RESUMO
Hypokalemia is a common laboratory finding in hospitalized patients, typically resulting from insufficient potassium intake, renal or gastrointestinal losses, or intracellular shifts. While the underlying cause is often easily identifiable, certain cases present diagnostic challenges, and if left unrecognized, the consequences can be life-threatening. We report a rare and atypical case of severe symptomatic hypokalemia as the initial presentation of newly diagnosed Graves' disease. The condition was caused by thyrotoxic periodic paralysis, a rare but serious complication of thyrotoxicosis, predominantly seen in East Asian populations. This disorder is characterized by episodes of acute, reversible muscle weakness associated with transient hypokalemia, which increases the risk of falls and traumatic injuries. The prompt identification of the etiology in such cases is critical for preventing recurrence and avoiding potentially fatal complications.
Assuntos
Hipopotassemia , Quadriplegia , Humanos , Quadriplegia/etiologia , Hipopotassemia/etiologia , Hipopotassemia/complicações , Adulto , Doença de Graves/complicações , Doença de Graves/diagnóstico , Masculino , Tireotoxicose/complicações , Tireotoxicose/diagnóstico , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/etiologia , Paralisia Periódica Hipopotassêmica/complicações , Feminino , Antitireóideos/uso terapêuticoAssuntos
Canais de Cloreto , Paralisia Periódica Hipopotassêmica , Mutação , Humanos , Feminino , Gravidez , Paralisia Periódica Hipopotassêmica/genética , Paralisia Periódica Hipopotassêmica/diagnóstico , Adulto , Canais de Cloreto/genética , Complicações na Gravidez/genética , Complicações na Gravidez/diagnósticoRESUMO
BACKGROUND: Familial hypokalemic periodic paralysis (HypoPP) is an uncommon genetic disorder characterized by recurrent episodes of muscle weakness and hypokalemia, typically starting in early adulthood. The existence of hyperthyroidism in the presence of HypoPP is more strongly associated with a diagnosis of thyrotoxic periodic paralysis (TPP), with most cases occurring in Asian males with pathogenic KCNJ2 or KCNJ18 variants and without a family history of the condition. This case is novel due to the combination of familial HypoPP and hyperthyroidism induced by Graves' disease, a rare occurrence especially in non-Asian populations. CASE PRESENTATION: A 40-year-old African American man presented with profound muscle weakness after consuming a high-salt meal. He had a significant family history of hyperthyroidism and hypokalemia. On examination, he showed profound weakness in all extremities. Laboratory tests confirmed hypokalemia and hyperthyroidism, and genetic testing identified a pathogenic variant in the CACNA1S gene (c.1583 G > A, p. R528H), with normal SCN4A, KCNJ2 and KCNJ18 sequencing. He was diagnosed with familial HypoPP and hyperthyroidism due to Graves' disease. He was started on PO methimazole 10 mg three times a day and PO acetazolamide 250 mg twice a day. He was advised to follow a low carbohydrate and low salt diet. CONCLUSIONS: This case highlights the importance of considering a genetic basis for HypoPP in patients with a family history of the condition, even when hyperthyroidism is present. The combination of familial HypoPP and Graves' disease is rare and emphasizes the need for careful genetic and clinical evaluation in similar cases. Management should focus on correcting hypokalemia, treating hyperthyroidism, and lifestyle modifications to prevent recurrence.
