Potassium abnormalities in current clinical practice: frequency, causes, severity and management

We aimed to investigate the prevalence and etiology of potassium abnormalities [hypokalemia and hyperkalemia] and management approaches for hospitalized patients. Over a 4-month period, all hospitalized patients at Hacettepe University Medical Faculty Hospitals who underwent at least one measurement of serum potassium during hospitalization were included. Data on serum levels of electrolytes, demographic characteristics, cause[s] of hospitalization, medications, etiology of potassium abnormality and treatment approaches were obtained from the hospital records. Of the 9,045 hospitalized patients, 1,265 [14.0%] had a serum potassium abnormality; 604 [6.7%] patients had hypokalemia and 661 [7.30%] had hyperkalemia. In the hypokalemic patients, the most important reasons were gastrointestinal losses in 555 [91.8%] patients and renal losses in 252 [41.7%] patients. The most frequent treatment strategies were correcting the underlying cause and replacing the potassium deficit. Of the 604 hypokalemic patients, 319 [52.8%] were normokalemic at hospital discharge. The most common reason for hyperkalemia was treatment with renin-angiotensin-aldosterone system blockers in 228 [34.4%] patients, followed by renal failure in 191 [28.8%]. Two hundred and ninety-eight [45.0%] patients were followed without any specific treatment. Of the 661 hyperkalemic patients, 324 [49.0%] were normokalemic at hospital discharge. This study showed a high prevalence of potassium imbalance among hospitalized patients. Although most of the potassium abnormalities were mild/moderate, approximately half of the patients treated for hypokalemia or hyperkalemia were discharged from the hospital with ongoing dyskalemia

effect of premedication on preoperative anxiety

The aim of this study was to evaluate the effect of premedication on anxiety, cortisol, residual gastric volume and gastric pH. Following the approval of the institutional Clinical Research Ethics Committee, 100 patients in ASA I-II scheduled for elective gynecologic surgery, were included into a double blind study. Patients were randomly allocated into two groups; the placebo and the premedicated. Oral 10 mg diazepam in the evening before surgery and 1.5 mg midazolam at least 15 min before surgery. The same anesthetic procedure was applied for both groups. Anxiety levels of patients were assessed by using Spiel Berger State- Trait Anxiety Inventory Scale [STAIs]. Blood samples for cortisol measurements were obtained at the preoperative visits, preanesthesia and intraoperative phases. Gastric contents were collected through an orally inserted gastric tube, acidity was measured by using Merck's pH paper. In placebo group, the pre anesthetic STAIs values were increased compared to the values obtained at preoperative visit [p<0.001]. The pre anesthetic STAIs values were decreased in premedicated group [p<0.001]. The changes of preanesthetic and preoperative visit values were statistically different [p<0.001]. The preanesthetic and intraoperative cortisol values were increased in both groups compared to values of preoperative visit. The augmentation was significantly higher in the placebo group [p<0.05]. Positive correlation was observed between basal state anxiety and basal cortisol values and preanesthetic STAIs and cortisol values in the placebo group [r=0.325, p<0.05]. These data support that preoperative sedation suppresses the preoperative anxiety and the cortisol augmentation resulting from surgery and stress

Surface versus core aerobic and anaerobic tonsillar flora in recurrent tonsillitis

Routine throat swabs taken from the surface of the tonsils do not always predict the real tonsillar flora since the pathogens are usually located in the core of the tonsil. The tonsil surface and core cultures of 52 tonsillectomy cases were studied under aerobic and anaerobic conditions. Group A beta-hemolytic streptococcus was found to be the most common pathogen isolated in recurrent tonsillitis, and it was isolated more in the core cultures than the surface cultures. Beta-hemolytic streptococcus isolation was found to increase in anaerobic incubation. All of the beta-hemolytic streptococcus strains were sensitive to penicillin. In 58.3% of the isolated Staphylococcus aureus strains beta-lactamare activity was determined