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ABSTRACT CONTEXT: Scrub typhus, caused by Orientia tsutsugamushi, has a wide range of clinical manifestations, including meningoencephalitis, acute renal failure, pneumonitis, myocarditis, and septic shock. However, there are no documented cases of scrub typhus with hypokalemia. In this report, we present a case of scrub typhus with hypokalemia and multiple organ failure syndrome, highlighting the importance of electrolyte imbalance in patients with scrub typhus. CASE REPORT: A 59-year-old woman presented to the emergency department with abdominal pain that had been present for 1 day. On admission, the physical examination and laboratory test results indicated that the patient had renal, liver, and circulatory failure, and hypokalemia. She developed meningitis and disseminated intravascular coagulation during hospitalization. She recovered with appropriate management, and was discharged on day 17. CONCLUSION: This report highlights the potential for atypical presentations of scrub typhus, including a previously undocumented association with hypokalemia. Although the contribution of hypokalemia to the patient's clinical course remains uncertain, this case underscores the importance of considering electrolyte imbalance in the management of patients with scrub typhus. Further research is warranted to better understand the relationship between scrub typhus and electrolyte imbalance.
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La hipertensión arterial (HTA) grave en pediatría responde fundamentalmente a causas secundarias. Presentamos una paciente adolescente de 14 años con HTA grave, alcalosis metabólica e hipopotasemia, secundaria a un tumor de células yuxtaglomerulares productor de renina, diagnosticado luego de dos años de evolución de HTA.
Severe arterial hypertension (HTN) in pediatrics is mainly due to secondary causes. Here we describe the case of a 14-year-old female adolescent with severe HTN, metabolic alkalosis, and hypokalemia, secondary to a renin-secreting juxtaglomerular cell tumor diagnosed after 2 years of HTN progression.
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Humanos , Feminino , Adolescente , Hipertensão/etiologia , Hipopotassemia/complicações , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico , Renina/metabolismo , Sistema Justaglomerular/metabolismo , Sistema Justaglomerular/patologiaRESUMO
Gitelman syndrome (GS) is an autosomal-recessive disorder distinguished by hypokalemia, hypomagnesemia, and hypocalciuria. Elderly people and women of childbearing age are highly affected by GC. Not much evidence is known about its effects on maternal and fetal outcomes. GS is caused by mutations in the thiazide-sensitive Na-Cl cotransporter gene. Due to its rarity and lack of knowledge, it is susceptible to misdiagnosis or being overlooked. In our case, the patient suffered from recurrent hypokalemia, hypomagnesemia, hypochloraemia, and hypocalciuria with hypotension. After taking proper medication, the patient recovered slowly, and during counseling, the patient was provided a diet chart by nutritionists to avoid recurrent electrolyte imbalances.
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Hypokalemia is a common electrolyte disorder in cancer patients that may be associated with the primary disease or a complication of treatment. In this article, we provide a brief description of hypokalemia and its appropriate management in cancer patients.
La hipokalemia es un trastorno hidroelectrolítico común en pacientes con cáncer que puede estar asociado a la enfermedad primaria o a una complicación del tratamiento. En este artículo nos enfocamos en entregar una breve descripción de la hipokalemia y su adecuado manejo en pacientes con cáncer.
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Humanos , Hipopotassemia/complicações , Hipopotassemia/terapia , Neoplasias/complicaçõesRESUMO
Sjogren’s syndrome is a chronic and slowly progressing autoimmune disease characterized by lyphocytic infiltration of exocrine glands resulting in Sicca syndrome (xerostomia and keratocunjuntivitis sicca). The disease can present alone or along with other autoimmune diseases leading to significant organ specific and systemic disease. Middle aged women (Female: Male: 9:1) are primarily affected. Extraglandular (systemic) manifestations are seen in one third of patients with Sjogren’s syndrome. Among the extraglandular manifestations, renal involvement is commonly seen. Renal involvement in the form of tubulointerstitial nephritis (TIN) is more common compared to glomerular involvement. Distal renal tubular acidosis (RTA) is more common manifestation of TIN presenting as mild hypokalemia, metabolic acidosis, and rarely with hypokalemic periodic paralysis. We report three cases of hypokalemic periodic paralysis with metabolic acidosis, two in respiratory paralysis, diagnosed as distal RTA. On further evaluation of distal RTA, the patient diagnosed to have Sjogren’s syndrome and managed accordingly. Our report shows that Sjogren’s syndrome is a rare but important cause of hypokaemic periodic paralysis due to RTA.