Assuntos
Hipertireoidismo , Paralisia Periódica Hipopotassêmica , Humanos , Masculino , Adulto , Paralisia Periódica Hipopotassêmica/genética , Paralisia Periódica Hipopotassêmica/etiologia , Paralisia Periódica Hipopotassêmica/diagnóstico , Hipertireoidismo/genética , Hipertireoidismo/complicações , Doença de Graves/genética , Doença de Graves/complicações , Canais de Cálcio Tipo L/genéticaRESUMO
PURPOSE: Thyrotoxic periodic paralysis (TPP) is characterized by muscle paralysis and significant intracellular potassium movement resulting in hypokalemia. Since TPP is a rare condition, only a few studies have explicated the clinical characteristics of patients with this disease. This study aimed to elucidate the clinical characteristics of patients with TPP by comparing them with those with thyrotoxicosis without paralysis (non-TPP) and sporadic periodic paralysis (SPP). METHODS: This was a single-center retrospective cohort study. Clinical data of patients with hyperthyroidism (n = 62) or periodic paralysis (n = 92) who were emergently admitted to our hospital was extracted from the electronic medical records and analyzed. RESULTS: All patients in the TPP group (15 males and 2 females) had Graves' disease, with 14 being newly diagnosed. The average serum potassium level on admission was 2.3±0.75 mEq/L. No significant correlation was observed among serum potassium level, amount of potassium required for normalization, and thyroid hormone levels. The TPP group showed significantly younger age, higher male ratio and body mass index (BMI), and lower serum potassium and phosphorus levels than the non-TPP group, which comprised 36 patients with Graves' disease. No significant differences were observed between the TPP and SPP (n = 11) groups in terms of age, sex, BMI, serum electrolyte levels, potassium requirement for normalization, and recovery time. MAIN CONCLUSIONS: Considering that most patients with TPP have undiagnosed Graves' disease, distinguishing TPP from SPP based on clinical information and course alone is difficult in emergency settings. Therefore, for early detection and launch of specific treatment of Graves' disease, screening for thyroid hormone and anti-thyroid stimulating hormone receptor antibody levels is necessary when treating patients with periodic paralysis.
Assuntos
Doença de Graves , Potássio , Tireotoxicose , Humanos , Masculino , Feminino , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Potássio/sangue , Doença de Graves/complicações , Doença de Graves/diagnóstico , Doença de Graves/sangue , Tireotoxicose/complicações , Tireotoxicose/diagnóstico , Tireotoxicose/sangue , Idoso , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/sangue , Adulto JovemRESUMO
Background: Thyrotoxic periodic paralysis is a rare and serious complication of hyperthyroidism. Case presentation: A man in his thirties of Asian descent, with non-compliant Graves' disease, presented with extremity paresis. Emergency blood tests revealed severe hypokalaemia, leading to a diagnosis of thyrotoxic periodic paralysis. The combination of uncontrolled hyperthyroidism, Asian ethnicity, paralysis, and severe hypokalaemia without other causes defined the diagnosis. Acute treatment involves non-selective beta-blockers, addressing hyperthyroidism, and potassium supplements. Interpretation: Swift recognition of thyrotoxic periodic paralysis is crucial for timely and life-saving treatment. If triggered by hyperthyroidism, as in Graves' disease, surgery or radioiodine is strongly indicated for definitive treatment. It is noteworthy that euthyroid patients cannot develop thyrotoxic periodic paralysis.
Assuntos
Doença de Graves , Hipopotassemia , Humanos , Masculino , Adulto , Doença de Graves/complicações , Doença de Graves/diagnóstico , Hipopotassemia/etiologia , Hipopotassemia/tratamento farmacológico , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/etiologia , Paralisia Periódica Hipopotassêmica/tratamento farmacológico , Antitireóideos/uso terapêutico , Potássio/sangue , Potássio/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Tireotoxicose/diagnóstico , Tireotoxicose/complicações , Hipertireoidismo/complicações , Hipertireoidismo/diagnósticoRESUMO
Renal tubular acidosis is a well-known consequence of primary Sjogren's syndrome (pSS), but a rare manifestation similar to acute pancreatitis in pSS. Here, we discuss the case of a woman in her 50s, who presented to a tertiary care hospital with recurrent episodes of sudden-onset weakness in all four limbs, recurrent vomiting and epigastric pain. She had non-anion gap metabolic acidosis with hypokalaemia and was diagnosed with pSS with hypokalaemic periodic paralysis. She was also diagnosed with acute pancreatitis based on elevated amylase and lipase levels and CT findings. The article highlights the diverse spectrum of clinical manifestations of pSS, including renal and pancreatic involvements, which can be rare consequences of the disease.
