1
|
Sharif S, Tang J. Potassium Derangements: A Pathophysiological Review, Diagnostic Approach, and Clinical Management. Physiology (Bethesda) 2022. [DOI: 10.5772/intechopen.103016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Potassium is an essential cation critical in fluid and electrolyte balance, acid–base regulation, and neuromuscular functions. The normal serum potassium is kept within a narrow range of 3.5–5.2 meq/L while the intracellular concentration is approximately 140–150 meq/L. The total body potassium is about 45–55 mmol/kg; thus, a 70 kg male has an estimated ~136 g and 60 kg female has ~117 g of potassium. In total, 98% of the total body potassium is intracellular. Skeletal muscle contains ~80% of body potassium stores. The ratio of intracellular to extracellular potassium concentration (Ki/Ke) maintained by Na+/K+ ATPase determines the resting membrane potential. Disturbances of potassium homeostasis lead to hypo- and hyperkalemia, which if severe, can be life-threatening. Prompt diagnosis and management of these problems are important.
Collapse
|
2
|
Yan MT, Yang SS, Tseng MH, Cheng CJ, Tsai JD, Sung CC, Hsu YJ, Lin SH. Allele-specific RT-PCR for the rapid detection of recurrent SLC12A3 mutations for Gitelman syndrome. NPJ Genom Med 2021; 6:68. [PMID: 34389731 PMCID: PMC8363728 DOI: 10.1038/s41525-021-00230-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/23/2021] [Indexed: 12/20/2022] Open
Abstract
Recurrent mutations in the SLC12A3 gene responsible for autosomal recessive Gitelman syndrome (GS) are frequently reported, but the exact prevalence is unknown. The rapid detection of recurrent SLC12A3 mutations may help in the early diagnosis of GS. This study was aimed to investigate the prevalence of recurrent SLC12A3 mutations in a Taiwan cohort of GS families and develop a simple and rapid method to detect recurrent SLC12A3 mutations. One hundred and thirty independent Taiwan families with genetically confirmed GS were consecutively enrolled to define recurrent SLC12A3 mutations and determine their prevalence. Using TaqMan probe-based real-time polymerase chain reaction, we designed a mutation detection plate with all recurrent mutations. We validated this mutation detection plate and tested its feasibility in newly diagnosed GS patients. A total of 57 mutations in the SLC12A3 gene were identified and 22 including 2 deep intronic mutations were recurrent mutations consisting of 87.1% (242/278, 18 triple) of all allelic mutations. The recurrent mutation-based TaqMan assays were fully validated with excellent sensitivity and specificity in genetically diagnosed GS patients and healthy subjects. In clinical validation, recurrent mutations were recognized in 92.0% of allelic mutations from 12 GS patients within 4 h and all were confirmed by direct sequencing. Recurrent SLC12A3 mutations are very common in Taiwan GS patients and can be rapidly identified by this recurrent mutation-based SLC12A3 mutation plate.
Collapse
Affiliation(s)
- Ming-Tso Yan
- Division of Nephrology, Department of Medicine, Cathay General Hospital, School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Sung-Sen Yang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Min-Hua Tseng
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Division of Pediatric Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Jen Cheng
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Jeng-Daw Tsai
- Division of Nephrology, Department of Pediatrics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Chien Sung
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Yu-Juei Hsu
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Shih-Hua Lin
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan. .,Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan.
| |
Collapse
|
3
|
Kamel KS, Halperin ML. Use of Urine Electrolytes and Urine Osmolality in the Clinical Diagnosis of Fluid, Electrolytes, and Acid-Base Disorders. Kidney Int Rep 2021; 6:1211-1224. [PMID: 34013099 PMCID: PMC8116912 DOI: 10.1016/j.ekir.2021.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/01/2021] [Indexed: 01/16/2023] Open
Abstract
We discuss the use of urine electrolytes and urine osmolality in the clinical diagnosis of patients with fluid, electrolytes, and acid-base disorders, emphasizing their physiological basis, their utility, and the caveats and limitations in their use. While our focus is on information obtained from measurements in the urine, clinical diagnosis in these patients must integrate information obtained from the history, the physical examination, and other laboratory data.
