Familial hyperkalemic periodic paralysis (HYPP) is a rare
genetic disorder in which the
sodium channels in skeletal muscle cells have altered structure and function. Small elevations in serum
potassium lead to inactivation of
sodium channels, causing episodic weakness or
paralysis. Exposure to cold,
anesthesia, fasting, emotional stress,
potassium ingestion, and rest after exercise can stimulate an attack. This case report describes a 65-year-old man with HYPP who was admitted for a right
total knee arthroplasty. He had a history of arteriosclerotic
heart disease and stenting 8 years earlier, previous
inferior wall myocardial infarction with ejection fraction of 65%, anxiety, degenerative
joint disease, well-controlled
type 2 diabetes mellitus, and a body mass index of 53.3 kg/m2. A combined spinal/
general anesthetic with a femoral nerve block for
postoperative pain control was chosen. Careful attention was given to monitoring and maintenance of core temperature, use of
insulin and
glucose to maintain normokalemia, and
carbohydrate loading the night before surgery. The patient recovered from the
anesthetic without complication and had
pain relief for approximately 22 hours postoperatively because of the femoral nerve block. The patient was without weakness or
paralysis related to HYPP in the postanesthesia care unit or throughout his hospitalization.