Persistent and serious hyperkalemia after surgery of primary aldosteronism: A case report / 北京大学学报(医学版)

Hyperkalemia was one of the complications after primary aldosteronism surgery. Hyperkalemia after primary aldosteronism surgery was uncommon in clinical practice, especially persistent and serious hyperkalemia was rare. This complication was not attached great importance in clinical work. A case about persistent and serious hyperkalemia after primary aldosteronism adrenal adenoma surgery was reported and the patient was followed-up for fourteen months in this study. This patient had a laparoscopic adrenalectomy due to primary aldosteronism. Hyperkalemia was detected one month after surgery of this patient, the highest level of plasma potassium was 7.0 mmol/L. The patient felt skin itchy, nausea, palpitation. Plasma aldosterone concentration fell to 2.12 ng/dL post-operation from 35.69 ng/dL pre-operation, zona glomerulosa insufficiency was confirmed by hormonal tests in this patient after surgery. And levels of 24 hours urinary potassium excretion declined. Decrease of aldosterone levels after surgery might be the cause of hyperkalemia. Hyperkalemia lasted for 14 months after surgery and kalemia-lowering drugs were needed. A systemic search with "primary aldosteronism", "hyperkalemia", "surgical treatment" was performed in PubMed and Wanfang Database for articles published between January 2009 and December 2019. Literature review indicated that the incidence of hyperkalemia after primary aldosteronism surgery was 6% to 29%. Most of them was mild to moderator hyperkalemia (plasma potassium 5.5 to 6.0 mmol/L) and transient. 19% to 33% in hyperkalemia patients was persistent hyperkalemia. Previous studies in the levels of plasma potassium reached the level as high as 7 mmol/L in our case were rare. Whether hypoaldosteronemia was the cause of hyperkalemia was not consistent in the published studies. Risk factors of hyperkalemia after primary aldosteronism surgery included kidney dysfunction, old age, long duration of hypertention. This paper aimed to improve doctors' aweareness of hyperkalemia complication after primary aldosteronism surgery. Plasma potassium should be monitored closely after primary aldosteronism surgery, especially in the patients with risk factors. Some patients could have persistent and serious hyperkalemia, and need medicine treatment.

Severe hypokalemia secondary to abuse of ß-adrenergic agonists in a pediatric patient: Case report / Hipocalemia grave secundária a abuso de agonistas ß-adrenérgicos em paciente pediátrico: relato de caso

ABSTRACT This study reports a case of a 13-year-old male with a 3-year history of severe and intermittent hypokalemia episodes of unknown origin, requiring admission to the intensive care unit (ICU) for long QT syndrome (LQTS), finally diagnosed of redistributive hypokalemia secondary to the abuse of β-adrenergic agonists in the context of a probable factitious disorder.

RESUMO O presente estudo relata o caso de um jovem de 13 anos de idade com histórico, há três anos, de episódios de hipocalemia grave intermitente de origem desconhecida, internado em unidade de terapia intensiva (UTI) por síndrome do QT longo (SQTL). O paciente foi diagnosticado com hipocalemia por redistribuição secundária ao abuso de agonistas β-adrenérgicos, em contexto de provável transtorno factício.

Cambios electrocardiográficos asociados a hipopotasemia: alteraciones del segmento ST imitando isquemia miocárdica de múltiples territorios / Electrocardiographic changes associated with hypokalemia: ST-segment abnormalities mimicking ischemia of multiple territories

Resumen: Se presenta el caso de un paciente de sexo femenino de 42 años sin antecedentes clínicos de relevancia, con hipopotasemia severa y cambios electrocardiográficos imitando isquemia miocárdica con enfermedad corona-ria de múltiples vasos.

Abstracts: A 42-year-old woman with no previous medical history developed severe hypokalemia. The ECG changes suggested multivessel coronary artery disease with ischemia in several territories.

Dentine hypersensitivity: analysis of self-care products

Dentine hypersensitivity is a condition that is often present in individuals, leading them to seek dental treatment. It has been described as an acute, provoked pain that is not attributable to other dental problems. Its actual prevalence is unknown, but it is interpreted as very unpleasant by individuals. Several therapeutic alternatives are available to manage dentine hypersensitivity, involving both in-office treatment and home-use products. The aim of this literature review was to evaluate self-care products for managing dentine hypersensitivity. Among the products available, dentifrices and fluorides are the most studied self-care products, with positive effects. However, a high percentage of individuals is affected by the placebo effect. Among dentifrices, those containing potassium salts seem to be the most promising. Dental professionals need to understand the advantages and limitations of these therapies and use this knowledge in a positive approach that might help in decreasing dentine hypersensitivity among patients.

