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 (KCI) to avoid rebound hyperkalemia. In contrast, higher doses of KCI should be administered to replete the large K+ deficiency in non-HPP.
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