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GENERAL PRACTITIONER'S SECTION
SICK “K” SYNDROME
OP Kapoor
In cardiology practice, we often see patients presenting with giddiness or palpitations. Sometimes, the cause of these complaints is “Sick Sinus Syndrome” (diagnosed with the help of electrophysiological studies of the heart). But the management of the patients having these complaints is difficult. In patients having brady-arrhythmias, if drugs are given to increase the pulse rate, the patient can end up with tachy-arrhythmia. Vice versa, in patients having tachy-arrhythmia, if drugs are given to slow the pulse rate, they may end up with brady- arrhythmia. The best thing to do, is to leave them alone and in case of difficulty, advice the implantation of a pacemaker.
Periodic paralysis syndrome reminds me of a similar type of illness. Sometimes apparently, healthy people can get an attack of paralysis of all the limbs lasting up to an hour or for a few days. In those with paralysis of short duration, the serum K levels may be normal (normokalaemia) or high (hyperkalaemia). But in patients, where paralysis lasts longer or for a few days, the serum K level is low (hypokalaemia).
If serum K levels are not tested during the attack, and an injection of IV Potassium or Glucose with Insulin (or Calcium Gluconate) is administered, the paralysis can become worse!
I see two to three patients with this syndrome every year. Mostly, I do not prescribe Acetazolamide (unless attacks are frequent). I only advise them to avoid heavy exertion and heavy meals.
I am writing this article after I saw a patient, who had such an attack in Karachi. He was admitted there and labelled as a case of Guillain Barre Polyneuritis and was advised a course of costly immunotherapy. Both, the patient and his doctors were proud of the fact that he had recovered within a day after the first injection of immuno-globulin with absolutely no neurological deficit! However, I was unhappy with the diagnosis. Since he had come from another country for an opinion, I asked for a few further tests including one for porphyria. In Mumbai, he suffered another attack and was admitted to a big hospital as an emergency. Due to low K level, “Periodic paralysis” was diagnosed.
But, had he been in a suburb, in a small nursing home,where sometimes Serum K levels cannot be tested and even if the doctor had made a diagnosis, he could have made the patient worse by empirical treatment, presuming that a low Serum K level was the cause of periodic paralysis, as was taught all these years.In the last few years, it has been shown that Serum K can be low, high or normal during an attack of "Periodic paralysis". In my opinion, this disease should be labelled as Sick K syndrome, when a wrong treatment (right according to the doctor) could make the patient worse!!
Therefore, if the Serum K levels cannot be tested during an attack of paralysis, it is better to wait and hold on any specific treatment because most of the times, these patients recover spontaneously.
Thus, this interesting neurological entity, mimicks the cardiac entity of Sick sinus syndrome where the SA node in the heart is “sick”. I was therefore tempted to call this neurological illness as `Sick “K” syndrome.'
This article was printed in the April Issue of Bombay Hospital Journal (Vol. 45, No. 2, 2003), with
omission of almost one paragraph, hence the corrected version has been reprinted.