Collapse
Affiliation(s)
- Kamel S. Kamel
- Renal Division, St. Michael’s Hospital and The University of Toronto, Toronto, Ontario, Canada
- Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Correspondence: Kamel S. Kamel, University of Toronto, Division of Nephrology, St. Michael’s Hospital, Toronto, Ontario, M5B 1W8, Canada.
| | - Mitchell L. Halperin
- Renal Division, St. Michael’s Hospital and The University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Tran KM, Hinther K, Bueti J, Karpinski M, Hingwala J. Toluene Toxicity: A Case Report of Transdermal Exposure Causing Hypokalemic Paralysis. Can J Kidney Health Dis 2019; 6:2054358119871594. [PMID: 31489200 PMCID: PMC6713954 DOI: 10.1177/2054358119871594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/01/2019] [Indexed: 01/25/2023] Open
Abstract
Rationale: Hypokalemia is a common finding. Typically asymptomatic presentations of neuromuscular weakness emerge at levels below 2.5 mmol/L. Causes include gastrointestinal losses, renal losses, or intracellular shift, with gastrointestinal losses and diuretics accounting for the majority. Although the cause is often apparent on clinical assessment, a systematic approach incorporating urine biochemistry can aid in narrowing the differential in obscure cases. Presentation: We describe a case of a previously healthy 27-year-old man who presented with acute ascending paralysis, with an associated severe hypokalemia and metabolic acidosis. There were no apparent causes on clinical assessment. Diagnosis: Based on analysis of urine biochemistry, we concluded that a pathologic kaluresis was present, and given his acidemia and transient pathology, we diagnosed the patient with hypokalemic paralysis secondary to toluene toxicity. Interventions: We provided supportive care and electrolyte repletion for our patient; no specific therapies for toluene were required. Our patient was counseled regarding appropriate protective measures when handling toluene. Outcomes: Complete neurologic recovery and biochemical normalization occurred within 48 hours of presentation with supportive care. He continued to use proper precautions when handling toluene, and experienced no symptom relapse, or further abnormalities on both blood and urine chemistry. Lessons learned: Using this case, we review an algorithmic approach incorporating urine biochemistries to aid in the workup of hypokalemia. We review toluene as a toxicologic entity and highlight its role as a cause of hypokalemia.
Collapse
Affiliation(s)
- Kelvin Mh Tran
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Kelsey Hinther
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Joe Bueti
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Health Sciences Centre, Winnipeg, MB, Canada
| | - Martin Karpinski
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Health Sciences Centre, Winnipeg, MB, Canada
| | - Jay Hingwala
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,Health Sciences Centre, Winnipeg, MB, Canada
| |
Collapse
|
5
|
De Backer E, Hannon H. Flucloxacillin-induced hypokalaemia: a case report. Acta Clin Belg 2018; 73:435-438. [PMID: 29447079 DOI: 10.1080/17843286.2018.1439274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE AND IMPORTANCE Flucloxacillin is a narrow-spectrum beta-lactam antibiotic with activity against penicillinase producing staphylococci and streptococci. Severe hypokalaemia is an uncommon, but serious adverse effect in patients treated with penicillin derivates. CLINICAL PRESENTATION We report a case of severe hypokalaemia in a patient treated with high dose intravenous flucloxacillin. CONCLUSION This case report highlights the importance of monitoring electrolytes during treatment with high dose flucloxacillin. If severe hypokalaemia is noted during treatment, this should be considered in the differential diagnosis.
