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Napiórkowska-Baran K, Treichel P, Czarnowska M, Drozd M, Koperska K, Węglarz A, Schmidt O, Darwish S, Szymczak B, Bartuzi Z. Immunomodulation through Nutrition Should Be a Key Trend in Type 2 Diabetes Treatment. Int J Mol Sci 2024; 25:3769. [PMID: 38612580 PMCID: PMC11011461 DOI: 10.3390/ijms25073769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
An organism's ability to function properly depends not solely on its diet but also on the intake of nutrients and non-nutritive bioactive compounds that exert immunomodulatory effects. This principle applies both to healthy individuals and, in particular, to those with concomitant chronic conditions, such as type 2 diabetes. However, the current food industry and the widespread use of highly processed foods often lead to nutritional deficiencies. Numerous studies have confirmed the occurrence of immune system dysfunction in patients with type 2 diabetes. This article elucidates the impact of specific nutrients on the immune system function, which maintains homeostasis of the organism, with a particular emphasis on type 2 diabetes. The role of macronutrients, micronutrients, vitamins, and selected substances, such as omega-3 fatty acids, coenzyme Q10, and alpha-lipoic acid, was taken into consideration, which outlined the minimum range of tests that ought to be performed on patients in order to either directly or indirectly determine the severity of malnutrition in this group of patients.
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Affiliation(s)
- Katarzyna Napiórkowska-Baran
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland;
| | - Paweł Treichel
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (P.T.); (M.C.); (M.D.); (K.K.); (A.W.); (O.S.); (S.D.); (B.S.)
| | - Marta Czarnowska
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (P.T.); (M.C.); (M.D.); (K.K.); (A.W.); (O.S.); (S.D.); (B.S.)
| | - Magdalena Drozd
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (P.T.); (M.C.); (M.D.); (K.K.); (A.W.); (O.S.); (S.D.); (B.S.)
| | - Kinga Koperska
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (P.T.); (M.C.); (M.D.); (K.K.); (A.W.); (O.S.); (S.D.); (B.S.)
| | - Agata Węglarz
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (P.T.); (M.C.); (M.D.); (K.K.); (A.W.); (O.S.); (S.D.); (B.S.)
| | - Oskar Schmidt
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (P.T.); (M.C.); (M.D.); (K.K.); (A.W.); (O.S.); (S.D.); (B.S.)
| | - Samira Darwish
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (P.T.); (M.C.); (M.D.); (K.K.); (A.W.); (O.S.); (S.D.); (B.S.)
| | - Bartłomiej Szymczak
- Student Research Club of Clinical Immunology, Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland; (P.T.); (M.C.); (M.D.); (K.K.); (A.W.); (O.S.); (S.D.); (B.S.)
| | - Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Toruń, 85-067 Bydgoszcz, Poland;
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Bosch NA, Vail EA, Law AC, Homer-Bouthiette C, Walkey AJ, Moitra VK. Practice Patterns and Outcomes of Potassium Repletion Thresholds during Critical Illness. Ann Am Thorac Soc 2024; 21:456-463. [PMID: 38134433 PMCID: PMC10913769 DOI: 10.1513/annalsats.202308-750oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023] Open
Abstract
Rationale: Potassium repletion is common in critically ill patients. However, practice patterns and outcomes related to different intensive care unit (ICU) potassium repletion strategies are unclear. Objectives: 1) Describe potassium repletion practices in critically ill adults; 2) compare the effectiveness of potassium repletion strategies; and 3) compare effectiveness and safety of specific potassium repletion thresholds on patient outcomes. Methods: This was a retrospective analysis of the PINC AI Healthcare Database (2016-2022), including all critically ill adults admitted to an ICU on Hospital Day 1 and with a serum potassium concentration measured on Hospital Day 2. We determined the frequency of potassium repletion (any formulation) at each measured serum potassium concentration in each ICU, then classified ICUs as having threshold-based (a large increase in potassium repletion rates at a specific serum potassium concentration) or probabilistic (linear relationship between serum concentration and the repletion probability) patterns of repletion. Between patients in threshold-based and probabilistic repletion ICUs, we compared outcomes (primary outcome: potassium repletion frequency). We reported unadjusted percentages per exposure group and the adjusted odds ratios (from hierarchical regression models) for each outcome. Among patients in threshold-based ICUs with the most common repletion thresholds (3.5 mEq/L and 4.0 mEq/L), we conducted regression discontinuity