Periodic Paralysis of the Hypokalemic Type in a Patient with Thyrotoxicosis

Image 1

A 30 yo with no significant medical hx c/o of lower extremity weakness.

The ecg shows sinus rhythm (~70 bpm), ST depression and prolonged QTc (~530 ms).

Work-up revealed low K (1.8), low TSH and elevated FT4. K was replaced and the weakness improved and was started on antithyroid medication and beta-blocker and discharged after a few days.

After correction of potassium, T wave looked normal and QT improved.

Image 2

ECG Interpretation: Hypokalemia
Case: Periodic paralysis of the hypokalemic type in a pt with thyrotoxicosis.

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Hypokalemia

A 40 yo F patient with h/o of alcoholism is admitted due to abdominal pain and vomiting.

Figure 1

There is a baseline artifacts (part of real-life ecg's). This is a regular narrow complex tachycarduia with prolonged QT/QTc. A QT interval that crosses the middle of an R to R is highly suspicious for for prolonged QTc. The QT interval is about 400 ms and at a rate of about 100-107 bpm, the QTc is  516-534 ms which is prolonged. There is also diffuse ST sagging. These ECG findings can be seen in hypokalemia. In this case, the K was 2.5. The tachycardia was due to alcohol withdrawal.

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Hypokalemia

A pt who was admitted due to ascites and diarrhea.

Image 1

You can see ST depression and prolonged QT. "I would like to call it the invasion of the  ST on P's personal space". The K during this time is 2.2

What was done?

Institutions often trigger K protocol. So, K here was replaced.

Image 2

Image #2 (after something was done - K replacement). The strip looked normal and no more invasion of P-ersonal space. K came back to 4.

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