Avoidance of hypothermia (heating
blanket, forced warm air) maintaining K level and acid-base status in the
normal range, continuous ECG monitoring and as follows. Hypokalemic form: A case of malignant
hyperthermia has been described but the response to in vitro muscle testing
was equivocal; there seems to be no association between hypokalemic periodic
paralysis and malignant hyperthermia but because of the dysregulation of
muscular calcium metabolism, a hypermetabolic state mimicking malignant
hyperthermia without hyperkalemia and muscular rigidity is possible. Avoid
infusion of glucose-containing solutions except in case of documented
hypoglycemia, when you should provide K in the IV infusion. Monitor muscle
relaxation at the facial nerve because it is usually spared during attacks.
Hyperkalemic form: In case of hyperkalemic attack, administer glucose and insulin, calcium
gluconate or chloride, or beta-agonists. Normokalemic form: In case of paralysis, administer a
large dose of NaCl.