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©2013 UpToDate ® Print Email Approach to acute onset of weakness * Hyponatremia, hypernatremia, hypokalemia, hypocalcemia, and hypophosphatemia may all be associated with muscle weakness. Δ Potassium may be high, low or normal in patients, and a family history is often present in patients with periodic paralysis. Adapted with permission from: Tsarouhas N, Decker JM. Weakness. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. Copyright © 2006 Lippincott Williams & Wilkins. file://www.lww.com