Daptomycin-Induced Severe Hyperkalemia With Normal Creatine Kinase in a Patient With Methicillin-Resistant Staphylococcus aureus Osteomyelitis.

We report a case of an asymptomatic 60-year-old female who presented to the emergency department due to a home health measured serum potassium of 7.7 mmol/L (normal range: 3.6-5.0 mmol/L) and was admitted for severe hyperkalemia. She was recently started on a low dose of daily intravenous daptomycin to treat methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis of her sacral decubitus ulcers. Laboratory results showed normal creatine kinase (CK). Her elevated serum potassium levels reversed throughout her hospital stay and remained within normal range after daptomycin discontinuation, establishing a temporal relationship between daptomycin and hyperkalemia. To our knowledge, no other cases report daptomycin-induced severe hyperkalemia in the absence of rhabdomyolysis. Our case emphasizes the importance of considering hyperkalemia as an adverse effect of daptomycin, especially in elderly hospitalized patients.

Halotherapy for Chronic Respiratory Disorders: From the Cave to the Clinical.

CONTEXT: Halotherapy (HT) is a form of speleotherapy, a respiratory therapy involving breathing inside a cave, and its therapeutic environment is similar to that of a natural salt cave. Natural crystallized salt is inhaled via aerosols or from the environment directly to enhance breathing and respiratory health-related quality of life (HRQoL). Clinicians need to be aware of its potential benefits, with relatively few or no adverse effects and consider its use an adjuvant therapy for standard care. OBJECTIVE: The current review intended to compile the existing literature on HT's use in various chronic respiratory diseases. It examines the use of dry salt inhalers; the use of saline nebulizer therapy is already well established in the literature. DESIGN: The research team performed a literature review to identify all articles published in the English language between January 1980 and December 2018 that used HT or heliotherapy and speleotherapy in the title. Pseudonyms such as salt cave therapy and salt mine therapy were also included. The source of data was the National Library of Medicine's MEDLINE/PubMed. SETTING: Literature search took primarily from the main campus of Brookdale University Hospital Medical Center and the Touro College of Osteopathic Medicine. RESULTS: Literature search and review yielded a total of 13 manuscripts that were completely assessed and incorporated into this review. Overwhelmingly studies comparing various methods of halotherapy showed improvement in various pulmonary function measures including forced expiratory volume in one second, forced vital capacity and peak expiratory flow. Other measures were also seen to improve such as HRQoL as assessed by questionnaires. CONCLUSIONS: HT has been found to have a positive effect on patients suffering from chronic respiratory diseases, improving mucociliary elimination and lung function in common chronic respiratory diseases and also HRQoL. Currently, no official guidelines exist on the use of HT in the form of salt rooms (halo chambers) or dry powder inhalers, but evidence exists for its use as a possible adjuvant therapy. More structured research in the form of randomized clinical trials is required.

A Rare Case of Advanced Urethral Diverticular Adenocarcinoma and a Review of Treatment Modalities.

Female urethral diverticular cancer is a very rare entity with only around 100 cases reported so far in literature and accounts for <1% of all malignancies. In this article, we present a 47-year-old African American female with repeated hospital visits for urinary retention, hematuria, and urinary tract infections. Initial computed tomography imaging and cystoscopy was unremarkable except for a distended urinary bladder. Subsequent magnetic resonance imaging and corresponding cystoscopy eventually indicated the presence of a urethral diverticulum. She underwent urethral diverticulectomy and was found to have a mass arising from urethral diverticulum extending to vaginal walls. Her biopsy was suggestive of invasive adenocarcinoma in advanced stages, for which she subsequently underwent a total pelvic exenteration. Next-generation sequencing of the tumor showed CDKN2A/B loss, MSI-stable, and low TMB, thereby ruling out the options for targeted therapies. Extensive literature search and expert opinions were sought for her case since no consensus exists regarding the optimal therapeutic approach due to the rarity of this tumor. A final decision was made to treat her with platinum-based chemotherapy. Different treatment approaches including neoadjuvant chemoradiation followed by surgery, surgery followed by adjuvant chemotherapy, and surgery followed by chemoradiation have been tried. Platinum-based chemotherapy has generally been preferred based on an extensive literature search. Multimodality treatment approach seems to be the current approach to management for advanced stages for better overall survival. This case illustrates the challenges faced in making diagnosis and treatment decisions due to the rarity of this type of tumor and lack of consensus in the treatment approach.