Collapse
Affiliation(s)
| | - Heidi Hannon
- Department of nephrology, AZ Maria Middelares, Ghent, Belgium
| |
Collapse
|
6
|
Kanarek-Kucner J, Stefański A, Barraclough R, Gorycki T, Wolf J, Narkiewicz K, Hoffmann M. Insufficiency of the zona glomerulosa of the adrenal cortex and progressive kidney insufficiency following unilateral adrenalectomy - case report and discussion. Blood Press 2018; 27:304-312. [PMID: 29742971 DOI: 10.1080/08037051.2018.1470460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Primary aldosteronism (PA) is the most common cause of secondary hypertension and bilateral adrenal hyperplasia (BAH) and aldosterone-producing adenoma (APA) seem to be the most common causes of PA. Unilateral adrenalectomy (UA) is the preferred treatment for APA, although the benefits are still difficult to assess. CASE REPORT We present a case report of a 69-year old man with a 30 year history of hypertension and probably long-standing PA due to APA, with typical organ complications. Since repeated abdominal CT scans were equivocal, not showing radiological changes characteristic for PA, the diagnosis of APA was delayed and was only finally confirmed by adrenal venous sampling which demonstrated unilateral aldosteronism. The patient underwent UA, complicated by mineralocorticoid deficiency syndrome and increased creatinine and potassium levels. At 12 months follow-up the patient still had hyperkalemia and was fludrocortisone dependent. CONCLUSIONS Older patients and patients with long-lasting PA who are treated with UA may demonstrate deterioration of renal function and develop transient or persistent insufficiency of the zona glomerulosa of the remaining adrenal gland necessitating fludrocortisone supplementation. Transient hyperkalemia may be observed following UA as a result of the prolonged effects of aldosterone antagonists and/or transient mineralocorticoid/glucocorticoid insufficiency. Additionally, the level of progression of chronic kidney disease after UA is difficult to predict. There likely exists a group of patients who might paradoxically have higher cardiovascular risk due to significant deterioration in kidney function not only resulting from the removal of the aldosterone induced glomerular hyperfiltration phenomenon. Identification of such a group requires further detailed investigation.
Collapse
Affiliation(s)
- Joanna Kanarek-Kucner
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Adrian Stefański
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Rufus Barraclough
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Tomasz Gorycki
- b Department of Radiology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Jacek Wolf
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Krzysztof Narkiewicz
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Michał Hoffmann
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| |
Collapse
|
7
|
Kardalas E, Paschou SA, Anagnostis P, Muscogiuri G, Siasos G, Vryonidou A. Hypokalemia: a clinical update. Endocr Connect 2018; 7:R135-R146. [PMID: 29540487 PMCID: PMC5881435 DOI: 10.1530/ec-18-0109] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/14/2018] [Indexed: 12/19/2022]
Abstract
Hypokalemia is a common electrolyte disturbance, especially in hospitalized patients. It can have various causes, including endocrine ones. Sometimes, hypokalemia requires urgent medical attention. The aim of this review is to present updated information regarding: (1) the definition and prevalence of hypokalemia, (2) the physiology of potassium homeostasis, (3) the various causes leading to hypokalemia, (4) the diagnostic steps for the assessment of hypokalemia and (5) the appropriate treatment of hypokalemia depending on the cause. Practical algorithms for the optimal diagnostic, treatment and follow-up strategy are presented, while an individualized approach is emphasized.
