2: Weak All Over

An 18 year old Asian male with a history of hypertension and alcohol abuse presented with total body muscle weakness which started after drinking heavily the night before. The patient was only able to move his hands and feet in the ED. There was concern over a psychiatric component to his symptoms.

What does his EKG Show?

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Here is a second EKG done 1-2 hours later.

ANSWER: The patient was found to have a potassium of 1.5. (The serum magnesium was normal. Good thought). The patient was treated with an IV potassium drip, but an hour later developed the changes shown on the second EKG. Despite appropriate ACLS treatment (Amiodarone and Procainamide were not given because of the long baseline QT) the patient went into this rhythm.

He eventually required cardioversion and intubation, but was successfully resuscitated.

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QUICK ESSENTIALS on PERIODIC PARALYSIS

Epidemiology: Autosomal dominant, onset age <25, after exercise or big meal
Hyperkalemic: Cx: Na channel. K nl/ but u slight ^ between attacks.
Rx: D50. Prevent: Diamox, HCTZ
Thyrotoxic: K shift, asian man 20-40, leg>arm, prox>dist, Afib, PVC;
Rx: K, propranolol; admit CMA
Hypokalemic: Proximal>distal, (extensors>flexors), legs>arms. Arrhythmia.
Rx: KCl, exercise. Dispo: see hypokalemia. Prevention: diamox > aldactone