The goal of therapy in hypoKPP is to prevent attacks. Prophylactic K+ supplementation is ineffective. Preventive measures include a low-carbohydrate, low-sodium diet, and drugs such as carbonic anhydrase inhibitors (eg, acetazolamide, dichlorphenamide), spironolactone, and triamterene. Carbonic anhydrase inhibitors prevent paralytic attacks and improve residual weakness between attacks. While the mechanism of action is not clear, these medications may work by inducing metabolic acidosis and preventing intracellular K+ shifts. In those who are unresponsive to or even worsen with these medications, triamterene or spironolactone may be used. Acute attacks are treated with oral K+ until muscle strength improves. In severe episodes, parenteral K+ may be necessary but should be administered in mannitol, not in dextrose or NaCl, which may lower K+ levels.