The DOI matches its Crossref record; 8 of the 8 references it cites were found in a registry or an index.
Hypokalemic Periodic Paralysis Exacerbated by Carbohydrate Load: A Case Report
Open accessAbstract
A 35-year-old male presented with weakness in all four extremities rendering him unable to ambulate. The patient stated the symptoms began after consuming an unknown, large amount of Oreo cookies; thus, a high carbohydrate load likely caused him to exceed the recommended dietary allowance (RDA) of 225-325 grams of carbohydrates per day, depending on one's daily caloric intake. Lab workup revealed a potassium level of 2.1 mmol/L. Upon potassium replacement, the patient's symptoms improved to baseline, and he was discharged home with follow-up instructions that included a referral for genetic testing. Hypokalemic periodic paralysis (HPP) is a rare condition that, despite having a relatively simple solution for treatment, can lead to an extensive and expensive workup if not considered early on the list of differential diagnoses. Herein, we will discuss the pathophysiology, clinical signs/symptoms, and management of HPP.
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“This insulin-driven shift exacerbates hypokalemia in predisposed individuals and can precipitate paralytic episodes in THPP [30].”
From Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms (2025) · cites this paper as [30]
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In the citing paper
“Consumption of carbohydrate-rich meals, especially those high in simple sugars, causes rapid elevations in blood glucose, stimulating insulin secretion from pancreatic β-cells. The resulting insulin surge promotes glucose and potassium uptake into skeletal muscle, potentially precipitating hypokalemic paralysis in predisposed individuals [30].”
From Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms (2025) · cites this paper as [30]
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Citations
Cites
Dietary Guidelines for Americans, 2020–2025
Phillips, J. A. (2021) · Workplace Health & Safety · doi:10.1177/21650799211026980 · Cited by 696
Dihydropyridine receptor mutations cause hypokalemic periodic paralysis
Ptáček, L. J. (1994) · Cell · doi:10.1016/0092-8674(94)90135-x · Cited by 426
Review of the Diagnosis and Treatment of Periodic Paralysis
Statland, J. M., Fontaine, B., Hanna, M. G., Johnson, N. E., Kissel, J. T., Sansone, V., Shieh, P. B., Tawil, R., Trivedi, J. R., Cannon, S. C., et al. (2017) · Muscle & Nerve · doi:10.1002/mus.26009 · Cited by 274
Lin, S.-H. (2001) · QJM · doi:10.1093/qjmed/94.3.133 · Cited by 173
Intravenous Treatment of Hypokalemic Periodic Paralysis
Griggs, R. C., Resnick, J. S., & Engel, W. K. (1983) · Archives of Neurology · doi:10.1001/archneur.1983.04050080039005 · Cited by 58
Clinical perspectives on the rationale for potassium supplementation
Weir, M. R., & Espaillat, R. (2015) · Postgraduate Medicine · doi:10.1080/00325481.2015.1045814 · Cited by 39
Insulin for the treatment of hyperkalemia: a double-edged sword?
Li, T., & Vijayan, A. (2014) · Clinical Kidney Journal · doi:10.1093/ckj/sfu049 · Cited by 38
Levis, J. T. (2012) · The Permanente Journal · doi:10.7812/tpp/12-015 · Cited by 38
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Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms
Qing, G., Zakaria, W. N. A., Rom, F. Z. M., Nik, W. N. F. H. W., Zulkeflee, H. A., & Rahim, S. N. A. (2025) · Endocrinology and Metabolism · doi:10.3803/enm.2025.2554 · Cited by 5
“This insulin-driven shift exacerbates hypokalemia in predisposed individuals and can precipitate para-lytic episodes in THPP [30].”
Metadata
- Authors
- Blanton, R., & Afzal, S.
- Affiliations
- Campbell University (US)
- Corresponding author
- Blanton, Ryan
- Venue
- Cureus
- Published
- 2022-09-06
- Volume
- 14
- Issue
- 9
- Pages
- e28851-e28851
- ISSN
- 2168-8184 (ISSN-L)
- PMC
- PMC9536358
- OpenAlex
- W4294811886
- Cited by
- 3
- References
- 8
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1
- FWCI
- 0.32
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Cureus (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Potassium and Related Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Ion channel regulation and function
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- hypokalemic periodic paralysis, carbohydrate load, hypokalemia, muscle weakness, potassium supplementation, dietary triggers, differential diagnosis, pathophysiology, genetic testing
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