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Schwartzmann A, Rodríguez A, Castromán P. Accidental epidural catheter infusion of potassium chloride for postoperative analgesia: A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:602-606. [PMID: 34840102 DOI: 10.1016/j.redare.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/11/2020] [Indexed: 06/13/2023]
Abstract
An infusion of 100 cc of 0,2% potassium chloride was accidental performed through a thoracic epidural catheter, inserted to perioperative analgesia, to a 66 years old man who was scheduled for right hemicolectomy, 48 h after surgery. Paresis of upper limbs, flaccid paralysis of lower limbs and a sensitive level at T8 was observed. An epidural lavage with an initial dose of 20 cc of saline was slowly injected, followed for a saline infusion of 20 cc per hour. Neurologic signs were totally reverted some hours later and 24 h after the incident the physical exam was normal. We reviewed the clinical presentation of the complication and its mechanisms, the more frequent clinical evolution, as well as treatment measures and strategies to prevent the incident.
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Affiliation(s)
- A Schwartzmann
- Departamento y Cátedra de Anestesiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - A Rodríguez
- Departamento y Cátedra de Anestesiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - P Castromán
- Departamento y Cátedra de Anestesiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
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Schwartzmann A, Rodríguez A, Castromán P. Accidental epidural catheter infusion of potassium chloride for postoperative analgesia: A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:S0034-9356(20)30290-5. [PMID: 34154825 DOI: 10.1016/j.redar.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/25/2020] [Accepted: 10/11/2020] [Indexed: 11/24/2022]
Abstract
An infusion of 100cc of 0,2% potassium chloride was accidental performed through a thoracic epidural catheter, inserted to perioperative analgesia, to a 66years old man who was scheduled for right hemicolectomy, 48hours after surgery. Paresis of upper limbs, flaccid paralysis of lower limbs and a sensitive level at T8 was observed. An epidural lavage with an initial dose of 20cc of saline was slowly injected, followed for a saline infusion of 20cc per hour. Neurologic signs were totally reverted some hours later and 24hours after the incident the physical exam was normal. We reviewed the clinical presentation of the complication and its mechanisms, the more frequent clinical evolution, as well as treatment measures and strategies to prevent the incident.
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Affiliation(s)
- A Schwartzmann
- Departamento y Cátedra de Anestesiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - A Rodríguez
- Departamento y Cátedra de Anestesiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - P Castromán
- Departamento y Cátedra de Anestesiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
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Jiménez-Marrero S, Cainzos-Achirica M, Monterde D, Vela E, Cleries M, García-Eroles L, Enjuanes C, Yun S, Garay A, Moliner P, Alcoberro L, Corbella X, Comín-Colet J. Impact on clinical outcomes and health costs of deranged potassium levels in patients with chronic cardiovascular, metabolic, and renal conditions. ACTA ACUST UNITED AC 2020; 74:312-320. [PMID: 32694080 DOI: 10.1016/j.rec.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Potassium derangements are frequent among patients with chronic cardiovascular conditions. Studies on the associations between potassium derangements and clinical outcomes have yielded mixed findings, and the implications for health care expenditure are unknown. We assessed the population-based associations between hyperkalemia, hypokalemia and clinical outcomes and health care costs, in patients with chronic heart failure, chronic kidney disease, diabetes mellitus, hypertension, and ischemic heart disease. METHODS Population-based, longitudinal study including up to 36 269 patients from a health care area with at least one of the above-mentioned conditions. We used administrative, hospital and primary care databases. Participants were followed up between 2015 and 2017, were aged ≥ 55 years and had at least 1 potassium measurement. Four analytic designs were used to evaluate prevalent and incident cases and the use of renin-angiotensin-aldosterone system inhibitors. RESULTS Hyperkalemia was twice as frequent as hypokalemia. On multivariable-adjusted analyses, hyperkalemia was robustly and significantly associated with an increased risk of all-cause death (HR from Cox regression models ranging from 1.31-1.68) and with an increased odds of a yearly health care expenditure >85th percentile (OR, 1.21-1.29). Associations were even stronger in hypokalemic patients (HR for all-cause death, 1.92-2.60; OR for health care expenditure> percentile 85th, 1.81-1.85). CONCLUSIONS Experimental studies are needed to confirm whether the prevention of potassium derangements reduces mortality and health care expenditure in these chronic conditions. Until then, our findings provide observational evidence on the potential importance of maintaining normal potassium levels.
