Emergency Care

Periodic Paralysis Patients at Increased Risk of MH

Patients with Hyperkalemic periodic paralysis and Paramyotonia Congenita are at increased risk for Malignant Hyperthermia (MH) during surgery. 

The regular colonoscopy prep can cause a hypokalemic episode in a patient with hypokalemic periodic paralysis. This colonoscopy prep, adapted to avoid hypokalemia, has been used by numerous patients with HypoKPP on the HKPP Listserv without provoking an episode afterwards. 

Colonoscopy Prep:

Day 1 Normal diet with an herbal tea laxative before bed.

Day 2 No solid foods, milk products or liquids with red or purple coloring; Suggested liquids are low sodium chicken stock, tea without milk, and water throughout the day.

Hao Cheng, MD   

The use of local anaesthetics on patients with periodic paralysis presents some unusual challenges. Many patients report that these agents trigger weakness or paralysis, a phenomenon which is substantiated in medical literature. Some patients also report that the agents do not produce the desired anaesthesia.

First Actions:

• Respiratory and cardiac arrest are possible.
• Check vitals - cardiac diliatation may cause hypotension and low pulse pressure
• Call for Cardiac Monitoring/EKG
• Draw electrolytes to determine serum K+
• Provide 02 - thimble may not reflect 02 saturation due to cardiac dilitation
• Lie patient in coma position to avoid aspiration.