Assuntos
Paralisia Periódica Hipopotassêmica , Pancreatite , Síndrome de Sjogren , Humanos , Feminino , Síndrome de Sjogren/complicações , Síndrome de Sjogren/diagnóstico , Pancreatite/diagnóstico , Pancreatite/etiologia , Pancreatite/complicações , Pessoa de Meia-Idade , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/etiologia , Diagnóstico Diferencial , Acidose Tubular Renal/diagnóstico , Acidose Tubular Renal/complicações , Doença Aguda , Tomografia Computadorizada por Raios XRESUMO
Thyrotoxic periodic paralysis (TPP) and thyrotoxic cardiomyopathy (TCMP) are potentially lethal complications of thyrotoxicosis that require emergent recognition and management to attenuate significant morbidity and mortality. We present the case of a 23-year-old Asian male with no prior medical history who developed TPP with coincident TCMP, which was successfully managed with antithyroid and heart failure therapies. The clinician should be aware of the diagnosis and treatment of these 2 life-threatening conditions in a hyperthyroid state.
Assuntos
Antitireóideos , Cardiomiopatias , Paralisia Periódica Hipopotassêmica , Tireotoxicose , Humanos , Masculino , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/etiologia , Tireotoxicose/complicações , Tireotoxicose/diagnóstico , Adulto Jovem , Cardiomiopatias/etiologia , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Antitireóideos/uso terapêutico , EletrocardiografiaAssuntos
Diabetes Mellitus Tipo 2 , Paralisia Periódica Hipopotassêmica , Linhagem , Adulto , Feminino , Humanos , Masculino , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/genética , Insulina , MutaçãoRESUMO
Introduction: Thyrotoxic periodic paralysis (TPP) is a type of hypokalemic periodic paralysis that is caused by an underlying thyrotoxicosis. It is a rare cause of hypokalemia due to intracellular potassium shift, causing acute muscle weakness.Case presentation: We present a case of a 19-year-old male of Thai descent with acute proximal symmetric lower limb weakness. The combination of these symptoms with profound hypokalemia, rapid recovery after normalization of serum potassium, and evidence of hyperthyroidism led to the diagnosis of thyrotoxic periodic paralysis, in this case due to an underlying Graves' disease.Conclusion: Clinicians should consider the diagnosis of TPP when a patient presents with the triad of acute paresis, profound hypokalemia and hyperthyroidism.
Assuntos
Hipopotassemia , Paralisia Periódica Hipopotassêmica , Humanos , Masculino , Adulto Jovem , Hipopotassemia/etiologia , Hipopotassemia/diagnóstico , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/etiologia , Doença de Graves/complicações , Doença de Graves/diagnóstico , Tireotoxicose/complicações , Tireotoxicose/diagnóstico , Debilidade Muscular/etiologia , Potássio/sangue , Potássio/uso terapêuticoAssuntos
Paralisia Periódica Hipopotassêmica , Debilidade Muscular , Tireotoxicose , Adulto , Humanos , Masculino , Diagnóstico Diferencial , Perna (Membro) , Imageamento por Ressonância Magnética , Debilidade Muscular/etiologia , Músculo Esquelético , Mialgia/etiologia , Redução de Peso , Distúrbios do Início e da Manutenção do Sono/etiologia , Braço , Tremor/etiologia , Hipopotassemia/etiologia , Suplementos Nutricionais , Tireotoxicose/complicações , Tireotoxicose/diagnóstico , Tireotoxicose/terapia , Paralisia Periódica Hipopotassêmica/complicações , Paralisia Periódica Hipopotassêmica/diagnóstico , TireoidectomiaRESUMO
Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism that manifests as painless flaccid paralysis. An East Asian man in his late 20s presented to the emergency department with an acute onset of quadriparesis associated with hypertonia and hyperreflexia. His initial symptoms and signs suggested involvement of the brain and spinal cord; however, MRI of the neuroaxis was normal. His serum potassium concentration was low, and thyroid test results were consistent with hyperthyroidism. The patient was diagnosed with TPP associated with Graves' disease and was treated with potassium supplementation, propranolol and methimazole. Motor strength improved to his baseline level of power; bulk was normal, and tone was increased. Although flaccid paralysis is a typical presentation of TPP, brisk reflexes and muscle spasticity cannot rule out this condition. This case highlights the importance of considering TPP as a possible diagnosis in patients presenting with acute quadriparesis.
