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Rianne Boot, Kristine W A C Koekkoek, Arthur R H van Zanten
PURPOSE OF REVIEW: To provide an overview of recent findings concerning refeeding syndrome (RFS) among critically ill patients and recommendations for daily practice. RECENT FINDINGS: Recent literature shows that RFS is common among critically ill ventilated patients. Usual risk factors for non-ICU patients addressed on ICU admission do not identify patients developing RFS. A marked drop of phosphate levels (>0.16 mmol/l) from normal levels within 72 h of commencement of feeding, selects patients that benefit from hypocaloric or restricted caloric intake for at least 48 h resulting in lower long-term mortality...
June 8, 2018: Current Opinion in Critical Care
Oleg Palygin, Oleh Pochynyuk, Alexander Staruschenko
PURPOSE OF REVIEW: Multiple clinical and translational evidence support benefits of high potassium diet; however, there many uncertainties underlying the molecular and cellular mechanisms determining effects of dietary potassium. Kir4.1 and Kir5.1 proteins form a functional heteromer (Kir4.1/Kir5.1), which is the primary inwardly rectifying potassium channel on the basolateral membrane of both distal convoluted tubule (DCT) and the collecting duct principal cells. The purpose of this mini-review is to summarize latest advances in our understanding of the evolution, physiological relevance and mechanisms controlling these channels...
June 11, 2018: Current Opinion in Nephrology and Hypertension
Wakako Fujiwara, Tomohiro Haruki, Yoshiteru Kidokoro, Takashi Ohno, Yohei Yurugi, Ken Miwa, Yuji Taniguchi, Hiroshige Nakamura
BACKGROUND: Ectopic ACTH-producing thymic carcinoid tumors are rare, but often behave aggressively with local invasion and distant metastasis. We herein report a case of ACTH-producing thymic typical carcinoid tumor with lymph node metastasis treated by surgery and postoperative radiation therapy. CASE PRESENTATION: A 61-year-old woman was admitted to be evaluated for hypoglycemia and hypokalemia. Laboratory data revealed elevation of serum cortisol and ACTH levels...
June 11, 2018: Surgical Case Reports
Ana Andrade, Catarina Sousa, Mónica Pedro, Martinho Fernandes
Caffeine (1,3,7-trimethylxanthine) is a natural product commonly presented in food's composition, beverages and medicinal products. Generally, it is thought to be safe under normal dosage, yet it can be fatal in case of severe intoxication. We report a case of a healthy 32-year-old woman who went to the local emergency department (ED) 30 min after ingesting, accidentally, 5000 mg of anhydrous caffeine for a preworkout supplement. At the ED, she presented an episode of presyncope followed by agitation. ECG showed polymorphic broad complex QRS tachycardia and arterial blood gas revealed metabolic acidaemia with severe hypokalemia...
June 8, 2018: BMJ Case Reports
Elena Tomaselli Muensterman, James E Tisdale
Prolongation of the heart rate-corrected QT (QTc) interval increases the risk for torsades de pointes (TdP), a potentially fatal arrhythmia. The likelihood of TdP is higher in patients with risk factors, which include female sex, older age, heart failure with reduced ejection fraction, hypokalemia, hypomagnesemia, concomitant administration of ≥ 2 QTc interval-prolonging medications, among others. Assessment and quantification of risk factors may facilitate prediction of patients at highest risk for developing QTc interval prolongation and TdP...
June 8, 2018: Pharmacotherapy
Emi Kawakita, Keizo Kanasaki, Taro Hirai, Shin-Ichi Tsuda, Ai Watanabe, Kyoko Nitta, Munehiro Kitada, Yoshio Ogura, Yuta Takagaki, Mizue Fujii, Takako Nagai, Keiji Shimada, Susumu Takagi, Yuiko Mizunuma, Itaru Monno, Fujimoto Shino, Hiroshi Minato, Nobuhiko Miyatake, Atsushi Nakagawa, Daisuke Koya
Vitamin D plays vital role for the health, and its deficiency has been implicated in the diverse pathological conditions such as hypomagnesemia and abnormal immune system. Here, we present a case of severe electrolytes disorders (hypokalemia and hypomagnesemia etc.) and kidney damages associated with vitamin D deficiency.
June 2018: Clinical Case Reports
Christian Lodberg Hvas, Peter Ott, Peter Paine, Simon Lal, Søren Peter Jørgensen, Jens Frederik Dahlerup
Bile acid diarrhea results from excessive amounts of bile acids entering the colon due to hepatic overexcretion of bile acids or bile acid malabsorption in the terminal ileum. The main therapies include bile acid sequestrants, such as colestyramine and colesevelam, which may be given in combination with the opioid receptor agonist loperamide. Some patients are refractory to conventional treatments. We report the use of the farnesoid X receptor agonist obeticholic acid in a patient with refractory bile acid diarrhea and subsequent intestinal failure...
