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Dear all I wonder if I can pick your brain regarding this patient A 26 year old lady who experienced recurrent episodes of "weakness and excessive tiredness" while she was in High School that resulted in many days of abscences and family attributed that to depression but she had never sought any medical medical help. These episodes meant that she could not maintain a job as she was constantly feeling tired. She is fostered with no information about family history other than a brother who suffers from epilepsy. She has moved area and was later diagnosed with fibromyalgia. She experiences a constant feeling of palpitations and had several A&E attendances with these symptoms heart rate 140 bpm, hypokalaemia 2.5mmol/L, lactic acidosis, sometimes hypoMg, breathlessness and sweating . She was diagnosed with inappropraite sinus tachycardia. 24hr heart rate was 115 bpm with a range of 90-160. Beta blockers and ablation had no effect on her heart rate. Thyroid function is normal and in between these episodes her bloods including K are all normal. No renal K wasting was found. These episodes can happen at any time and there is no definite precipitating factor. She said that she started to experience constant weakness in her left arm with weak grip and is waiting for an EMG. Genetics (CACNA1S and SCN4A) have excluded Hypokalaemic periodic paralysis, Conn's have been excluded as well. She has a right kidney stone. Do you think that the HypoK is secondary to the sustained tachycardia? If that is the case why would her potassium be normal in between the episodes if she experiences constant tachycardia ? Any other investigations that should be done in this case? Many thanks for your help in revealing the mystery of this case. BW Soha ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/