Laboratory tests to determine the cause of hypokalemia and paralysis

Shih Hua Lin, Yuh Feng Lin, Dung Tsa Chen, Pauling Chu, Chin Wang Hsu, Mitchell L. Halperin

Research output: Contribution to journalArticle

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Abstract

Background: Hypokalemia and paralysis may be due to a short-term shift of potassium into cells in hypokalemic periodic paralysis (HPP) or due to a large deficit of potassium in non-HPP. Failure to make a distinction between HPP and non-HPP may lead to improper management. Therefore, we evaluated the diagnostic value of spot urine tests in patients with hypokalemia and paralysis during 3 years. Methods: Before therapy, the urine potassium concentration, potassium-creatinine ratio, and transtubular potassium concentration gradient were determined in a second voided urine sample. Results: Forty-three patients with hypokalemia and paralysis were identified: 30 had HPP and 13 had non-HPP. There was no significant difference in the plasma potassium or bicarbonate concentrations and in the pH of arterial blood between the 2 groups. All but 2 patients in the non-HPP group had urine potassium concentration values less than 20 mmol/L. Although the potassium concentration was significantly lower in the HPP group, there was some overlap. In contrast, the transtubular potassium concentration gradient and potassium-creatinine ratio differentiated patients with HPP vs non-HPP. Although only a mean ± SD of 63 ± 36 mmol of potassium chloride was administered in the patients with HPP, rebound hyperkalemia (>5 mmol/L) occurred in 19 (63%) of these 30 patients. Conclusions: Calculating the transtubular potassium concentration gradient and potassium-creatinine ratio provided a simple and reliable test to distinguish HPP from non-HPP. Minimal potassium chloride supplementation should be given to avoid rebound hyperkalemia in patients with HPP.

Original languageEnglish
Pages (from-to)1561-1566
Number of pages6
JournalArchives of Internal Medicine
Volume164
Issue number14
DOIs
Publication statusPublished - Jul 26 2004
Externally publishedYes

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Hypokalemic Periodic Paralysis
Hypokalemia
Paralysis
Potassium
Urine
Creatinine
Hyperkalemia
Potassium Chloride

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Laboratory tests to determine the cause of hypokalemia and paralysis. / Lin, Shih Hua; Lin, Yuh Feng; Chen, Dung Tsa; Chu, Pauling; Hsu, Chin Wang; Halperin, Mitchell L.

In: Archives of Internal Medicine, Vol. 164, No. 14, 26.07.2004, p. 1561-1566.

Research output: Contribution to journalArticle

Lin, Shih Hua ; Lin, Yuh Feng ; Chen, Dung Tsa ; Chu, Pauling ; Hsu, Chin Wang ; Halperin, Mitchell L. / Laboratory tests to determine the cause of hypokalemia and paralysis. In: Archives of Internal Medicine. 2004 ; Vol. 164, No. 14. pp. 1561-1566.
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