analyses to examine the effectiveness of potassium repletion at each potassium threshold. Results: We included 190,490 patients in 88 ICUs; 35.0% received at least one dose of potassium on the same calendar day. Rates of potassium repletion were similar between 22 threshold-based strategy ICUs (33.5%) and 22 probabilistic strategy ICUs (36.4%). There was no difference in the adjusted risk of potassium repletion between patients admitted to threshold-based strategy ICUs versus probabilistic strategy ICUs (adjusted odds ratio, 1.09; 95% confidence interval [CI], 0.76-1.57). In regression discontinuity analysis, crossing the 3.5 mEq/L threshold from high to low potassium levels resulted in a 39.1% (95% CI, 23.7-42.4) absolute increase in potassium repletion but no change in other outcomes. Similarly, crossing the 4.0 mEq/L threshold resulted in a 36.4% (95% CI, 22.4-42.2) absolute increase in potassium repletion but no change in other outcomes. Conclusions: Potassium repletion is common in critically ill patients and occurs over a narrow range of "normal" potassium levels (3.5-4.0 mEq/L); use of a threshold-based repletion strategy to guide potassium repletion in ICU patients is not associated with clinically meaningful differences in outcomes.
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Affiliation(s)
- Nicholas A. Bosch
- Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Emily A. Vail
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Penn Center for Perioperative Outcomes Research and Transformation, Philadelphia, Pennsylvania; and
| | - Anica C. Law
- Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Collin Homer-Bouthiette
- Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Allan J. Walkey
- Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Vivek K. Moitra
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Liu B, Huang C, Pan Y, Yao J. An unusual cause of hypokalaemia. BMJ 2024; 384:e077724. [PMID: 38331452 DOI: 10.1136/bmj-2023-077724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Bo Liu
- Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, China
| | - Cao Huang
- Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, China
| | - Yunfei Pan
- Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, China
| | - Jianping Yao
- Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, China
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Hsu SY, Rau CS, Tsai CH, Chou SE, Su WT, Hsieh CH. The Influence of Hyponatremia and Hypokalemia on the Risk of Fractures in Various Anatomical Regions among Adult Trauma Patients: A Propensity Score-Matched Analysis. Diagnostics (Basel) 2024; 14:355. [PMID: 38396394 PMCID: PMC10888465 DOI: 10.3390/diagnostics14040355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Hyponatremia and hypokalemia are common electrolyte imbalances in trauma patients and have been identified to be risk factors for a fall. In addition, hyponatremia was reported to be related to osteoporosis and fragility fractures, while the association between hypokalemia and osteoporosis has only been reported in rare case reports. This study investigated the impact of hyponatremia and hypokalemia on the incidence of fractures in various body regions of adult trauma patients, using the propensity score-matched patient cohort to reduce the influence of patients' baseline characteristics. METHODS The study analyzed data from 11,173 hospitalized adult trauma patients treated from 1 January 1998, to 31 December 2022. The study included 1968 patients with hyponatremia and 9205 without, and 1986 with hypokalemia and 9187 without. Different 1:1 propensity score-matched cohorts were generated to create the 1903 pairings of patients with or without hyponatremia, 1977 pairings of patients with or without hypokalemia, and 380 pairing of patients with both hyponatremia and hypokalemia vs. normal control patients. Analysis was conducted on the incidence of fracture in various anatomic regions. RESULTS Hyponatremic patients had increased odds of thoracic vertebral fracture [odds ratio (95% confidence interval) 1.63 (1.10-2.42), p = 0.014], pelvic fracture [2.29 (1.12-4.67), p = 0.019], and femoral fracture [1.28 (1.13-1.45), p < 0.001] but decreased odds of radial and patella fractures. Hypokalemic patients showed no significant differences in fracture risk except for a decreased likelihood of radial fractures. The patients with both hyponatremia and hypokalemia showed a decreased likelihood of radial fractures and patella fractures. CONCLUSION Hyponatremia may have a greater impact on the occurrence of bone fractures than hypokalemia in trauma patients who have suffered a fall. Electrolyte abnormalities should be taken into account while assessing the risk of fractures in trauma patients.
