal, A. (2014) · Electronic Journal of General Medicine · doi:10.15197/sabad.1.11.02 · Cited by 3
Sung, C., & Lin, S. (2012) · Adverse Drug Reaction Bulletin · doi:10.1097/fad.0b013e328353e4a9 · Cited by 3
Self-citationSung, C., Chen, Y.-S., & Lin, S. (2011) · The Lancet · doi:10.1016/s0140-6736(10)61356-6 · Cited by 3
Self-citationDankar, R., Barakat, S., El‐Charabaty, E., Hashmi, S. S. H., & Sayegh, S. E. E. (2025) · European Journal of Case Reports in Internal Medicine · doi:10.12890/2025_005195 · Cited by 2
Gitelman's Syndrome: Asymptomatic Hypokalaemia in a Chinese Boy
Fu, A., Lee, K., & Tong, L. (2013) · Cited by 2
Metadata
- 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)
- 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)
- 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 › Nephrology › 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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