Clinical analysis on hyperpotassemia induced by pharmacologic interaction between tacrolimus and other drugs in 10 renal ;transplant recipients / 器官移植

Objective To investigate the therapeutic methods of hyperpotassemia induced by excessively high blood concentration of tacrolimus (FK506) caused by drug use after renal transplantation. Methods Clinical data of 10 patients diagnosed with hyperpotassemia induced by excessively high blood concentration of FK506 after administration of antifunga l medication following renal transplantation were collected and retrospectively analyzed. Results At 1-2 months after renal transplantation, 10 patients suffered from pulmonary infectiono r pneumonia complicated with pulmonary fungal infection . An appropriate dose of compound sulfamethoxazole, micafungin, cefoperazone sodium-sulbactam sodium and moxifloxacin was administered for antifungal infection. After potassium-lowering therapy, termination of antifungal medication and FK506 dose adjustment (replaced by cyclosporin for certain cases), the serum level of potassium was declined and maintained within normal range for 10 cases. The serum concentration of FK506 was within normal range. No sign of excessively high level of potassium was observed without any potassium-lowering intervention. Conclusions Postoperative administration of drugs is likely to cause excessively high level of FK506 and hyperpotasesmia. Potassium-lowering therapy, termination of drug use and adjustment of immunosuppressive agents should be adopted to avoid the incidence of adverse pharmacologic interaction.

1 case with lactic acidosis combined with hypoglycemic coma, diabetic ketoacidosis and hyperkalemia and literature analysis / 中国基层医药

Objective To ummarized the clinical characteristics of lactic acidosis combined with hypoglycemic coma,diabetic ketoacidosis and hyperkalemia,so to improve the physician's treatment ability by summary the clinical feature of lactic acidosis combined with hypoglycemic coma,diabetic ketosis and hyperkalemia.Methods Analyzed the clinical characteristics and disease development of one case with lactic acidosis combined with hypoglycemic coma,diabetic ketoacidosis and hyperkalemia,and reviewed literature.Results The patient had hypoglycemia and acidosis at the same time due to taking phenformin and glibenclamide.After 2 days,the patient was better through correcting acidosis,intravenous fluid therapy,lowering blood potassium and controlling blood glucose.Conclusion Because acidosis caused the potassium transfer from intracellular to extracellular,the latter leads to hyperpotassemia,lactic acidosis caused by phenformin should be treated with intravenous fluid therapy,correcting acidosis.

Parálisis periódica hiperpotasémica / Hyperpotassemia periodic paralysis

La parálisis periódica hiperpotasémica es una canalopatía del músculo esquelético que se caracteriza por episodios recurrentes de debilidad muscular que pueden ser desencadenados por el ejercicio, el frío, el reposo poco después del ejercicio y el aporte de potasio. Se presenta el caso de una paciente de 13 años de edad, con diagnóstico de parálisis periódica hiperpotasémica, sin antecedentes familiares de esta entidad y sin miotonía asociada. Los ataques de debilidad muscular sucedían en ocasiones diariamente y cada 2 o 3 días, con duración variable desde media hora hasta 24 a 48 h. Durante un episodio de debilidad muscular se constataron concentraciones de potasio en sangre de 7,14 mmol/L y el electromiograma mostró un patrón miopático. Se observó una disminución de la frecuencia de los episodios de debilidad muscular a los 2 meses de iniciado el tratamiento con acetazolamida por vía oral

The periodic hyperpotassemia paralysis is a striated muscle channelopathy characterized by recurrent episodes of muscular asthenia that may to be triggered by exercise, cold, not rest after exercise and potassium support. This the case of a female patient aged 13 diagnosed with hyperpotassemia periodic paralysis without family backgrounds of this entity and also without associated myotonia. The seizures of muscular asthenia occurred almost daily and each 2 or 3 days with a variable length from a half hour to 24 to 48 hours. During a episode of muscular asthenia there were blood potassium concentrations of 7,14 mmol/L and the electromyogram showed a myopathic pattern. There was a frequency decrease of episodes of muscular asthenia at 2 months of treatment onset with oral acetazolamide

Influence factors for limb salvage of bone fracture patients with hyperpotassemia caused by earthquake / 中南大学学报(医学版)

Objective To determine the influence factors for limb salvage of bone fracture patients with hyperpotassemia caused by Wenchuan earthquake,to discuss the clinical symptom and to improve the clinical treatment. Methods The clinical symptom, drug therapy, limb incision decompression, hemodialysis, and limb salvage of hyperpotassemia caused by earthquake were analyzed by logistic regression. Results All the 37 patients received drug therapy: 9 patients received incision and decompression singlely,8 received hemodialysis singlely,and the other 20 received decompression and hemodialysis simultaneously. The concentration of potassium decreased from (6.25 ± 0.91) mmol/L to (4.47±0.65) mmol/L,with significant difference (P＜0.05).Five patients with Gustilo III grade open injury received amputation at the concentration of potassium of (6.13±(0.78)) mmol/L, while the concentration of potassium for the other 32 patients was (6.25±0.31) (mmol/L). There was no significant difference between them(P>0.05). Logistic regression analysis found the time of compression, the time before incision and decompression, and the time before hemodialysis were the main factors to affect limb salvage. The OR value of these factors was 4.394, 3.793 and 5.432;while the P value was 0.013, 0.047, and 0.015, respectively. Conclusion Decreasing the time of compression, appropriate incision and decompression, and hemodialysis help improve the result of limb salvage in hyperpotassemia patients with bone fracture caused by earthquake.

Emergency Treatment Experiences of Acute & Chronic Renal Failure with Hyperpotassemia / 中国医师杂志

Objective To analyze the clinical conditions and emergency treatment experiences of acute and chronic renal failure with hyperpotassemia. Methods Retrospective analyzed 542 clinical cases of supervening hyperpotassemia, which were treated by hemodialysis on 186 patients of renal failure with hyperpotassemia for 5 years. Results 540 cases clinical symptom was improved, serum potassium concentration was down to normal range and hyperpotassemia disappeared in electro cardiogram. 2 cases died after salvage. Rate of success was 99.6%. Conclusion Hemodialysis therapy is the most effective treatment to hyperpotassemia. Use bicarbonate with kalium pH indicator of 3.0～3.5mmol/L in dialysis is useful to lower hyperpotassemia, and safe also. In the early stage of hemodialysis, pure ultrafiltration dehydration treatment is not suitable. There is still danger of heartbeat stop deal to high kalium in the early stage of dialysis; emergency treatments should be standby all the time.