Factors that may produce mucle weakness in a patient with hypokalemic periodic paralysis:
(1) emotional stress or anxiety
(2) physical stress, including intense exercise
(3) exposure to cold
(4) high carbohydrate load
(5) high sodium load
(6) infection
(7) metabolic alkalosis
(8) any drug associated with hypokalemia (administration of insulin, potassium-wasting diuretic, corticosteroids, etc)
(9) anesthetic agents and/or depolarizing muscle relaxants
(10) any medical condition associated with hypokalemia
(11) in women, pregnancy or menstruation
(12) heavy alcohol use
where:
• An anxious patient may hyperventilate, which can cause respiratory alkalosis.
• Heavy alcohol use might include a high carbohydrate load.