June 7, 2018: World Journal of Gastroenterology: WJG
Carolina Monteiro de Lemos Barbosa, Fernanda Magalhães Ferrão, Jones B Graceli
Organotin compounds (OTs) are synthetic persistent organometallic xenobiotics widely used in several commercial applications. They exert well-described harmful effects in brain, liver, adipose tissue, and reproductive organs, as they are endocrine-disrupting chemicals (EDCs), but the effects in the kidneys are less known. The kidneys are especially vulnerable to environmental contaminants because they are a metabolizing site of xenobiotics, therefore, pollutants can accumulate in renal tissue, leading to impaired renal function and to several renal abnormalities...
2018: Frontiers in Endocrinology
Jason C George, Waleed Zafar, Ion Dan Bucaloiu, Alex R Chang
BACKGROUND AND OBJECTIVES: Rapid correction of severe hyponatremia can result in serious neurologic complications, including osmotic demyelination. Few data exist on incidence and risk factors of rapid correction or osmotic demyelination. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a retrospective cohort of 1490 patients admitted with serum sodium <120 mEq/L to seven hospitals in the Geisinger Health System from 2001 to 2017, we examined the incidence and risk factors of rapid correction and osmotic demyelination...
June 5, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Matthew Correia, Mark Darocki, Eva Tovar Hirashima
BACKGROUND: Periodic paralysis is a rare complication of hyperthyroidism. Patients of East Asian descent are most commonly affected. Presentation is characterized by recurrent episodes of painless, abrupt-onset weakness, with laboratory evaluation characterized by profound hypokalemia. Underlying hyperthyroidism may not be clinically evident, but differentiation from the familial variant is critical due to differing treatment pathways. CASE REPORT: We describe the presentation of a 22-year-old man with recurrent relapsing-remitting weakness with undiagnosed hyperthyroidism...
June 2, 2018: Journal of Emergency Medicine
Yicheng K Bao, Vishwanath C Ganesan, Richard Rapp, Shunzhong S Bao
Reported is a case of a 39-year-old Caucasian man who presented to the emergency department with sudden onset bilateral lower extremity paralysis after consuming a large amount of carbohydrates and alcohol. A CT, MRI, and lumbar puncture were performed with negative results; lab results showed hyperthyroidism and hypokalemia. The patient was diagnosed with thyrotoxic periodic paralysis. In a patient presenting with sudden onset paralysis and hypokalemia, the emergency physician should include thyrotoxic periodic paralysis in the differential diagnosis and focus on treating and working up the hypokalemia instead of the paralysis...
2018: Case Reports in Emergency Medicine
Krupali Bulsari, Louise Maple-Brown, Henrik Falhammar
BACKGROUND: Congenital adrenal hyperplasia (CAH) is a rare autosomal recessive disorder caused by deficiency of various enzymes responsible for adrenal steroidogenesis. 11-Beta-hydroxylase deficiency (11βOHD) and 17-hydroxylase/17,20-lyase deficiency (17OHD) are rare causes of CAH. METHODS/RESULTS: We hereby present a 65-year-old man with 11βOHD and a 33-year-old woman with 17OHD. The man with 11βOHD presented with peripheral precocious puberty and hypertension at age 15 years, fathered two children but developed complications of chronic glucocorticoid therapy on long-term follow-up...
March 2018: Hormones: International Journal of Endocrinology and Metabolism
Zahraa Abdul Sater, Smita Jha, Raven McGlotten, Iris Hartley, Mustapha El Lakis, Katherine Araque Triana, Lynnette K Nieman
Context: Patients taking exogenous glucocorticoids are at risk of gastrointestinal (GI) complications including peptic ulcer disease with perforation, and gastric bleeding. However, little is known about the GI co-morbidity in patients with endogenous hypercortisolemia. Case descriptions: We describe six patients with endogenous Cushing's Syndrome (CS) who developed sudden perforation of colonic diverticula requiring urgent exploratory laparotomy. Most of these patients shared the following features of Cushing's syndrome: significant skin thinning, severe hypercortisolemia (24-hour urine free cortisol ≥10X the upper limit of normal), ectopic secretion of ACTH, and severe hypokalemia...
May 28, 2018: Journal of Clinical Endocrinology and Metabolism
Ashish Verma, Muhammad Hassan Shahid, Laura Youngblood
No abstract text is available yet for this article.
