Hypokalemic Periodic Paralysis: Treatment, Cost and Side Effects

It is uncommon diesease marked by paralysis or muscle weakness. Hypokalemic Periodic Paralysis comes in the people in the form of sudden Paralysis attacks. These attacks are very harmful to the body of a person. These attacks are caused due to the sudden changes in the body temperature of a person, taking meals with high sodium content and high carbohydrate meals, loud noise and high flashing lights etc.

Symptoms of Hypokalemic Periodic Paralysis include the following:

1. Low levels of potassium in the blood of patient
2. Body muscle pain
3. Regular attacks on daily, weekly or monthly level
4. Also causes muscle abnormalities in the patient
5. intense muscle weakness in early days

The hypokalemic periodic paralysis doesn’t really have a proper treatment process but when the paralysis attack occurs the person needs to be taken to emergency. The emergency treatment’s first actions will be:

• Calling for cardiac monitoring
• Drawing electrolytes for determining serum K+
• Provide 02 - thimble might not bring in 02 saturation because of the cardiac dilatation
• Lie patient in coma position to avoid aspiration.

If the patient is able to swallow or breathe on their own, KCL solutions of 15 – 30 mml will be given to adults and 10 – 15 mml for children. The release from KCL tablets is leisure and takes time to effect and if the patient shows symptoms like:

• No improvements after 4 – 6 doses of KCL solution.
• Nausea
• Diarrhea
• Sickness
• Weakness

Administration of KCl is necessary. The patient will be kept under observation until control state. However, the strength is restored post treatment.

The treatment doses may differ from person to person on the basis of age group, level of severity of the attacks, first timers and chronically affected. The diagnosis is done through tests like:

• Electrocardiogram (ECG)
• Electromyography (EMG)
• Muscle biopsy.

If any of the tests above show abnormal results other tests may be recommended to rule out the other causes of the abnormal results. HypoPP (Hypokalemic periodic paralysis) responds well to treatment. Treatment may prevent, and even reverse, progressive muscle weakness. The muscle strength between the attacks may weaken and with repeated attacks it may eventually cause worsening and permanent muscle weakness between attacks can pose serious problems.

The patient will show certain symbols and sings, others around need to notice and report the patient’s health status to the doctors if the patient is showing signs that include.

Weakness or paralysis in the areas like:-

1. Most commonly at shoulders and hips.
2. Also effects the arms, legs, muscles of eyes and muscles that help in breathing (diagraph , Pectoral, minor, vertebral, extensors, serratus, anterior)
3. Occurs on and off
4. Most visible upon wakening or after resting.
5. Is rarely seen during exercising and triggered at resting.
6. High-carbohydrate, high-salt meals, stress, pregnancy, heavy exercise, and cold are the triggers.
7. An attack usually lasts for several hours up to a day

The patient will not be treated for the hypokalemic periodic paralysis when these things occur:

• If the tests of (ECG, EMG and muscle biopsy) are normal at all times.
• If the tests (CG, EMG, and muscle biopsy) show abnormal results due to some other reason and the hypokalemic periodic paralysis is ruled out due to the tests.
• If the person has some other treatment going on and the weakness could be the reason for the side effect of the treatment.
• If the person is not showing any strong symptoms of hypokalemic periodic paralysis.

Even after the above mentioned rules have been implied and the person still wants to go for the treatment then he/she can go for the diagnosis for the clarity of reports.

The medications are having their own different side effects some of them include but the attacks too damage the body as the side effect:

• Kidney stones
• Irregular heartbeats
• Permanent muscle damage or constant weakening of muscles.
• Difficulty breathing
• Difficulty swallowing or speaking
• loss of consciousness

These side effects are only few. The hypokalemic periodic paralysis is not life frightening in most of the cases and it is very rare case where a person loses life due to the hypokalemic periodic paralysis but leaves a great impact in lives of the patients with so many side effects because of attacks and then the medications will also affect the patient’s body.

The treatment doesn’t really end because there is no treatment for curing it completely as the medication dichlorphenamide (Keveyis) and acetazolamide (Diamox) will help reducing the attacks and some people will be cured due to the constant treatment however there are many cases where the treatment continued for longer time and sometimes lifetime. What goes on is the post treatment process which needs to be extremely strict. The triggers are usually different for different people. Some triggers are:

• sugary or starchy foods
• Food that has too much salt
• Long gap between meals
• Too much consumption of food.
• Physical exertion at extreme.
• Temperature fluctuations
• Too much emotion
• Specific medications

The person starts recovering between the attacks but after every period of attacks the damage is done to the body and will need to recover again after the attack. It depends upon the frequency of period of attacks the patient has if there are enough gaps between the attacks person may recover the muscle weakness and can be treated with less side effects. Frequent attacks can lead the major damage to the body causing the organs to fail. If the gaps are good enough to recover the recovery process will take very little time but if the organs are failing due to short gaps between the periods of attacks will lead to high dose treatment and the body being damaged with severe side - effects can take time.

With the consultation fees from PRs: 1000- 5000/- the treatment through medications such as Dichlorphenamide, Thiazide diuretics, carbonic anhydrase inhibitors etc. From 500 – 1000 per medicine. The core treatment process costs around PRs: 15000-30000/- depending upon the organization.

No, in very rare cases we see the patient getting completely cured but most of the cases will continue to get treatment every time they are affected or experience the period of attacks. The treatment will reduce the frequency of period of attacks for a specific time and can only reduce or stop the attacks for some time but there is no permanent treatment for hypokalemic periodic paralysis.

Some of the alternatives are:

• Thyrotoxic periodic paralysis: Controls thyrotoxicosis and beta-blocking agents.
• Continuous ECG monitoring is always needed during the treatment
• Acetazolamide is an off-label alternative that is administered at a dose of 125-1500 mg/d in divided doses
• Best way is to try and avoid the triggers.