Analysis of the changes of serum potassium concentration before operation in rectal cancer patients / 国际外科学杂志

Objective To observe the changes of serum potassium concentration in rectal cancer patients from the admission to before the operation,to provide clinical evidence for preventing serum potassium disorder during and after their operation.Methods Monitoring of the changes of serum potassium concentration of 40 cases of rectal cancer patients according to three time points including the first day of admission,before taking of cathartics and the morning before operation.They were divided into different groups according to their age(young,middle age and elderly group),gender(male and female group),diet(normal,decreased slightly and serious decline group) and course(long,middle and short course group) of disease.The serum potassium concentration was observed between each time point of each group and SPSS13.0 statistical software was used to analyze the changes above.Results The mean of all patients' serum potassium concentration was (4.09 ± 0.62) mmol/L on the first day of admission,was (3.83 ± 0.46) mmoL/L before taking of cathartics that was decreased compared to the former and there was significant difference (P ＜ 0.01),it was (3.36 ±0.40) mmol/L on the morning of operation and had significant difference with the above two groups (P ＜ 0.01).It hadn't significant difference between different gender and age groups at different time points (P ＞ 0.05) except between the young group and the elderly group in the morning of the operation (P ＜ 0.05).There were statistically significant differences between the different diet condition and different course at anytime point (P ＜ 0.01).Conclusions The rectal cancer patients were possiblely in hypokalemia before operation,the causes might be relative to the long course of disease,the decreased diet,the aged and infirm,the diet structure change after admission and taking cathartics cleaning intestinal tract.

Analysis on the factors influencing the serum potassium concentration changes before and after massive blood transfusion and transfusion hyperkalemia occurred / 中国医学装备

Objective: To study the changes of blood transfusion and blood potassium concentration and the occurrence of hyperkalemia after transfusion factors influence. Methods: In our hospital from 2010 April to select the diagnosis and treatment of -2012 in April 132 cases of non crush injury patients, these patients were randomly divided into two groups, the control group without blood transfusion therapy group, the observation group for massive transfusion treatment group, changes of serum potassium were compared between the two groups before and after transfusion, and to analyze the related effect factors. Results:The serum potassium levels showed no significant difference between the two groups of patients before and after blood transfusion, operation process, but the postoperative within 12h, observation of blood potassium level group were significantly higher than that in control group, the difference is significant, with statistical significance (t=1.562, P<0.05), in addition to 12h after operation, blood potassium levels between the two groups no significant difference. Conclusion: The clinical blood transfusion is not the main cause of hyperkalemia in patients with, but there are still some patients in massive transfusion potassium increased, therefore, in the process of transfusion, or to close monitoring and observation of the serum potassium level, but also to pay attention to changes in renal function, has ruled out the elevation of serum potassium results in impaired renal function because, in order to reduce the incidence of complications.

Diabetic ketoacidosis: difference between potassium determined by blood gas analysis versus plasma measurement / Cetoacidose diabética: diferença entre as concentrações do potássio na gasometria sanguínea versus potássio plasmático

OBJECTIVE: To evaluate the accuracy of potassium concentrations measured by blood gas analysis (PBG) compared with laboratory serum potassium (LSP), in the initial care of patients with diabetic ketoacidosis (DKA). SUBJECTS AND METHODS: Fifty three patients with diabetes mellitus were evaluated in a retrospective analysis. PBG was carried out using the Radiometer ABL 700 (Radiometer Copenhagen®), and results were compared with LSP ADVIA 1650 Chemistry system (Siemens®), the gold standard method. Both methods are based on potentiometry. RESULTS: Mean PBG was 3.66 mmol/L and mean LSP was 4.79 mmol/L. Mean difference between PBG and LSP was -1.13 mmol/L (p < 0.0005, 95 percent CI, -1.39 to -0,86). Lin concordance correlation coefficient was rc = 0.28 (95 percent CIb, 0.10 to 0.45), demonstrating low concordance between the methods. CONCLUSION: Although PBG measurement is faster and easier, it should not be used as a surrogate for LSP in the clinical treatment of DKA.