Collapse
Affiliation(s)
- Efstratios Kardalas
- Department of Endocrinology and DiabetesEvangelismos Hospital, Athens, Greece
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes'Aghia Sophia' Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Anagnostis
- Unit of Reproductive EndocrinologyFirst Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giovanna Muscogiuri
- Division of EndocrinologyDepartment of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy
| | - Gerasimos Siasos
- First Department of CardiologyHippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology and DiabetesHellenic Red Cross Hospital, Athens, Greece
| |
Collapse
|
8
|
Elkoundi A, Kartite N, Bensghir M, Doghmi N, Lalaoui SJ. Gitelman syndrome: a rare life-threatening case of hypokalemic paralysis mimicking Guillain-Barré syndrome during pregnancy and review of the literature. Clin Case Rep 2017; 5:1597-1603. [PMID: 29026553 PMCID: PMC5628240 DOI: 10.1002/ccr3.1122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/26/2017] [Accepted: 07/20/2017] [Indexed: 11/29/2022] Open
Abstract
In rare cases, patients with Gitelman syndrome may present with hypokalemic paralysis mimicking Guillain–Barré syndrome. The severity of resultant symptoms may be life‐threatening. Controversial drugs such as aldactone, amiloride, and eplerenone should be used in this situation despite the lack of safety data.
Collapse
Affiliation(s)
- Abdelghafour Elkoundi
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Noureddine Kartite
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Mustapha Bensghir
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Nawfal Doghmi
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| | - Salim Jaafar Lalaoui
- Department of Anesthesiology and Intensive Care Military Hospital Mohammed V Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco
| |
Collapse
|
9
|
Sung CC, Cheng CJ, Chiang WF, Chau T, Hsu YJ, Yang SS, Lin SH. Etiologic and therapeutic analysis in patients with hypokalemic nonperiodic paralysis. Am J Med 2015; 128:289-96.e1. [PMID: 25447623 DOI: 10.1016/j.amjmed.2014.09.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hypokalemic nonperiodic paralysis represents a group of heterogeneous disorders with a large potassium (K(+)) deficit. Rapid diagnosis of curable causes with appropriate treatment is challenging to avoid the sequelae of hypokalemia. We prospectively analyzed the etiologies and therapeutic characteristics of hypokalemic nonperiodic paralysis. METHODS Over an 8-year period, patients with hypokalemic nonperiodic paralysis were enrolled by excluding those with hypokalemic periodic paralysis due to acute shift of K(+) into cells. Blood and spot urine samples were collected for the measurements of electrolytes, pH, and biochemistries. Intravenous potassium chloride (KCl) at a rate of 10-20 mmol/h was administered until muscle strength recovered. RESULTS We had identified 58 patients with hypokalemic nonperiodic paralysis from 208 consecutive patients with hypokalemic paralysis, and their average K(+) concentration was 1.8 ± 0.2 mmol/L. Among patients with low urinary K(+) excretion (n = 17), chronic alcoholism, remote diuretic use, and anorexia/bulimia nervosa were the most common causes. Among patients with high urinary K(+) excretion (n = 41) and metabolic acidosis, renal tubular acidosis and chronic toluene abuse were the main causes, while primary aldosteronism, Gitelman syndrome, and diuretics were the leading diagnoses with metabolic alkalosis. The average KCl dose needed to restore muscle strength was 3.8 ± 0.8 mmol/kg. Initial lower plasma K(+), volume depletion, and high urinary K(+) excretion were associated with higher recovery KCl dosage. During therapy, patients with paradoxical hypokalemia (n = 32) who required more KCl supplementation than patients without (4.1 ± 0.7 vs 3.4 ± 0.7 mmol/kg, P < 0.001) often exhibited significantly higher plasma renin activity and received a higher volume of normal saline before its appearance. CONCLUSIONS Understanding the common etiologies of hypokalemic nonperiodic paralysis may aid in early diagnosis. Patients with initial lower plasma K(+), renal K(+) wasting, and hypovolemia required higher recovery K(+) dosage. Paradoxical hypokalemia is prone to develop in hypovolemic patients even during K(+) supplementation with volume repletion.