Assuntos
Doença de Graves , Hipertireoidismo , Paralisia Periódica Hipopotassêmica , Tireotoxicose , Humanos , Masculino , Doença de Graves/complicações , Hipertireoidismo/complicações , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/tratamento farmacológico , Paralisia Periódica Hipopotassêmica/etiologia , Paralisia/complicações , Potássio , Quadriplegia/complicações , Reflexo Anormal , Tireotoxicose/complicações , Tireotoxicose/diagnóstico , Tireotoxicose/tratamento farmacológico , AdultoRESUMO
BACKGROUND: The CACNA1S gene encodes the alpha 1 S-subunit of the voltage-gated calcium channel, which is primarily expressed in the skeletal muscle cells. Pathogenic variants of CACNA1S can cause hypokalemic periodic paralysis (HypoPP), malignant hyperthermia susceptibility, and congenital myopathy. We aimed to study the clinical and molecular features of a male child with a CACNA1S variant and depict the molecular sub-regional characteristics of different phenotypes associated with CACNA1S variants. CASE PRESENTATION: We presented a case of HypoPP with recurrent muscle weakness and hypokalemia. Genetic analyses of the family members revealed that the proband had a novel c.497 C > A (p.Ala166Asp) variant of CACNA1S, which was inherited from his father. The diagnosis of HypoPP was established in the proband as he met the consensus diagnostic criteria. The patient and his parents were informed to avoid the classical triggers of HypoPP. The attacks of the patient are prevented by lifestyle changes and nutritional counseling. We also showed the molecular sub-regional location of the variants of CACNA1S which was associated with different phenotypes. CONCLUSIONS: Our results identified a new variant of CACNA1S and expanded the spectrum of variants associated with HypoPP. Early genetic diagnosis can help avoid diagnostic delays, perform genetic counseling, provide proper treatment, and reduce morbidity and mortality.
Assuntos
Paralisia Periódica Hipopotassêmica , Humanos , Masculino , Criança , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/genética , Paralisia Periódica Hipopotassêmica/complicações , Mutação , Fenótipo , Debilidade Muscular , Família , Canais de Cálcio Tipo L/genéticaRESUMO
Primary Sjögren´s Syndrome is an immune-mediated disease characterized by exocrine glands dysfunction due to lymphoplasmacytic infiltration with sicca symptoms being one of its main features. The disease may, however, present as distal renal tubular acidosis due to renal involvement, which can range from asymptomatic to life-threatening. We describe the case of a 33-year-old woman with hypokalemic paralysis and metabolic acidosis secondary to distal renal tubular acidosis, leading to the diagnosis of primary Sjögren´s Syndrome. Although rare, recognizing primary Sjögren´s Syndrome as a possible cause of distal renal tubular acidosis may elicit an earlier diagnosis and treatment, improving the patient´s prognosis.
Assuntos
Acidose Tubular Renal , Hipopotassemia , Paralisia Periódica Hipopotassêmica , Síndrome de Sjogren , Feminino , Humanos , Adulto , Acidose Tubular Renal/complicações , Síndrome de Sjogren/complicações , Hipopotassemia/diagnóstico , Paralisia/diagnóstico , Paralisia Periódica Hipopotassêmica/diagnósticoRESUMO
BACKGROUND: Hypokalemic periodic paralysis (HPP) is a rare channelopathy characterized by episodic attacks of acute muscle weakness concomitant with hypokalemia. The etiology of hypokalemia is the shift of potassium into the cells, and the clinical symptoms resolve when potassium starts to leak back to the serum. Most of the time, the underlying ion channel defects are well compensated, and an additional trigger is often required to initiate an attack. Well-known trigger factors include carbohydrate-rich meals, exercise followed by rest, stress, cold weather, and alcohol consumption. CASE PRESENTATION: Here, we present the case of a 26-year-old Asian man who suffered from an acute onset of bilateral lower limb weakness with hypokalemia following dexamethasone injection. He was diagnosed with HPP. CONCLUSIONS: We would like to remind physicians to think of steroids as an unusual precipitating factor while managing patients with HPP, per results of this case study.