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Affiliation(s)
- Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (C.-H.T.); (S.-E.C.); (W.-T.S.)
| | - Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (C.-H.T.); (S.-E.C.); (W.-T.S.)
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (C.-H.T.); (S.-E.C.); (W.-T.S.)
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (C.-H.T.); (S.-E.C.); (W.-T.S.)
| | - Ching-Hua Hsieh
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (S.-Y.H.); (C.-H.T.); (S.-E.C.); (W.-T.S.)
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Bhargava J, Viswanathan S. Incidence, Risk Factors and Prognosis of Hypokalaemia in Patients with Normokalaemia at Hospital Admission. Indian J Endocrinol Metab 2023; 27:537-543. [PMID: 38371186 PMCID: PMC10871015 DOI: 10.4103/ijem.ijem_159_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/11/2023] [Accepted: 06/25/2023] [Indexed: 02/20/2024] Open
Abstract
Background Hypokalaemia (K+<3.5 mmol/L) is observed in 20% of hospitalised patients. Previous studies have often dealt with the symptoms, prevalence and risk factors in hospitalised patients. Very few studies have dealt with hospital-induced hypokalaemia. The aim was to determine the incidence, predisposing risk factors and prognosis of patients developing hypokalaemia after admission. Materials and Methods A prospective observational study was performed for two months. Patients with at least two potassium values after admission and normal K values at admission were considered for inclusion. Clinical features, diagnoses, laboratory reports and treatment details, including antibiotics, were noted. Results A total of 653 patients were studied; 138 (21.1%) developed hypokalaemia. Diabetes, ischaemic heart disease (IHD), heart failure, chronic kidney disease, hypertension, chronic liver disease and chronic obstructive pulmonary disease (COPD) were the most associated comorbidities. Urea, creatinine, transaminases and neutrophilia at admission differed significantly between those with and without hypokalaemia groups. Most patients developed mild hypokalaemia (78.2%). Hypokalaemia developed mostly on the second (22.4%) and third (24.6%) days of hospitalisation. Antibiotics were used in 60% of patients. The potassium values returned to normal within 2.5 ± 1.9 days. Three patients subsequently developed hyperkalaemia. Conclusion Patients admitted under general medicine mostly developed mild hypokalaemia, even if they had multiple risk factors for developing hypokalaemia. Inpatient hypokalaemia had an incidence of 21%. An overwhelming majority (~88%) had at least one risk factor. Hypokalaemia was not attributed to causing mortality in any patient.
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Affiliation(s)
- Jakka Bhargava
- Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Pondicherry, India
| | - Stalin Viswanathan
- Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Pondicherry, India
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Jomova K, Makova M, Alomar SY, Alwasel SH, Nepovimova E, Kuca K, Rhodes CJ, Valko M. Essential metals in health and disease. Chem Biol Interact 2022; 367:110173. [PMID: 36152810 DOI: 10.1016/j.cbi.2022.110173] [Citation(s) in RCA: 195] [Impact Index Per Article: 97.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/10/2022] [Accepted: 09/05/2022] [Indexed: 11/03/2022]
Abstract
In total, twenty elements appear to be essential for the correct functioning of the human body, half of which are metals and half are non-metals. Among those metals that are currently considered to be essential for normal biological functioning are four main group elements, sodium (Na), potassium (K), magnesium (Mg), and calcium (Ca), and six d-block transition metal elements, manganese (Mn), iron (Fe), cobalt (Co), copper (Cu), zinc (Zn) and molybdenum (Mo). Cells have developed various metallo-regulatory mechanisms for maintaining a necessary homeostasis of metal-ions for diverse cellular processes, most importantly in the central nervous system. Since redox active transition metals (for example Fe and Cu) may participate in electron transfer reactions, their homeostasis must be carefully controlled. The catalytic behaviour of redox metals which have escaped control, e.g. via the Fenton reaction, results in the formation of reactive hydroxyl radicals, which may cause damage to DNA, proteins and membranes. Transition metals are integral parts of the active centers of numerous enzymes (e.g. Cu,Zn-SOD, Mn-SOD, Catalase) which catalyze chemical reactions at physiologically compatible rates. Either a deficiency, or an excess