Q: 24 year old male from Thailand is brought from college volleyball field with full body muscle weakness worsening very quickly. Diagnosis of Thyrotoxic Periodic Paralysis (TPP) with hypokalemia is made, but no improvement with potassium replacement noticed while in ED. Patient is now admitted to ICU. Which of the following drug tends to help patients with refractory thyrotoxic Periodic Paralysis (TPP)?
A) Intravenous calcium
B) Doubling the dose of Potassium
C) Intravenous (IV) Propranolol
D) Clonidine
E) Intravenous (IV) Thyroxine
Answer: C
Periodic paralysis (PP) is a well known autosomal dominant disease, manifests by painless muscle weakness and precipitates by exercise, fasting, or high-carbohydrate foods. PP can also be an acquired disease in association with hyperthyroidism. TPP is classically get presented in Asian males. If potassium replacement does not resolve an attack, IV propranolol may reverse the weakness and the hypokalemia. The dose is 1 mg of IV propranolol every 10 minutes up to a maximum dose of 3 mg. Propranolol is a beta adrenergic blocker, and reverses the excessive stimulation of the sodium-potassium ATPase and reverses drive of potassium into the cells.
#endocrinology
#electrolytes
References:
1. Shayne P, Hart A. Thyrotoxic periodic paralysis terminated with intravenous propranolol. Ann Emerg Med 1994; 24:736.
2. Birkhahn RH, Gaeta TJ, Melniker L. Thyrotoxic periodic paralysis and intravenous propranolol in the emergency setting. J Emerg Med 2000; 18:199.
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