Assuntos
Hipopotassemia , Paralisia Periódica Hipopotassêmica , Masculino , Humanos , Adulto , Paralisia Periódica Hipopotassêmica/induzido quimicamente , Paralisia Periódica Hipopotassêmica/diagnóstico , Hipopotassemia/induzido quimicamente , Hipopotassemia/diagnóstico , Hipopotassemia/complicações , Potássio , Debilidade Muscular/complicações , EsteroidesRESUMO
BACKGROUND: Primary hypokalemic periodic paralysis (HypoPP), a rare skeletal muscle channelopathy resulting in episodic muscle weakness or paralysis under hypokalemic conditions, is caused by autosomal-dominant genetic mutations. HypoPP limits physical activity, and cardiac arrhythmias during paralytic attacks have been reported. We describe a rare familial HypoPP case complicated by sinus arrest and syncope requiring urgent temporary pacemaker implantation. CASE REPORT: A 27-year-old Vietnamese man with a family history of periodic paralysis presented with his third attack of muscle weakness triggered by intense football training the previous day. Clinical and laboratory features justified a HypoPP diagnosis. During intravenous potassium replacement, the patient experienced syncopal sinus arrest requiring urgent temporary pacemaker implantation. The patient gradually improved, responding favorably to oral potassium supplements. Genetic testing revealed an Arg1132Gln mutation in the sodium ion channel (SCN4A, chromosome 17: 63947091). At discharge, the patient received expert consultation regarding nonpharmacological preventive strategies, including avoidance of vigorous exercise and carbohydrate-rich diet. CONCLUSIONS: No evidence has established a relationship between hypokalemia and sinus arrest, and no specific treatment exists for familial HypoPP due to SCN4A mutation. Clinician awareness of this rare condition will promote appropriate diagnostic approaches and management strategies for acute paralytic attacks. Treatment should be tailored according to HypoPP phenotypes and genotypes.
Assuntos
Hipopotassemia , Paralisia Periódica Hipopotassêmica , Humanos , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/genética , Canal de Sódio Disparado por Voltagem NAV1.4/genética , Mutação , Potássio , Debilidade MuscularRESUMO
Hypothyroidism, a commonly encountered thyroid disorder, usually manifests with readily recognizable typical features. However, an unusual presentation of a classic thyroid disorder may hinder accurate diagnosis in certain instances. One such rare initial presentation of hypothyroidism is recurrent hypokalemic paralysis, and existing reports in the literature are sparse. It has been more commonly reported in thyrotoxicosis. We report the case details and clinical outcomes of two middle-aged individuals (a 34-year-old male and a 37-year-old female) with recurrent episodes of hypokalemic paralysis. Their clinical examination revealed pure motor hyporeflexia quadriparesis with hypotonia and diminished deep tendon reflexes without any autonomic dysfunction. They had no significant previous medical history. Biochemical findings revealed hypokalemia in both cases (1.4 and 1.9 mEq/L, respectively) with elevated levels of thyroidstimulating hormone and thyroidrelated antibodies in both individuals, thus, confirming the diagnosis of autoimmune hypothyroidism. Immediate treatment with intravenous and oral potassium correction helped in the recovery. Thyroxine supplementation was considered a follow-up treatment, and for a one-year follow-up period there were no complaints of limb weakness reported in both individual.
