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Hyperkalemia hypokalemia

Tomáš Šálek
Hyperkalemia is a potentially lethal condition. Pseudohyperkalemia should be always excluded before implementing treatment to prevent inappropriate cause of hypokalemia - equally a potentially lethal condition. Here we present a case report of a 62 year female with chronic myeloproliferative disorder, i.e. essential thrombocythemia. The laboratory test results for potassium concentration were 6.3 mmol/L, for platelet count 1305 x109 /L and for leukocyte count 39.8 x109 /L. This was due to a temporary drug withdrawal after a surgical intervention for gastric bleeding...
February 15, 2018: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
Rambod Amirnovin, Phuong Lieu, Flerida Imperial-Perez, Carol Taketomo, Barry P Markovitz, David Y Moromisato
OBJECTIVE: Hypokalemia in children following cardiac surgery occurs frequently, placing them at risk of life-threatening arrhythmias. However, renal insufficiency after cardiopulmonary bypass warrants careful administration of potassium (K+). Two different nurse-driven protocols (high dose and tiered dosing) were implemented to identify an optimal K+ replacement regimen, compared to an historical low-dose protocol. Our objective was to evaluate the safety, efficacy, and timeliness of these protocols...
January 1, 2018: Journal of Intensive Care Medicine
Pankaj Singhai, Shruti Krishnan, Vikram Uttam Patil
Thyrotoxic periodic paralysis (TPP), a disorder most commonly seen in Asian men, is characterized by abrupt onset of hypokalemia and paralysis. The condition primarily affects the lower extremities and is secondary to thyrotoxicosis. Early recognition of TPP is vital to initiating appropriate treatment and to avoiding the risk of rebound hyperkalemia that may occur if high-dose potassium replacement is given. Here we present a case of 31 year old male with thyrotoxic periodic paralysis with diagnostic and therapeutic approach...
November 2017: Journal of the Association of Physicians of India
Qiang Chen, Wei-Guo Zhang, Shu-Chang Chen
RATIONALE: The occurrence of hyperkalemia after esophagectomy is clinically rare. Patients who underwent esophagectomy often have a serum potassium level due to perioperative reduced intake, fluids loss, consumption and other reasons. These patients often require the artificial administration of potassium. Rapid fluid loss and physiological consumption lead to the deficiency of potassium, even hypokalemia. Patients often require the addition of a large amount of potassium after operation...
December 2017: Medicine (Baltimore)
Kamini Patel, Jonathan V McCoy, Patrick M Davis
Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare but potentially serious complication of thyrotoxicosis. The resulting muscle weakness is profound, associated with more severe hypokalemia, yet reversible. However, clinicians must be cautious because patients can develop life-threatening hyperkalemia during treatment. Underlying causes should be investigated as repeated episodes of THPP may occur.
January 2018: JAAPA: Official Journal of the American Academy of Physician Assistants
Udensi K Udensi, Paul B Tchounwou
Potassium is the most abundant cation in the intracellular fluid and it plays a vital role in the maintenance of normal cell functions. Thus, potassium homeostasis across the cell membrane, is very critical because a tilt in this balance can result in different diseases that could be life threatening. Both Oxidative stress (OS) and potassium imbalance can cause life threatening health conditions. OS and abnormalities in potassium channel have been reported in neurodegenerative diseases. This review highlights the major factors involved in potassium homeostasis (dietary, hormonal, genetic, and physiologic influences), and discusses the major diseases and abnormalities associated with potassium imbalance including hypokalemia, hyperkalemia, hypertension, chronic kidney disease, and Gordon's syndrome, Bartter syndrome, and Gitelman syndrome...
2017: International Journal of Clinical and Experimental Physiology
Hiroyuki Yamazaki, Tadakazu Kondo, Kazunai Aoki, Kouhei Yamashita, Akifumi Takaori-Kondo
Liposomal amphotericin B (L-AMB) has the potential to cause two major adverse events, renal dysfunction and serum potassium abnormality; however, appropriate clinical management of these events remains unclear. We retrospectively analyzed data regarding 128 hematology patients who received L-AMB in our institute and examined the association between clinical characteristics and renal dysfunction or serum potassium abnormality. We found that the median weight-normalized dose of L-AMB was 2.69mg/kg and the median administration period was 16days...