Síndrome de Bartter: diagnóstico diferencial da hipopotassemia intensa e assintomática: relato de caso e revisão de literatura / Batter Syndrome: distinguishing diagnosis of the intense and asymptomatic hypokalemia: case story and review of the literature

Relata-se caso de paciente de 51 anos de idade com hipocalemia intensa e assintomática em que foi iniciada a suplementação de potássio sem sua normalização. A identificação de hiperaldosteronismo hiperreninêmico permitiu estabelecer o diagnóstico de síndrome de Bartter.

Diabetic ketosis as a presenting feature of acromegaly.

Secondary diabetes mellitus is known to occur in acromegaly due to insulin resistance caused by growth hormone excess. However diabetes in acromegaly usually does not lead to ketosis. We describe here a case of acromegaly who presented in diabetes ketosis, which is unusual.

Quinine-induced arrhythmia in a patient with severe malaria.

It was reported that there was a case of severe malaria patient with jaundice who presented with arrhythmia (premature ventricular contraction) while getting quinine infusion was reported. A man, 25 years old, was admitted to hospital with high fever, chill, vomiting, jaundice. The patient was fully conscious, blood pressure 120/80 mmHg, pulse rate 100 x/minute, regular. On admission, laboratory examination showed Plasmodium falciparum (++++), total bilirubin 8.25 mg/dL, conjugated bilirubin 4.36 mg/dL, unconjugated bilirubin 3.89 mg/dL, potassium 3.52 meq/L Patient was diagnosed as severe malaria with jaundice and got quinine infusion in dextrose 5% 500 mg/8 hour. On the second day the patient had vomitus, diarrhea, tinnitus, loss of hearing. After 30 hours of quinine infusion the patient felt palpitation and electrocardiography (ECG) recording showed premature ventricular contraction (PVC) > 5 x/minute, trigemini, constant type--sinoatrial block, positive U wave. He was treated with lidocaine 50 mg intravenously followed by infusion 1500 mg in dextrose 5%/24 hour and potassium aspartate tablet. Quinine infusion was discontinued and changed with sulfate quinine tablets. Three hours later the patient felt better, the frequency of PVC reduced to 4 - 5 x/minute and on the third day ECG was normal, potassium level was 3.34 meq/L. He was discharged on 7th day in good condition. Quinine, like quinidine, is a chincona alkaloid that has anti-arrhythmic property, although it also pro-arrhythmic that can cause various arrhythmias, including severe arrhythmia such as multiple PVC. Administration of parenteral quinine must be done carefully and with good observation because of its pro-arrhythmic effect, especially in older patients who have heart diseases or patients with electrolyte disorder (hypokalemia) which frequently occurs due to vomiting and or diarrhea in malaria cases.

Neonatal Bartter syndrome.

Bartter syndrome is an inherited renal tubular disorder with hypokalemia, hypochloremic metabolic alkalosis, normal blood pressure with hyper-reninemia and increased urinary loss of sodium, potassium and chloride. We report an infant with neonatal Bartter syndrome, who improved with potassium supplements.

Utilidad y efecto de potasio en el desarrollo y recuperacion integral del niño desnutrido grave (departamento de Pediatria-Hospital Materno Infantil German Urquidi - 2004) / sss

La valoracion del estado nutricional es uno de los mejores indicadores de salud, especialmente en los niños en los que el crecimiento y desarrollo estan condiciondos por la nutricion. El uso del potasio coadyuvara en recuperacion nutricional y psicomotora. A todo niño con diagnostico de Desnutrido III grado se realizo determinacion de potasio, si ademas presentaban infeccion, se trato de patologia luego la rehabilitacion nutricional y potasio, pero a un grupo no se administro potasio. Tambien se sometio a programa de estimulacion del desarrollo psicomotor evaluado con formulario de Denver. Los resultados fueron estadisticamente significativos en la recuperacion nutricional y psicomotora con la administracion de potasio en el tratamiento...

