Serum K

Carbohydrate load after exercise KCI load

Hyperkalemic without myotonia More frequent; provoked by rest after exercise


More severe and prolonged than hyperkalemic

KCI load but in practice it may be difficult to differentiate these from akinetic seizures or certain varieties of syncope in which the loss of consciousness is so brief that it is difficult for the patient to decide whether he lost consciousness or not. One must probe very carefully to elicit a history of a brief warning to identify syncope or obtain an EEG to rule out an akinetic seizure.

The most interesting and rare disorders causing episodic weakness are the periodic paralyses, which are associated with genetic disorders of the potassium and sodium channels. In the great majority of cases these disorders are familial and autosomal dominant. Currently, they are classified according to the level of serum potassium during the attack (see Table 15-1.5 ). During an attack variable weakness of the limbs occurs, and usually the legs are affected before the arms. Then the weakness may progress to affect the trunk muscles, but the diaphragm, sphincters, and cranial and ocular musculature are generally spared. The attack usually evolves over minutes to several hours and may last a few hours if the attack is mild or several days if it is severe. These forms of paralysis can also be distinguished from each other by the factors that provoke an attack of weakness, the duration and severity of the attacks, and the presence of myotonia.


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