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severe hypokalaemia

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https://www.readbyqxmd.com/read/28500918/experience-using-high-dose-glucose-insulin-potassium-gik-in-critically-ill-patients
#1
Elise M A Slob, Rob Shulman, Mervyn Singer
PURPOSE: To audit the use of GIK in terms of safety, haemodynamic effects, and impact on catecholamine dosage. MATERIALS AND METHODS: A retrospective, descriptive, evaluative audit of GIK use within the adult ICU of a London teaching hospital was conducted. Rescue therapy of GIK (up to 1.0Unitsinsulin/kg/h) was administered to improve cardiac function. Outcomes were ICU survival, change in cardiac index (CI) and blood lactate levels, events of hypoglycaemia, hyperglycaemia, hypokalaemia and hyperkalaemia, and discontinuation time of catecholamine inotropes...
April 26, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28487303/female-phenotype-with-male-karyotype-a-clinical-enigma
#2
Suja Sukumar, Pavan Uppula, Santosh Kumar, Anil Bhansali
Development of gonadal and phenotypic sex during embryogenesis invariably corresponds to the genotypic sex. However, some disorders of sex development are associated with discordance between the chromosomal, gonadal or phenotypic sex which include complete androgen insensitivity syndrome, 46XY complete gonadal dysgenesis (Swyer syndrome) and, rarely, congenital adrenal hyperplasia due to CYP 17A1 (17α-hydroxylase) deficiency. The enzyme CYP17A1 includes 17α-hydroxylase and 17,20-lyase which are required for the synthesis of cortisol and sex steroids, respectively...
May 9, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28469890/hypokalaemia-addressing-human-factors-and-improving-education-around-prescription-and-administration-of-intravenous-iv-potassium-infusion-in-trauma-and-orthopaedics
#3
Vanushia Thirumal, Gavin Love
A high incidence of hypokalaemia was noted in Trauma and Orthopaedics of Ninewells Hospital. We sought to establish the reason behind this and implemented three PDSA cycles via questionnaires to 30 ward staff, both doctors and nurses over a 1 week period in December, February and July 2016. Key baseline measures include availability of IV fluids with 40mmol potassium on the wards, confidence prescribing or administering IV fluids with 40mmol potassium, necessity for cardiac monitoring during slow IV potassium replacement and recognition of confusion and learning need in this area...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28456753/severe-hypercalcaemia-and-hypophosphataemia-with-an-optimised-preterm-parenteral-nutrition-formulation-in-two-epochs-of-differing-phosphate-supplementation
#4
Shaveta Mulla, Susan Stirling, Sarah Cowey, Rosie Close, Sara Pullan, Rosalind Howe, Lynne Radbone, Paul Clarke
OBJECTIVE: To compare in two epochs of differing phosphate provision serum calcium, phosphate, potassium, and sodium concentrations and the frequency of abnormality of these electrolytes and of sepsis in preterm infants who received an optimised higher amino acid-content formulation. DESIGN AND SETTING: Retrospective cohort study at a single tertiary-level neonatal unit. PATIENTS: Preterm infants given parenteral nutrition (PN) in the first postnatal week during two discrete 6-month epochs in 2013-2014...
April 29, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/28386507/an-unusual-case-of-resistant-hypokalaemia-in-a-patient-with-large-bowel-obstruction-secondary-to-neuroendocrine-carcinoma-of-the-prostate
#5
Umasankar Mathuram Thiyagarajan, A Ponnuswamy, A Bagul, A Gupta
Neuroendocrine Carcinoma of the Prostate (NECP) is rare and only few cases have been reported, constituting less than 0.5% of prostatic malignancies. We report a rare case of large bowel obstruction from NECP posing a further challenge in management due to resistant hypokalaemia. A 70-year-old man presented with clinical signs of large bowel obstruction who was known to have prostatic carcinoma three years ago, treated initially with hormone therapy then chemoradiation. The blood profile showed a severe hypokalaemia and CT scan revealed liver and lung metastases apart from confirming large bowel obstruction from local invasion of NECP...
