EpistemisAcute generalized weakness
Specialty: General.
Why it occurs
- Hypokalemic or hyperkalemic periodic paralysis (disorder of muscle ion channels causing attacks of acute flaccid weakness)
- Myasthenia gravis with myasthenic crisis or acute decompensation (acute autoimmune postsynaptic blockade of acetylcholine receptors)
- Ischemic stroke of the posterior fossa or brainstem (affecting the bilateral motor pathways in a descending manner)
- Acute poisoning by organophosphates, heavy metals or botulinum toxin (irreversible blockage or inhibition of acetylcholine release)
- Hyperacute onset bacterial sepsis with generalized hemodynamic and muscular collapse.
Initial workup
Immediate emergency hospital admission: serum electrolytes (potassium, sodium, calcium, magnesium) with rapid results, arterial blood gas analysis, 12-lead electrocardiogram, lumbar puncture for analysis of cerebrospinal fluid, urgent electromyography, and brain tomography or magnetic resonance imaging.
red flags
Presence of obvious respiratory difficulty with tachypnea and use of accessory muscles, absolute inability to swallow saliva or cough forcefully, flaccid muscle paralysis of rapid ascending evolution (hours), or syncope.
Standard management
- Potassium chloride — controlled intravenous infusion in ICU if severe hypokalemia causing paralysis is confirmed
- Intravenous human immunoglobulin — 0.4 g/kg per day for 5 days if Guillain-Barré syndrome or myasthenic crisis is confirmed
- Neostigmine or Pyridostigmine (under strict supervision in the hospital setting if the cause is a motor plate disorder).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- General
- Listed causes
- 5
- Treatment options
- 3