Abstract: SA-PO0530
Topiramate: Game Changer in Patients with Hypokalemic Periodic Paralysis?
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 3
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Thiruvarudsothy, Srikanth, Virtua Health Inc, Marlton, New Jersey, United States
- Srikanth, Theesitha, Brown University, Providence, Rhode Island, United States
Introduction
Hypokalemic periodic paralysis is a rare but known disease entity with not many great treatment options. It is disabling and requires frequent supplementation to maintain steady potassium levels. Different genetic mutations have been implicated. Attacks can be precipitated by exercise, stress or high carbohydrate meals. Here we present a case of a young man who has had hypokalemic periodic paralysis since birth and with multiple hospitalizations for symptomatic hypokalemia despite the traditional treatment including supplementation as well as acetazolamide.
Case Description
This is a 21-year-old African-American male with history of hypokalemic periodic paralysis which was diagnosed at birth, multiple hospitalizations for symptomatic hypokalemia presenting with generalized muscle weakness. He follows up with nephrology and was getting potassium infusion 3 times weekly in addition to oral supplementation daily. He was also maintained on acetazolamide. Despite the efforts, he was getting admitted 1 to twice a month for similar complaints. He presented with a potassium of 2.2 mg/dL. Magnesium was low at 1.7 mg/dL. His Potassium was repleted aggressively and was up at 5.7 mg/dL later. Magnesium was also repleted and was on oral supplementation. In addition to continuing acetazolamide, we started him on topiramate. He was subsequently discharged with close outpatient follow-up. In the past few months, he has maintained his potassium levels well and did not require hospitalizations. He is still getting IV potassium infusions and on acetazolamide as well as topiramate.
Discussion
In our patient, he was getting hospitalized almost once to twice a month for symptomatic hypokalemic episodes. Note that this is despite potassium infusion 3 times a week, oral potassium supplementation daily along with magnesium and acetazolamide. There were no clear inciting events. This was disabling to the patient to say the least. There were some case reports about the use of topiramate. Mechanism not clear but likely related to carbonic anhydrase inhibitor properties of the medication. Will need further investigation to have this as a a treatment option for hypokalemic periodic paralysis especially in refractory cases.