Lin Hung-Wei, Chau Tom, Lin Chin-Sheng, Lin Shih-Hua
Tri-Service General Hospital, Department of Medicine, Number 325, Section 2, Cheng-Kung Road, Taipei, Neihu 114, Taiwan.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.07.2008.0577. Epub 2009 Mar 17.
A 22-year-old Chinese man presented with sudden onset of generalised muscular weakness and paralysis upon awakening in the morning, due to sporadic periodic paralysis (SPP), a type of hypokalaemic periodic paralysis (HPP) without hyperthyroidism or familial history of paralysis. Laboratory studies showed marked hypokalaemia (K(+) 1.6 mmol/litre). He received intravenous KCl supplementation at a rate of 0.14 mmol/kg/h and developed a paradoxical fall in serum K(+) concentration from 1.6 to 1.4 mmol/litre during KCl therapy. After 160 mmol KCl supplementation his muscular strength recovered, but muscular paralysis recurred 2 h later. Acute recurrent hypokalaemia was the presumptive initial diagnosis and intravenous KCl supplementation was briefly reinitiated. Despite no obvious abnormalities on ECG monitoring, a 12-lead ECG clearly demonstrated tented T waves in the precordial leads suggestive of hyperkalaemia, later found to be 6.9 mmol/litre. After treatment with intravenous calcium gluconate, insulin and loop diuretics, his serum K(+) concentration fell to 4.7 mmol/litre and muscular paralysis resolved in 3 h.
一名22岁的中国男性早晨醒来后突然出现全身肌肉无力和麻痹，诊断为散发性周期性麻痹（SPP），这是一种无甲状腺功能亢进或麻痹家族史的低钾性周期性麻痹（HPP）。实验室检查显示明显低钾血症（血钾1.6 mmol/L）。他接受了以0.14 mmol/kg/h的速度静脉补充氯化钾治疗，在补钾治疗期间血钾浓度出现反常下降，从1.6 mmol/L降至1.4 mmol/L。补充160 mmol氯化钾后他的肌肉力量恢复，但2小时后肌肉麻痹复发。初步诊断为急性复发性低钾血症，并再次短暂静脉补充氯化钾。尽管心电图监测无明显异常，但12导联心电图显示胸前导联T波高耸，提示高钾血症，后来发现血钾为6.9 mmol/L。经静脉注射葡萄糖酸钙、胰岛素和袢利尿剂治疗后，他的血钾浓度降至4.7 mmol/L，肌肉麻痹在3小时内缓解。
