A simple and rapid approach to hypokalemic paralysis

Am J Emerg Med. 2003 Oct;21(6):487-91. doi: 10.1016/s0735-6757(03)00159-1.


Hypokalemia with paralysis (HP) is a potentially reversible medical emergency. It is primarily the result of either hypokalemic periodic paralysis (HPP) caused by an enhanced shift of potassium (K(+)) into cells or non-HPP resulting from excessive K(+) loss. Failure to make a distinction between HPP and non-HPP could lead to improper management. The use of spot urine for K(+) excretion rate and evaluation of blood acid-base status could be clinically beneficial in the diagnosis and management. A very low rate of K(+) excretion coupled with the absence of a metabolic acid-base disorder suggests HPP, whereas a high rate of K(+) excretion accompanied by either metabolic alkalosis or metabolic acidosis favors non-HPP. The therapy of HPP requires only small doses of potassium chloride (KCl) to avoid rebound hyperkalemia. In contrast, higher doses of KCl should be administered to replete the large K(+) deficiency in non-HPP.

Publication types

  • Case Reports

MeSH terms

  • Acid-Base Equilibrium
  • Adult
  • Bartter Syndrome / complications
  • Bartter Syndrome / diagnosis
  • Bartter Syndrome / therapy
  • Diagnosis, Differential
  • Emergency Medical Services / methods
  • Female
  • Humans
  • Hyperthyroidism / complications
  • Hyperthyroidism / diagnosis
  • Hyperthyroidism / therapy
  • Hypokalemic Periodic Paralysis / blood
  • Hypokalemic Periodic Paralysis / complications
  • Hypokalemic Periodic Paralysis / diagnosis*
  • Hypokalemic Periodic Paralysis / therapy*
  • Hypokalemic Periodic Paralysis / urine
  • Infusions, Intravenous
  • Male
  • Potassium / urine
  • Potassium Chloride / administration & dosage
  • Sjogren's Syndrome / diagnosis
  • Sjogren's Syndrome / therapy
  • Treatment Outcome


  • Potassium Chloride
  • Potassium