2017: Case Reports in Surgery
https://www.readbyqxmd.com/read/28348804/cytolethal-distending-toxin-producing-escherichia-coli-strains-causing-severe-diarrhoea-in-young-mexican-children
#6
Mario Meza-Segura, Mussaret Bano Zaidi, Samantha Maldonado-Puga, Jazmin Huerta-Cantillo, Lucia Chavez-Dueñas, Fernando Navarro-Garcia, Teresa Estrada-Garcia
Introduction. Cytolethal distending toxins (CDTs), encoded by cdt genes, have DNase activity leading to cellular and nuclear distension, resulting in irreversible cell cycle arrest and apoptosis of target cells. cdt-positive Escherichia coli strains have been isolated from children with diarrhoea. There is, however, scant information on the prevalence and clinical presentation of diarrhoeal disease caused by these strains. Furthermore, toxin production of cdt-positive strains is rarely confirmed. We report five young children with diarrhoea caused by CDT-producing E...
February 2017: JMM Case Reports
https://www.readbyqxmd.com/read/28348753/delayed-recognition-of-fatal-invasive-meningococcal-disease-in-adults
#7
Frederick W Nagel, Ifeoma Ezeoke, Mike Antwi, Paula E Del Rosso, Marie Dorsinville, Beth M Isaac, Althea Hayden, Robert S Hoffman, Scott D Weingart, Don Weiss
INTRODUCTION: Invasive meningococcal disease can be difficult to detect early in its course when patients may appear well and the severity of their illness is obscured by non-specific complaints. CASE PRESENTATION: We report five cases of meningococcal sepsis in adult patients who presented to an emergency department early in the course of their disease, but whose severity of illness was not recognized. CONCLUSION: Suspicion of meningococcal sepsis should be heightened in the setting of hypotension, tachycardia, elevated shock index, leukopaenia with left shift, thrombocytopaenia and hypokalaemia, prompting early sepsis care...
June 2016: JMM Case Reports
https://www.readbyqxmd.com/read/28287295/-differential-diagnostic-dilemmas-after-use-of-an-out-of-date-antihypertensive-medication-case-report
#8
Péter Arányi, János Tomcsányi
Hydrochlorothiazide became one of the most commonly prescribed first-line antihypertensive medication, though its use is often complicated with serious side-effects. A 66-year-old female patient with a history of hypertension had suffered a transient loss of consciousness, and referred to our cardiology unit with an ST-segment elevation and giant negative T-waves in V1-2 ECG leads, long QT-segment and elevated serum creatine-kinase (5392 U/L) and troponin I (4,357 ng/ml) levels. Acute myocardial infarction was not proven (later coronarography revealed preserved coronary circulation), but severe hyponatraemia and hypokalaemia was detected, explaining a possible symptomatic seizure, and which could be accounted for a 25 mg daily hydrochlorothiazide antihypertensive treatment and - as a precipitating insult - a one-week history of gastroenteritis...
March 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/28263150/-rhabdomyolysis-caused-by-hyperemesis-gravidarum
#9
Lana Rashid Flachs Madsen, Marie Søgaard
Hyperemesis gravidarum (HG) is a condition of severe nausea and vomiting during pregnancy, accompanied by dehydration, electrolyte derangement and lack of nutrition. We describe a 26-year-old woman pregnant at 29 weeks of gestation, complaining about muscle pain and difficulties standing up after suffering from long-term HG followed by a weight loss of 35 kg. She had severe hypokalaemia and abnormally elevated muscle enzyme concentrations as a result of a massive catabolic process. We discuss severe HG as a rare cause of rhabdomyolysis and the importance of early aggressive resuscitation to avoid renal failure...
