Drug induced hypokalemia: a retrospective study

To study the association between the use of diuretics, steroids, or their combination and hypokalemia. One hundred fifty patients receiving diuretics, steroids, or both as a treatment for different medical problems [none of them was receiving potassium supplement] at Al-Hussain hospital in Karbala city, Iraq, were categorized into 3 groups according to the medication used whether it was diuretics, steroids, or combination of both. After detailed medical history and careful physical examination to detect any clinical feature of hypokalemia, electrocardiography and serum potassium estimation was done for every patient. Hypokalemia was considered when the serum potassium was less than 3.5 mm/1. The mean serum potassium for the study subjects was 3.9 +/- 0.61mmol/l, and 26.7% were found to have hypokalemia. Mild hypokalemia was present in 22% in patients receiving diuretics, and 14% in patients receiving steroids; and 36% in patients receiving combination of them. Moderate hypokalemia was found in 8% of patients receiving diuretics and steroids combination. Only 12% of patients in this study showed symptoms suggestive of hypokalemia [muscle weakness, fatigue, cramps], the majority being in patients receiving combination of diuretics and steroids. No physical signs of hypokalemia were detected in any patient of the study subjects. The study showed an association between decreased serum potassium concentrations with increasing duration of treatment. Electrocardiographic changes of hypokalemia were present in 6% of our patients. Hypokalemia is a common electrolyte disturbance associated with the use of diuretics and/ or steroids which should be looked after in order to avoid its serious consequences

Left ventricular diastolic filling dynamics during isometric exertion in patients with microvascular angina assessed with transmitral doppler flow velocities

The patients in this study were divided into three groups. The first group included 34 patients [22males and 12 females with a mean age of 48 +/- 3.21 years] with documented microvascular angina [typical anginal pain, positive electrocardiography on exercise with ST-T segment depression >1 mm, abnormal perfusion scans, normal coronary angiography]. The second group included 27 patients [19 males and 8 females having a mean age of 50 +/- 4.1 years with documented coronary artery disease. The third group included 15 healthy subjects of the same age group as controls [8 males and 7 females, mean age was 47 +/- 6.26 years]. Moderate isometric exertion [one half-maximal effort in one minute] produced approximately one-third increase in the mean arterial pressure and 30% increase in heart rate in all studied groups. In conclusion, isometric exertion, in form of firm sustained hand grip, induced left ventricular diastolic filling indices abnormalities in patients with microvascular angina. Similar changes were observed in patients with established diagnosis of coronary artery disease. These changes are consistent with impaired ventricular relaxation and support a generalized left ventricular abnormality in patients with microvascular angina

Addition of low dose meperidine [pethidine] to bupivacaine spinal anaesthesa: effects on shivesing and characteristics of block

The aim of this study was to investigate whether prophylactic intrathecal 20mg meperidine added to 0.5% hyperbaric bupivacaine would influence the incidence and severity of shivering in patients receiving spinal anaesthesia and whether it would affect the duration of sensory and motor blockade as well as postoperative analgesia Eighty patients of ASA physical status I or II presenting for surgery of inguinal hernia were divided into two equal groups according to the type of solution injected in the subarachnojd space. Patients of group I received 2Omg meperidine in addition to 0.5% bupivacaine while patients of group II received 0.5% bupivacajne alone. Shivering occurred in 5% of patients of group I and in 70% of patients in group II No single patient in group I experienced grade 2 or 3 shivering. The duration of sensory and motor blockade was significantly prolonged with addition of meperidire. Prolonged postoperative analgesia was obtained in meperidine - bupivacaine group which lasted for 19.4 +/- 4.5 hours compared to 9.6 +/- 2.8 in bupivacaine group. 70% of patients had no pain and required no analgesia up to 24 hours as regards complications pruritis occurred in the first group only [5 patients] which was experienced in the face and upper chest No early or late respiratory depression occurred in first group. it can be concluded that intrathecal 20mg meperidine added to bupivacaine reduced significantly the incidence and severity of shivering and significantly prolonged the duration of sensory and motor blockade as well as Postoperative analgesia with no deleterious effects on patients