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@#Introduction: Potassium level is measured for patients with high risk of hyperkalemia in the emergency department (ED) using both blood gas analyser (BGA) and biochemistry analyser (BCA). The study was conducted to evaluate the correlation and agreement of potassium measurement between BGA and BCA. Materials and Methods: This is a prospective cross-sectional study on the data obtained from Hospital Universiti Sains Malaysia (Hospital USM) from Jun 2018 until May 2019. Blood samples were taken via a single prick from venous blood and sent separately using 1ml heparinised syringe and were analysed immediately in ED using BGA (Radiometer, ABL800 FLEX, Denmark) and another sample was sent to the central laboratory of Hospital USM and analysed by BCA (Architect, C8000, USA). Only patients who had potassium levels ≥5.0mmol/L on blood gas results were included. A total of 173 sample pairs were included. The correlation and agreement were evaluated using Passing and Bablok regression, Linear Regression and Bland-Altman test. Result: Of the 173 sample pairs, the median of potassium level based on BGA and BCA were 5.50mmol/L (IQR: 1.00) and 5.90mmol/L (IQR: 0.95) respectively. There was significant correlation between two measurements (p<0.001, r: 0.36). The agreement between the two measurements showed within acceptable mean difference which was 0.27 mmol/L with 95% limit of agreement were 1.21mmol/L to 1.73mmol/L. Conclusion: The result of blood gas can be used as a guide for initial treatment of hyperkalaemia in critical cases where time is of the essence. However, BCA result is still the definitive value.
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@#The incidence of Addison’s disease (AD) is rare. One of the most common causes of AD in developed countries is autoimmune. On the other hand, in developing countries, infective causes still predominate. The symptoms are mostly insidious in onset and non-specific, making it challenging to diagnose AD. The delay in starting the right treatment predisposes to high mortality due to Addison’s crisis. Hence, biochemical parameters play a vital role in diagnosing AD since they usually will present with prominent hyponatraemia, hyperkalaemia and hypoglycaemia. Here, we report a case of a 66-year-old man with multiple co-morbidities and disseminated histoplasmosis who presented with asymptomatic hyponatraemia and hyperkalaemia and was eventually diagnosed with Addison’s disease. Although the non-specific symptoms from his multiple co-morbidities obscured the diagnosis of AD, comprehensive biochemical tests have helped in establishing the diagnosis.
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Background: Electrolyte disorders are common in patients in the emergency department and intensive care unit, and have been associated with increased morbidity and mortality. In this respect sodium and potassium are the most important cations, whose improper adjustment may cause severe neuromuscular disorders. This study was designed to compare values obtained by laboratory and point-of-care testing and also to find most frequent electrolyte abnormalities.Methods: Observational Study was done on 51 patients presenting to Tertiary care Hospital emergency department with altered sensorium between 1st January 2016 to 31st May 2017 fulfilling the inclusion criteria and willing for participation by giving written informed consent. Electrolytes were tested in patients with GCS 14 or less by both point of care system and in the laboratory.Results: The distribution of mean sodium and potassium levels did not differ significantly between two techniques (P-value>0.05). The sodium and potassium levels by POC and laboratory techniques are significantly and positively correlated (P-value<0.001). The distribution of mean along with 95% CI of mean of amount of bias in the estimation of Sodium and Potassium levels by POC against Laboratory method is 3.50 [2.79-4.20] mEq/L and 0.83 [0.55-1.11] mEq/L respectively. The most common electrolyte abnormality was hyponatremia.Conclusions: We concluded that it is advisable to do a point-of-care electrolyte in Emergency department and Intensive care unit. By use of point-of-care testing, we can identify electrolytes imbalance early in emergency department. Point-of-care electrolyte levels had a near comparable value with laboratory electrolyte levels.
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Mild hyperkalaemia does not typically cause cardiac symptoms. However, for an elderly patient on atrio-ventricular (AV) nodal blocker, even mild hyperkalaemia may result in disastrous outcome. We report a case of persistent bradyarrythmia caused by iatrogenic hyperkalaemia in a patient who had concomitant use of AV nodal medication. An 81-year-old lady with multiple comorbidities and a long list of medications presented with symptomatic bradyarrhythmia. She, in fact, had two AV nodal blockers in her prescription, a beta-blocker and amiodarone. Her potassium level was found to be mildly elevated due to acute renal failure. She remained bradycardic despite initial treatment and was subsequently dependant on intravenous isoproterenol until her renal function improved. This case highlights the different threshold for manifestation of hyperkalaemic symptoms in a growing group of patients: elderly patients with multiple comorbidities and polypharmacy.
