Hyperkalemic periodic paralysis is an inherited disorder of sodium channels that results in myotonia and periodic paralysis. Attention to certain details permits safe administration of anesthesia in these patients.
The most important concern is to minimize exposure to potassium and total body potassium levels:
(1) avoid potassium in diet and intravenous fluids
(2) in patients with hyperkalemia consider preoperative depletion of total body potassium with diuresis using furosemide or thiazide diuretics
(3) some patients benefit from use of a carbonic anhydrase inhibitors (acetazolamide)
Hyperkalemia should be treated with intravenous infusion of calcium gluconate.
Avoid
Action
hypothermia
Maintain body temperature in the perioperative period.
vigorous exercise
Minimize physical exertion prior to surgery.
stress and fatigue
Allow sufficient rest prior to surgery. Consider an anxiolytic agent.
metabolic acidosis
Monitor acid-base balance during and after surgery.
starvation
Administer intravenous infusion with glucose during the perioperative fast.
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