Hyperkalemia: Pharmacotherapies and Clinical Considerations

Hyperkalemia has been defined as a condition where a serum potassium level is >5.5 mmol/l. It is associated with fatal dysrhythmias and muscular dysfunction. Certain medical conditions, such as chronic kidney disease (CKD), diabetes mellitus, and others, can lead to hyperkalemia. Many of the signs of hyperkalemia are nonspecific. A history and physical examination can be beneficial in the diagnosis of the condition. In this regard, certain characteristic electrocardiogram findings are associated with hyperkalemia along with laboratory potassium levels. In acute and potentially lethal conditions, hyperkalemia treatments include glucose and insulin, bicarbonate, calcium gluconate, beta-2 agonists, hyperventilation, and dialysis. There are several drugs, both old and new, that can additionally aid in the reduction of serum potassium levels. The present investigation evaluated some of these different drugs, including sodium polystyrene sulfonate (SPS), sodium zirconium cyclosilicate (SZC), and patiromer. These drugs each have increased selectivity for potassium and work primarily in the gastrointestinal (GI) tract. Each of these medications has unique benefits and contraindications. Clinicians must be aware of these medications when managing patients with hyperkalemia.

The Role of Alpha-2 Agonists for Attention Deficit Hyperactivity Disorder in Children: A Review

INTRODUCTION

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders, characterized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is marked by symptoms such as inappropriate levels of inattention, hyperactivity, and impulsivity that can affect academic, social, and personal functioning in children and adolescents. This review summarizes clinical trials demonstrating the effectiveness of Alpha-2 agonists in reducing symptoms of inattention, hyperactivity, and impulsivity in children with ADHD. Studies were identified through a systematic search of PubMed and Cochrane databases. However, these medications' long-term safety and efficacy remain uncertain, with a lack of data on their effects on growth, cardiovascular function, and other adverse events. Further studies are required to determine these medications' optimal dose and treatment duration.

METHODS

Medications that target the noradrenergic system, such as Alpha-2 agonists, have been increasingly used as a treatment option for ADHD, with guanfacine and clonidine being two of the most commonly used medications. They function by selectively targeting Alpha-2 adrenergic receptors in the brain leading to improved attention and reduced hyperactivity and impulsivity symptoms in children with ADHD.

RESULTS

Clinical trials have demonstrated the effectiveness of Alpha-2 agonists in treating ADHD in children by reducing symptoms of inattention, hyperactivity, and impulsivity. However, these medications' long-term safety and efficacy still need to be completely understood. Due to a lack of information on the effects of Alpha-2 agonists on growth, cardiovascular function, and other long-term adverse events, more studies must investigate the optimal dose and treatment duration for these medications.

CONCLUSIONS

Despite these concerns, Alpha-2 agonists remain a valuable treatment option for ADHD in children, especially those unable to tolerate stimulant medications or who have coexisting conditions such as tic disorders. Future research should continue to explore the safety and efficacy of Alpha-2 agonists in the long term. In conclusion, Alpha-2 agonists show promise as a treatment for ADHD in children; however, the safety and efficacy of these drugs in the long term are not yet completely understood. Additional studies are required to investigate the optimal dose and treatment duration for these medications in their use as a treatment for this debilitating disease.

Costal Cartilage Lateral Crural Strut Graft for Correction of External Nasal Valve Dysfunction in Primary and Revision Rhinoplasty

OBJECTIVE

To evaluate and compare the costal cartilage lateral crural strut graft's (LCSG) ability to support a weak lateral crus in patients with external nasal valve dysfunction (EVD) undergoing primary versus revision functional rhinoplasty.

METHODS

This is a prospective cohort study of 26 patients (mean [SD]: 40.23 [6.75] years of age; 10 [38%] females) with clinically diagnosed EVD, who underwent primary versus revision functional rhinoplasty with the use of a costal cartilage LCSG (10 [38%] primary functional rhinoplasty patients and the 16 [62%] revision patients). Preoperative and 12-month postoperative subjective and objective functional measurements along with statistical analysis were performed.