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Background: Primary aldosteronism is a disorder due to excessive aldosterone production in the presence of low renin levels. It is an underdiagnosed pathology despite its simple screening. Establishing the unilateral or bilateral location represents the greatest diagnostic challenge and is crucial to define the therapeutic approach. Adrenal venous catheterization (AVC) is the best test to establish the location, but it is invasive and expensive. New predictive markers of laterality are being developed. Case series presentation: We present a case series of 8 patients diagnosed with primary aldosteronism due to arterial hypertension with hypokalaemia, elevated aldosterone-renin ratio and compatible computed tomography. 4 patients underwent adrenal venous catheterization. Conclusion: In patients who underwent catheterization as well as in those who did not, the Küpers score adequately predicted lateralization in 75% of cases and it could be a useful tool to discriminate unilateral from bilateral aldosteronism.
Introducción: El hiperaldosteronismo primario es un desorden debido a una producción excesiva de aldosterona en presencia de niveles bajos de renina. Es una patología infradiagnosticada a pesar de su simple tamizaje. Definir la localización unilateral o bilateral representa el más importante desafío diagnóstico y es crucial para el abordaje terapéutico. El cateterismo venoso adrenal (CVA) es la mejor prueba para establecer la localización, pero es invasivo y costoso. Nuevos marcadores predictivos de unilateralidad se encuentran en desarrollo. Presentación de serie de casos: Presentamos una serie de casos de 8 pacientes diagnosticados con hiperaldosteronismo primario debido a hipertensión arterial con hipocalemia, radio aldosterona-renina elevado y tomografía compatible. 4 pacientes fueron sometidos a cateterismo venoso adrenal. Conclusión: Tanto en los pacientes que fueron sometidos a cateterismo venoso adrenal como en los que no, el score de Küpers predijo adecuadamente la lateralidad en 75% de los casos y puede ser una herramienta útil para diferenciar el hiperaldosteronismo unilateral del bilateral.
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Severe hypokalemia is defined as the concentration of serum potassium lower than 2.5 mmol/L, which may lead to serious arrhythmias and cause mortality. We report an unusual case of potentially fatal ventricular arrhythmias induced by severe hypokalemia in a patient undergoing laparoscopic partial nephrectomy in Peking University Third Hospital due to irregular use of indapamide before operation. Indapamide is a sulfonamide diuretic with vasodilative and calcium antagonistic effects, which enhances sodium delivery to the renal distal tubules resulting in a dose-related increase in urinary potassium excretion and decreases serum potassium concentrations. The electrolyte disorder caused by the diuretic is more likely to occur in the elderly patients, especially those with malnutrition or long-term fasting. Hence, the serum potassium concentration of the patients under indapamide therapy, especially elderly patients, should be monitored carefully. Meanwhile, the potassium concentration measured by arterial blood gas analysis is different from that measured by venous blood or laboratory test. According to the previous research, the concentration of potassium in venous blood was slightly higher than that in arterial blood, and the difference value was 0.1-0.5 mmol/L. This error should be taken into account when rapid intravenous potassium supplementation or reduction of blood potassium level was carried out clinically. In the correction of severe hypokalemia, the standard approach often did not work well for treating severe hypokalemia. The tailored rapid potassium supplementation strategy shortened the time of hypokalemia and was a safe and better treatment option to remedy life-threatening arrhythmias caused by severe hypokalemia with a high success rate. Through the anesthesia management of this case, we conclude that for the elderly patients who take indapamide or other potassium excretion diuretics, the electrolyte concentration and the general volume state of the patients should be comprehensively measured and fully evaluated before operation. It may be necessary for us to reexamine the serum electrolyte concentration before anesthesia induction on the morning of surgery in patients with the history of hypokalemia. For severe hypokalemia detected after anesthesia, central venous cannulation access for individualized rapid potassium supplementation is an effective approach to reverse the life-threatening arrhythmias caused by severe hypokalemia and ensure the safety of the patients.