of essential metals may result in various disease states arising in an organism. Some typical ailments that are characterized by a disturbed homeostasis of redox active metals include neurological disorders (Alzheimer's, Parkinson's and Huntington's disorders), mental health problems, cardiovascular diseases, cancer, and diabetes. To comprehend more deeply the mechanisms by which essential metals, acting either alone or in combination, and/or through their interaction with non-essential metals (e.g. chromium) function in biological systems will require the application of a broader, more interdisciplinary approach than has mainly been used so far. It is clear that a stronger cooperation between bioinorganic chemists and biophysicists - who have already achieved great success in understanding the structure and role of metalloenzymes in living systems - with biologists, will access new avenues of research in the systems biology of metal ions. With this in mind, the present paper reviews selected chemical and biological aspects of metal ions and their possible interactions in living systems under normal and pathological conditions.
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Affiliation(s)
- Klaudia Jomova
- Department of Chemistry, Faculty of Natural Sciences and Informatics, Constantine The Philosopher University in Nitra, 949 01, Nitra, Slovakia
| | - Marianna Makova
- Faculty of Chemical and Food Technology, Slovak University of Technology in Bratislava, 812 37, Bratislava, Slovakia
| | - Suliman Y Alomar
- King Saud University, Zoology Department, College of Science, Riyadh, 11451, Saudi Arabia
| | - Saleh H Alwasel
- King Saud University, Zoology Department, College of Science, Riyadh, 11451, Saudi Arabia
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Kamil Kuca
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic; Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Marian Valko
- Faculty of Chemical and Food Technology, Slovak University of Technology in Bratislava, 812 37, Bratislava, Slovakia; King Saud University, Zoology Department, College of Science, Riyadh, 11451, Saudi Arabia.
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Blanton R, Afzal S. Hypokalemic Periodic Paralysis Exacerbated by Carbohydrate Load: A Case Report. Cureus 2022; 14:e28851. [PMID: 36225513 PMCID: PMC9536358 DOI: 10.7759/cureus.28851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
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Jones SE, Quimby JM, Summers SC, Adams SM, Caney SMA, Rudinsky AJ. Survey of defecation habits in apparently healthy and chronic kidney disease cats. J Feline Med Surg 2022; 24:131-141. [PMID: 34013812 PMCID: PMC10812175 DOI: 10.1177/1098612x211012684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Changes in bowel movements (BMs) are an important clinical sign in many diseases, including chronic kidney disease (CKD), and the purpose of this study was to collect information on BMs and fecal scores in both apparently healthy and CKD cats. A secondary aim was to assess owner awareness of BM frequency. METHODS Owners were asked to complete an initial online questionnaire about their cat's health and litter box habits (including predicted BM frequency and fecal scores) and were then asked to clean the box daily for 7 days and report results (observed frequency of BMs and fecal scores) daily. Differences in BM frequency and fecal scores between apparently normal and CKD cats were compared using the Mann-Whitney test, and predicted vs observed data were compared using the Wilcoxon signed rank test. Difference in percentage of cats defecating more or less than once daily were assessed with Fisher's exact test. RESULTS Survey data from 124 owners of apparently healthy cats and 43 owners of CKD cats who submitted two or more days of daily observations (in addition to the initial questionnaire) were analyzed. Eighty-five percent of apparently healthy cats were observed to defecate one or more times per day and 15% defecated less than once per day. Fifty-eight percent of CKD cats defecated one or more times per day and 42% defecated less than once per day. A significantly higher percentage of CKD cats defecated less than once per day in comparison with apparently healthy cats (P <0.0001). Observed BM frequency was significantly less in CKD cats compared with healthy cats (P = 0.02). Observed fecal scores were not significantly different between healthy and CKD cats. CONCLUSIONS AND RELEVANCE The observed BM frequency of cats with CKD was less than apparently healthy cats and represents a clinically important variation from normal.