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Affiliation(s)
- Santiago Jiménez-Marrero
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore (MD), United States; Facultad de Medicina y Ciencias de la Salud, Universidad Internacional de Cataluña, Barcelona, Spain
| | - David Monterde
- Unitat d'Informació i Coneixement, Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Emili Vela
- Unitat d'Informació i Coneixement, Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Montse Cleries
- Unitat d'Informació i Coneixement, Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Luis García-Eroles
- Unitat d'Informació i Coneixement, Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Cristina Enjuanes
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lidia Alcoberro
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Grupo de Evaluación de Determinantes de Salud y Políticas Sanitarias, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Comín-Colet
- Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clínicas, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain.
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Aytuluk HG, Topcu H. Severe hypokalemia and rebound hyperkalemia during barbiturate coma in patients with severe traumatic brain injury. Neurocirugia (Astur) 2020; 31:216-22. [PMID: 32146086 DOI: 10.1016/j.neucir.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/21/2019] [Accepted: 12/01/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the incidence of severe potassium disturbances during barbiturate coma therapy in patients with severe traumatic brain injury (TBI), and the characteristics of these patients. METHODS The study comprised 37 patients with severe TBI who were treated for barbiturate coma between 2015 and 2017 in level 3 intensive care units of two hospitals. RESULTS No potassium disturbance occurred in 14 patients. Seventeen patients developed mild-moderate hypokalemia (2.6-3.5mEq/L), and 6 patients developed severe hypokalemia (<2.5mEq/L) following the induction of barbiturate therapy. The incidence of mild-to-severe barbiturate-induced hypokalemia was 62.2% and the rate of severe hypokalemia was 16.2%. The mean potassium supply per day during thiopentone therapy was statistically significantly different between patients with mild-to-moderate hypokalemic and those with severe hypokalemic (p<0.001). Four of 6 patients with severe hypokalemia developed rebound hyperkalemia exceeding 6mEq/L following the cessation of barbiturate infusion. The nadir potassium concentration was 1.5mEq/L and the highest value was 6.8mEq/L. The mean time to reach nadir potassium concentrations was 2.8 days. The mortality rate of the 6 patients was 66.7%. Of the 2 survivors of severe hypokalemia, the Glasgow Outcome Scale (GOS) on discharge and the extended GOS one year after the trauma were 5 and 8 respectively. CONCLUSIONS Severe hypokalemia refractory to medical treatment and rebound hyperkalemia is a serious adverse effect of thiopentone coma therapy in patients with severe TBI. Excessive and aggressive potassium replacement during the barbiturate-induced hypokalemia period must be avoided. Weaning barbiturate treatment over time may be advantageous in the management of severe serum potassium disturbances.
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Ubetagoyena Arrieta M, Areses Trapote R, Mendia Ubetagoyena J, Perez Revuelta M, García Albizua I. [Basal renal function in paediatric patients: correlation of methods that depend on a 24h urine collection with simpler methods that do not require a timed urine]. An Pediatr (Barc) 2020; 92:65-70. [PMID: 31668896 DOI: 10.1016/j.anpedi.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In daily clinical practice a quick, easy and accessible method is needed to adequately assess renal function. The objectives of this study were: 1. To quantify the relationship and concordance of the glomerular filtration rate (GF) calculated by the clearance of creatinine in 24h urine (CCr) and the original and modified Schwartz equation (SE); and 2. To correlate urine elimination of substances that depends on the volume of excreted urine in a unit of time with other parameters that are calculated measuring the concentration of these substances in blood and urine. MATERIAL AND METHODS The study included 401 healthy children with ages between 3 to 14 years (187 male and 214 female). The analysis between the variables was carried out using Pearson's correlation coefficient and the intraclass correlation coefficient (ICC). RESULTS The correlation between values of CCr and the original SE (non-standardised creatinine measurement) was r=0.58 (P<0.001) and the concordance, ICC=0.74. The correlation between CCr values and the modified SE (standardised creatinine measurement) was r=0.68 (P<.001), and the concordance ICC=0.78. There was a very significant correlation between the elimination of sodium in a 24h urine (mEq/kg/24h) and the Na-Fractional-Excretion (EFNa): r=0.8 (P<.001). There was a correlation between the potassium elimination in 24h (mEq/kg/24h) and EFK: r=0.85 (P<.001). Between volume/min/1.73m2 and the urine volume percent of GF was: r=0.88 (P<.001). CONCLUSIONS These equations provide valuable information of the state of the basal renal function without having to use a timed urine.