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Humanos , Idoso , Hipopotassemia/complicações , Indapamida/efeitos adversos , Arritmias Cardíacas/terapia , Diuréticos/efeitos adversos , Potássio , Eletrólitos/efeitos adversos , Anestesia Geral/efeitos adversosRESUMO
Objective:To evaluate the effect of intravenous infusion of dexmedetomidine before induction of anesthesia on concentrations of blood potassium and blood glucose in the patients with gastrointestinal tumors.Methods:One hundred and twenty patients, irrespective of gender, aged 18-75 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, scheduled for elective radical gastrointestinal tumor surgery, were divided into 3 groups ( n=40 each) using a random number table method: control group (group C), dexmedetomidine 0.5 μg/kg group (group D 1), and dexmedetomidine 1.0 μg/kg group (group D 2). Dexmedetomidine 0.5 and 1.0 μg/kg were intravenously infused prior to anesthesia induction over 10 min in D 1 and D 2 groups, while the equal volume of normal saline 20 ml was intravenously infused instead in group C. Before intravenous infusion (T 0), at 15 min after intravenous infusion (T 1), and at 30 min after intravenous infusion (T 2), blood samples from the radial artery were collected for blood gas analysis, and concentrations of blood potassium and blood glucose were recorded. The occurrence of complications such as hyperglycemia, hypoglycemia, hyperkalemia, hypokalemia, hypotension, hypertension, tachycardia and bradycardia was also recorded. Results:Compared with C group, the blood glucose concentrations were significantly increased at T 1 in D 1 and D 2 groups and at T 2 in D 2 group ( P<0.05). The blood glucose concentrations were significantly higher at T 1, 2 in D 2 group than in D 1 group ( P<0.05). There was no significant difference in blood potassium concentrations at T 0-T 2 among the three groups ( P>0.05). No patients presented with complications such as hyperglycemia, hypoglycemia, hyperkalemia, hypokalemia, hypotension, hypertension, tachycardia and bradycardia. Conclusions:Intravenous infusion of dexmedetomidine before induction of anesthesia exerts no marked effect on blood potassium concentrations and can increase glucose concentrations to a certain extent, but the elevation has no clinical significance in the patients with gastrointestinal tumors.
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OBJECTIVE To investigate the risk factors for hypokalemia caused by amphotericin B liposome, and to provide reference for clinical use of drugs. METHODS A retrospective analysis was used to collect the information of patients who used amphotericin B liposome during the hospitalization in First Affiliated Hospital of Hainan Medical College from January 2012 to December 2021. The details of use information about amphotericin B liposome and the potassium supplementation were collected. The patients were divided into hypokalemia group and normal group according to the occurrence of hypokalemia. Univariate and multi-variate Logistic regression analyses were used to analyze the risk factors for hypokalemia induced by amphotericin B liposome. RESULTS Of the 121 patients included in this analysis, 60 patients were in hypokalemia group, 61 patients were in normal group. The following parameters of the hypokalemic group were significantly higher or longer than those of the normal group, such as the maintenance dose, cumulative dose and maximum daily dose (in patients with severe hypokalemia) of amphotericin B liposome, treatment days, the maintained days of hypokalemia, daily dose of potassium supplement (in patients with moderate or severe hypokalemia), the duration of potassium supplement (in patients with moderate hypokalemia). Results of single factor analysis showed that the cumulative dose of amphotericin B liposome ≥200 mg and the duration of treatment ≥5 days were independent risk factors of hypokalemia caused by this drug (P<0.05). Multi-variate analysis results showed that the presence of basic hypokalemia, body weight <50 kg, cumulative dose of amphotericin B liposome ≥200 mg and the duration of treatment ≥5 days were the independent risk factors for hypokalemia caused by amphotericin B liposome (P<0.05). CONCLUSIONS The incidence of hypokalemia caused by amphotericin B liposome is high, the independent risk factors for hypokalemia include cumulative dose ≥200 mg, treatment days ≥5 days, the presence of basic hypokalemia and body weight < 50 kg. It is suggested that serum potassium should be elevated to normal level before amphotericin B liposome treatment, and the level of serum potassium should be monitored during medication to reduce the occurrence of hypokalemia.