May 26, 2018: American Journal of Medicine
P F Tian, X G Wang, Y H Zhang, J F Zhang, B Xu, Z L Hu, C J Ye, C M Han
Objective: To investigate the clinical characteristics of patients with hydrofluoric acid (HF) burns. Methods: Clinical data of 316 patients with HF burns admitted to Zhejiang Quhua Hospital from January 2004 to December 2016 were retrospectively analyzed. Patients were divided into non and mild poisoning group (NMP, n =157), moderate poisoning group (MP, n =120), and severe and fatal poisoning group (SFP, n =39) based on the severity of poisoning. Occurrences of hypocalcemia, hypomagnesemia, hypokalemia, and hyperkalemia of patients within 24 hours after admission were recorded...
May 20, 2018: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Oleg E Osadchii
OBJECTIVES: In normal conditions, sudden heart rate acceleration provokes a rapid reduction in ventricular action potential duration (APD). The protracted APD rate adaptation favors early afterdepolarizations and precipitates arrhythmia. Nevertheless, it is uncertain as to whether the rate-dependent changes of ventricular repolarization can be adversely modified by arrhythmogenic drugs (quinidine and procainamide) and hypokalemia, in comparison to the agents with safe therapeutic profile, such as lidocaine...
May 25, 2018: Scandinavian Cardiovascular Journal: SCJ
Yiting Lei, Qiang Huang, Shaoyun Zhang, Guo Chen, Guorui Cao, Fuxing Pei
Objective: To evaluate the effectiveness and safety of restrictive fluid therapy combined with preoperative urination training during perioperative period in an enhanced recovery after surgery (ERAS) program for primary total hip arthroplasty (THA). Methods: A retrospective study were conducted in 73 patients who underwent unilateral THA with liberal intravenous fluid therapy on the day of surgery between April 2015 and March 2016 (control group) and in 70 patients with restrictive fluid therapy and preoperative urination training between November 2016 and April 2017 (trial group)...
November 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Spencer Corey Greene, John Morgan Carey
A 4-year-old female presented to the emergency department with 2 days of abdominal pain, nausea, and vomiting. She was tachycardic and had abdominal tenderness. Laboratory studies revealed a leukocytosis, hypokalemia, and metabolic acidosis. Her Pediatric Appendicitis Score (MDCalc) was calculated as 6, indicating that appendicitis could not be excluded. She was transferred to our pediatric hospital for further evaluation. Her ultrasound at our facility was normal. Upon reexamination, the patient was noted to have a red mark on her left index finger, and the family reported that the patient may have been stung by a puss caterpillar before the onset of her symptoms...
May 23, 2018: Pediatric Emergency Care
Charlie Fehl, Caleb D Vogt, Rahul Yadav, Kelin Li, Emily E Scott, Jeffrey Aubé
Inhibition of androgen biosynthesis is clinically effective for treating androgen-responsive prostate cancer. Abiraterone is a clinical first-in-class inhibitor of cytochrome P450 17A1 (CYP17A1) required for androgen biosynthesis. However, abiraterone also causes hypertension, hypokalemia, and edema, likely due in part to off-target inhibition of another steroidogenic cytochrome P450, CYP21A2. Abiraterone analogs were designed based on structural evidence that B-ring substituents may favorably interact with polar residues in binding CYP17A1 and sterically clash with residues in the CYP21A2 active site...
May 24, 2018: Journal of Medicinal Chemistry
Eriko Yamaguchi, Kazuhiro Yoshikawa, Izaya Nakaya, Karen Kato, Yoshikazu Miyasato, Terumasa Nakagawa, Yutaka Kakizoe, Masashi Mukoyama, Jun Soma
BACKGROUND: Liddle's syndrome is a rare monogenic form of hypertension caused by truncating or missense mutations in the C termini of the epithelial sodium channel (ENaC) β or γ subunits. Patients with this syndrome present with early onset of hypertension, hypokalemia, metabolic alkalosis, hyporeninemia and hypoaldosteronism, and a potassium-sparing diuretics (triamterene or amiloride) can drastically improves the disease condition. Although elderly patients having these characteristics were considered to have Liddle's syndrome or Liddle's-like syndrome, no previous report has indicated that Liddle's-like syndrome could be caused by nephrotic syndrome of primary glomerular disease, which is characterized by urinary excretion of > 3 g of protein/day plus edema and hypoalbuminemia, or has explained how the activity function of ENaC could be affected in the setting of high proteinuria...
May 23, 2018: BMC Nephrology
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