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Affiliation(s)
- Sarah E Jones
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Jessica M Quimby
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Stacie C Summers
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
| | - Sierra M Adams
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Sarah MA Caney
- Vet Professionals Ltd, Midlothian Innovation Centre, Edinburgh, UK
| | - Adam J Rudinsky
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
- Comparative Hepatobiliary and Intestinal Research Program (CHIRP), College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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Li Y, Xu R, Cao CS, Huang L. The successful use of extracorporeal membrane oxygenation combined with continuous renal replacement therapy for a cardiac arrest patient with refractory hypokalemia and diabetic ketoacidosis. World J Emerg Med 2022; 13:337-340. [PMID: 35837568 PMCID: PMC9233963 DOI: 10.5847/wjem.j.1920-8642.2022.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/12/2022] [Indexed: 12/10/2023] Open
Affiliation(s)
- Yang Li
- Department of Emergency Medicine, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Rui Xu
- Department of Emergency Medicine, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Chun-Shui Cao
- Department of Emergency Medicine, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Liang Huang
- Department of Emergency Medicine, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
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Chen YW, Yang M, Wang MX, Jiang JH, Jiang DY, Chen ZL, Yang L. Refractory hypokalemia caused by cetuximab with advanced colorectal cancer patients: the case series and literature review. Anticancer Drugs 2022; 33:e789-e794. [PMID: 34419963 PMCID: PMC8670339 DOI: 10.1097/cad.0000000000001212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/19/2021] [Indexed: 01/20/2023]
Abstract
Cetuximab is the first-line treatment for advanced metastatic colon cancer. But cetuximab can cause electrolyte disturbances, including hypomagnesemia and hypokalemia. Among them, hypokalemia is often caused by hypomagnesemia, not directly caused by cetuximab. This article reports two cases of refractory hypokalemia caused by cetuximab without hypomagnesemia. The two patients had no abnormalities in serum potassium before cetuximab treatment. The occurrence of hypokalemia was clearly correlated with the cetuximab, and they were significantly improved after stopping or reducing the dose. At the same time, the appearance of hypokalemia is significantly related to the efficacy of cetuximab. They have received 37 and 35 cycles of cetuximab-related therapy, with condition stable periods of 12.8 and 15.1 months, respectively. Obviously, our report refutes the above view. In our opinion, hypokalemia, a side effect of cetuximab, may be directly caused by it, rather than secondary to hypomagnesemia. Similar to hypomagnesemia, the appearance of hypokalemia often indicates a better curative effect of cetuximab.
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Affiliation(s)
- Yun-Wang Chen
- The Qingdao University Medical College, Qingdao, Shandong
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang
| | - Min Yang
- The Qingdao University Medical College, Qingdao, Shandong
| | - Ming-Xing Wang
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang
- Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, Anhui Province, China
| | - Jia-Hong Jiang
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang
| | - Ding-Yi Jiang
- The Qingdao University Medical College, Qingdao, Shandong
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang
| | - Zhe-Ling Chen
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang
| | - Liu Yang
- The Qingdao University Medical College, Qingdao, Shandong
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang
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Frenkel A, Hassan L, Segal A, Israeli A, Binyamin Y, Zlotnik A, Novack V, Klein M. Estimation of Potassium Changes Following Potassium Supplements in Hypokalemic Critically Ill Adult Patients-A Patient Personalized Practical Treatment Formula. J Clin Med 2021; 10:jcm10091986. [PMID: 34063164 PMCID: PMC8125284 DOI: 10.3390/jcm10091986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 10/29/2022] Open
Abstract
Hypokalemia is common among critically ill patients. Parenteral correction of hyperkalemia depends on dosages and patient characteristics. Our aims were to assess changes in potassium levels following parenteral administration, and to derive a formula for predicting rises in serum potassium based on patient characteristics. We conducted a population-based retrospective cohort study of adults hospitalized in a general intensive care unit for 24 h or more between December 2006 and December 2017, with hypokalemia. The primary exposures were absolute cumulative intravenous doses of 20, 40, 60 or 80 mEq potassium supplement. Adjusted linear mixed models were used to estimate changes in serum potassium. Of 683 patients, 422 had mild and 261 moderate hypokalemia (serum potassium 3.0-3.5 mEq/L and 2.5-2.99 mEq, respectively). Following doses of 20-80 mEq potassium, serum potassium levels rose by a mean 0.27 (±0.4) mEq/L and 0.45 (±0.54) mEq/L in patients with mild and moderate hypokalemia, respectively. Changes were associated with creatinine level, and the use of mechanical ventilation and vasopressors. Among critically ill patients with mild to moderate hypokalemia, increases in serum potassium after intravenous potassium supplement are influenced by several clinical parameters. We generated a formula to predict the expected rise in serum potassium based on clinical parameters.