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Objective:To investigate changes in arterial acid-base and electrolytes after repeated episodes of ventricular fibrillation (VF) and defibrillation in a swine model.Methods:Sixteen Peking white swine, weighting (32±2.5) kg, were placed with temporary pacemaker electrodes via the left femoral vein into the right ventricle after anesthesia. Then VF was electrically induced by using a programmed electrical stimulation instrument. An arterial cannula was inserted into the left femoral artery to measure mean arterial blood pressure and cardiac output using a PiCCO monitor, with blood samples collected. The pigs were randomly divided into two group: the manual defibrillation group (MD, n=8) and the automated external defibrillation group (AED, n=8). The first defibrillation was attempted with the manufacturer’s dose (150 J) for 15 s after the successful induction of VF in the MD group. If spontaneous circulation was not recovered, 2-min chest compression and subsequent defibrillation (200 J) were attempted. For the AED group, the defibrillation was delivered following voice prompts of the AED. After the return of spontaneous circulation, the pig was allowed to stabilize for 30 min, followed by the induction of the next episode of VF. The above process was repeated five times. Arterial blood gas, cardiac biomarkers, and hemodynamic variables were measured at 30 min after the return of spontaneous circulation. Results:All pigs were successfully induced VF five times and defibrillated successfully. There were no significant changes in heart rate and mean arterial blood pressure between the two groups after repeated episodes of VF and defibrillation. Compared with baseline measurements, cardiac output tended to decrease after repeated episodes of VF and defibrillation but was not statistically significant (all P>0.05). There were no significant differences in arterial pH, HCO 3-, sodium, and lactic acid in the two groups between each measurement time point and baseline values after repeated VF (all P>0.05), but potassium levels in the two groups decreased with time, and the difference was statistically significant compared with the baseline measurement (all P<0.05). There were no significant differences in myoglobin, creatine kinase isoenzyme-MB, and cardiac troponin I for the two groups compared with baseline values after repeated episodes of VF and defibrillation or various episodes of VF between the two groups (all P > 0.05). Conclusions:Repeated episodes of VF and defibrillation have no significant effect on pH balance, but significantly decrease blood potassium. Clinical approaches (MD vs. AED) do not affect defibrillation effect, with no significant differences in hemodynamic variables and myocardial injuries.
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Objective:To explore the clinical characteristics and genetics of a Chinese patient with Gitelman syndrome (GS) and improve the awareness and diagnosis of GS among clinicians.Methods:Retrospectively analyzed the GS patient's clinical feature, laboratory examination, diagnosis, treatment and literature review admitted to Hebei General Hospital in September 2022.Results:A twelve-year-old boy was admitted to our department due to weakness of lower limbs. Laboratory tests after admission showed hypokalemia, hypomagnesemia, hypocalcemia and metabolic alkalosis. Genetic testing showed tow compound heterozygous mutations in the SLC12A3 gene (c.1456G>A and c.634G>A), which ultimately diagnosed as GS. The patient is on the mend and allowed to leave the hospital after treated by potassium supplement.Conclusion:The rate of leak diagnosis is high. Genetic testing should be undergo earlier if the patients suspected GS.
