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Clinical features and recovery pattern of secondary hypokalaemic paralysis

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Abstract

Purpose

Information regarding frequency, details of neurological signs and recovery patterns of patients with secondary hypokalaemic paralysis (HP) is limited. This study aimed to analyse the frequency, aetiology, clinical features and recovery patterns of patients with secondary HP.

Methods

The clinical and laboratory records of 18 consecutive patients with secondary HP aged ≥ 18 years admitted to our hospital between April 2011 and March 2022 were reviewed. Patients with inherited hypokalaemic periodic paralysis were excluded.

Results

Of the 18 patients, 16 had a common aetiology: chronic alcoholism, diarrhoea or an imbalanced diet. Initial symptoms, such as fatigue, were often atypical. Three patients had prominent asymmetric limb weakness and four had predominant upper limb weakness. On admission, the mean serum potassium and creatine kinase (CK) levels of the patients were 1.90 mmol/L and 4488 U/mL, respectively. Ten patients (56%) had decreased potassium levels after admission, despite potassium replacement treatment (rebound hypokalaemia). Twelve patients presented with increased CK levels even after 2–5 days (delayed hyperCKaemia). Low serum magnesium levels significantly correlated with rebound hypokalaemia.

Conclusions

Secondary HP can be caused by a variety of conditions, but mainly occurs due to lifestyle conditions/disorders. Secondary HP often presents with atypical symptoms, and the initial symptoms can be non-specific. Rebound hypokalaemia and delayed hyperCKaemia are common in secondary HP, despite potassium replacement. As such, careful serial monitoring is needed for patients with secondary HP.

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Data availability

The data of this study are not openly available due to privacy reasons and are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Neurology, Chiba Rosai Hospital, 2-16 Tatsumidai-Higashi, Ichihara-shi, Chiba, 290-0003, Japan

    Akiyuki Hiraga & Kazuho Kojima

  2. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan

    Satoshi Kuwabara

Authors
  1. Akiyuki Hiraga
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  2. Kazuho Kojima
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  3. Satoshi Kuwabara
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Correspondence to Akiyuki Hiraga.

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Hiraga, A., Kojima, K. & Kuwabara, S. Clinical features and recovery pattern of secondary hypokalaemic paralysis. J Neurol 270, 5571–5577 (2023). https://doi.org/10.1007/s00415-023-11923-8

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  • DOI: https://doi.org/10.1007/s00415-023-11923-8

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