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Affiliation(s)
| | - Ramón Areses Trapote
- Sección de Nefrología Pediátrica, Hospital Universitario Donostia, San Sebastián, España
| | | | - Marisol Perez Revuelta
- Sección de Nefrología Pediátrica, Hospital Universitario Donostia, San Sebastián, España
| | - Irati García Albizua
- Sección de Nefrología Pediátrica, Hospital Universitario Donostia, San Sebastián, España
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López A, García B, Gómez A, González L, González N, Martín L, Jaime G. Concordance of the ions and GAP anion obtained by gasometry vs standard laboratory in critical care. Med Intensiva 2018; 43:521-527. [PMID: 30193741 DOI: 10.1016/j.medin.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the differences observed in ion and GAP anion determinations obtained by point-of-care (POC) blood gas versus laboratory biochemical testing, and to analyze the possible errors according to the limits of normality. MATERIAL AND METHODS A descriptive, cross-sectional retrospective study was made to assess concordance between two diagnostic tests in patients admitted to the Critical Care Unit of Ourense University Hospital Complex (Spain), between July and November 2015, involving at least one coinciding biochemical test and POC determination. Patients under 18years of age were excluded. RESULTS A total of 1,073 samples were analyzed. Lin's concordance correlation coefficients for sodium, potassium and chlorine were 0.87, 0.84 and 0.72, respectively. Kappa concordance of the normality limits for sodium, potassium and chlorine was 0.63, 0.74 and 0.32. The results indicated poor correlation of the anion GAP and null concordance between POC and biochemical testing, including the value corrected for albumin. CONCLUSIONS Poor concordance was observed between the ion values as determined by biochemistry and blood gases; the two methods are therefore not interchangeable. Kappa agreement with normality limits was good for sodium and potassium, and weak for chlorine. Possible validity was noted in orienting the classification within the ion limits, with the exception of chlorine. No agreement was recorded in relation to the anion GAP, even that corrected for albumin.
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Affiliation(s)
- A López
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España.
| | - B García
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Costa del Sol, Marbella, Málaga, España
| | - A Gómez
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - L González
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - N González
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - L Martín
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - G Jaime
- Servicio de Análisis Clínicos, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
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Hernáez Á, Delgado JF, Cinca J, Fernández-Avilés F, Marrugat J. Prevalence and incidence of hyperkalaemia in the Spanish population with heart failure with reduced ejection fraction: a systematic review and populational relevance. Rev Clin Esp 2018; 218:253-260. [PMID: 29496276 DOI: 10.1016/j.rce.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/01/2017] [Accepted: 01/23/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Hyperkalaemia (K+ levels≥5.5mmol/L) is a severe ion imbalance that occurs in patients who have heart failure (HF) with reduced ejection fraction (HFrEF) and increases the risk of ventricular fibrillation. Given that there are no estimates on the number of patients with this complication, the aim of this study was to estimate the prevalence and incidence of hyperkalaemia in patients with HFrEF in Spain. MATERIAL AND METHODS Based on a systematic literature search and through a meta-analysis, we calculated an HFrEF prevalence of ≤40% in the European and U.S. POPULATION Based on another systematic literature search, we calculated the prevalence of hyperkalaemia in patients with HF and its annual incidence rate. Considering the previous values and the Spanish population pyramid in 2016, we estimated the number of individuals with HFrEF who currently have hyperkalaemia and those who develop it each year in Spain. RESULTS Approximately 17,100 (10,000 men and 7100 women) of the 508,000 patients with HFrEF in Spain have hyperkalaemia. Furthermore, approximately 14,900 patients with HFrEF (9500 men and 5400 women) develop hyperkalaemia each year. CONCLUSIONS Approximately 1 of every 30 patients with HFrEF has plasma potassium values >5.5 mmol/L.
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Affiliation(s)
- Á Hernáez
- Grupo de investigación en Riesgo Cardiovascular y Nutrición-REGICOR, Institut Hospital d'Investigacions Mèdiques IMIM, Barcelona, España; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
| | - J F Delgado
- Fundación Investigación i+12, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | - J Cinca
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - F Fernández-Avilés
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España; Departamento de Cardiología, Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Marrugat
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España; Grupo de investigación en Epidemiología y Genética Cardiovascular-REGICOR, Institut Hospital d'Investigacions Mèdiques IMIM, Barcelona, España.
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