並列摘要
A 23-year-old Chinese female presented with sudden of general muscular weakness of all extremities and the inability to ambulate upon awakening in the morning. She denied any systemic disease or a family history of muscle weakness. Her blood pressure was 116/70 mm Hg, heart rate 60 beats/min, respiratory rate 16/min, and body temperature 36.2º C. There was no enlarged thyroid gland. Cardiopulmonary examination was unremarkable. A neurologic examination revealed that deep tendon reflexes were symmetrically diminished. The muscular strength in all extremities showed total paralysis. The remainder of the examination was normal. The laboratory investigations disclosed serum Na+ 141 mmol/L,K+1.7mmol/L, Cl- 106 mmol/L,BUN 10mg/dL, creatinine0.7 mg/dL, glucose 140 mg/dL, SGOT 21 IU/L, total calcium 9.8mg/dL, inorganic phosphate 2.7 mg/dL, and magnesium 2.1 mg/dL, EKG revealed normal sinus rhythm with rate of 60 beats/min and prominent U waves. Her paralysis lasted for 12 hours even with 80 mmol KCl supplementation. She was treated with KCl 16 mmol/day to prevent the attack of paralysis. Nevertheless, she was readmitted due to recurrent paralysis in the morning one week later. Serum Na+ concentration was 138 mmol/L+ 1.8 mmol/L Cl- 103 mmol/L.Arterial blood gas showed pH 7.39,PCO2 39 mmHg, PO2 103 mmHg and HCO3-23.1 mmol/L. Urine NA+ was 108 mmol/L, K+ was 7 mmol/L and Cl- was 102 mmol/L, creatinine 74 mg/dL and osmolality 624 mosm/kgH2O. She was treated with intravenous KCl at a rate of 10 mmol/hr. Her muscle strength recovered at the sixth hour, then KCl was discontinued. Hyper-kalemia 5.8 mmol/L was observed 2 hours after recovery. Her thyroid function and immune study were normal.