OBJETIVO: Avaliar a acurácia da mensuração da concentração de potássio realizado nos analisa-dores de gasometria sanguínea (PGS) em relação ao potássio plasmático laboratorial (PPL) no atendimento inicial dos pacientes com cetoacidose diabética (CAD). SUJEITOS E MÉTODOS: Foram avaliados, retrospectivamente, 53 pacientes com diabetes melito e CAD. A análise do PGS foi realizada pelo equipamento ABL 700 (Radiometer Copenhagen®), sendo este comparado ao método padrão-ouro de PPL ADVIA 1650 (Siemens®), ambos por potenciometria. RESULTADOS: A média do PGS foi de 3,66 mmol/L e do PPL, de 4,79 mmol/L. A diferença das médias do PGS em relação ao PPL foi de -1,13 mmol/L (p < 0,0005, IC = 95 por cento; -1,39 a -0,86). O coeficiente de concordância de Lin foi de rc = 0,28 (ICb = 95 por cento; 0,10 a 0,45), demonstrando, assim, uma baixa concordância entre os métodos. CONCLUSÃO: Apesar de a realização do PGS ser tecnicamente mais rápida e fácil, não deve ser usada como parâmetro substituto ao PPL para o tratamento clínico da CAD.

Impaired homeostatic mechanism of potassium handling after acute oral potassium load in diabetes mellitus

Chronic stable diabetic patients (n = 6) were compared with healthy control subjects (n = 5) after acute oral intake of 50 mEq of potassium chloride (KCl) to investigate for possible derangements of homeostatic responses for acute term (3 hrs) to acute potassium load. Plasma renin activity (PRA), plasma aldosterone (PA), and transtubular potassium concentration gradient (TTKG) known as a useful semiquantative index of distal nephron potassium secretion were measured. All the baseline parameters were comparable between diabetic and non-diabetic subjects except for significantly reduced creatinine clearance in diabetics (mean +/- SEM, 105 +/- 4 vs. 85 +/- 5 ml/min, p 5.0 mEq/L). PRA did not show any significant changes, whereas PA was increased simultaneously with increments in serum potassium in both groups, with blunted increases in the diabetics. However, TTKG was increased prominently in control subjects (8.18 from 4.98), but only slightly in diabetic subjects (4.55 from 4.18), with statistical difference between the two groups (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The Changes of Metabolic and Acid - base Status and Respiratory Gases Elicited by Pneumatic Tourniquet for Lower Extremity Surgery / 대한마취과학회지

For extremity surgery, tourniquet is placed routinely. With deflation of the tourniquet, the metabolic product is flushed into the systemic circulation and theoretically poses a potential for toxic reactions. In actual fact, these are rare events with this technique. Vigilant monitoring will detect cardiovascular depression at this time. By the tourniquet application, lactic acidemia, abnormal coagulopathy, hypotention, hyperkalemia, increased PaCO2, and production of noxious oxygen free radicals were reported following the release of the tourniquet. But the serial changes of metabolic derangement, degree of lactic acidemia following the use of the tourniquet were not exactly known. To confirm the safety of the pneumatic tourniquet use for two hours, the serial changes of lactic acid levels, acid-base status, potassium concentration, concentration of respiratory gaaes (arterial and end-tidal CO2,) and also hypotension, dysrhythmias and respiratory pattern following release of the tourniquet were studied. Patients were anesthetized with 1% halothane, 50% nitrous oxide and 50% oxygen. Ventilation was maintained by the ventilator to keep the end-tidal CO2, to 4.0% just before the release, and then respiratory parameters (respiratory rate, tidal volume) were constantly maintained through the study. The data were measured from arterial samples or monitors with the following interval; just before tourniquet apply (BTA), before tourniquet release (BTR), at 1, 3, 5, 15 and 30 minutes after the tourniquet release (ATR 1 m, 3m, 5 m, 15 m 30 m). Data measured before the tourniquet apply were used as control values. All data were analyzed by the paired t-test with control. Changes of mean values of each time in one parameter were analyzed by one-way ANOVA. Correlationships between the parameters and duration of ischemia induced by the tourniquet were analyzed by simple regression. The results of this study were as follows; 1) The arterial concentration of lactic acid was maximally increased at 3 minutes after tourniquet release and not returned to control value until 30 minutes after tourniquet release. 2) End-tidal CO, was reached to maximal values of 5.3% at 5 minutes after release of tourniquet. Accompanying theses changes, spontaneous respiration was recovered from the controlled ventilation in 11 patients out of 13 and fought with mechanical ventilator due to asynchronism of respiratory cycles. 3) Mild metabolic acidosis showing the decreased arterial pH and increased PaCO2, in arterial blood gas analysis was maintained in 30 minutes following the release of tourniquet. 4) There were no significant changes of concentrations of potassium. 5) Three episodes of mild hypotension were observed out of 13 patients, but dysrhythmias and other significant clinical changes not observed through the study. The above results showed the possibility of lactic acidemia and changes of respiratory pattern by increased PaCO2, after release of the tourniquet may occur. More intent monitoring is needed to the patients who have had the metabolic derangement in acid-base balance and increased intracranial pressure in application of tourniquet on limbs.