Hypokalemia

Sjögren's syndrome is an autoimmune disease with multisystem involvement and varying clinical presentation. We report the clinical course and outcome of a case who presented with repeated episodes of hypokalemia mimicking hypokalemic periodic paralysis and metabolic acidosis, which was later diagnosed as distal renal tubular acidosis secondary to primary Sjögren's syndrome. A 50-year-old lady, who was previously diagnosed as hypokalemic periodic paralysis, presented with generalized weakness and fatigue. She was found to have severe hypokalemia with normal anion-gap metabolic acidosis consistent with distal renal tubular acidosis. Subsequent evaluation revealed Sjögren's syndrome as the cause of her problems. Kidney biopsy done to evaluate significant proteinuria revealed nonproliferative morphology with patchy acute tubular injury and significant chronic interstitial nephritis. The patient responded well to potassium supplementation and oral prednisolone. Presentation o...

Ogilvie’s syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a rare, nonobstructive dilation of the colon of unclear etiology. We present the case of a patient who presented with Ogilvie’s syndrome and significant hypokalemia due to colonic loss despite repletion. This case report demonstrates the difficulty in diagnosis, treatment, and outcome.

The purpose of this article is to give current information on the effect of aging on heart, clasification of heart failure (HF) in geriatric dogs and therapeutic advances and challenges. The aging process results in a host of physiological and biological changes that lead to progressive HF. Nearly any cardiovascular disease (CVD) can lead to HF. HF in geriatric dogs is broadly classified into: Diastolic heart failure is defined as HF with preserved ejection fraction (HF/PEF), systolic heart failure is also known as HF with low ejection fraction (HF/low-EF). Importantly, HF/PEF accounts for approximately 50% of all HF patients and its prevalence is higher in the elderly. In humans, mortality and morbidity benefits for HF/low-EF have been reported with angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs), β-blockers and aldosterone antagonists, and the hydralazine–nitrate combination in patients intolerant to ACE inhibitors or nitrates. Therapies f...

Acute myopathy is a common cause of acute motor quadriparesis which has various etiologies with different courses of illness and prognosis depending on the cause. Understanding this diversity helps us in proper approach toward diagnosis, predicting the prognosis, and possible complications and in improving the treatments that are being provided. This study was planned to study the clinical, electrophysiological, and etiological profile of patients presenting with acute myopathy. We also studied how dengue-related acute myopathy differs from other causes and also difference between myopathy due to myositis and hypokalemia in cases of dengue. This was a prospective, observational study involving all clinically suspected cases of acute myopathy of not more than 4 weeks duration with raised serum creatine kinase (CK) level. They were subjected to detailed clinical evaluation along with hematological, biochemical, microbiological, and electrophysiological studies and followed-up for outc...

Introduction To evaluate the association of serum electrolytes with disease severity and obstetric complications in pregnant women with Coronavirus disease 2019 (COVID-19). Materials and Methods This prospective cohort study was conducted on pregnant women with confirmed COVID-19. Study population was divided into two groups: 1) Mild COVID-19 group (n = 811) and 2) Moderate/severe COVID-19 group (n = 52). Demographic features, clinical characteristics, obstetric complications, and serum electrolytes were compared between the groups. Afterward, a correlation analysis was performed to investigate the association between serum electrolyte disturbances with COVID-19 severity and obstetric complications. Results Highest serum sodium, hypernatremia, potassium replacement, hypopotassemia, hyperchloremia, initial serum magnesium, hypermagnesemia, and hypocalcemia were significantly higher in the moderate/severe COVID-19 group. The lowest serum sodium, lowest serum potassium, and initial ser...

McKittrick-Wheelock syndrome is a rare complication of rectosigmoid villous adenoma leading to secretory diarrhea, prerenal acute kidney injury and severe fluid and electrolyte imbalances. There are about 50 cases reported in literature. We represent a case of 71 year-old patient with persistant chronic diarrhea, prerenal azotemia, severe hypokalemia, and hyponatremia. Initially, the patient's kidney function and serum potassium values were normalized by conservative treatment, and villous adenoma was removed by surgery.

