Hypomagnesemia and hypokalemia: a successful oral therapeutic approach after 16 years of potassium and magnesium intravenous replacement therapy

Total serum magnesium in cats with chronic kidney disease with nephrolithiasis

OBJECTIVES

Magnesium has been 'the forgotten ion' for many years. Over the past decade, however, the role of magnesium in essential physiological functions and several illness conditions have been elucidated. Nevertheless, the investigation of magnesium in cats with chronic kidney disease (CKD) and nephrolithiasis is yet to be determined. The purpose of this study was to investigate whether CKD cats with nephrolithiasis have changes in total serum magnesium concentrations, and whether magnesium disorders may be associated with other electrolyte disturbances, as well as with prognosis. We also aimed to evaluate whether total serum magnesium concentration differs between CKD cats with and without nephrolithiasis.

METHODS

Total serum magnesium concentrations were assessed in 42 cats with CKD with stage 1-4 nephrolithiasis. The correlation between magnesium and other electrolytes, as well as Kaplan-Meier survival analysis, were performed. We also selected 14 control cats with CKD without nephrolithiasis age-matched with 14 cats with CKD with nephrolithiasis.

RESULTS

Hypermagnesemia was observed in 16/42 (38.1%) and hypomagnesemia in 6/42 (14.3%) cats. Serum magnesium abnormalities were observed in cats of all stages, and marked hypermagnesemia was noted in cats with stage 4 CKD with nephrolithiasis (P <0.001). There was a negative correlation between total serum magnesium and ionized calcium (r = -0.64; P <0.01), and a positive correlation between total serum magnesium and serum phosphorus (r = 0.58, P = 0.01). Cats with CKD with nephrolithiasis and hypomagnesemia or hypermagnesemia had higher mortality than those with normal total serum magnesium concentration (P <0.01), regardless of CKD stage. There was no difference in total serum magnesium concentration between CKD cats with and without nephrolithiasis.

CONCLUSIONS AND RELEVANCE

Cats with CKD with nephrolithiasis have magnesium abnormalities. Hypomagnesemia and hypermagnesemia were associated with an increase in mortality, and thus total serum magnesium abnormalities may be used as prognostic factors in these cases.

Development of hypokalemia in patients with chronic hepatitis B: Causes and nursing care

AIM: To investigate the causes of hypokalemia in patients with chronic hepatitis B and summarize the methods of care.

METHODS: Clinical data for 60 chronic hepatitis B patients with hypokalemia treated from January 2012 to December 2013 at Yanchi County People's Hospital were analyzed retrospectively. The methods of care were discussed.

RESULTS: Main causes of hypokalemia in patients with chronic hepatitis B were drug-induced pseudo-aldosteronism (70.0%) and excessive chronic loss (30.0%). Potassium content was 3.1 mmol/L ± 0.5 mmol/L before nursing care and 4.3 mmol/L ± 1.1 mmol/L after nursing, and the difference was statistically significant (P < 0.05). Before nursing care, patients' chronic hepatitis B and hypokalemia-related knowledge scores were 63.6 points ± 4.8 points and 55.3 points ± 7.4 points, respectively; after nursing care, these scores were significantly elevated to 84.6 points ± 5.1 points and 80.4 points ± 5.5 points, respectively (P < 0.05). Nursing care also significantly improved SAS and SDS scores (55.3 points ± 6.3 points vs 23.3 points ± 2.7 points, 54.8 min ± 6.5 min vs 24.3 points ± 2.3 points, P < 0.05).

CONCLUSION: Hypokalemia in chronic hepatitis B occurs mainly due to drug-induced pseudo-aldosteronism and chronic loss. Nursing care and treatment should be strengthened to reduce the occurrence of hypokalemia in chronic hepatitis B.