Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, Uttar Pradesh 226014, India.
Postgrad Med J. 2010 Dec;86(1022):692-5. doi: 10.1136/pgmj.2010.104026. Epub 2010 Oct 10.
Acute flaccid paralysis is a common neurological emergency with diverse causes and variable outcome. There is a paucity of reports documenting the spectrum of hypokalaemic paralysis in neurological practice.
To report the clinical features, aetiology, and outcome of patients with hypokalaemic paralysis in a tertiary care teaching hospital in India.
Consecutive patients with acute flaccid paralysis with hypokalaemia from 2008 to 2010 were included in the study. Patients with Guillain-Barré syndrome, porphyria, polio and non-polio enterovirus infection and myositis were excluded. Detailed clinical examination, urinalysis, renal function tests, arterial blood gas analysis, thyroid hormones, and electrocardiogram were carried out. Patients received intravenous or oral potassium supplementation and their underlying causes were treated.
Thirty patients aged 17-52 years, including three females, were included. Secondary causes of hypokalaemic paralysis were present in 13 patients and included thyrotoxic paralysis in five and renal tubular acidosis (RTA) and Gitelman syndrome in four each. All the patients had quadriparesis and 10 had severe weakness (MRC grade <2). Tendon reflexes were reduced in eight and brisk in four patients. Respiratory paralysis was present in six patients and one needed artificial ventilation. Fifteen patients had severe hypokalaemia (<2 mmol/l), four had acidosis, and six had alkalosis. The secondary group had more severe hypokalaemia and needed longer time to recover.
43.3% of patients with hypokalaemic paralysis had a secondary cause for their condition. Patients with severe hypokalaemia with acidosis or alkalosis should be investigated for secondary causes as their management differ.
急性弛缓性瘫痪是一种常见的神经急症，病因多样，预后不一。目前鲜有报道描述印度一家三级教学医院神经科低钾性瘫痪患者的临床表现、病因和结局。
报告印度一家三级教学医院低钾性瘫痪患者的临床特征、病因和结局。
连续纳入 2008 年至 2010 年间低钾性急性弛缓性瘫痪患者。排除格林-巴利综合征、卟啉病、脊髓灰质炎和非脊髓灰质炎肠道病毒感染、肌炎患者。详细的临床检查、尿液分析、肾功能检查、动脉血气分析、甲状腺激素和心电图检查。患者接受静脉或口服补钾治疗，针对潜在病因进行治疗。
纳入 30 例年龄 17-52 岁的患者，包括 3 例女性。低钾性瘫痪的继发性病因包括甲状腺毒症性瘫痪 5 例、肾小管酸中毒（RTA）和 Gitelman 综合征各 4 例。所有患者均表现为四肢瘫痪，10 例患者肌力严重减弱（MRC 分级<2）。8 例患者腱反射减弱，4 例患者腱反射活跃。6 例患者存在呼吸肌瘫痪，1 例患者需要人工通气。15 例患者血钾严重降低（<2 mmol/L），4 例患者存在酸中毒，6 例患者存在碱中毒。继发性组患者血钾降低更严重，需要更长时间才能恢复。
低钾性瘫痪患者中有 43.3%存在继发性病因。对于低钾血症伴酸中毒或碱中毒的严重患者，应进行继发性病因检查，因为其治疗方法不同。