A cluster of atypical pneumonia cases were reported in Wuhan china at the end of 2019. The disease was subsequently named covid-19. Later on it spread across the globe and WHO declared it as greatest pandemic of 21st century. Previous studies show that majority of the patients have hyponatremia, hypokalemia and hypochloremia. Recent study also suggests that the value of D-Dimer, ferritin and troponin I increasewhile O2 saturation drops in covid-19 patients.A cross sectional observational study was carried out in Peshawar Pakistan. A total of 195 patients above 18 years of age, confirmed through real time PCR were studied. Most of the patients have normal levels of electrolytes (Reference range of sodium 135-150mmol/L, potassium 3.5-5.1mmol/L, chloride 96-112mmol/L)while the patients with abnormal levels includedhyponatremic patients (having sodium level less than 135mmol/L), hyperkalemic patients (having potassium level higher than 5.1mmol/L) and hypochloremic patients (having chlor...

We sought to measure the clinical benefits of adrenal venous sampling (AVS), a test recommended by guidelines for primary aldosteronism (PA) patients seeking surgical cure, in a large registry of PA patients submitted to AVS. Data of 1625 consecutive patients submitted to AVS in 19 tertiary referral centers located in Asia, Australia, Europe, and North America were collected in a large multicenter international registry. The primary end points were the rate of bilateral success, ascertained lateralization of PA, adrenalectomy, and of cured arterial hypertension among AVS-guided and non AVS-guided adrenalectomy patients. AVS was successful in 80.1% of all cases but allowed identification of unilateral PA in only 45.5% by the criteria in use at each center. Adrenalectomy was performed in 41.8% of all patients and cured arterial hypertension in 19.6% of the patients, 2-fold more frequently in women than men ( P <0.001). When AVS-guided, surgery provided a higher rate of cure of hype...

Potassium levels are often abnormal in patients with heart failure (HF) and have a detrimental effect on clinical outcome. We evaluated potassium levels in a real-world cohort of patients with HF and its effect on mortality. All patients with a diagnosis of HF at a health maintenance organization were evaluated and followed for cardiac-related hospitalizations and death. The cohort consisted of 6,073 patients with HF. Mean potassium levels were 4.57 ± 0.53 mmol/L. Most patients (68%) had potassium levels in the normal range (4.0 to 5.0 mmol/L). High-normal potassium levels (5.0 to 5.5) were present in 17% of the patients, low potassium levels (<4.0) in 11%, and hyperkalemia (K ≥5.5) in 4%. Mean follow-up was 576 days. The overall mortality rate during this period was 14%. Survival rate by Kaplan-Meier analysis demonstrated that hypokalemia (K ≤3.5) was associated with the lowest survival rate. Survival was highest in patients with high-normal potassium levels. Cox regression anal...

This manuscript presents findings from the first dichotomous data pooling analysis on clinical trials (CT) regarding the effectiveness of binding potassium. The results emanated from pairwise and network meta-analyses aiming evaluation of response to commercial potassium-binding polymers, that is, to achieve and maintain normal serum potassium (n = 1,722), and the association between this response and an optimal dosing of renin-angiotensin-aldosterone system inhibitors (RAASi) needing individuals affected by heart failure (HF) or resistant hypertension, who may be consuming other hyperkalemia-inducing drugs (HKID) (e.g., β-blockers, heparin, etc.), and frequently are affected by chronic kidney disease (CKD) (n = 1,044): According to the surface under the cumulative ranking area (SUCRA), sodium zirconium cyclosilicate (SZC) (SUCRA >0.78), patiromer (SUCRA >0.58) and sodium polystyrene sulfonate (SPS) (SUCRA <0.39) were different concerning their capacity to achieve normokale...

