Hypokalaemic periodic paralysis
Mild attacks may need no treatment and some patients find that light exercise can abort an attack. If they are more severe, potassium tablets (usually ones that can be dissolved in water) may shorten an attack, and if taken last thing at night may prevent the common problem of weakness on waking in the morning.
It is important that potassium tablets are not dissolved in a drink that contains carbohydrate [such as a sweet drink] since large amounts of carbohydrate may bring on an attack. If the attacks are very troublesome, acetazolamide tablets taken regularly can be very effective in preventing attacks. Acetazolamide is a diuretic (a drug which makes you pass more urine) and exactly how it works in hypokalaemic periodic paralysis is uncertain.
Hyperkalaemic periodic paralysis
Most attacks are brief and mild and don’t require treatment. Eating or drinking carbohydrate-rich foods such as a sweet drink, bread or sugar cubes may shorten and reduce the severity of attacks. Fasting, unaccustomed exercise and exposure to cold should be avoided.
Very severe attacks, leading to hospital admission, may be treated by injection of glucose and insulin. If the potassium level in the blood is very high, calcium gluconate may also be given by injection, to protect the heart which can be affected by such high levels. Diuretic tablets make the patient pass more urine, which contains potassium, and can be very helpful if the attacks are frequent or severe.
If a patient is experiencing regular significant attacks they can usually be prevented or at least reduced by the drug acetazolamide described above. Another drug called salbutamol can also be a useful treatment for aborting acute attacks. This is a drug taken using a small inhaler device. It is most commonly used in asthma, but it has been shown that if a patient feels an attack of paralysis coming on, inhaling a small amount of salbutamol may stop the attack progressing.
Andersen’s syndrome
It is essential that all patients with Andersen’s syndrome are assessed by a cardiologist. Specialised heart treatments may be needed if there are significant disturbances of the heart rhythm. The attacks of paralysis can be effectively prevented by the drug acetazolamide.