Interesting in India PA becomes advanced enough to be a major cause of periodic paralysis

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Should note that I saw the first reported Pt with PA in all of Inida when I

was in Dr. Conn's Lab.

Natl Med J India. 2006 Sep-Oct;19(5):246-9.

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Aetiological, clinical and metabolic profile of hypokalaemic periodic

paralysis in adults: a single-centre experience.

Rao N, M, N, Rajaratnam S, Seshadri MS.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical

College, Ida Scudder Road, Vellore 632004, Tamil Nadu, India.

BACKGROUND: Hypokalaemic periodic paralysis constitutes a heterogeneous group

of disorders that present with acute muscular weakness. In this analysis, we

discuss the aetiological factors that appear to be more common in the Indian

population. METHODS: From 1995 to 2001, 31 patients presented with periodic

paralysis (mean age 34.5 years, range 11-68 years). Of the 31 patients, 19 were

men. The clinical and laboratory data of these patients were analysed. Patients

were investigated for possible secondary causes of hypokalaemla. RESULTS:

There were 13 patients (42%) with renal tubular acidosis, 13 with primary

hyperaldosteronism (42%), 2 each with thyrotoxic periodic paralysis and sporadic

periodic paralysis, and I with Gitelman syndrome. Of the 13 patients with renal

tubular acidosis, 10 had proximal and 3 distal renal tubular acidosis. Three of

these patients with renal tubular acidosis had Sjogren syndrome. The patients

diagnosed to have renal tubular acidosis had significantly lower serum

bicarbonate (18.7 [14.6] v. 29.6 [5.0] mEq/L; p < 0.05) and higher levels of

chloride

(107.5 [6.0] v. 99.5 [3.4] mEq/L; p < 0.05) compared with those who had

primary hyperaldosteronism, although the potassium values were similar (2.4

[0.65]

v. 2.26 [0.48] mEq/L; p = 0.43). All patients with primary hyperaldosteronism

had hypertension at presentation and were proven to have adrenal adenomas.

CONCLUSION: A significant number of patients in this study had secondary and

potentially reversible causes of hypokalaemic periodic paralysis. The common

causes were renal tubular acidosis and primary hyperaldosteronism. A detailed

work-up for secondary causes should be undertaken in Indian patients with

hypokalaemic periodic paralysis.

May your pressure be low!

Clarence E. Grim, BS, MS, MD

Senior Consultant to Shared Care Research and Consulting, Inc.

(sharedcareinc.com)

Clinical Professor of Internal Medicine and Epidemiology Med. Col. WI

Clinical Professor of Nursing, Univ. of WI, Milwaukee

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

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