February 2018: Diagnostic Microbiology and Infectious Disease
Bryan M Cook, Danielle M Carter, Heather Dell'Orfano, Lina Matta
Potassium supplementation can be administered intravenously or orally with either immediate release or sustained release formulations. Sustained release potassium chloride allows for delayed absorption and peak effects. In the inpatient setting, it is important to monitor and prevent both hypokalemia and hyperkalemia. Our tertiary-care academic hospital created a clinical pathway for sustained release potassium chloride supplementation in the inpatient population. Our clinical pathway for sustained release potassium chloride creates dosing restrictions designed to prevent hyperkalemia, while allowing exceptions for patients with high requirements...
December 2017: Critical Pathways in Cardiology
Matthieu Legrand, Pierre-Olivier Ludes, Ziad Massy, Patrick Rossignol, Jiri Parenica, Jin-Joo Park, Shiro Ishihara, Khalid F AlHabib, Aldo Maggioni, Òscar Miró, Naoki Sato, Alain Cohen-Solal, Enrique Fairman, Johan Lassus, Veli-Pekka Harjola, Christian Mueller, Franck W Peacock, Dong-Ju Choi, Patrick Plaisance, Jindřich Spinar, Mikhail Kosiborod, Alexandre Mebazaa, Etienne Gayat
BACKGROUND: The interaction between chronic medications on admission and the association between serum potassium level and outcome in patients with acute heart failure (AHF) are unknown. METHODS: Observational intercontinental study of patients admitted with AHF. 15954 patients were included from 12 cohorts in 4 continents. Main outcome was 90-day mortality. Clinical presentation (medication use, hemodynamics, comorbidities), demographic, echocardiographic, and biochemical data on admission were recorded prospectively in each cohort, with prospective adjudication of outcomes...
October 28, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Biff F Palmer, Deborah J Clegg
Hyperkalemia, defined as serum potassium concentrations greater than 5.0 to 5.5 mEq/L, is a frequent occurrence in clinical practice because of the increasing incidence and prevalence of CKD. Patients at risk for this disorder are commonly treated with drugs that interfere in the renin-angiotensin-aldosterone system, thereby enhancing the occurrence and prevalence of this disorder. Discontinuation of these drugs because of the development of hyperkalemia deprives these patients the renal-protective and cardiovascular benefits this class of pharmacology has been shown to provide...
September 2017: Advances in Chronic Kidney Disease
Sarah Gilligan, Kalani L Raphael
Abnormalities of serum potassium are common in patients with CKD. Although hyperkalemia is a well-recognized complication of CKD, the prevalence rates of hyperkalemia (14%-20%) and hypokalemia (12%-18%) are similar. CKD severity, use of medications such as renin-angiotensin-aldosterone system inhibitors and diuretics, and dietary potassium intake are major determinants of serum potassium concentration in CKD. Demographic factors, acid-base status, blood glucose, and other comorbidities contribute as well. Both hyperkalemia and hypokalemia are associated with similarly increased risks of death, cardiovascular disease, and hospitalization...
September 2017: Advances in Chronic Kidney Disease
Thomas D DuBose
Disturbances of potassium homeostasis can cause either hyperkalemia or hypokalemia and result in serious consequences. Although the consequences of acute and chronic hyperkalemia and treatment of these conditions in CKD have been widely appreciated by nephrologists, more recent information has focused attention on the consequences of chronic hypokalemia. Several recent studies have documented a "U-shaped" relationship between the serum [K+ ] and higher mortality in several clinical studies. The causes of dyskalemias are placed into the unique perspective of patients with CKD and its evolution with progression of CKD to later stages and focuses on the pathophysiology of these disorders...
September 2017: Advances in Chronic Kidney Disease
Julio Núñez, Antoni Bayés-Genís, Faiez Zannad, Patrick Rossignol, Eduardo Núñez, Vicent Bodí, Gema Miñana, Enrique Santas, Francisco J Chorro, Anna Mollar, Arturo Carratalá, Jorge Navarro, Jose Luis Gorriz, Josep Lupón, Oliver Husser, Marco Metra, Juan Sanchis
Background -The prognostic value of long-term potassium monitoring and dynamics in heart failure (HF) has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute HF admission. Methods -Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling...