Utilidad de la terapéutica metabólica G-I-K en cirugía de cardiacos / On metabolic therapeutics G-I-K in surgery of cardiac patients

Se exponen en forma sintética los principios básicos de la terapéutica metabólica, en su modalidad de las venoclisis con glucosa, insulina y potasio, ya propuestas a su tiempo por el Dr. Demetrio Sodi Pallares. Se relata la sucesión cronológica de la aplicación de dicho tratamiento en las fases preoperatoria, transoperatoria y postoperatoria de cirugía cardiovascular. Se describen asimismo algunas observaciones personales de uno de los autores. Se concluye que la mezcla glucosa-insulina-potasio constituye un poderoso sistema donador de energía y el aporte generoso de esta última es muy útil para la protección del miocardio dañado en cirugía cardíaca y no cardíaca. Lo demuestra el gran número de publicaciones al respecto. Las más recientes señalan la reducción de los síndromes de bajo gasto debidos a intervenciones sobre las arterias coronarias, así como la baja del nivel de ácidos grasos circulantes tras las angioplastías primarias. Las soluciones mencionadas, en concentraciones mayores que las iniciales, podrían volverse una medida rutinaria en los centros de medicina y cirugía generales.

The basic principles of the metabolic therapeutics with glucose-insulin-potassium solutions, already proposed by Dr. Demetrio Sodi Pallares, are exposed. Chronologic succession of this treatment during the preoperative, transoperative and postoperative phases of heart surgery, as well as some personal observations of one of the authors, are described. The glucose-insulin-potassium solution is a powerful system, providing very useful energy to protect the injured myocardium during cardiovascular surgery. Many publications support this assertion. The most recent ones indicate a reduction of low output syndromes due to interventions on coronary arteries, as well as a significant diminution of circulating fatty acids after primary angioplasty. The mentioned solution, in higher concentrations than the initial one, could become routine therapeutics in medicine and surgery centers, in general.

Cambios en el metabolismo cardíaco y su posible aprovechamiento en la terapéutica (Parte II) / Chages in cardiaac metabolism and their possible use in therapeutics (prtt ii)

En esta segunda parte de nuestra revisión se propone a la solución polarizante como una alternativa más, además de otras ya existentes, para el mantenimiento de las células cardíacas durante un infarto, apoyado en el cambio metabólico cardíaco durante la hipoxia.

Based on the cardiac metabolic changes during hypoxia, in this second part of our review we propose, the polarizing solution as an alternative for the maintenance of the cardiac cells during an infarction, in conjunction with other alternative therapies.

Thyrotoxic hypokalaemic paralysis in a pregnant Afro-Caribbean woman. A case report and review of the literature

This paper reports the case of a 21-year-old Afro-Caribbean pregnant woman with hyperthyroidism and hypokalaemic quadriparesis and reviews the literature on the topic. Thyrotoxic periodic paralysis is a very rare condition in the Caribbean. This case reminds West Indian physicians to consider this rare condition in any patient that presents with paralysis

Tetraparesia hipocalêmica em paciente com hipertireoidismo / Hypokalemic tetraparesis in patient with hyperthyreoidism

Os autores apresentam um caso de tetraparesia causada por hipocalemia em um paciente com hipertireoidismo assintomático diagnosticado através do exame neurológico, exames laboratoriais e estudo eletroneurofisiológico. A reposição do potássio e o tratamento do hipertireoidismo ocasionaram melhora dos sintomas. O relato deste caso visa salientar a valorização dos sintomas e da rotina de investigação frente a suspeita de tetraparesia sem uma causa aparente.

Estudo experimental em cães da ação protetora de solução cardioplégica de lidocaína e potássio / Experimental study of the protection provided by a cardioplegic solution of lidocaine and potassium in dogs

