Acute Hypercapnic Respiratory Failure due to Thyrotoxic Periodic Paralysis
Abstract
Acute hypercapnic respiratory failure is a potentially life-threatening complication of profound hypokalemia usually seen in patients with large total-body potassium (K+) deficits. It has rarely been reported in thyrotoxic periodic paralysis (TPP), which is due to intra-cellular shifts of K+. The authors report on a 29-year-old man who presented with sudden onset of muscle paralysis in all extremities and acute progressive respiratory insufficiency requiring artificial respiratory support. He was treated with intravenous KCl. After six hours, muscular strength had returned to normal, with plasma K+ concentration of 3.0 mmol/L. At the eighth hour, rebound hyperkalemia (6.6 mmol/L) developed with high-tented T waves, even after the KCl was discontinued. Ventilatory support was uneventfully weaned at 14 hours. Elevated free thyroxine and undetectable thyroid-stimulating hormone confirmed the diagnosis of TPP. TPP should be kept in mind as a cause of acute respiratory failure in association with acute muscle weakness to avoid delayed diagnosis and improper management.
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Exceptional cases of bulbar weakness and respiratory weakness requiring ventilatory support have been reported in TPP.
“Exceptional cases of bulbar weakness and respiratory weakness requiring ventilatory support have been reported in TPP [23].”
From Thyrotoxic Periodic Paralysis: Clinical Challenges (2014) · cites this paper as [23]
Cites
Thyrotoxic Periodic Paralysis in the United States Report of 7 Cases and Review of the Literature
OBER, K. P. (1992) · Medicine · doi:10.1097/00005792-199205000-00001 · Cited by 289 · see citing works
Clinical and Metabolic Features of Thyrotoxic Periodic Paralysis in 24 Episodes
Manoukian, M. A., Foote, J. A., & Crapo, L. M. (1999) · Archives of Internal Medicine · doi:10.1001/archinte.159.6.601 · Cited by 255 · see citing works
Internal Potassium Balance and the Control of the Plasma Potassium Concentration
Sterns, R. H., Cox, M., Feig, P. U., & Singer, I. I. (1981) · Medicine · doi:10.1097/00005792-198109000-00002 · Cited by 244 · see citing works
Catecholamine-thyroid hormone interactions and the cardiovascular manifestations of hyperthyroidism
Levey, G. S., & Klein, I. L. (1990) · The American Journal of Medicine · doi:10.1016/0002-9343(90)90533-j · Cited by 212 · see citing works
Hypokalemic paralyses: A review of the etiologies, pathophysiology, presentation, and therapy
Stedwell, R. E., Allen, K., & Binder, L. S. (1992) · The American Journal of Emergency Medicine · doi:10.1016/0735-6757(92)90048-3 · Cited by 186 · see citing works
Lin, S.-H. (2001) · QJM · doi:10.1093/qjmed/94.3.133 · Cited by 173 · see citing works
Self-citationLin, S.-H., & Lin, Y.-F. (2001) · American Journal of Kidney Diseases · doi:10.1053/ajkd.2001.22090 · Cited by 148 · see citing works
Self-citationAhlawat, S. K., & Sachdev, A. (1999) · Postgraduate Medical Journal · doi:10.1136/pgmj.75.882.193 · Cited by 141 · see citing works
Theophylline Toxicity and the Beta-Adrenergic System
Kearney, T. E., MANOGUERRA, A. S., CURTIS, G. P., & ZIEGLER, M. G. (1985) · Annals of Internal Medicine · doi:10.7326/0003-4819-102-6-766 · Cited by 99 · see citing works
Hypokalemic quadriplegia and respiratory arrest revealing primary Sjögren's syndrome.
Poux, J., Peyronnet, P., Meur, Y. L., Favereau, J. P., Charmes, J. P., & Leroux-Robert, C. (1992) · PubMed · Cited by 78 · see citing works
Emile, J. (1968) · PubMed · Cited by 59 · see citing works
Shishiba, Y., Shimizu, T., Saito, T., & Shizume, K. (1972) · Metabolism · doi:10.1016/0026-0495(72)90071-6 · Cited by 56 · see citing works
Schorn, T. F., Olbricht, C. J., Schüler, A., Franz, A., Wittek, K., Balks, H. J., Hausmann, E., & Hh, W. (1991) · Intensive Care Medicine · doi:10.1007/bf01708412 · Cited by 41 · see citing works
Ohtani, H., Imai, H., Kodama, T., et al. (1999) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/14.9.2201 · Cited by 35 · see citing works
Retal tubular acidosis complicated with hypokalemic periodic paralysis
Chang, Y., Huang, C.-C., Chiou, Y., & Yu, C. (1995) · Pediatric Neurology · doi:10.1016/0887-8994(95)00080-y · Cited by 34 · see citing works
Primary Sjo¨gren’s Syndrome Presenting as Hypokalaemic Periodic Paralysis and Respiratory Arrest
Fujimoto, T., Shiiki, H., Takahi, Y., et al. (2001) · Clinical Rheumatology · doi:10.1007/s100670170028 · Cited by 33 · see citing works
HYPOKALÆMIA OF BARIUM POISONING
Berning, J. (1975) · The Lancet · doi:10.1016/s0140-6736(75)91125-3 · Cited by 33 · see citing works
Severe Hypokalemia Induced by Hemodialysis
Wiegand, C. (1981) · Archives of Internal Medicine · doi:10.1001/archinte.1981.00340020029012 · Cited by 32 · see citing works
Hypokalemic Respiratory Arrest in Diabetic Ketoacidosis
Dorin, R. I. (1987) · JAMA · doi:10.1001/jama.1987.03390110093035 · Cited by 30 · see citing works
Kao, K., Tsai, Y., Lin, M., et al. (2000) · Journal of Toxicology Clinical Toxicology · doi:10.1081/clt-100102021 · Cited by 29 · see citing works
da Silva, O. A., Amaral, C. F. S., da Silveira, J. C. B., et al. (1981) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.1981.30.69 · Cited by 23 · see citing works
Hypokalemia and respiratory arrest in an infant with status asthmaticus
Kolski, G. B., Cunningham, A. S., Niemec, P. W., et al. (1988) · The Journal of Pediatrics · doi:10.1016/s0022-3476(88)80076-3 · Cited by 15 · see citing works
Koul, P. A., & Saleem, S. M. (1992) · Acta Paediatrica · doi:10.1111/j.1651-2227.1992.tb12299.x · Cited by 15 · see citing works
Carbenoxolone-induced hypokalaemia simulating Guillain-Barré syndrome.
