What can we learn from management of Hypokaliemic Periodic Paralysis? This may be useful to ME patients with low/borderline plasma potassium levels and muscles weakness Here an interesting link with some extracts : "Ion channels are tiny pores (openings) that allow ions (molecules) of sodium and potassium to move through the cell membrane. For the muscles to work properly sodium and potassium ions must be kept in the correct ratio inside and outside the cell. When the level of potassium in the blood falls these ion channels fail to regulate the flow of ions properly. The ratio of sodium and potassium inside and outside the cell become unbalanced. The muscle responds less when asked to move, which is felt as weakness. If the imbalance becomes pronounced the muscle quits responding at all, i.e. is paralysed. This person with HypoKPP is very sensitive to drops in serum potassium. Some patients with HypoKPP may become paralyzed while their potassium levels remain within "normal" limits." "However the level of potassium always falls. Sweets or starchy foods trigger attacks because these foods cause potassium to move into the muscle cell, and lower the level of potassium in the blood. Potassium (by mouth or by an IV line) makes the attack go away." "Many HypoKPP attacks are triggered by food. Food triggers include sweet or starchy foods like candy, cakes, pie and other desserts, soft drinks which are sweetened with sugar, fruit juices, bread, cereal products, rice, potatoes, and pasta. Foods like these are digested very quickly and raise blood sugar rapidly. The pancreas responds to this rapid rise in blood sugar by producing a lot of insulin. Insulin drives potassium from the blood into the muscle cell, which triggers weakness. Salty foods, like potato chips or pickles, are also a trigger for many HypoKPP patients. Getting too hungry, or eating a large meal (especially if you are very hungry) triggers episodes in many patients. Other common triggers include unusual activity or exercise - usually the day before the attack, but sitting still for too long may also trigger attacks. Patients learn that pacing their activities is absolutely vital. The activity level should be kept close to the same each day. Sleep is a strong trigger. Many patients wake up paralyzed in the morning or after a nap. Getting too cold (or too hot) makes some patients weak. Humid weather or a rapid change in the weather (like a storm) can trigger attacks in some patients." "Some medications may cause attacks. These include muscle relaxants and beta-blockers, some tranquilizers, pain killers, antihistamines, the puffers used to treat asthma attacks, some antibiotics and cough syrups. The eye drops used to dilate the pupil during eye exams have been reported to cause paralysis. Epinephrine or adrenaline , a drug routinely added to local anesthetics, should be absolutely avoided by patients with HypoKPP. Many patients report paralysis attacks occurring in the dentist's chair or following dental work, or after having a wound stitched or a mole removed. Over the counter drugs can be dangerous and should be avoided if at all possible. If it’s necessary to take something it's wise to try 1/4 of the recommended dose to make sure it doesn’t cause weakness." "What medications are prescribed for HypoKPP? "The carbonic anhydrase inhibitor 'Diamox' (acetazolomide) is often prescribed for HypoKPP patients. This medication helps keep the potassium from getting out of balance in the first place, by affecting the mechanism that moves potassium from the blood into the cell. ...." "Diuretics which cause the kidneys to 'spare' (or conserve) potassium are also used to treat HypoKPP. Dyrenium and Aldactone (spironolactone) are in this family. .....Patients who are taking diuretics which cause the kidneys to conserve potassium should consult with their doctors before taking potassium supplements." "Most people with HypoKPP still require potassium, even on diuretic therapy, but it should be carefully monitored. Those on carbonic anhydrase inhibitors generally need to take some potassium to replace what is lost due to therapy itself. Most patients with HypoKPP use potassium to abort developing episodes. Patients differ in their reactions to different forms of potassium but, as a rule, most people find that the effervescent potassium citrate or bicarbonate tablets which dissolve in water are the most effective and easiest on the stomach. Potassium chloride tablets are slow to dissolve and are hard on most people's stomachs, though some forms of potassium chloride capsules have coated granules of potassium which dissolve in the intestine and are much easier on the digestive system. If potassium chloride tablets are required these are preferred by many patients."