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https://www.readbyqxmd.com/read/29674401/licorice-induced-apparent-mineralocorticoid-excess-compounded-by-excessive-use-of-terbutaline-and-high-water-intake
#1
Laust Frisenberg Buhl, Frederik Nørregaard Pedersen, Marianne Skovsager Andersen, Dorte Glintborg
This case highlights the clinical course of a 54-year-old male patient presenting with hypertension and long-term refractory hypokalaemia. He reported long-term malaise, fatigue and physical discomfort. Diarrhoea, vomiting, over-the-counter drugs, dietary supplements and any kind of medical abuse were all denied. Physical examination was normal. Suppressed plasma renin activity along with a low aldosterone level and elevated urinary cortisone/cortisol metabolite excretion ratio raised the suspicion of apparent mineralocorticoid excess (AME)...
April 19, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29587582/spironolactone-to-increase-natriuresis-in-congestive-heart-failure-with-cardiorenal-syndrome
#2
Frederik H Verbrugge, Pieter Martens, Koen Ameloot, Veerle Haemels, Joris Penders, Matthias Dupont, W H Wilson Tang, Walter Droogné, Wilfried Mullens
BACKGROUND: Signs and symptoms of volume overload are the most frequent reason for hospital admission in acute heart failure (AHF). Diuretics are mainstay treatment, but their optimal type and dose regimen remain unclear, especially in patients with cardiorenal syndrome. METHODS: This prospective study aimed to include 80 AHF patients with volume overload and cardiorenal syndrome. Through a 2 × 2 factorial design, patients were randomised towards (1) combinational treatment with acetazolamide and low-dose loop diuretics versus high-dose loop diuretics; and (2) open-label oral spironolactone 25 mg OD given upfront versus at discharge...
March 27, 2018: Acta Cardiologica
https://www.readbyqxmd.com/read/29572370/two-cases-of-hypokalaemic-rhabdomyolysis-same-but-different
#3
Philipp Pecnik, Petra Müller, Sybille Vrabel, Martin Windpessl
In this paper, we present two women with hypokalaemic rhabdomyolysis in the context of increased diuretic intake and gastroenteritis, respectively. While their clinical manifestations and laboratory results were strikingly similar, two different underlying disorders were subsequently unveiled. The first patient was diagnosed with Conn syndrome, and adrenalectomy led to significant improvement of hypertension and sustained normokalaemia. The diagnosis in the second patient was Gitelman syndrome. Electrolyte supplements improved long-term lassitude and the frequency of muscle cramps declined significantly...
March 22, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29540487/hypokalaemia-a-clinical-update
#4
Efstratios Kardalas, Stavroula A Paschou, Panagiotis Anagnostis, Giovanna Muscogiuri, Gerasimos Siasos, Andromachi Vryonidou
Hypokalaemia is a common electrolyte disturbance, especially in hospitalized patients. It can have various causes, including endocrine ones. Sometimes, hypokalaemia requires urgent medical attention. The aim of this review is to present updated information regarding: 1) the definition and prevalence of hypokalaemia, 2) the physiology of potassium homeostasis, 3) the various causes leading to hypokalaemia, 4) the diagnostic steps for the assessment of hypokalaemia and 5) the appropriate treatment of hypokalaemia depending on the cause...
March 14, 2018: Endocrine Connections
https://www.readbyqxmd.com/read/29519778/outcome-of-critically-ill-patients-undergoing-mandatory-insulin-therapy-compared-to-usual-care-insulin-therapy-protocol-for-a-pilot-randomized-controlled-trial
#5
Peter J Watkinson, Vicki S Barber, J Duncan Young
BACKGROUND: Observational and interventional studies in patients with both acute medical conditions and long-standing diabetes have shown that improved blood glucose control confers a survival advantage or reduces complication rates. Policies of "tight" glycaemic control were rapidly adopted by many general intensive care units (ICUs) worldwide in the mid 00's, even though the results of the studies were not generalizable to mixed medical/surgical ICUs with different intravenous feeding policies...
March 8, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29515224/blood-potassium-and-urine-aldosterone-after-doxapram-therapy-for-preterm-infants
#6
Tomoyuki Shimokaze, Katsuaki Toyoshima, Jun Shibasaki, Yasufumi Itani
OBJECTIVE: We often encounter infants who developed hypokalaemia following low-dose doxapram for apnea of prematurity (AOP). AIMS: To determine changes in blood potassium (K+) levels after doxapram administration. STUDY DESIGN: We studied infants born before 30 weeks gestation. Doxapram (0.1-0.3 mg/kg/h) in addition to methylxanthines was used to treat AOP refractory to methylxanthines. RESULTS: Twenty-five infants received doxapram were studied...