Royston, A., & Prout, B. J. (1976) · BMJ · doi:10.1136/bmj.2.6028.150-a · Cited by 13 · see citing works
Acute respiratory arrest due to hypokalemia
Alvarez, J., & Low, R. B. (1988) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(88)80126-4 · Cited by 11 · see citing works
Coronary disease prevention. Proof of the anticholesterol pudding.
Podell, R. (1984) · Postgraduate medicine · doi:10.1080/00325481.1984.11716319 · Cited by 11 · see citing works
Hypokalaemic, hyperchloraemic metabolic acidosis requiring ventilation
Dunn, S. R., Farnsworth, T. A., & Karunaratne, W. U. (1999) · Anaesthesia · doi:10.1046/j.1365-2044.1999.00645.x · Cited by 8 · see citing works
Acute respiratory failure secondary to severe hypokalaemia
Puddy, B. R. (2000) · Anaesthesia · doi:10.1046/j.1365-2044.2000.01798-13.x · Cited by 3 · see citing works
Hypokalemic Respiratory Arrest in Diabetic Ketoacidosis
Rushakoff, R. J. (1987) · JAMA · doi:10.1001/jama.1987.03390240069019 · Cited by 3 · see citing works
[Barium intoxication: a case report].
Jan, I., Jong, Y. S., & Hm, L. (1991) · PubMed · Cited by 2 · see citing works
Mutlu, G. M., & Factor, P. H. (2002) · CHEST Journal · doi:10.1378/chest.121.6.2036 · Cited by 1 · see citing works
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Thyrotoxic Periodic Paralysis: A Diagnostic Challenge
Kung, A. W. C. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-0356 · Cited by 371 · see citing works
Chang, C.-C., Cheng, C.-J., Sung, C.-C., Chiueh, T.-S., Lee, C.-H., Chau, T., & Lin, S.-H. (2013) · European Journal of Endocrinology · doi:10.1530/eje-13-0381 · Cited by 114 · see citing works
Self-citationThyrotoxic Periodic Paralysis: Clinical Challenges
Vijayakumar, A., Ashwath, G., & Thimmappa, D. (2014) · Journal of Thyroid Research · doi:10.1155/2014/649502 · Cited by 88 · see citing works
“Exceptional cases of bulbar weakness and respiratory weakness requiring ventilatory support have been reported in TPP [23].”
RetractedAnalytic review: thyrotoxic periodic paralysis: a review
Pothiwala, P., & Levine, S. N. (2010) · Journal of Intensive Care Medicine · doi:10.1177/0885066609358849 · Cited by 80 · see citing works
Thyrotoxic periodic paralysis: clinical and molecular aspects
Falhammar, H., Thorén, M., & Calissendorff, J. (2012) · Endocrine · doi:10.1007/s12020-012-9777-x · Cited by 74 · see citing works
(2018) · Handbook of clinical neurology · doi:10.1016/b978-0-444-64076-5.00032-6 · Cited by 61 · see citing works
- Authors
- Liu, Y.-C., Tsai, W.-S., Chau, T., & Lin, S.-H.
- Affiliations
- Tri-Service General Hospital (TW)
- Corresponding author
- Lin, Shih-Hua
- Venue
- The American Journal of the Medical Sciences
- Publisher
- Elsevier BV
- Published
- 2004-05
- Volume
- 327
- Issue
- 5
- Pages
- 264-267
- ISSN
- 0002-9629 (ISSN-L)
- OpenAlex
- W1998770456
- Cited by
- 63
- References
- 31
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 2 · 2016: 2 · 2015: 3 · 2014: 4 · 2013: 4 · 2012: 7
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of the Medical Sciences (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Muscle and Compartmental Disorders
- Keywords
- thyrotoxic periodic paralysis, hypercapnic respiratory failure, hypokalemia, muscle weakness, hyperthyroidism, ventilatory support, T wave changes
- MeSH terms
- Acute Disease, Adult, Humans, Hypercapnia, Male, Potassium, Potassium Chloride, Respiratory Insufficiency, Thyrotoxicosis, Hypokalemic Periodic Paralysis
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