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Affiliation(s)
- Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, Beer-Sheva 8410101, Israel;
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Correspondence: ; Tel.: +972-8-640-0727; Fax: +972-8-640-3390
| | - Lior Hassan
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Adi Segal
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Adir Israeli
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Yair Binyamin
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva 8410101, Israel
| | - Alexander Zlotnik
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Department of Anesthesiology, Soroka University Medical Center, Beer-Sheva 8410101, Israel
| | - Victor Novack
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 8410101, Israel; (L.H.); (A.S.); (A.I.)
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, Beer-Sheva 8410101, Israel;
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel; (Y.B.); (A.Z.); (V.N.)
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Li J, Ma H, Lei Y, Wan Q. Diagnostic value of parameters from a spot urine sample for renal potassium loss in hypokalemia. Clin Chim Acta 2020; 511:221-226. [PMID: 33096028 DOI: 10.1016/j.cca.2020.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/23/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND We assessed the value of 1) a spot urine test for diagnosing hypokalemia caused by renal potassium loss, and 2) actual 24-hour urine potassium excretion (24 hUK-actual) for diagnosing hypokalemia caused by renal potassium loss in patients treated with potassium supplementation. The study population was from Southwest China. METHODS Patients with hypokalemia were divided into 2 groups: hypokalemia caused by renal potassium loss (n = 67) and hypokalemia caused by extrarenal potassium loss (n = 63). Urine potassium concentration (UK), urine creatinine concentration (UCr), urine potassium-creatinine ratio (UK/UCr), fractional excretion of potassium (FEK), transtubular potassium concentration gradient (TTKG), and 24-h urine potassium excretion (24 hUK-calculated) were derived from spot urine samples collected on admission, before initiation of therapy. Patients received intravenous potassium chloride 0.4 or 0.6 g/h. 24 hUK-actual was detected in patients whose serum potassium did not return to normal after 24 h of therapy. RESULTS Patients with hypokalemia caused by renal potassium loss had significantly higher UK, UK/UCr, FEK, TTKG and 24 hUK-calculated compared to patients with hypokalemia caused by extrarenal potassium loss (P < 0.05). FEK predicted renal potassium loss in hypokalemia with high accuracy at a cut-off of 9.29% (sensitivity, 80.6%; specificity, 85.7%). The area under the curve for 24 hUK-actual in predicting renal potassium loss in patients with hypokalemia treated with low or high-dose potassium chloride infusion were 0.939 or 0.956, respectively. On the spot urine test, FEK showed the highest correlation with 24 hUK-actual during low or high dose potassium chloride infusion (r = 0.831, p < 0.001 or r = 0.764, p < 0.001). CONCLUSIONS FEK from a spot urine sample represents a convenient and reliable parameter to predict renal potassium loss in patients with hypokalemia.