February 27, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28250297/multimodal-treatment-of-vasoactive-intestinal-polypeptide-producing-pancreatic-neuroendocrine-tumors-with-liver-metastases
#10
REVIEW
Mari Iwasaki, Kouhei Tsuchida, Hidehito Jinnai, Toshinori Komatsubara, Takahiro Arisaka, Misako Tsunemi, Masakazu Nakano, Makoto Iijima, Hideyuki Hiraishi
A 53-year-old man presented with diarrhoea and hypokalaemia and was diagnosed with a neuroendocrine tumour of unknown origin with multiple liver metastases. Somatostatin analogues led to a reduction in the size of the tumours and improvement of his symptoms. However, after several years, the tumours grew in size, and the patient's clinical symptoms recurred. The patient underwent transcatheter arterial embolization (TAE) of the hepatic artery to treat the liver metastases. Immediately after embolization, the symptoms disappeared...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28224871/-a-patient-with-severe-digoxin-toxicity
#11
K P van Rhee, R van Bentum, K van Keulen, M I Kuypers, M B Haak
BACKGROUND: Digoxin is a cardiac glycoside that is frequently prescribed in atrial fibrillation and heart failure. Symptoms such as nausea, hyperkalaemia, cardiac arrhythmias and cardiac arrest are seen in digoxin toxicity. The treatment focuses on reduction of digoxin absorption, prevention of hypokalaemia and hyperkalaemia, treatment of symptoms and, in severe toxicity, administration of digoxin antibodies. CASE DESCRIPTION: A 73-year-old man with a history of extensive cardiac disease was seen 45 minutes after ingesting 20 mg of digoxin...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28154278/near-fatal-anorexia-nervosa-in-a-middle-aged-woman
#12
Luca Foppiani, Bruno Massobrio, Christian Cascio, Giancarlo Antonucci
Anorexia nervosa (AN) is a serious psychiatric disorder which typically occurs in young women; however, more and more cases in middle-aged women are being reported. The management of this complex disease requires a team approach, and full recovery occurs only in 50% of patients. Endocrine and metabolic complications are commonly observed, the latter of which may even be life-threatening, and require prompt and proper management. Infections, albeit reported, are not usually a major clinical problem in these patients...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28148578/hypokalaemia-in-sj%C3%A3-gren-s-syndrome-the-missing-piece
#13
Umer Farooq Khan, Lee Chun Tsu, Kong-Bing Tan, Jingxiang Huang, Audrey LiAnn Wong
A 58-year-old Chinese woman with well controlled type 1 diabetes mellitus presented with acute and progressive bilateral lower limb weakness. Investigations revealed severe hypokalaemia (1.3 mmol/L) and hypophosphataemia (<0.32 mmol/L) with rhabdomyolysis and electrocardiogram changes, without other concurrent biochemical abnormalities. Immediate intravenous and oral potassium and phosphate replacement was initiated with objective improvement in weakness with replenished electrolyte levels. Urine studies confirmed renal potassium wasting...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28125972/gitelman-syndrome-in-a-south-african-family-presenting-with-hypokalaemia-and-unusual-food-cravings
#14
Pieter Du Toit van der Merwe, Megan A Rensburg, William L Haylett, Soraya Bardien, M Razeen Davids
BACKGROUND: Gitelman syndrome (GS) is an autosomal recessive renal tubular disorder characterised by renal salt wasting with hypokalaemia, metabolic alkalosis, hypomagnesaemia and hypocalciuria. It is caused by mutations in SLC12A3 encoding the sodium-chloride cotransporter on the apical membrane of the distal convoluted tubule. We report a South African family with five affected individuals presenting with hypokalaemia and unusual food cravings. METHODS: The affected individuals and two unaffected first degree relatives were enrolled into the study...
January 26, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/27994859/primary-sclerosing-cholangitis-a-new-cause-of-distal-renal-tubular-acidosis
#15
Valentin Goutaudier, Ilan Szwarc, Jean-Emmanuel Serre, Georges-Philippe Pageaux, Àngel Argilés, Jean Ribstein
We describe the first case of distal renal tubular acidosis (dRTA) associated with primary sclerosing cholangitis. A 26-year-old Lao-Thai male patient presented with severe jaundice, metabolic acidosis and hypokalaemia. He was diagnosed of dRTA. Liver transplantation resulted in correction of electrolyte disturbances and hyperbilirubinaemia. A fludrocortisone-furosemide test revealed normal urinary acidification, demonstrating no residual dRTA. This observation suggests that dRTA may be an early manifestation of bilirubin-associated nephropathy or the consequence of an immune mechanism...