Collapse
Affiliation(s)
- Chih-Chien Sung
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Jen Cheng
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Fang Chiang
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan
| | - Tom Chau
- Department of Medicine, Providence St. Vincent Medical Center, Portland, Ore
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sung-Sen Yang
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
10
|
Chiang WF, Cheng CJ, Wu ST, Sun GH, Lin MY, Sung CC, Lin SH. Incidence and factors of post-adrenalectomy hyperkalemia in patients with aldosterone producing adenoma. Clin Chim Acta 2013; 424:114-8. [DOI: 10.1016/j.cca.2013.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/23/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
|
11
|
Chiang WF, Yan MT, Wu TJ, Lin SH. A hypokalaemic woman with nephrocalcinosis: rebirth of old knowledge. Ann Clin Biochem 2013; 50:176-9. [PMID: 23440542 DOI: 10.1177/0004563212474551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The coexistence of hypokalaemia and nephrocalcinosis poses a challenge in rapid diagnosis and appropriate management. We describe a 38-year-old woman who presented with thirst, intermittent carpopedal spasm, paresthaesia of both hands and progressive weakness of lower extremities for two years. She had a history of chronic hypokalaemia of unknown cause with intermittent potassium supplementation for 7-8 y and bilateral nephrocalcinosis notable for one year. She denied vomiting, diarrhoea or use of laxatives, alcohol or diuretics. Her blood pressure was normal. Laboratory investigations showed hypokalaemia (2.7 mmol/L) and metabolic alkalosis (HCO3(-) 32.6 mmol/L, pH 7.46). Two random urine samples both showed a consistently high urine K(+) excretion but with excretion rates of Na(+), Cl(-) and divalent cations which were high in one sample but not the other. Ingestion of furosemide 120 mg daily for body image for 7-8 y was uncovered. With furosemide cessation and potassium supplementation, her hypokalaemia with neuromuscular symptoms was corrected but nephrocalcinosis persisted. Surreptitious use of diuretics for various purposes should be kept in mind as an important cause of hypokalaemia and/or nephrocalcinosis. Measurement of electrolyte concentrations in at least two random urine samples is warranted to distinguish it from true renal tubular disorders and extrarenal causes.
Collapse
Affiliation(s)
- Wen-Fang Chiang
- Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan 325, Taiwan
| | | | | | | |
Collapse
|
12
|
Cruz AJ, Castro A. Gitelman or Bartter type 3 syndrome? A case of distal convoluted tubulopathy caused by CLCNKB gene mutation. BMJ Case Rep 2013; 2013:bcr-2012-007929. [PMID: 23345488 DOI: 10.1136/bcr-2012-007929] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 32-year-old woman with no significant medical history was sent to our consultation due to hypokalaemia (<3.0 mmol/l). Her main complaints were longstanding polyuria and nocturia. Physical examination was normal. Basic investigations showed normal renal function, low serum potassium (2.7 mmol/l) and magnesium (0.79 mmol/l), metabolic alkalosis (pH 7.54; bicarbonate 32.5 mmol/l), elevated urinary potassium (185 mmol/24 h) and normal urinary calcium (246 mg/24 h). Thiazide test revealed blunted response. Chronic vomiting and the abuse of diuretics were excluded. Genetic tests for SLC12A3 gene mutation described in Gitelman syndrome (GS) came negative. CLCNKB gene mutation analysis present in both GS and Bartter (BS) type 3 syndromes was positive. The patient is now being treated with potassium and magnesium oral supplements, ramipril and spironolactone with stable near-normal potassium and magnesium levels. This article presents the case of a patient with hypokalaemia caused by CLCNKB gene mutation hard to categorise as GS or BS type 3.