RESULTS

While all baseline demographic and preoperative functional measurement scores were similar between the 2 groups, the primary cohort's preoperative scores were higher overall. Follow-up was a mean of 14.58 months. The primary group demonstrated a greater difference in score improvement postoperatively in all categories. All patients had significantly improved visual analog scale (VAS), Nasal Obstruction Symptom Evaluation Scale, 22-Item Sinonasal Outcome Test, and nasal peak inspiratory flow (NPIF) scores. When comparing the overall score outcome and surgical efficacy of the LCSG, both groups had near equal final score outcomes with the exception of VASL and NPIF.

CONCLUSION

The LCSG is a viable and versatile option in the management of EVD for both primary and revision rhinoplasty patients.

Variability of the Anterior Ethmoid Artery in Endoscopic Sinus Surgery

INTRODUCTION

The anterior ethmoidal artery (AEA) demonstrates anatomic variability relative to its descent from the anterior skull base. Our study's objective was to assess for correlation of AEA descent and laterality, in addition to correlation of AEA descent and the presence of supraorbital ethmoid cells (SOEC) and concha bullosae (CB).

METHOD

A retrospective study was performed at a tertiary rhinology center from January 2019 to January 2020. Noncontrast maxillofacial computed tomography scans were examined independently by 2 fellowship trained rhinologists. The vertical distance from both left and right AEAs to the ipsilateral skull base were compared and correlated with the presence of ipsilateral SOEC and CB.

RESULTS

Computed tomography scans from 50 subjects were included. Mean age was 50.68 years (40% females). The distance of AEA to the skull base was greater on the left when compared to the right (62% vs 48%) (P < .05). The left AEA had an average descent of 2.84 mm versus 1.78 mm on the right (P < .05). An SOEC was present in 56% of cases. Thirty-eight percent of subjects had both SOEC and AEA descent on the right, while 52% of subjects had both on the left. This reached a statistical significance on both sides (P < .05). Concha bullosa was present in 35% of cases, with both AEA descent and CB present in 16% on the right, and 32% on the left.

CONCLUSION

The AEA displays variability in vertical descent from the skull base, with greater variability on the left. These findings implore vigilance with evaluation of preoperative imaging and during sinus surgery, especially in the presence of SOEC and CB.

Some observations on the narcotizing ability of electric currents on the common carp Cyprinus carpio

Some effects of alternating current electronarcosis and of rectified current electronarcosis on C. carpio were investigated. In all instances recovery from narcosis was accompanied by convulsive spasms. Haemorrhaging of the gills was also observed to occur. Carp do not appear to be suitable candidates for electronarcosis.

The use of electronarcosis as anaesthetic in the cichlid, Oreochromis mossambicus (Peters). III. The effects of changing physical and electrical parameters on the narcotizing ability of half-wave rectified currents

The narcotizing potential of various rectified current configurations on Oreochromis mossambicus was investigated. A 50 Hz, 200 Vp. half-wave rectified current, applied for 30 s, was found to be a suitable configuration for electronarcosis.

The use of electronarcosis as anaesthetic in the cichlid, Oreochromis mossambicus (Peters). II. The effects of changing physical and electrical parameters on the narcotizing ability of alternating current

The effects of wave form, voltage, frequency and current as well as application time on the narcotizing ability of alternating current were investigated. A 60 Vrms, 50 Hz sine wave current applied for 30 s produced narcosis of sufficient duration to enable handling and blood sampling. A triangle wave form was inferior in narcotizing ability to both sine wave and square wave forms. Duration of narcosis increased with increasing water conductivity but was reduced by increasing water temperatures.

The use of electronarcosis as anaesthetic in the cichlid, Oreochromis mossambicus (Peters). I. General experimental procedures and the role of fish length on the narcotizing effects of electric currents

Procedures to narcotize fish by means of alternating or direct electrical currents are described and a method of evaluating the narcotic effects on fish of electrical currents is detailed. The role of fish length on the narcotizing potential of electrical currents was investigated. The results indicate that there is a positive correlation between fish length and the duration of narcosis.

Some observations on the influence of stress on ECG patterns in Oreochromis mossambicus and Cyprinus carpio

Electrocardiograms of undisturbed, resting fish as well as disturbed (stressed) fish were recorded by biotelemetry. Both fish species showed marked changes in heartbeat patterns in response to stress with tilapia exhibiting the most pronounced changes. A theory is advanced to account for the marked changes in electrocardiogram patterns of disturbed fishes.