The Effects of Magnesium Supplementation for Correcting Hypokalemia in Gitelman Syndrome / 대한신장학회잡지

BACKGOUND: Gitelman's syndrome is manifested by hypokalemia, metabolic alkalosis, normal blood pressure, hyperreninemic hyperaldosteronism, hypomagnesemia and hypocalciuria. This study was carried out to investigate the effects of magnesium supplementation for correcting hypokalemia in Gitelman syndrome. METHODS: A Gitelman patient without hyperaldosteronism in our hospital was studied, oral supplementation periods of regimens for 60 days were divided into eight stages (each stage is at least over 5 days) such as 1 stage:no regimen supplementation period 2 stage:spironolactone 100 mg, alone period 3 stage:spironolactone 100 mg, MgO 1 g mixed period, 4 stage:spironolactone 100 mg, alone period, 5 stage:spironolactone 100 mg, MgO 1 g mixed period, 6 stage:spironolactone 150 mg, MgO 1 g mixed period, 7 stage: spironolactone 150 mg, MgO 1.5 g mixed period, 8 stage:spironolactone 150 mg, MgO 1.5 g, KCl 3.6 g mixed period. RESULTS: The highest value of plasm [K] was 3.3 mEq/L, the lowest value of TTKG was 2.6 during 3 stage, plasm [K] had tendency to increased and TTKG decreased, however next during 4 stage, the tendency of correcting hypokalemia diminished. The highest value of plasm [K] was only 3.3 mEq/L during 7 stage, the highest value of plasm [K] was 4.6 mEq/L during 8 stage. And the highest value of plasm ionized [Mg++] was 0.44 mmol/L during MgO 1.5 g supplementation. CONCLUSION: Magnesium alone fails to completely correct potassium and magnesium depletion despite tendency of correcting. Therefore, the optimal therapeutic regimens for correcting hypokalemia in Gitelman syndrome without hyperaldosteronism would be the magnesium and additional K supplementation.

Evaluation of Bartter-like Syndrome Associated with Aminoglycoside Micronomocin Sulfate Administration During Acute Pyelonephritis Treatment / 대한신장학회잡지

The aminoglycoside antibiotics is widely used in the treatment of infectious caused by gram-negative bacteria and for synergistic effect with(beta-lactam antibiotics. However, its therapeutic usefulness is limited by this potential nephrotoxicity and by disturbance of electrolyte homeostasis resulting in hypomagnesemia, hypokalemia, hypocalcemia such as Bartter-like syndrome. Many case repots have been reported on development of Bartter-like syndrome after aminoglycosides administration. But these reports had the many differences of such as types of aminoglycosides, age of patients, duration and total dose of treatment, combined antibiotics and baseline diseases. Therefore, the purpose of this study is to assess the effects of micronomocin sulfate on magnesium, calcium and potassium status of patients in acute pyelonephritis. Twenty one patients in acute pyelonephritis(18 female/3 male, ages 20-75) was treated with single or combined antibiotics. Eleven of twenty one patients as study group were treated with both micronomicin sulfate(aminoglycoside, 4mg/kg/day, during 5-8days) and flomoxef sodium (3rd cephalosporine, 2g/day, during 5-8days), and ten of twenty one patients as control group were treated only with flomoxef sodium(3rd cephalosporine. 2g/day. during 5-8days). Renal values, plasma and urinary electrolytes were measured before and at the end of IV antibiotic therapy. After micronomicin sulfate administrated for 6.4+/-1.5days, serum Mg, Ca, K, FEMg (fractional excretion of Mg), TTKG(transtubular K concentration gradient) and FECa(fractional excretion of Ca) did not significantly change(p>0.05). Therefore, those results suggest that micromonicin sulfate therapy within dose of 240mg/day(4mg/kg/day) for 6.4+/-1.5days may not cause disturbance of electrolyte homeostasis such as Bartter-like syndrome in acute pyelonephritis. Howerever, electrolyte disturbance is an important complication when aminoglycosides is given in larges doses over extended periods. Therefore, monitoring of blood concentration and urinary losses of electrolyte should be carried out along with careful observation of Bartter-like syndrome.

Effects of Interdialytic Interval and Potassium(K) Removal via Dialvsis on the Plasma Potassium Concentration in Maintenance Hemodialysis / 대한신장학회잡지

To evaluate potassium(K) homeostasis during in-terdialytic and dialytic phases in chronic hemodialysis patients, we analyzed pre- and post- dialysis plasma K concentration(n=28) over n week with an interdialytic interval of 7Zhrs, 48hrs(l), and 48hrs(II), respectively, and the quantity of total dialytic K removal via dialysate. The predialysis plasma K at 72h interval(prePK72h: 4.89+/-0.17mEq/L) was significantly higher than those at 48h interval(prePK48h-I: 4.57+/-0.15mEq/L, and prePK48h-II: 4.40+/-15mEq/L) (p=0.000, p=0.000). 10.7% in prePK72h were categorized into severe hyperkalemia more than 6.0mEq/L, but none in prePK48h-I, II(p=0.000, p=0.000). In contrast no difference between 72-h and 42-h intervals was found in the postdialysis plasma K(postPK72h: 3.59+/-0.07 vs postPK48h-I : 3.530+/-08mEq/L, p>0.05) and in the quantity of total dialytic K removal via dialysate(delta Ktota172h : 74+/-2.6 vs delta Ktota148h-I:71+/-2.2mEq, p>0.05). On approach to this with two-compartment model, there was significant difference in dialytic K removal from ECF(delta Kecf72h:22.2+/-1.6 vs delta Kecf48h-I:17.7+/-1.6mEq, p0.05). In all 28 patients, age, sex and body weight were not correlated with either pre- and post- plasma K levels or total K removal per kg body weight. In conclusion, the majority of dialytic K removal is from the replenishment of the ICF potassium and it has rather constant feature in that there was no autoregulatory increment even with the higher predialysis plasma K concentration. So the plasma K concentration on chronic maintenace hemodialysis is more dependent on the potassium gain during interdialytic phase than the potassium removal during dialytic phase. Also it is reasonable to restrict dietary K intake and apply K-exalate orientating to the interdialytic phase of 72hrs because severe hyperkalemia is rare in that of 48hrs.