October 12, 2017: Circulation
Hodaka Yamada, Shunsuke Funazaki, Masafumi Kakei, Kazuo Hara, San-E Ishikawa
Diabetic ketoacidosis (DKA) is a critical complication of type 1 diabetes associated with water and electrolyte disorders. Here, we report a case of DKA with extreme hyperkalemia (9.0 mEq/L) in a patient with type 1 diabetes on hemodialysis. He had a left frontal cerebral infarction resulting in inability to manage his continuous subcutaneous insulin infusion pump. Electrocardiography showed typical changes of hyperkalemia, including absent P waves, prolonged QRS interval and tented T waves. There was no evidence of total body water deficit...
2017: Endocrinology, Diabetes & Metabolism Case Reports
Allan J Collins, Bertram Pitt, Nancy Reaven, Susan Funk, Karen McGaughey, Daniel Wilson, David A Bushinsky
BACKGROUND: The relationship between serum potassium, mortality, and conditions commonly associated with dyskalemias, such as heart failure (HF), chronic kidney disease (CKD), and/or diabetes mellitus (DM) is largely unknown. METHODS: We reviewed electronic medical record data from a geographically diverse population (n = 911,698) receiving medical care, determined the distribution of serum potassium, and the relationship between an index potassium value and mortality over an 18-month period in those with and without HF, CKD, and/or DM...
2017: American Journal of Nephrology
Taiwona L Elliott
Hypokalemia (ie, potassium levels less than 3.5 mEq/L) occurs in fewer than 1% of healthy individuals, but is present in up to 20% of hospitalized patients, 40% of patients taking diuretics, and 17% of patients with cardiovascular conditions. Hypokalemia often is asymptomatic; symptoms are more common in older adults. Common symptoms are cardiac arrhythmias and muscle weakness or pain. Management consists of intravenous potassium replacement during cardiac monitoring for patients with marked symptoms, echocardiogram (ECG) abnormalities, or severe hypokalemia (ie, level less than 3...
August 2017: FP Essentials
Arash Nayeri, Hannah Gluck, Eric Farber-Eger, Srikanth Krishnan, Kamran Shamsa, Michael Lee, Quinn S Wells, John A McPherson
Hypokalemia has been consistently reported as a common occurrence during targeted temperature management (TTM) in comatose survivors of cardiac arrest. We sought to better describe changes in serum potassium throughout the different stages of TTM and to assess for any prognostic significance. We analyzed a prospectively collected cohort of 240 patients treated with TTM following cardiac arrest at a tertiary care hospital between 2007 and 2014. The primary outcome was poor neurologic outcome at hospital discharge, defined as a Cerebral Performance Category score >2...
October 1, 2017: American Journal of Cardiology
John Ashurst, Shane R Sergent, Benjamin J Wagner, Jeremy Kim
Hypokalemia and hyperkalemia are the most common electrolyte disorders managed in the emergency department. The diagnosis of these potentially life-threatening disorders is challenging due to the often vague symptomatology a patient may express, and treatment options may be based upon very little data due to the time it may take for laboratory values to return. This review examines the most current evidence with regard to the pathophysiology, diagnosis, and management of potassium disorders. In this review, classic paradigms, such as the use of sodium polystyrene and the routine measurement of serum magnesium, are tested, and an algorithm for the treatment of potassium disorders is discussed...
November 22, 2016: Emergency Medicine Practice
Erik Nilsson, Alessandro Gasparini, Johan Ärnlöv, Hairong Xu, Karin M Henriksson, Josef Coresh, Morgan E Grams, Juan Jesus Carrero
BACKGROUND: Hypo- and hyperkalemia in clinical settings are insufficiently characterized and large-scale data from Europe lacking. We studied incidence and determinants of these abnormalities in a large Swedish healthcare system. METHODS: Observational study from the Stockholm CREAtinine Measurements project, including adult individuals from Stockholm accessing healthcare in 2009 (n=364,955). Over 3-years, we estimated the incidence of hypokalemia, defined as potassium<3...
October 15, 2017: International Journal of Cardiology
Adam J Singer, Henry C Thode, W Frank Peacock
OBJECTIVE: Disturbances in potassium (K) levels are relatively common and may be associated with significant morbidity and mortality; however, treatments vary. Our purpose was to determine the incidence, treatments, and outcomes associated with hyperkalemia and hypokalemia in emergency department (ED) patients. METHODS: We performed a structured, retrospective review of electronic medical records of consecutive adult ED patients with K measured while in the ED. Demographic, clinical, and laboratory data as well as treatments, disposition, and in-hospital complications were collected...
June 2017: Clinical and Experimental Emergency Medicine
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