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A 10-year follow-up case of aldosterone and cortisol-secreting adrenocortical carcinoma, a rare disease presenting as an adrenal space-occupying lesion accompanied with hypertension and hypokalemia was reported, and the medical record was investigated in detail. Through case presentation and literature review, it was noted that patients with adrenocortical carcinoma presented a difference in clinical manifestations, pathology, and biological behaviors. This paper may help clinicians enhance their understanding of adrenocortical carcinoma. Especially significant adrenal space-occupying lesions highly suspicious of recurrence and producing different types of endocrine hormones should be paid more attention.
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@#Abstract: Bartter syndrome (BS) is a kind of inherited metabolic disease characterized by electrolyte and endocrine disorder, resulting from genetic gene mutation or deletion. Clinically, it manifests as vomiting, constipation, feeding difficulties, weight loss, growth retardation. The laboratory examination shows hypokalemia, metabolic alkalosis, hyperreninemia, aldosteronism, etc. As an autosomal recessive genetic disease, BS has an extremely low incidence rate, making diagnosis and treatment quite challenging. In recent years, with the progress of gene detection and other technologies, China has made great progress in the study of BS, more and more BS has been diagnosed accurately. According to known gene mutation types, it can be divided into type 1, type 2, type 3, type 4, type 5 and Gitelman syndrome, a total of 6 types, with type 4 further divided into type 4a and type 4b. At present, the most common type of children with BS in clinical practice is type 3, which is the classic type of BS. This paper reports a case of Bartter syndrome type 4b (BS4b). After two rounds of three-generation family gene sequencing, it was discovered that the infant had a combined mutation of both the CLCNKA and CLCNKB alleles, in addition to Alport syndrome, and both parents were carriers of this type of gene defect. The child was finally diagnosed as BS4b and Alport syndrome. This report, combined with the patient's clinical features, diagnosis and treatment process, as well as related literature analysis, aims to provide experience for understanding and diagnosis and treatment of this disease.
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La Parálisis Periódica Hipopotasémica Tirotóxica (PPHT) es una complicación rara del hipertiroidismo. Se presenta el caso de un paciente de 50 años sin historia previa de enfermedades crónicas, que presentó episodios recurrentes de debilidad y cuadriparesia, con normopotasemia y sin síntomas evidentes de hipertiroidismo, lo que retrasó el diagnóstico de parálisis periódica tirotóxica, hasta la presentación franca de hipopotasemia.
Thyrotoxic Hypokalemic Periodic paralysis (PPHT) is a rare complication of hyperthyroidism. The case of a 50-year-old patient with no previous history of chronic diseases is presented, who presented recurrent episodes of weakness and quadriparesis, with normokalemia and without obvious symptoms of hyperthyroidism, which delayed the diagnosis of thyrotoxic periodic paralysis, until the frank presentation of hypokalemia.
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Resumen ANTECEDENTES: La rabdomiólisis es un síndrome causado por una lesión en las fibras musculares que produce la liberación de componentes intracelulares (mioglobina, creatinfosfocinasa, aldolasa y lactato deshidrogenasa; electrolitos) hacia el espacio extracelular y la circulación sanguínea, lo que resulta en complicaciones graves (alteraciones cardiovasculares, edema cerebral y muerte). Existen pocos casos reportados de rabdomiólisis durante el embarazo, los informes descritos en la bibliografía se enfocan en infecciones y alteraciones hidroelectrolíticas. CASO CLÍNICO: Paciente de 28 años, primigesta, que inició con alteraciones musculares luego de un cuadro infeccioso, en la semana 18 del embarazo, por lo que se le practicaron estudios para encontrar la causa del desequilibrio hidroelectrolítico (determinación de hipocalemia), con elevación súbita de creatinfosfocinasa. El urocultivo resultó positivo a Escherichia coli. El tratamiento consistió en reposición hidroelectrolítica, con administración de potasio ajustado a los requerimientos de la paciente, antibiótico y aporte nutricional, con alta hospitalaria a los dos días. Continuó en control prenatal y en la semana 32.2 tuvo preeclampsia, por lo que se decidió efectuar cesárea, de la que se obtuvo un recién nacido masculino, de 2395 g, Apgar 9/9, con evolución satisfactoria de la madre y su hijo. CONCLUSIONES: El embarazo es un estado fisiológico que implica mayor susceptibilidad de infecciones o complicaciones asociadas con desequilibrio hidroelectrolítico. Es importante considerar la rabdomiólisis durante el embarazo; el diagnóstico se establece mediante examen clínico y estudios de laboratorio.
