Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Secondary hypokalemic myoplegias

Full Text:


Objective: to investigate the features of clinical manifestations and course of secondary hypokalemic myoplegia (SHM) of various etiologies.

Patients and methods. The investigation enrolled 10 patients with SHM. The patients' mean age was 39.5±16.2 years. The cause of SHM was hyperaldosteronism in 3 cases, thyrotoxicosis in 1, nontraumatic rhabdomyolysis in 2, and severe toxicosis and massive obstetric hemorrhage in 4.

Results and discussion. The blood potassium level difference between days 7 and 1 of hospitalization in patients with hyperaldosteronism and thyrotoxicosis was 2.2±0.4 mmol/l; this indicator in the other patients was less (1.6±0.8 mmol/l). The dynamics of an increase in the blood potassium concentrations during the 7 days differed significantly in 4 pregnant women who had undergone a cesarean section for placental abruption, antenatal fetal death, or their severe toxicosis with suddenly developed neuromuscular disorders (2.1±0.8 mmol/l), and in other patients with SHM (1.4±0.2 mmol/l). SHM in Conn's syndrome and thyrotoxicosis was characterized by long-term (11.8±3.6-day) neuromuscular disorders, while in SHM of another etiology, there were shorter (5.8±4-day) muscle weakness episodes (p<0.05). The SHM duration was recorded to be shorter in 4 pregnant women (4.3±4 days) than that in the other patients (10.3±2.9 days) (p<0.05). In nontraumatic rhabdomyolysis, the duration of hypokalemic paralysis (HP) was significantly longer (9±1.4 days) than in pregnancy (4.3±3.9 days). The episodes of HP in thyrotoxicosis and aldosteroma turned out to be longer (495.8±331.5 days) (p<0.05) than those in the presence of electrolyte changes in pregnant women and in rhabdomyolysis (14±5.7 days). In patients without adrenal tumors, thyrotoxicosis, the SHM periods requiring urgent hospitalization were more prolonged in nontraumatic rhabdomyolysis (30±8.5 days) (p<0.05) than those in the presence with electrolyte disorders in pregnant women (11.2±3.7 days).

Conclusion. The differential diagnostic algorithm for examining patients with acute flaccid paralysis of various etiologies due to hypokalemia has not been well elaborated, especially in endocrine disease and rhabdomyolysis. The differences in the rate of hypokalemia reversal in hyperaldosteronism, thyrotoxicosis, and rhabdomyolysis are likely to be associated with the multifactorial etiology of SHM. An incorrect assessment of the etiology of SHM is a common reason for its late diagnosis and inadequate treatment.

About the Authors

T. G. Sakovets
Kazan State Medical University, Ministry of Health of Russia
Russian Federation
49, Butlerov St., Kazan 420012

E. I. Bogdanov
Kazan State Medical University, Ministry of Health of Russia
Russian Federation
49, Butlerov St., Kazan 420012


1. Statland JM, Fontaine B, Hanna MG, et al. Review of the Diagnosis and Treatment of Periodic Paralysis. Muscle Nerve. 2018 Apr; 57(4):522-530. doi: 10.1002/mus.26009. Epub 2017 Nov 29.

2. Lehmann-Horn F, Rü del R, Jurkat-Rott K. Hereditary Muscle Channelopathies. In: Rimoin D, Pyeritz R, Korf B, editors. Emery and Rimoin's Principles and Practice of Medical Genetics. Elsevier; 2013. Chapter 129. P. 1-17.

3. Rhee EP, Scott JA, Dighe AS. Case 4-2012: a 37-year-old man with muscle pain, weakness, and weight loss. N Engl J Med. 2012 Feb 9; 366(6):553-60. doi: 10.1056/NEJMcpc1110051.

4. Sakovets TG, Bogdanov EI. Hypokalemic myoplegia. Kazanskii meditsinskii zhurnal. 2013;(6):933-7 (In Russ)..

5. Sakovets TG, Bogdanov EI. Secondary hypokalemic paralysis: clinical observation. Nevrologicheskii vestnik. 2013;(2): 66-71. (In Russ).

6. Amato AA. Disorders of Skeletal Muscle. In: Daroff RB, Jankovic J, Mazziotta JC et al, editors. Bradley's Neurology in Clinical Practice. 7th ed. Elsevier; 2016. P. 1915-55.

7. Mayr FB, Hans D, Laggner AN. Hypokalemic paralysis in a professional bodybuilder American. Am J Emerg Med. 2012 Sep;30(7):1324.e5-8. doi: 10.1016/j.ajem.2011.06.029. Epub 2011 Aug 25.

8. Aronson MA. Laxatives. In: Aronson JK, editor. Meyler's Side Effects of Drugs. 16th ed. Elsevier; 2016. P. 488-94.

9. Kalinin AP, Kotov SV, Rudakova IG. Nevrologicheskie rasstroistva pri endokrinnykh zabolevaniyakh: rukovodstvo dlya vrachei [Neurological disorders in endocrine diseases. Guide for doctors]. 2nd ed. Moscow: MIA; 2009. 488 p.

10. Allon M. Disorders of potassium metabolism. In: Gilbert SJ, Daniel EW, editors. National kidney foundation primer on kidney diseases. 10th ed. Elsevier; 2018. P. 97-106.

