By Alberto J. Espay MD MSc, José Biller MD FACP FAAN FAHA
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They are located mainly in the forebrain and are the main source of EPSPs in the CNS (seizurogenic). AMPA receptors agonized by β-N-oxalyl aminoL-alanine (BOAA) can lead to lathyrism (spastic paraparesis caused by chronic chickpeas ingestion). The kainate r eceptors are localized in primary afferent C-fibers in the spinal cord. The indir ectly gated (metabotr opic) mGluR1-8 r eceptors, coupled to second messengers cAMP and PLC, are involved in synaptic plasticity, learning, memory, and neuroprotection.
0 mmol/L. 0 mmol/L (rhabdomyolysis). Digoxin toxicity is increased by hypokalemia. Tetany is seen during alkalosis, which decreases ionized calcium by binding calcium to proteins. Paradoxically, when hypocalcemia is present, hypokalemia protects against tetany. Corr ection of hypokalemia can pr ecipitate hypocalcemic tetany. Magnesium deficiency causes reduced intracellular Kϩ (impaired Naϩ/Kϩ-ATPase) and renal Kϩ wasting. Transcellular Shift β2-sympathomimetics (albuterol, terbutaline, metaproterenol, ephedrine, pseudoephedrine, phenylpropanolamine) xanthines (theophylline, caffeine), verapamil intoxication, chloroquine intoxication, insulin overdose Increased Renal Loss Diuretics (acetazolamide, thiazides, furosemide), mineralocorticoids (fludrocortisone), high-dose penicillin and glucocorticoids Through Mg+ depletion: cisplatin, aminoglycosides, amphotericin B Disorders: hyperthyroidism, familial hypokalemic periodic paralysis, high-epinephrine conditions Metabolic alkalosis due to vomiting, hyperaldosteronism, and Cushing’s distal renal tubular acidosis Kϩ replacement should be given at a rate ≤20 mmol/h in glucose-free solutions with cardiac monitoring.
Myotonia of eyelids and limbs is present between attacks. Progressive vacuolar myopathy develops over time. Respiratory muscles are spared. • Paramyotonia congenita (PMC) is characterized by myotonia during or after exercise or exposure to cold. Interictally, facial, eyelid, and pharyngeal myotonia may be present. EMG shows myotonic activity and decreased CMAP amplitudes with muscle cooling. • Potassium-aggravated myotonia is not affected by cold exposure. Chloride Channels (Autosomal Dominant and Recessive; CLCN1, 7q) • Myotonia congenita (AD: Thomsen disease; AR: Becker myotonia ) results in attacks of myotonia triggered by forceful muscle contraction after a period of rest.