Abstract BACKGROUND: Rhabdomyolysis is a syndrome, caused by injury to the muscle fiber, which produces the release of intracellular components such as myoglobin, creatine kinase, aldolase and lactate dehydrogenase, electrolytes, into the extracellular space and blood circulation, which can cause serious complications. such as cardiovascular disorders, cerebral edema and death. There are few reported cases of rhabdomyolysis in pregnancy, the reports described in the literature have been associated with infections and hydroelectrolytic changes. The clinical case is presented due to the importance of the repercussion to the maternal-fetal binomial, since it can result in a serious outcome. CLINICAL CASE: The case of a primiparous pregnant patient is presented, who debuted with clinical symptoms accompanied by muscular alterations after an infection, in week 18 of gestation, for which a study protocol was requested with the finding of hydroelectrolyte imbalance, of the hypokalemia type, with sudden elevation of creatine phosphokinase. A positive urine culture for Escherichia coli was found. Management with hydroelectrolyte replacement was indicated, with potassium replacement adjusted to requirements, antibiotic, and nutritional contribution, with hospital discharge after 2 days. Prenatal control was continued and at week 32.2 she presented preeclampsia, which is why a cesarean section was decided, a male weighing 2395 g, Apgar 9/9, with satisfactory evolution of the binomial was obtained. CONCLUSIONS: Pregnancy is more susceptible to infections or complications associated with hydroelectrolyte imbalances, rhabdomyolysis can occur in pregnancy, and it is important not to rule it out, its diagnosis can be made clinically and through laboratory tests.
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Se describe el caso de un varón de 68 años con antecedente de hipertensión arterial no tratada, diagnosticada un año antes, que ingresó con un cuadro de anasarca, debilidad muscular y disnea al reposo. Los primeros exámenes realizados mostraron hipopotasemia severa, alcalosis metabólica, litiasis renal y vesical y enfermedad renal crónica. La tomografía abdominal reveló una tumoración suprarrenal derecha, hidronefrosis bilateral y litiasis renal y vesical. Con la sospecha de hiperaldosteronismo primario se completó el estudio, con la determinación de relación aldosterona/concentración de renina directa, que resultó alta. El estudio metabólico arrojó hipercalciuria e hiperuricosuria y la gradiente transtubular de potasio mayor de 7. El paciente fue sometido a tratamiento quirúrgico con nefrectomía derecha, sin embargo, falleció en el postoperatorio inmediato, por shock hipovolémico e insuficiencia respiratoria.
SUMMARY We report the case of a 68-year-old male with a history of non-treated arterial hypertension diagnosed the previous year that was admitted with anasarca, muscle weakness and dyspnea at rest. The first laboratory exams showed severe hypopotassemia, metabolic alkalosis, renal and gallbladder lithiasis and chronic renal disease. The abdominal tomography revealed a right suprarenal tumor, bilateral hydronephrosis and renal and gallbladder lithiasis. Under the suspicion of primary hyperaldosteronism, the diagnosis was confirmed with the determination of the relationship between aldosterone/direct renin concentration, which was high. The metabolic study showed hypercalciuria and hyperuricosuria and the potassium trans tubular gradient was above 7. The patient underwent right nephrectomy, nonetheless, died at the immediate post-operatory period due to a hypovolemic shock and respiratory failure.