December 2016: Clinical Kidney Journal
https://www.readbyqxmd.com/read/27957745/exploring-new-zealand-prescription-data-using-sequence-symmetry-analyses-for-predicting-adverse-drug-reactions
#16
P S Nishtala, T-Y Chyou
WHAT IS KNOWN AND OBJECTIVE: Prescription sequence symmetry analyses (PSSA) is a ubiquitous tool employed in pharmacoepidemiological research to predict adverse drug reactions (ADRs). Several studies have reported the advantage of PSSA as a method that can be applied to a large prescription database with computational ease. The objective of this study was to validate New Zealand (NZ) prescription database as a potential source for identifying ADRs using the PSSA method. METHODS: We analysed de-identified individual-level prescription data for people aged 65 years and above for the period 2005 to 2014 from the pharmaceutical collections supplied by the NZ Ministry of Health...
December 13, 2016: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/27927710/adrenocortical-carcinoma-an-unusual-cause-of-secondary-hypertension
#17
Daniel Veron Esquivel, Fernando Batiz, Alfonso Farias Vega, Perla A Carrillo Gonzalez
We present the case of a female patient aged 39 years who was admitted to our hospital due to hypertension, severe hypokalaemia and metabolic alkalosis; physical examination was remarkable for plethoric moon face, centripetal obesity and bilateral lower extremity oedema. She was admitted for intravenous potassium replacement and further assessment of hypertension and associated clinical findings. Laboratory testing showed increased levels of aldosterone, renin, cortisol, testosterone and androstenedione. An abdominal CT revealed a large mass in the right adrenal gland with hepatic involvement...
December 7, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27905308/a-case-of-extreme-hypokalaemia
#18
L M Ten Bos, T C Veenstra, B D Westerhof, F H Bosch
Hypokalaemia is a common clinical problem. It can lead to severe disturbances in cardiac, neurological and muscle function. We present the case of a 45-year-old woman who was transported to our hospital with cardiac arrest following ventricular fibrillation. Blood sampling revealed severe acidosis (pH 7.02) and extreme hypokalaemia (0.9 mmol/l). The low serum potassium level was most likely caused by the combination of a very deficient diet and use of a thiazide diuretic. She never reported any symptoms. An acute intracellular shift of potassium due to epinephrine and perhaps also the cathecholamines in Red Bull may have further decreased the serum potassium concentration...
November 2016: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/27782749/lower-physical-fitness-in-patients-with-primary-aldosteronism-is-linked-to-the-severity-of-hypertension-and-kalaemia
#19
V Tuka, M Matoulek, T Zelinka, J Rosa, O Petrák, O Mikeš, Z Krátká, B Štrauch, R Holaj, J Widimský
Hypokalaemia as a typical feature of primary aldosteronism (PA) is associated with muscle weakness and could contribute to lower cardiopulmonary fitness. The aim of this study was to describe cardiopulmonary fitness and exercise blood pressure and their determinants during a symptom-limited exercise stress test in patients with PA. We performed a cross-sectional study of patients with confirmed PA who were included before adrenal vein sampling on whom a symptom-limited exercise stress test with expired gas analysis was performed...
October 26, 2016: Physiological Research
https://www.readbyqxmd.com/read/27730793/ondansetron-induced-life-threatening-hypokalemia
#20
S K Mathew, K Krishnan Kutty, I Ramya, C Padmakumar, Prince Pius
Ondansetron is widely used in general practice for nausea and vomiting due to any cause. We report a rare side effect, life-threatening hypokalaemia following intravenous Ondansetron injection. It may be judicious to restrict the use of Odansetron to patients with severe vomiting due to chemotherapy or in post-operative state. Life-threatening hypokalemia can occur without any warning and may be difficult to manage in a primary set up.
February 2016: Journal of the Association of Physicians of India
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