PP and Carbs

Q: A high-carbohydrate load is recommended in patients who present with hypokalemic Periodic paralysis (PP), including thyrotoxic PP.

A) True

B) False

Answer: B

PP attacks in hypokalemic thyrotoxic patients result from increased release of epinephrine or insulin, causing intracellular potassium shifts and low serum potassium levels. Known inciting events are:

• strenuous physical activity
• stress
• high-carbohydrate load (answer for above Q)
• cold exposure
• infection
• alcohol intake
• pulse corticosteroid therapy
• beta-2 adrenergic bronchodilator 
• menses 
• exogenous epinephrine or insulin
• acetazolamide
• thyroid supplements 

#electrolytes

References:

1. Hsieh MJ, Lyu RK, Chang WN, et al. Hypokalemic thyrotoxic periodic paralysis: clinical characteristics and predictors of recurrent paralytic attacks. Eur J Neurol 2008; 15:559.

2. Qing G, Zakaria WNA, Rom FZM, Nik WNFHW, Zulkeflee HA, Rahim SNA. Thyrotoxic Hypokalemic Periodic Paralysis: Pathophysiological Mechanisms. Endocrinol Metab (Seoul). 2025 Dec;40(6):821-829. doi: 10.3803/EnM.2025.2554. Epub 2025 Dec 11. PMID: 41376301; PMCID: PMC12765881.

3. Chang CC, Cheng CJ, Sung CC, et al. A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants. Eur J Endocrinol 2013; 169:529.