OBJETIVO: Os autores estudam experimentalmente em cães a ação cardioplégica de solução sangüínea normotérmica contendo lidocaína e potássio. MATERIAL E MÉTODO: Foram operados 14 animais, de cerca de 25kg, sob anestesia geral e intubação traqueal. Os cães foram submetidos a esternotomia mediana, sendo canulados a aorta ascendente e o átrio direito, para colocação em perfusão extracorpórea.Durante o procedimento, foram feitas dosagens gasométricas e de eletrólitos, visando à manutenção de boas condições cardiocirculatórias. Em 5 cães, os quais compõem grupo designado não protegido (NP), foi feita a parada cardíaca anóxica, através de pinçamento da raiz da aorta, durante 120 minutos. Nesses animais não foi tomada nenhuma medida visando à proteção miocárdica. No outro grupo, designadogrupo protegido (P), o procedimento foi semelhante, sendo que, após o pinçamento da aorta, foi feita proteção cardioplégica. A técnica de cardioplegia consistiu em indução com injeção de 100 mg de lidocaína e 2,5 mEq de potássio, diluídos em 60 ml de sangue da linha arterial,após o que infundiu-se sangue durante 30 segundos. A parada cardíaca foi imediata. A fase de manutenção consistiu em infusões de sangue da linha arterial, por 30 segundos, de 20 em 20 minutos. RESULTADOS: Todos os animais desse grupo protegido sobreviveram enquanto que no grupo não protegido, após o restabelecimento da circulação coronariana pelo desclampeamento aórtico, todos vieram a falecer. Em todos os 14 animais foram feitas determinaçõesecocardiográficas de fração de ejeção e delta D, sendo esses valores normais...

Neonatal Bartter syndrome.

A case of neonatal Bartter syndrome is reported. The baby born pre-term following a pregnancy complicated by polyhydramnios, presented at 7 months of age with failure to thrive, gastroenteritis and facial dysmorphisms. An unusual feature was the absence of the classical biochemical abnormality of hypochloremic alkalosis early in the course of the disease. Metabolic acidosis was the initial manifestation at 5 weeks of age. Awareness of this presentation is important to avoid delay in diagnosis and treatment.

A long-term study on the efficacy of a herbal plant, Orthosiphon grandiflorus, and sodium potassium citrate in renal calculi treatment.

The study was performed to compare the efficacy of a herbal plant, Orthosiphon grandiflorus (OG), and the drug sodium potassium citrate (SPC) in treatment of renal calculi. Forty-eight rural stone formers identified by ultrasonography were recruited and randomly assigned to two treatment groups (G1 and G2). For a period up to 18 months, subjects in G1 received 2 cups of OG tea daily, each tea cup made from an OG tea bag (contained 2.5 g dry wt), and G2 received 5-10 g of granular SPC in solution divided into three times a day. Once every 5 to 7 weeks, subjects were interviewed, given an additional drug supply, administered a kidney ultrasound and had spot urine samples collected for relevant biochemical analysis. From the recorded ultrasound images, rates of stone size reduction per year (ROSRPY) were calculated. The mean ROSRPY was 28.6+/-16.0% and 33.8+/-23.6% for G1 and G2, respectively. These two means were not significantly different. ROSRPY values of G1 and G2 were combined and divided into three levels: Level A (ROSRPY > mean + 0.5 SD), Level M (ROSRPY = mean +/- 0.5 SD) and Level B (ROSRPY < mean - 0.5 SD). Dissolution of stones was least in Level B which was related to higher excretions of Ca and uric acid in the urine. After treatment, 90% of the initial clinical symptoms (ie back pain, headaches and joint pain) were relieved. Fatigue and loss of appetite were observed in 26.3% of G2 subjects. Our study indicates that treatment of renal calculi with OG tea is an alternative means of management. Further investigation is needed to improve dissolution of stones with a low ROSRPY.

Paralisia periódica tireotóxica (PPT) / Thyrotoxic periodic paralysis

A paralisia periódica tireotóxica (PPT) é caracterizada por episódio recorrentes de fraqueza muscular, de intensidade variável, associada com hiperfunçäo tireodiana, atingindo, de forma muito preferencial, jovensasiáticos do sexo masculino. É associada, via de regra, com baixos níveis séricos de potássio e, frequentemente, desencadeada por exercícios físicos e ingestäo de carboidratos. Nós descrevemos um caso da doença em um jovem brasileiro, do sexo masculino e sem ascendência asiática, que se apresentou com um episódio de paralisia muscular e sem diagnóstico prévio de hipertireodismo. Foram encontrados níveis aumentados de T3, T4 e T4 livre e o TSH estava diminuido devido a um bócio tóxico difuso. A PPT deve ser considerada no diagnóstico diferencial de todos os episódios agudos de paralisia muscular em pacientes jovens mesmo em nosso país. A determinaçäo de potássio sérico e hormônios tiroideanos auxiliam o diagnóstico. O diagnóstico preciso é importante para o tratamento antitiroideano que evita episódio subsequentes de paralisia muscular