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Affiliation(s)
- Jia Li
- Department of Endocriology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan, China.
| | - Hongyan Ma
- Department of Endocriology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan, China
| | - Yi Lei
- Department of Endocriology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan, China
| | - Qin Wan
- Department of Endocriology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan, China
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Serum Potassium Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients. ACTA ACUST UNITED AC 2020; 56:medicina56050236. [PMID: 32423140 PMCID: PMC7279137 DOI: 10.3390/medicina56050236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
Background and Objectives: The optimal range of serum potassium at hospital discharge is unclear. The aim of this study was to assess the relationship between discharge serum potassium levels and one-year mortality in hospitalized patients. Materials and Methods: All adult hospital survivors between 2011 and 2013 at a tertiary referral hospital, who had available admission and discharge serum potassium data, were enrolled. End-stage kidney disease patients were excluded. Discharge serum potassium was defined as the last serum potassium level measured within 48 h prior to hospital discharge and categorized into ≤2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, 4.5–4.9, 5.0–5.4 and ≥5.5 mEq/L. A Cox proportional hazards analysis was performed to assess the independent association between discharge serum potassium and one-year mortality after hospital discharge, using the discharge potassium range of 4.0–4.4 mEq/L as the reference group. Results: Of 57,874 eligible patients, with a mean discharge serum potassium of 4.1 ± 0.4 mEq/L, the estimated one-year mortality rate after discharge was 13.2%. A U-shaped association was observed between discharge serum potassium and one-year mortality, with the nadir mortality in the discharge serum potassium range of 4.0–4.4 mEq/L. After adjusting for clinical characteristics, including admission serum potassium, both discharge serum potassium ≤3.9 mEq/L and ≥4.5 mEq/L were significantly associated with increased one-year mortality, compared with the discharge serum potassium of 4.0–4.4 mEq/L. Stratified analysis based on admission serum potassium showed similar results, except that there was no increased risk of one-year mortality when discharge serum potassium was ≤3.9 mEq/L in patients with an admission serum potassium of ≥5.0 mEq/L. Conclusion: The association between discharge serum potassium and one-year mortality after hospital discharge had a U-shaped distribution and was independent of admission serum potassium. Favorable survival outcomes occurred when discharge serum potassium was strictly within the range of 4.0–4.4 mEq/L.
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Ramchandran R, Verma S, Dasgupta R, Thomas N. Bitter experience with liquorice sweetening agent resulting in apparent mineralocorticoid excess with periodic paralysis. BMJ Case Rep 2018; 2018:bcr-2018-225686. [DOI: 10.1136/bcr-2018-225686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Joseph TT, DiMeglio M, Huffenberger A, Laudanski K. Behavioural patterns of electrolyte repletion in intensive care units: lessons from a large electronic dataset. Sci Rep 2018; 8:11915. [PMID: 30093668 PMCID: PMC6085366 DOI: 10.1038/s41598-018-30444-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022] Open
Abstract
Repletion of electrolytes often depends on provider-specific behavior and hospital policy. We examined the pattern of electrolyte repletion across several intensive care units (ICU) in a large healthcare system from 2010–2015. This included 109 723 potassium repletions, 51 833 magnesium repletions, 2 306 calcium repletions, 8 770 phosphate repletions, and 3 128 249 visit-days over 332 018 visits. Potassium, magnesium, and calcium were usually repleted within the institutional reference range. In contrast, the bulk of phosphate repletion was done with pre-repletion serum level below the reference range. The impact of repletion on post-repletion levels was significant but uniformly small. The pre-repletion serum level had a significant inverse correlation with the post-repletion level of each electrolyte. Potassium, magnesium and phosphate follow-up labs were scheduled in 9–10 hours after their repletion. In contrast, calcium was rechecked in less than 20 minutes. Routine repletion of potassium, magnesium and calcium had no effect on the incidence of tachyarrhythmias. We estimated the expense from electrolyte repletion within the reference range was approximately $1.25 million. Absent a specific clinical indication, repleting electrolytes when the serum concentration are within normative values may represent an avenue for cost savings, staff burden unload and potential reduction in frequency of complications in the ICUs.
