Polyglandular autoimmune syndrome presenting as acute renal failure with severe hyperkalemia

Management of severe hyperkalemia without hemodialysis: Case report and literature review

PURPOSE

To report a case of severe hyperkalemia successfully managed without the use of hemodialysis and to provide a review of the literature regarding the management of severe hyperkalemia.

METHODS

A clinical case report from the medical-surgical intensive care unit of a teaching hospital and a literature review are presented. The case involves a 59-year old man with diabetes mellitus, essential hypertension, and gout, who presented to hospital with severe hyperkalemia (K(+) = 10.4 mEq/L) and normal renal function. He was treated with intravenous fluids, sodium bicarbonate, calcium chloride, insulin, calcium resonium, and furosemide.

RESULTS

The hyperkalemia resolved with conservative treatment within 8 hours, and dialytic therapy was not required. The literature review supported an initial conservative management approach in stable patients with intact renal function.

CONCLUSIONS

Hemodialysis is not necessary for all cases of severe hyperkalemia and should be reserved for patients with acute or chronic renal failure or those with life-threatening hyperkalemia unresponsive to more conservative measures.

Schmidt’S Syndrome and Severe Hyponatremia: Report of an Unusual Case and Review of the Related Literature

OBJECTIVE

To describe a rare case of profound hyponatremia in a male patient with autoimmune polyglandular syndrome type 2 (Schmidt's syndrome).

METHODS

We present the clinical and laboratory data in our patient and review the related published reports from the English language literature on the association of hyponatremia with Schmidt's syndrome.

RESULTS

A 31-year-old man presented to the emergency department because of nausea, anorexia, and weakness for 6 days. He was found to have severe hyponatremia (serum sodium concentration, 101 mEq/L) and mild hyperkalemia. Endocrine testing revealed the presence of Addison's disease and severe primary hypothyroidism, consistent with Schmidt's syndrome. The patient responded to treatment with volume and hormone replacement. An extensive literature search disclosed only one previously reported case (of a female patient) in which Schmidt's syndrome led to the development of a degree of hyponatremia as severe as that in our patient.

CONCLUSION

Concomitant occurrence of primary adrenal insufficiency and primary hypothyroidism can result in a greater degree of hyponatremia than would be expected from either disease alone. Likely explanations include the additive effects of primary hypothyroidism and adrenal failure in the development of hyponatremia and, possibly, in some patients exquisite renal sensitivity to hemodynamic changes and altered hormonal status.