title: Recurring paralysis.
abstract: A 22-year-old Chinese man presented with sudden onset of generalised muscular weakness and paralysis upon awakening in the morning, due to sporadic periodic paralysis (SPP), a type of hypokalaemic periodic paralysis (HPP) without hyperthyroidism or familial history of paralysis. Laboratory studies showed marked hypokalaemia (K(+) 1.6 mmol/litre). He received intravenous KCl supplementation at a rate of 0.14 mmol/kg/h and developed a paradoxical fall in serum K(+) concentration from 1.6 to 1.4 mmol/litre during KCl therapy. After 160 mmol KCl supplementation his muscular strength recovered, but muscular paralysis recurred 2 h later. Acute recurrent hypokalaemia was the presumptive initial diagnosis and intravenous KCl supplementation was briefly reinitiated. Despite no obvious abnormalities on ECG monitoring, a 12-lead ECG clearly demonstrated tented T waves in the precordial leads suggestive of hyperkalaemia, later found to be 6.9 mmol/litre. After treatment with intravenous calcium gluconate, insulin and loop diuretics, his serum K(+) concentration fell to 4.7 mmol/litre and muscular paralysis resolved in 3 h.
authors.affiliation: Tri-Service General Hospital, Department of Medicine, Number 325, Section 2, Cheng-Kung Road, Taipei, Neihu 114, Taiwan.
authors.forename: Hung-Wei
authors.initials: HW
authors.lastname: Lin
authors.forename: Tom
authors.initials: T
authors.lastname: Chau
authors.forename: Chin-Sheng
authors.initials: CS
authors.lastname: Lin
authors.forename: Shih-Hua
authors.initials: SH
authors.lastname: Lin