March 7, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29510671/an-unexpected-mild-phenotype-of-glucocorticoid-resistance-associated-with-glucocorticoid-receptor-gene-mutation-case-report-and-review-of-the-literature
#7
Ágnes Molnár, Attila Patócs, István Likó, Gábor Nyírő, Károly Rácz, Miklós Tóth, Beatrix Sármán
BACKGROUND: Glucocorticoid resistance is a rare, sporadic or familial condition caused by mutation of the gene encoding the glucocorticoid receptor (GR). Clinically it is characterized by symptoms developed due to local, tissue-specific, or generalized partial insensitivity to glucocorticoids. CASE PRESENTATION: A 31-year-old woman was evaluated because of infertility at the Endocrine Unit of the 2nd Department of Medicine, Semmelweis University. During her laboratory investigations, elevated serum and salivary cortisol were observed which failed to be suppressed after administration of 1 mg dexamethasone...
March 6, 2018: BMC Medical Genetics
https://www.readbyqxmd.com/read/29478732/feasibility-of-dose-escalated-hypofractionated-chemoradiation-in-human-papilloma-virus-negative-or-smoking-associated-oropharyngeal-cancer
#8
S Meade, P Gaunt, A Hartley, M Robinson, V Harrop, J Cashmore, L Wagstaff, J Babrah, S J Bowden, H Mehanna, P Sanghera
AIMS: Oropharyngeal squamous cell carcinoma (OPSCC) can be divided into favourable and poor prognostic groups by association with human papilloma virus (HPV) and smoking. This study prospectively investigated a dose-intensified schedule in poor/intermediate prognosis OPSCC. MATERIALS AND METHODS: Patients with p16/HPV-negative or p16-positive N2b OPSCC with a greater than 10 pack-year smoking history were eligible. Patients were planned to receive 64 Gy in 25 fractions with cisplatin...
February 22, 2018: Clinical Oncology: a Journal of the Royal College of Radiologists
https://www.readbyqxmd.com/read/29477991/severe-hypophosphataemia-a-rare-cause-of-postoperative-muscle-weakness
#9
Aarti Narayan, Arun Subramanian
We report a case of severe generalised muscle weakness in a 66-year-old man who underwent revision of left knee arthroplasty. On postoperative day 1, he developed non-focal muscle weakness and shortness of breath which progressed over a 6-hour period. Serum phosphorus level was severely low at 0.5 mg/dL, along with mild degree of hypokalaemia, hypocalcaemia and hypomagnesaemia. His symptoms completely resolved after emergent phosphorus replacement. The authors believe this case is of educational interest to physicians as generalised muscle weakness is an uncommon presentation of severe hypophosphataemia...
February 23, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29472988/mineralocorticoid-hypertension-and-hypokalaemia-induced-by-posaconazole
#10
Charlotte Boughton, David Taylor, Lea Ghataore, Norman Taylor, Benjamin C Whitelaw
We describe severe hypokalaemia and hypertension due to a mineralocorticoid effect in a patient with myelodysplastic syndrome taking posaconazole as antifungal prophylaxis. Two distinct mechanisms due to posaconazole are identified: inhibition of 11β hydroxylase leading to the accumulation of the mineralocorticoid hormone 11-deoxycorticosterone (DOC) and secondly, inhibition of 11β hydroxysteroid dehydrogenase type 2 (11βHSD2), as demonstrated by an elevated serum cortisol-to-cortisone ratio. The effects were ameliorated by spironolactone...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29464741/accuracy-of-adrenal-computed-tomography-in-predicting-the-unilateral-subtype-in-young-patients-with-hypokalaemia-and-elevation-of-aldosterone-in-primary-aldosteronism
#11
Hironobu Umakoshi, Tatsuki Ogasawara, Yoshiyu Takeda, Isao Kurihara, Hiroshi Itoh, Takuyuki Katabami, Takamasa Ichijo, Norio Wada, Yui Shibayama, Takanobu Yoshimoto, Yoshihiro Ogawa, Junji Kawashima, Masakatsu Sone, Nobuya Inagaki, Katsutoshi Takahashi, Minemori Watanabe, Yuichi Matsuda, Hiroki Kobayashi, Hirotaka Shibata, Kohei Kamemura, Michio Otsuki, Yuichi Fujii, Koichi Yamamto, Atsushi Ogo, Toshihiko Yanase, Shintaro Okamura, Shozo Miyauchi, Tomoko Suzuki, Mika Tsuiki, Mitsuhide Naruse
CONTEXT: The current Endocrine Society Guideline suggests that patients aged <35 years with marked primary aldosteronism (PA) and unilateral adrenal lesions on adrenal computed tomography (CT) scan may not need adrenal vein sampling (AVS) before proceeding to unilateral adrenalectomy. This suggestion is, however, based on the data from only one report in the literature. OBJECTIVE: We sought to determine the accuracy of CT findings in young PA patients who had unilateral adrenal disease on CT with hypokalaemia and elevation of aldosterone...