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Background: Patients with diabetes mellitus (DM) are at an increased risk of dying from cardiovascular diseases, the reason for which is not completely understood. Aim: To study the clinico-demographic profile of type 2 diabetes patients with cardiac autonomic neuropathy (CAN). Materials and methods: This was a cross sectional study involving 100 patients attending the diabetic clinic of a tertiary care hospital. Demographic data was collected and autonomic function testing was done with Ewing and Clark’s tests. Results: The prevalence of CAN was 58 %. CAN had statistically significant association with increasing duration of diabetes (p < 0.00001), increasing values of HbA1c (p < 0.00001), and with combined use of insulin and oral medications (p < 0.05). Conclusion: There is a high prevalence of CAN in the diabetic population providing a large pool of patients awaiting effective interventions.
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Aim: The aim of this study was to determine the levels of basic biochemical parameters like uric acid, potassium, sodium, bicarbonate and chloride in umbilical cord blood with a view to assess its suitability for stem cell transplantation. Study Design: This is a cross-sectional prospective study. Place and Duration of the Study: The study was carried out at the Departments of Obstetrics and Gynaecology, and Chemical Pathology University of Benin Teaching Hospital, Benin City Nigeria between July 2010 and March 2011. Methodology: Cord blood from a total of 164 pregnant women (HIV, hepatitis B and C negative) who delivered in University of Benin Teaching Hospital from July 2010 to March 2011 were analyzed for some basic biochemical parameters. Results: The levels of the biochemical parameters were sodium 135.4±6.1mmol/L (128 to 150mmol/L), potassium 7.08±1.9mmol/L (4.5 to 14.7mmol/L), bicarbonate 19.6±2.4mmol/L(14-25mmol/L), chloride 101.7±3.8mmol/L (90-109mmol/L) and uric acid 1.63±0.9mmol/L (0.19-3.09mmol/L) chloride was the most stable with a CV of 3.71% while uric acid was the least stable with a CV of 12.63%. Conclusion: Umbilical cord blood could become an important source of stem cell in sub-sahara Africa especially with the large number of deliveries. However careful selection of quality cord blood must be enforced to avoid contaminants and haemolysis which may be responsible for the hyperkalaemia as seen in this study.
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Paciente feminina, 59 anos, branca, hipertensa há 20 anos, apresentou hipertensão grave e hipocalemia. Hiperaldosteronismo primário (HAP) foi comprovado após triagem laboratorial, que indicou aldosterona plasmática elevada e renina plasmática baixa. A tomografia computadorizada de abdômen superior detectou a presença de uma massa na glândula adrenal direita. A paciente foi submetida à adrenalectomia por videolaparoscopia. Após a cirurgia, a hipertensão persistiu mas foi controlada com uso de drogas antihipertensivas. HAP é uma das formas mais comuns de hipertensão secundária. Pode ser causada por adenoma produtor de aldosterona (APA) ou hiperplasia adrenal bilateral (HAB). A doença é caracterizada principalmente por retenção de sódio, supressão da atividade da renina plasmática e aumento da secreção de aldosterona. O "padrão-ouro" para confirmar o diagnóstico de HAP é a ausência da supressão de aldosterona em resposta à fludrocortisona e/ou à dieta hipersódica. O cateterismo das veias adrenais é o melhor método para diferenciar APA de HAB, uma vez que a presença de uma massa adrenal unilateral nos estudos por imagem não garante o diagnóstico de APA. O tratamento para APA é a adrenalectomia unilateral, que pode ser realizada por videolaparoscopia ou por cirurgia aberta (AU)
A 59-year-old female white patient, hipertensive for 20 years, presented severe hipertension and hipokalemia. Primary hiperaldosteronism (PHA) was confirmed after laboratory screening, which indicated high plasmatic aldosterone and low plasmatic renin. Computerized tomography (CT) of the upper abdomen detected the presence of a mass in the right adrenal gland. The patient underwent a videolaparoscopic adrenalectomy. After surgery, hypertension persisted but was controled by use of anti-hypertensive drugs. PHA is one of the most common forms of secondary hypertension. It can be caused by aldosterone producing adenoma (APA) or bilateral adrenal hyperplasia (BAH). The disease is characterized mainly by sodium retention, supression of plasma renin activity and increased aldosterone secretion. The "gold-standard" to the diagnosis of PHA is the absence of aldosterone supression in response to fludrocortisone and/or high sodium diet. The catheterism of adrenal veins is the best method to differentiate APA from BAH since the presence of a unilateral adrenal mass as confirmed by imaging studies does not warrant the diagnosis of APA. The treatment of APA is unilateral adrenalectomy, which can be performed by videolaparoscopy or open surgery (AU)