並列摘要
Hypokalemic paralysis (HP) is a potentially reversible electrolyte and muscle disorder in emergency medicine. A vigorous search of the underlying etiology is mandatory to avoid missing a treatable cause. The measurement of blood and urine electrolytes and acid-base parameters can provide valuable clues to simplify different diagnosis. In patients with hypokalemic periodic paralysis (HPP) due to increased transcellular shift of potassium ions (K+) into cells, there is usually no acid-base disturbance, a low rate of K+ excretion and a very low transtubular potassium gradient(TTKG). Family history of paralysis, hypernatremia, clinical symptoms or signs related to hyperthyroidism, and drug histories are important keys to differentiate the subgroups of HPP. In patients with non-HPP, there is excessive excretion of K+ in association with an acid-base balance abnormality and a high TTKG. Hence non-HPP patients can readily be divided into two groups; one with hyperchloremic metabolic acidosis and the other with hypochloremic metabolic alkalosis. Assessment of urine ammonium excretion will subdivide the former group whereas blood pressure, plasma renin activity and aldosterone concentrations will clarify the causes of the latter group. In patients with HPP, the dose of KCl should be as small as possible to avoid rebound hyperkalemia. In contrast, patients in the non-HPP group with excessive renal K+ excretion need large doses of KCl to correct the severe deficit of a total body K+.
延伸閱讀
- 李忠政、黃文德、林石化（2011）。Diagnosis and Treatment of Hypokalemia。內科學誌，22(1)，31-39。https://doi.org/10.6314/JIMT.2011.22(1).04
- 魏光宇、鄭智仁、林石化（2017）。Hypokalemia。腎臟與透析，29(1)，17-24。https://doi.org/10.6340/KD.2017.29(1).04
- Chen, C. C., & Lin, S. H. (2005). Case 1: An Alcoholic Male with Profound Hypokalemia. Acta Nephrologica, 19(2), 74-74. https://www.airitilibrary.com/Article/Detail?DocID=10131671-200504-19-2-74-74-a
- Shiang, J. C., Kuo, T. S., & Lin, S. H. (2001). A Puzzling Cause of Worsening Hypertension and Hypokalemia. Acta Nephrologica, 15(3), 95-96. https://www.airitilibrary.com/Article/Detail?DocID=10131671-200107-15-3-95-96-a
- Lin, C. L., Yang, S. N., & Shiah, I. S. (2015). Concurrent Hypokalemic Periodic Paralysis and Bipolar Disorder. Journal of Medical Sciences, 35(5), 224-225. https://doi.org/10.4103/1011-4564.167779