February 21, 2018: Clinical Endocrinology
https://www.readbyqxmd.com/read/29448987/the-refeeding-syndrome-importance-of-phosphorus
#12
REVIEW
Marta Araujo Castro, Clotilde Vázquez Martínez
Refeeding syndrome (RS) is a complex disease that occurs when nutritional support is initiated after a period of starvation. The hallmark feature is the hypophosphataemia, however other biochemical abnormalities like hypokalaemia, hypomagnesaemia, thiamine deficiency and disorder of sodium and fluid balance are common. The incidence of RS is unknown as no universally accepted definition exists, but it is frequently underdiagnosed. RS is a potentially fatal, but preventable, disorder. The identification of patients at risk is crucial to improve their management...
February 12, 2018: Medicina Clínica
https://www.readbyqxmd.com/read/29447079/flucloxacillin-induced-hypokalaemia-a-case-report
#13
Eva De Backer, Heidi Hannon
Objective and importance Flucloxacillin is a narrow-spectrum beta-lactam antibiotic with activity against penicillinase producing staphylococci and streptococci. Severe hypokalaemia is an uncommon, but serious adverse effect in patients treated with penicillin derivates. Clinical presentation We report a case of severe hypokalaemia in a patient treated with high dose intravenous flucloxacillin. Conclusion This case report highlights the importance of monitoring electrolytes during treatment with high dose flucloxacillin...
February 15, 2018: Acta Clinica Belgica
https://www.readbyqxmd.com/read/29369537/evaluation-of-an-individualized-dose-titration-regimen-of-patiromer-to-prevent-hyperkalaemia-in-patients-with-heart-failure-and-chronic-kidney-disease
#14
Bertram Pitt, David A Bushinsky, Dalane W Kitzman, Frank Ruschitzka, Marco Metra, Gerasimos Filippatos, Patrick Rossignol, Charles Du Mond, Dahlia Garza, Lance Berman, Mitja Lainscak
AIMS: Hyperkalaemia risk precludes optimal renin-angiotensin-aldosterone system inhibitor use in patients with heart failure (HF), particularly those with chronic kidney disease (CKD). Patiromer is a sodium-free, non-absorbed potassium (K+ )-binding polymer approved for the treatment of hyperkalaemia. In PEARL-HF, patiromer 25.2 g (fixed dose) prevented hyperkalaemia in HF patients with or without CKD initiating spironolactone. The current study evaluated the effectiveness of a lower starting dose of patiromer (16...
January 25, 2018: ESC Heart Failure
https://www.readbyqxmd.com/read/29363235/e7777-in-japanese-patients-with-relapsed-refractory-peripheral-and-cutaneous-t-cell-lymphoma-a-phase-i-study
#15
MULTICENTER STUDY
Ken Ohmachi, Kiyoshi Ando, Michinori Ogura, Toshiki Uchida, Kensei Tobinai, Dai Maruyama, Masayuki Namiki, Tadashi Nakanishi
E7777, a recombinant cytotoxic fusion protein comprising diphtheria toxin fragments A and B and human interleukin-2, shares an amino acid sequence with denileukin diftitox but has improved purity and an increased percentage of active protein monomer species. A phase I study was carried out to evaluate the tolerability, safety, pharmacokinetics, and antitumor activity of E7777 in Japanese patients with relapsed/refractory peripheral and cutaneous T-cell lymphoma. E7777 (6, 12, and expanded 9 μg/kg/day) was given to 13 patients by i...