Assuntos
Hipopotassemia , Paralisia Periódica Hipopotassêmica , Hipotireoidismo , Tireotoxicose , Masculino , Pessoa de Meia-Idade , Feminino , Humanos , Adulto , Hipopotassemia/diagnóstico , Tireotoxicose/complicações , Tireotoxicose/diagnóstico , Tireotoxicose/tratamento farmacológico , Paralisia/tratamento farmacológico , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Potássio , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisia Periódica Hipopotassêmica/tratamento farmacológico , Paralisia Periódica Hipopotassêmica/etiologiaRESUMO
BACKGROUND: Thyrotoxic periodic paralysis (TPP) is a rare and most often acquired subtype of hypokalemic periodic paralysis. The association of varying degrees of muscle weakness, hyperthyroidism and hypokalemia characterizes it. The treatment requires potassium supplementation, control of hyperthyroidism and prevention measures. It is a frequent disease in Asian men, but much rare in Caucasian or African populations. This is the first report of TPP associated with lactic metabolic acidosis in an African man. CASE PRESENTATION: A 23 year-old African man, native from Morocco, with recurrent episodes of tetraparesis for eleven months, and abdominal pain, was referred for evaluation. Biochemical investigations showed severe hypokalemia associated with hyperthyroidism and lactic metabolic acidosis. His EKG showed signs of hypokalemia such as sinus tachycardia and U waves. After potassium supplementation, neurological recuperation was quick and complete. Thyroid ultrasound identified a hypoechogenic and hypervascularized goiter, associated with high levels of thyroid antibodies, in favor of Grave's disease. With antithyroid drugs and life-style changes, the patient did not have any other attack. REVIEW OF LITERATURE: In addition to the case report, this article presents an extended review of literature, from the first large study reporting the diagnosis and incidence of TPP in 1957 to nowadays. Are reported here the latest information concerning epidemiology, clinical manifestations, complementary examinations, management and genetic finding. The lactic acidosis observed initially is exceptional, never described in TPP. TPP is a diagnostic and therapeutic emergency, requiring careful potassium supplementation, in order to avoid the risk of the onset of rebound hyperkalemia, to be maintained until the etiological treatment is effective. Paraclinical assessment with emergency EKG and electromyogram are essential to assess the impact. DISCUSSION: It is essential in the face of any hypokalaemic periodic paralysis, including in non-Asian subjects, to search hyperthyroidism. CONCLUSIONS: This report demonstrates the importance of thyroid testing in case of acute muscle weakness, even in non-Asian patients in order to diagnose TPP. This is a rare but possible etiology, to be distinguished from the familial form of hypokalemic periodic paralysis. It also questions on the impact of TPP on energetic metabolism, in particular on lactic metabolism.
Assuntos
Acidose Láctica , Hipertireoidismo , Hipopotassemia , Paralisia Periódica Hipopotassêmica , Tireotoxicose , Masculino , Humanos , Adulto Jovem , Adulto , Tireotoxicose/complicações , Tireotoxicose/diagnóstico , Hipopotassemia/complicações , Hipopotassemia/tratamento farmacológico , Paralisia Periódica Hipopotassêmica/complicações , Paralisia Periódica Hipopotassêmica/diagnóstico , Hipertireoidismo/complicações , Potássio/uso terapêutico , Debilidade Muscular/complicações , Debilidade Muscular/tratamento farmacológico , Paralisia/complicações , Paralisia/tratamento farmacológicoRESUMO
This study aimed to examine changes in electrolytes and acid-base status in primary and secondary hypokalaemic periodic paralysis (HypoPP), which will help early differential diagnosis of HypoPP. A total of 64 HypoPP patients were enrolled and relevant data from clinical records was collected. Overall, 64 patients (mean age 28.2±7.3 years) of which 58(91%) were males, with 39, 11 and 14 patients, respectively, diagnosed as primary HypoPP, thyrotoxic HypoPP, and other secondary HypoPPs at discharge, were assessed. Those with HypoPP secondary to conditions other than hyperthyroidism were more likely to develop acid-base imbalance (p<0.001); they had higher pH (p=0.046) and HCO3 levels (p=0.014) at baseline, and needed a higher dose of potassium supplement before the serum potassium level returned to normal (p=0.007) and a longer time to regain full muscle strength (p=0.004), compared with those with primary or thyrotoxic HypoPP. Emergent arterial blood gas analysis may aid early differential diagnosis of patients with primary and secondary HypoPP.