11. Kim K, Lee JH, Kim SC, et al. A case of primary aldosteronism combined with acquired nephrogenic diabetes insipidus. Kidney Res Clin Pract. 2014 Dec;33(4):229-33. doi: 10.1016/j.krcp.2014.09.001. Epub 2014 Nov 26.

12. Ryan DP, da Silva MR, Soong TW, et al. Mutations in potassium channel Kir2.6 cause susceptibility to thyrotoxic hypokalemic periodic paralysis. Cell. 2010 Jan 8;140(1):88-98. doi: 10.1016/j.cell.2009.12.024.

13. Wang X, Chow CC, Yao X, et al. The predisposition to thyrotoxic periodic paralysis (TPP) is due to a genetic variant in the inwardrectifying potassium channel, KCNJ2. Clin Endocrinol (Oxf). 2014 May;80(5):770-1. doi: 10.1111/cen.12277. Epub 2013 Jul 31.

14. Jayasinghe KS, Mendis BL, Mohideen R, et al. Medullary sponge kidney presenting with hypokalemic paralysis. Postgrad Med J. 1984 Apr;60(702):303-4.

15. Kilpatrick RE, Seiler-Smith S, Levine SN. Thyrotoxic hypokalemic periodic paralysis: report of four cases in black American males. Thyroid. 1994 Winter;4(4):441-5. doi: 10.1089/ thy.1994.4.441.

16. Cerrato DR, Angle E, Carrillo M, et al. Acute limb paralysis in a patient with Graves disease. Chest. 2015;148 (4_MeetingAbstracts):259.

17. Ghalyoun BA, Khaddash I,, Mourad I, et al. Thyrotoxic periodic paralysis crosses boarders from muscles to the heart: a case of hypokalemic ventricular tachycardia. J Am Coll Cardiol. 2019;73(9):2323

18. Amirlak I, Dawson KP. Barter syndrome: an overview. Q QJM. 2000 Apr;93(4):207-15. doi: 10.1093/qjmed/93.4.207

19. Malhotra HS, Garg RK. Dengue-associated hypokalemic paralysis: Causal or incidental? J Neurol Sci. 2014 May 15;340(1-2):19-25. doi: 10.1016/j.jns.2014.03.016. Epub 2014 Mar 15.

20. Manary MJ, Keating JP, Hirshberg GE. Quadriparesis due to potassium depletion. Crit Care Med. 1986 Aug;14(8):750-2. doi: 10.1097/00003246-198608000-00020.

21. Cappell MS. Gastrointestinal disorders during pregnancy. In: Steven G, Niebyl JR, Joe LS, et al, editors. Obstetrics: Normal and Problem Pregnancies. 7th ed. Elsevier; 2017. P. 1012-29.

22. Castillo MJ, Phillippi JC. Hyperemesis gravidarum: a holistic overview and approach to clinical assessment and management. J Perinat Neonatal Nurs. 2015 Jan-Mar;29(1):12-22; quiz E1. doi: 10.1097/JPN.0000000000000075.

23. London V, Grube S, Sherer DM, et al. Hyperemesis Gravidarum: a review of recent literature. Pharmacology. 2017;100(3-4): 161-171. doi: 10.1159/000477853. Epub 2017 Jun 23.

24. Trivedi TH, Daga GL, Yeolekar ME. Geophagia leading to hypokalemic quadriparesis in a popartum patient. J Assoc Physicians India. 2005 Mar;53:205-7.

25. Gueguen J, Hanouna G, Chemouny JM. Persistent hypokalemia with renal losses in a 31-year-old pregnant woman. astroenterology. 2018 May;154(6):1580-1581. doi: 10.1053/j.gastro.2017.07.012. Epub 2017 Jul 19.

26. Aronson MA. Thiazide diuretics. In: Aronson JK, editor. Meyler's Side Effects of Drugs. 16th ed. Elsevier; 2016. P. 839-84.

27. Keltz E, Khan FY, Mann G. Rhabdomyolysis. The role of diagnostic and prognostic factors. Muscles Ligaments Tendons J. 2014 Feb 24; 3(4):303-12. eCollection 2013 Oct.

28. Haseley L, Jefferson JA. Pathophysiology and etiology of acute kidney injury. In: Feehally J, Floege, J, Tonelli M, et al, editors. Comprehensive Clinical Nephrology. 16th ed. Elsevier; 2019. P. 786-801.

29. Balhara KS, Highet B, Omron R. Hypokalemia causing rhabdomyolysis in a patient with short bowel syndrome. J Emerg Med. 2015 Apr;48(4):e97-9. doi: 10.1016/j.jemermed.2014.12.018. Epub 2015 Feb 11.

30. Patel KG, Aggarwal G, Owusu B, et al. Hypokalemia-induced rhabdomyolysis in a 61-year-old woman: a case report. PM R. 2015; 7:83-222.

31. Kulsum U, Sherani K, Patel V, et al. A case of non-traumatic, non-exertional acute compartment syndrome from severe hypokalemia. Chest. 2016;150(4):249A

For citation:

Sakovets T.G., Bogdanov E.I. Secondary hypokalemic myoplegias. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3):52-56. (In Russ.)

Views: 41

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)