Collapse
Affiliation(s)
- António José Cruz
- Serviço de Medicina Interna, Centro Hospitalar de Entre o Douro e Vouga-Hospital de São Sebastião, Santa Maria da Feira, Portugal.
| | | |
Collapse
|
13
|
|
14
|
Severe hypokalemia, paralysis, and AIDS-associated isospora belli diarrhea. J Emerg Med 2008; 41:e129-32. [PMID: 18993015 DOI: 10.1016/j.jemermed.2008.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 04/23/2008] [Accepted: 05/01/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hypokalemia of clinical significance, severe enough to cause paralysis and cardiac dysrhythmias, is an uncommon life-threatening medical disorder. Hypokalemic periodic paralysis (HPP), where an abrupt intracellular shift of potassium has occurred, must be distinguished from hypokalemic non-periodic paralysis (non-HPP), where a total body potassium deficit exists. The challenge for emergency physicians is to swiftly and accurately differentiate disease etiology and institute prompt treatment. Aggressive potassium repletion, required in non-HPP etiologies, may predispose HPP patients to dangerous and potentially fatal rebound hyperkalemia as the intracellular potassium shift resolves. OBJECTIVES Describe the process by which HPP and non-HPP can be differentiated on clinical and laboratory grounds leading to appropriate resuscitation from severe and clinically relevant hypokalemia. Chronic diarrhea syndromes and possibly normal alkaline phosphatase levels alert the clinician to the potential for non-HPP. CASE REPORT A case of HIV/AIDS-associated isospora belli diarrheal illness with severe hypokalemia of the non-HPP type is presented. Historical, laboratory, and clinical findings, which assisted in the differentiation from HPP, are emphasized. Clinical progression and treatment strategies, as well as electrocardiogram findings with T-U-P fusion waves, are described in detail. CONCLUSION The history, especially the time course of disease, is essential in differentiating HPP and non-HPP, allowing treatment to proceed without overcorrection and rebound hyperkalemia. Although other infectious diseases have been linked to non-HPP, to our knowledge this is the first report linking non-HPP to isospora belli diarrheal illness.
Collapse
|
15
|
Hainsworth AJ, Gatenby PA. Oral potassium supplementation in surgical patients. Int J Surg 2008; 6:287-8. [PMID: 18485847 DOI: 10.1016/j.ijsu.2008.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 03/18/2008] [Indexed: 11/17/2022]
Abstract
Hospital inpatients are frequently hypokalaemic. Low plasma potassium levels may cause life threatening complications, such as cardiac arrhythmias. Potassium supplementation may be administered parenterally or enterally. Oral potassium supplements have been associated with oesophageal ulceration, strictures and gastritis. An alternative to potassium salt tablets or solution is dietary modification with potassium rich food stuffs, which has been proven to be a safe and effective method for potassium supplementation. The potassium content of one medium banana is equivalent to a 12 mmol potassium salt tablet. Potassium supplementation by dietary modification has been shown to be equally efficacious to oral potassium salt supplementation and is preferred by the majority of patients. Subsequently, it is our practice to replace potassium using dietary modification, particularly in surgical patients having undergone oesophagogastrectomy or in those with peptic ulcer disease.
Collapse
|
16
|
Lin SH. A Practical and Pathophysiologic Approach to Hypokalemia. Int J Organ Transplant Med 2008. [DOI: 10.1016/s1561-5413(08)60014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
17
|
Garcia E, Nakhleh N, Simmons D, Ramsay C. Profound hypokalemia: unusual presentation and management in a 12-year-old boy. Pediatr Emerg Care 2008; 24:157-60. [PMID: 18347493 DOI: 10.1097/pec.0b013e318166868e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hypokalemia is a frequent electrolyte abnormality that rarely requires more than oral supplementation to correct. We describe a case of profound hypokalemia and cardiac arrhythmia requiring unusually large amounts of "bolused" potassium to restore to normal sinus rhythm. Our patient presented with significant dehydration and electrolyte abnormalities after several days of emesis. Most alarming of these findings was a serum potassium level of 1.2 mEq/L. The electrocardiogram showed changes consistent with hypokalemia that rapidly degraded into pulseless ventricular tachycardia. Potassium chloride of 140 mEq was hand-pushed during the resuscitation with return of spontaneous rhythm. The patient was discharge 11 days later in his prearrest state.
Collapse
Affiliation(s)
- Estevan Garcia
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA.
| | | | | | | |
Collapse
|