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Hypokalemia is a common electrolyte disturbance in hospitalized patients, which prompts appropriate identification of hypokalemia symptoms and signs. As many as 20% of hospitalized patients are found to have hypokalemia. Many hypokalemia patients could also have systemic disease.A 55-year-old woman was presented with weakness, nausea, and vomiting for 2 days before admission. Vomit consisted of water; there was no bloodin the vomit. Defecation was normal; consistency and odor of feces were normal. Patient had diabetes and was already on insulin regiment. Insulin was discontinued during hospitalization since blood sugar was close to lower limit. Electrocardiography (ECG)was within normal limit.Symptoms and signs of hypokalemia may not be readily apparent, as seen in this case. Treatment of hypokalemia should intend not to only replenish potassium, but also to identify underlying cause. Causes include gastrointestinal losses, intracellular shift, renal potassium losses, and inadequate intake.
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Resumen La hipertensión arterial secundaria es poco frecuente y está asociada con una causa que puede ser tratable, por lo cual su diagnóstico y tratamiento oportuno son importantes. La orientación diagnóstica se hace con base en los datos obtenidos en la anamnesis y examen físico del paciente buscando posibles etiologías. Se presenta el caso de un hombre de 63 años, con hipertensión arterial resistente, sin otra sintomatología ni antecedentes personales o familiares. Se realizaron estudios iniciales que documentaron hipopotasemia, lo que hizo sospechar hiperaldosteronismo primario, se solicitaron pruebas complementarias con aldosterona plasmática elevada, actividad de la renina plasmática baja, además con imagen diagnóstica por resonancia nuclear magnética que mostró nódulo suprarrenal derecho. Se considero llevar a adrenalectomía derecha, con reporte de patología compatible con adenoma cortical adrenal. Durante el seguimiento en atención primaria presento adecuado control en cifras de presión arterial con disminución del número de medicamentos antihipertensivos requeridos.
Abstract Secondary arterial hypertension is rare, it is associated with a cause that can be treatable, for which its diagnosis and treatment are not important.The diagnostic orientation is made based on the data obtained in the anamnesis and physical examination of the patient, looking for possible etiologies.We present the case of a 63-year-old man with resistant hypertension, without other symptoms or personal or family history. Initial studies were performed that documented hypokalemia, which led to the suspicion of primary hyperaldosteronism. Complementary tests were requested with high plasma aldosterone, low plasma renin activity, in addition to a diagnostic magnetic resonance imaging that showed an adrenal nodule. A right adrenalectomy was considered, with a report of pathology compatible with adrenal cortical adenoma.During the follow-up in primary care, patient presented adequate control in blood pressure figures with a decrease in the number of antihypertensive drugs required.
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Humanos , Pessoa de Meia-IdadeRESUMO
Thyrotoxic periodic paralysis (TPP) is a rare disease of muscle, presenting with sudden onset weakness of muscles with or without features of hyperthyroidism. The disease most commonly occurs in the Asian population representing about 1.9% of thyrotoxic patients. It involves a predominantly male population with no family history, with or without hypokalemia. Pathophysiology is still not clearly understood. We are describing, a case series of two different patients of TPP presented to our emergency department (ED). One patient presented with classical episodic weakness of both lower limbs specifically during the night times with spontaneous reversal of weakness early in the morning. Another patient presented with complete weakness of both lower limbs for the past 1 day. Both of them had a history of weight loss and intermittent palpitations. They were promptly diagnosed in the ED and successfully treated. We recommend evaluating thyroid function status in the emergency room with the aforementioned clinical features, as early recognition and correction of thyrotoxic state are the definitive treatment helping in a complete reversal of weakness. Potassium supplements, beta-blockers, and antithyroid medications are used in treating acute attacks and preventing recurrence
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Hypokalemia leading to Rhabdomyolysis is a potentially fatal disorder if not identified and treated early. In this case report we present a patient who had one week history of asymmetric painful Quadriparesis with neck drop and preserved reflexes. Evaluation revealed Hypokalemia with raised creatine.