*Hospital Management Guidelines
Patients with Thyrotoxic Hypokalemic Paralysis
Birthdate: ________Height: _______Weight: _______
Physician contact: ___________________________________________
Emergency contact: Your emergency contact should be someone who can speak for you when you cannot advocate for yourself.
home phone# _________________ cell#_____________________
PRECAUTIONS: Place patient in coma position to avoid aspiration during weakness/paralytic attack. Weakness can rapidly progress to paralysis and respiratory failure, monitor the patient closely. Paralyzed patients may appear to be unconscious, but are awake and aware. Do not assume they cannot feel pain or hear conversations.
Normal BP: _______________Normal heart rate:______________
Common symptoms during attacks; ____________________________
Age at onset of symptoms; _________________
Frequency of attacks; _____________________________________________
Genetic mutation if known; __________________________
Family history? _____________________________
Dietary Requirements: Low carbohydrate (under ___ grams daily), high protein, low sodium diet. ________________________________________
Normal range of K+ when asymptomatic: __________________________
Target range of K+: ______________________________
Medications: Including dosages and timing of doses: ________________
Medications to Avoid: Epinephrine, drugs which reduce serum K+. Antibiotics which reduce neuromuscular transmission: aminoglycosides: Strepto-, Neo-, Kana-, and Clindamycin Macrolides: Erythromycin, Telithromycin, Azithromycin; Fluoroquinolones: Ciprofloxacin and others
Food and Drug Allergies: a) b) c) d)
Potassium Supplementation: (Describe your schedule of K+ administration or other management.)
Monitor K+ frequently as needed. Labs should be stat and avoid use of tourniquet if possible.
Cardiac Involvement: Monitor cardiac activity and respiration.
IV USE: for maintenance when potassium is not the primary issue: Avoid IV use if sufficient fluids, medication and K+ levels can be maintained orally. Avoid glucose drip use dilute saline, or Ringer’s.
General Anesthetics: RISK of MALIGNANT HYPERTHERMIA: Patients with Periodic Paralysis are more than usually susceptible to malignant hyperthermia. Avoid the use of all halogenated ethers (isoflurane, ethrane, sevoflurane, and desflurane) as well as halothane (which is an alkane) and Suxamethonium chloride (INN), aka suxamethonium or succinylcholine. All are potential triggers of MH. a) patients with any form of Periodic Paralysis often take longer to come out of anesthesia and may experience post-anesthetic paralysis and an extended period of post-anesthetic weakness. b) While there is no standard protocol for anesthetic use in HypoKPP, the following have worked for some patients: Propofol, Fetanyl, Versed – Rocuronium, Toradol.
Local Anesthetics: USE NO EPINEPHRINE Lidocaine works inconsistently in many PP patients, and not at all in some patients. If lidocaine does not work use an alternative such as articaine, bupivacaine or mepivicaine without epi. In children the injection site may be numbed with Emla Cream to reduce syncopal response to injection.
OPERATING ROOM: TEMPERATURE CONTROL: Chilling is a primary trigger in all forms of periodic paralysis. Patient should be kept warm during procedures, but both chilling and overheating are attack triggers in many patients.
MOVEMENT: a) If feasible arrange for breaks from electronic monitoring (or other items that inhibit movement) periodically to enable patient to move around to lessen and/or prevent attacks. b) If confined to bed periodically encourage as much movement of limbs as possible from bed to mitigate/recover from weakness, and prevent embolus.
Communication: If the patient is unable to speak and can blink ask yes or no questions, say, “Blink once for yes, twice for no.”
Physician’s List: (Include any that apply with contact information)