Lin S H, Lin Y F
Department of Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Am J Kidney Dis. 2001 Mar;37(3):620-3.
Hypokalemia and hypophosphatemia are commonly encountered during paralysis in patients with thyrotoxic periodic paralysis (TPP) and may contribute to neuromuscular manifestations. Potassium and phosphate supplements have been recommended to hasten recovery and prevent cardiopulmonary complications. However, this recommendation has not yet proven efficacious. Hyperadrenergic activity has been implicated in the pathogenesis of TPP. We tested whether nonselective beta-blockers could terminate neuromuscular symptoms rapidly while reducing an intracellular shift of potassium and phosphate. We describe two patients who had an acute attack of TPP with characteristic hypokalemia and hypophosphatemia associated with low urinary potassium and phosphate excretion. After oral propranolol, 3 mg/kg, serum potassium and phosphate concentrations increased promptly in 2 hours in both patients, and there was complete amelioration of paralysis. No rebound hyperkalemia or hyperphosphatemia was detected. Given their efficacy in this pilot study, they should be considered as a first-line therapy for TPP.
甲状腺毒症性周期性瘫痪（TPP）患者在瘫痪期间常出现低钾血症和低磷血症，这可能导致神经肌肉表现。推荐补充钾和磷酸盐以加速恢复并预防心肺并发症。然而，这一推荐尚未被证实有效。高肾上腺素能活性与TPP的发病机制有关。我们测试了非选择性β受体阻滞剂是否能迅速终止神经肌肉症状，同时减少钾和磷酸盐的细胞内转移。我们描述了两名患有TPP急性发作的患者，他们伴有特征性低钾血症和低磷血症，同时尿钾和尿磷排泄减少。口服3mg/kg普萘洛尔后，两名患者的血清钾和磷酸盐浓度在2小时内迅速升高，瘫痪完全缓解。未检测到反弹性高钾血症或高磷血症。鉴于其在这项初步研究中的疗效，应将其视为TPP的一线治疗方法。