Objectives: This study was designed to evaluate the prevalence, and the severity of hypokalemia, and the factors associated with hypokalemia among patients hospitalized with COVID-19. Methods: Random sampling technique was employed in this study. Socio-demographic data such as age, gender, weight (kg), height (meters) and BMI (kg/m2) as well as presenting symptoms (pulmonary and extra-pulmonary), duration of admission, the need for mechanical ventilation and treatment outcomes (discharged or died) as well as the plasma level of potassium (mmol/l) were extracted from the medical records of RT-PCR confirmed hospitalized cases of COVID-19 patients. Data collected were analyzed with IBM/ SPSS version 25.0 software. Discrete variables were presented as percentages and frequencies and the associations between qualitative variables tested using the Chi-square test at a level of significance of p < 0.05. Results: Hypokalaemia was detected in 61 out of 117 COVID-19 positive subjects used ...

espanolEl sindrome de realimentacion (SR) es un cuadro clinico complejo que se produce como consecuencia de la reintroduccion de la alimentacion, ya sea de forma oral, enteral o parenteral en pacientes malnutridos. Estos pacientes presentan trastornos en el balance de fluidos, alteraciones electroliticas (hipofosfatemia, hipomagnesemia e hipopotasemia) y deficits vitaminicos. Este tipo de alteraciones provocan manifestaciones clinicas como alteraciones respiratorias, neurologicas, cardiacas, neuromusculares y hematologicas. EnglishThe refeeding syndrome (RS) is a complex syndrome that takes place as a consequence of the nutrition reintroduction (oral, enteral or parenteral) in malnourished patients. These patients present disorders in the fluid balance, electrolyte alterations (hypophosphatemia, hypomagnesemia, hypokalemia) and vitamin deficiencies. These type of alterations cause clinical manifestations such as respiratory, neurological, cardiac, neuromuscular and hematological alt...

Objective: To determine the frequency of electrolyte disorders, i.e., serum sodium and potassium and to evaluate its effect on mortality rate among children admitted at the pediatric intensive care unit. Study Design and Setting: This was a descriptive cross sectional study conducted at Pediatric Intensive care unit of Civil Hospital Karachi from April to December 2017 Methodology: Informed consent was obtained from 150 parents of the children who fulfill the inclusion criteria. Laboratory data (serum sodium and serum potassium) were recorded during the stay in the pediatric intensive care unit. Data was analyzed using SPSS version 20. Mean ± S.D was calculated for quantitative variables. Frequency and percentage were calculated for gender, electrolyte disorders and mortality. Effect modifiers were controlled by stratification of age, gender and electrolyte disorders (Hypernatremia, Hyponatremia, Hyperkalemia, and Hypokalemia). Post-stratification, Chi-squared test was applied. P-va...

Trimetrexate, a new nonclassical antifolate, was evaluated in a phase I trial in children with refractory cancer including nine with acute leukemia and 21 with solid tumors. The drug was administered as an i.v. bolus injection weekly for three doses, and courses were repeated every 28 days. The dose ranged from 35 to 145 mg/m2. Thirty patients who received a total of 33 courses were evaluable for toxicity, including 19 who were evaluable for hematological toxicity. The maximally tolerated dose for patients with a solid tumor and leukemia was 110 mg/m2. The dose-limiting toxicities were myelosuppression, mucositis and a pruritic, diffuse maculopapular rash. Other side effects observed included transient, mild elevations of serum transaminases, mild nausea and vomiting, and a local phlebitis at the site of injection at higher dose levels. A single patient with delayed drug clearance had evidence of renal toxicity with a transient increase in serum creatinine. The pharmacokinetics of trimetrexate were studied in 25 patients over the entire dose range. There was considerable interpatient variability in total drug clearance (range 9.2 to 215 ml/min/m2) and half-life (2.1 to 20 h). There was a suggestion of a correlation between plasma concentration at 24 h and the development of hematological toxicity at the highest dose level. Trimetrexate was cleared primarily by biotransformation with renal clearance accounting for only 10% of total clearance. Two metabolites of trimetrexate which inhibit the enzyme dihydrofolate reductase were identified in the urine. One of these appears to be a glucuronide conjugate.