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Affiliation(s)
- Thomas T Joseph
- Department of Anaesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Matthew DiMeglio
- Center for Connected Medicine, University of Pennsylvania Health system, Philadelphia, USA
| | | | - Krzysztof Laudanski
- Department of Anaesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
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Buhl LF, Pedersen FN, Andersen MS, Glintborg D. Licorice-induced apparent mineralocorticoid excess compounded by excessive use of terbutaline and high water intake. BMJ Case Rep 2018; 2018:bcr-2017-223918. [PMID: 29674401 DOI: 10.1136/bcr-2017-223918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This case highlights the clinical course of a 54-year-old male patient presenting with hypertension and long-term refractory hypokalaemia. He reported long-term malaise, fatigue and physical discomfort. Diarrhoea, vomiting, over-the-counter drugs, dietary supplements and any kind of medical abuse were all denied. Physical examination was normal. Suppressed plasma renin activity along with a low aldosterone level and elevated urinary cortisone/cortisol metabolite excretion ratio raised the suspicion of apparent mineralocorticoid excess (AME). The patient started treatment with spironolactone, but serum potassium levels were persistently fluctuating and the patient was hospitalised for further evaluation. During hospitalisation, repeated medical history and diagnostic examinations revealed licorice-induced AME complicated by excessive use of terbutaline and massive water intake. Licorice discontinuation, reduction of terbutaline and normalisation of water intake led to fully normalised potassium levels. Despite careful clinical history and diagnostic work-up, hospitalisation may be necessary in selected patients with long-term hypokalaemia.
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Affiliation(s)
| | | | | | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Piva E, Sciacovelli L, Pelloso M, Plebani M. Performance specifications of critical results management. Clin Biochem 2017; 50:617-621. [DOI: 10.1016/j.clinbiochem.2017.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 11/27/2022]
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Serum potassium concentrations: Importance of normokalaemia. Med Clin (Barc) 2017; 148:562-565. [PMID: 28431898 DOI: 10.1016/j.medcli.2017.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/23/2022]
Abstract
Abnormalities in potassium concentrations are associated with morbidity and mortality. In recent years it has been considered that small variations in serum potassium concentrations within normal intervals may also be associated with mortality. Strategies for achieving normokalaemia include dietary measures, limiting the use of potassium retaining drugs, and use of conventional cation exchange resins (calcium/sodium polystyrene sulfonate) and/or the new non-absorbed cation exchange polymer (patiromer).
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You L, Li W, Chen T, Tang D, You J, Zhang X. A retrospective analysis of postoperative hypokalemia in pituitary adenomas after transsphenoidal surgery. PeerJ 2017; 5:e3337. [PMID: 28560099 PMCID: PMC5444367 DOI: 10.7717/peerj.3337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/20/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pituitary adenoma is one of the most common intracranial neoplasms, and its primary treatment is endoscopic endonasal transsphenoidal tumorectomy. Postoperative hypokalemia in these patients is a common complication, and is associated with morbidity and mortality. This study aimed to analyze the etiopathology of postoperative hypokalemia in pituitary adenomas after endoscopic transsphenoidal surgery. METHODS AND MATERIALS This retrospective study included 181 pituitary adenomas confirmed by histopathology. Unconditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Repeated measures ANOVA was used to analyze change in serum potassium levels at different time points. RESULTS Multiple Logistic regression analysis revealed that only ACTH-pituitary adenoma (OR = 4.92, 95% CI [1.18-20.48], P = 0.029) had a significant association with postoperative hypokalemia. Moreover, the overall mean serum potassium concentration was significantly lower in the ACTH versus the non-ACTH group (3.34 mmol/L vs. 3.79 mmol/L, P = 0.001). Postoperative hypokalemia was predominantly found in patients with ACTH-pituitary adenoma (P = 0.033). CONCLUSIONS ACTH-pituitary adenomas may be an independent factor related postoperative hypokalemia in patients despite conventional potassium supplementation in the immediate postoperative period.
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Affiliation(s)
- Lili You
- Department of Clinical Epidemiology, First Hospital of Jilin University, Changchun, China
| | - Wenpeng Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Tang Chen
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Dongfang Tang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Jinliang You
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xianfeng Zhang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Fielding CL, Meier CA, Fellers GK, Magdesian KG. Ability of clinicopathologic variables and clinical examination findings to predict race elimination in endurance horses. Am J Vet Res 2017; 78:50-56. [DOI: 10.2460/ajvr.78.1.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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