March 2018: Cancer Science
https://www.readbyqxmd.com/read/29352703/inotuzumab-ozogamicin-in-combination-with-low-intensity-chemotherapy-for-older-patients-with-philadelphia-chromosome-negative-acute-lymphoblastic-leukaemia-a-single-arm-phase-2-study
#16
Hagop Kantarjian, Farhad Ravandi, Nicholas J Short, Xuelin Huang, Nitin Jain, Koji Sasaki, Naval Daver, Naveen Pemmaraju, Joseph D Khoury, Jeffrey Jorgensen, Yesid Alvarado, Marina Konopleva, Guillermo Garcia-Manero, Tapan Kadia, Musa Yilmaz, Gautam Bortakhur, Jan Burger, Steven Kornblau, William Wierda, Courtney DiNardo, Alessandra Ferrajoli, Jovitta Jacob, Rebecca Garris, Susan O'Brien, Elias Jabbour
BACKGROUND: Inotuzumab ozogamicin, an anti-CD22 monoclonal antibody bound to a toxin, calicheamicin, has shown single-agent activity in relapsed or refractory acute lymphoblastic leukaemia. We aimed to assess the activity and safety of inotuzumab ozogamicin in combination with low-intensity chemotherapy in older patients with acute lymphoblastic leukaemia. METHODS: We did a single-arm, phase 2 study at the MD Anderson Cancer Center (Houston, TX, USA). Eligible patients were aged 60 years or older and had newly diagnosed, Philadelphia chromosome-negative, acute lymphoblastic leukaemia, and an Eastern Cooperative Oncology Group performance status of 3 or lower...
February 2018: Lancet Oncology
https://www.readbyqxmd.com/read/29338765/infantile-hypertrophic-pyloric-stenosis-a-4-year-experience-from-two-tertiary-care-centres-in-cameroon
#17
Rene Ndongo, Paul Nkemtendong Tolefac, Faustin Félicien Mouafo Tambo, Matin Hongieh Abanda, Marcelin Ngowe Ngowe, Olivier Fola, Bonaventure Dzekem, Patrick Eroyl Weledji, Maurice Aurelien Sosso, Jacqueline Ze Minkande
OBJECTIVE: This study aimed to describe the clinical characteristics of patients with infantile hypertrophic stenosis, management and its outcome in two tertiary care centres in Cameroon. RESULTS: A total of 21 patients were included from the two centres. The mean age at presentation was 5.2 ± 1.2 weeks, predominantly male with a male-to-female ratio of 4.25:1. The triad of vomiting, visible peristalsis and palpable mass was present in only 7 (33.3%) of the participants...
January 16, 2018: BMC Research Notes
https://www.readbyqxmd.com/read/29326401/efficacy-and-tolerability-of-trastuzumab-emtansine-in-advanced-human-epidermal-growth-factor-receptor-2-positive-breast-cancer
#18
W Yeo, M Y Luk, I S Soong, T Ys Yuen, T Y Ng, F Kf Mo, K Chan, S Y Wong, J Tsang, C Leung, J Js Suen, R Kc Ngan
INTRODUCTION: The management of human epidermal growth factor receptor 2 (HER2)-positive breast cancer has changed dramatically with the introduction and widespread use of HER2-targeted therapies. There is, however, relatively limited real-world information about the effectiveness and safety of trastuzumab emtansine (T-DM1) in Hong Kong Chinese patients. We assessed the efficacy and toxicity profiles among local patients with HER2-positive advanced breast cancer who had received T-DM1 therapy in the second-line setting and beyond...
February 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/29319266/gitelman-syndrome-presenting-during-pregnancy-with-adverse-foetal-outcome
#19
N Nand, A R Deshmukh, R Mathur, V Chauhan, Brijlal
Gitelman syndrome (GS) is a rare autosomal recessive salt-losing tubulopathy. The incidence of Gitelman syndrome is 25 cases in 1 million among western population. This patient presented with loose stool, vomiting and sudden onset quadriparesis. Investigations revealed hypokalaemia, metabolic acidosis, hypomagnesaemia, hypocalciuria, hypermagnesuria. Symptoms and hypokalemia improved after starting oral magnesium and potassium supplements. But the patient again presented with symptomatic hypokalemia and delivered a still born foetus with hydrocephalus...
October 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/29305081/extending-knowledge-of-the-clinical-picture-of-balkan-adder-vipera-berus-bosniensis-envenoming-the-first-photographically-documented-neurotoxic-case-from-south-western-hungary
#20
Csaba Varga, Tamás Malina, Viktória Alföldi, Gergely Bilics, Ferenc Nagy, Tibor Oláh
We report a severe envenoming associated with minimal local symptoms following a Balkan adder (Vipera berus bosniensis) bite in South-Western Hungary. A 63-year-old male with a history of hypertension and sinus bradycardia (45/min) was bitten by a sub-adult specimen of V. b. bosniensis in Somogy County on 04 May 2017. The patient was transported to and treated at the Emergency Department of "Moritz Kaposi" General Hospital, Kaposvár. Locally only pain and minimal swelling with a small haematoma developed on the bitten finger...
March 1, 2018: Toxicon: Official Journal of the International Society on Toxinology
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