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Differential diagnosis of hypokalemic paralysis * Type of potassium imbalance Cause Drugs (tocolytics, theophylline toxicity, chloroquine toxicity, insulin overdose) Thyrotoxic periodic paralysis Transcellular shift Familial periodic paralysis Sporadic periodic paralysis Barium poisoning Drugs: diuretics Primary hyperaldosteronism Pseudohyperaldosteronism: licorice ingestion Renal loss of Bartter's syndrome, Gitelman's syndrome potassium Renal tubular acidosis Other: nephrotic syndrome, acute tubular necrosis, diabetic keto- acidosis, and ureterosigmoidostomy Celiac disease Gastrointestinal Tropical sprue loss of potassium Infectious diarrhea: Salmonella enteritis, Strongyloides enteritis, and Yersinia enterocolitis Short bowel syndrome * Adapted from references 2, 7, 8, 14, and 19.
Acetazolamide therapy has been useful in familial periodic paralysis, although its efficacy in thyrotoxic periodic paralysis is doubtful and its effects potentially deleterious.
Potassium chloride ER is indicated for the treatment of patients with hypokalemia with or without metabolic alkalosis, in digitalis intoxications, in patients with hypokalemic familial periodic paralysis, and for the prevention of hypokalemia in patients who would be at particular risk if hypokalemia were to develop (digitalized patients or patients with significant cardiac arrhythmias, hepatic cirrhosis with ascites, states of aldosterone excess with normal renal function, potassium-losing nephropathy, and certain diarrheal states).

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