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La Bella S, Vivarelli M, Di Ludovico A, Di Donato G, Chiarelli F, Breda L. Kidney manifestations of pediatric Sjögren's syndrome. Pediatr Nephrol 2024; 39:711-721. [PMID: 37638982 DOI: 10.1007/s00467-023-06135-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
Approximately 1% of all patients with Sjögren's syndrome (SS) are children. Unlike the adult form, in which sicca syndrome is the main presentation, in children, the most common clinical finding is recurrent enlargement of the salivary glands. In pediatric SS, extraglandular manifestations represent a significant feature and, among these, kidney manifestations are relevant. Kidney involvement is observed in 5-20.5% of children with SS, most frequently tubulointerstitial nephritis. This injury can lead to serious phenotypes, including distal kidney tubular acidosis with the development of severe hypokalemia, which can lead to ECG abnormalities, weakness, and hypokalemic periodic paralysis. Kidney implications in pediatric SS also include nephrolithiasis, nephrocalcinosis, and various types of glomerular damage, which often require immunosuppressive therapies. Laboratory findings are usually comparable to adults, including hyperglobulinemia and high rates of antinuclear antibodies (ANA, 63.6-96.2%), and anti-Ro/SSA (36.4-84.6%). The current classification criteria for SS are inaccurate for the pediatric population, and more specific criteria are needed to improve the diagnostic rate. Due to the rarity of the disease, strong recommendations for treatment are lacking, and several therapeutic strategies have been reported, mostly based on glucocorticoids and disease-modifying antirheumatic drugs, with different outcomes. The aim of this paper is to provide an overview of the kidney implications of pediatric SS based on the latest evidence of the medical literature.
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Affiliation(s)
- Saverio La Bella
- Department of Pediatrics, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy.
| | - Marina Vivarelli
- Division of Nephrology, Laboratory of Nephrology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Armando Di Ludovico
- Department of Pediatrics, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giulia Di Donato
- Department of Pediatrics, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Luciana Breda
- Department of Pediatrics, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
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2
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Wu MZ, Teng THK, Tsang CTW, Chan YH, Lee CH, Ren QW, Huang JY, Cheang IF, Tse YK, Li XL, Xu X, Tse HF, Lam CSP, Yiu KH. Risk of hyperkalaemia in patients with type 2 diabetes mellitus prescribed with SGLT2 versus DPP-4 inhibitors. Eur Heart J Cardiovasc Pharmacother 2024; 10:45-52. [PMID: 37942588 DOI: 10.1093/ehjcvp/pvad081] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
AIMS To investigate the risk of hyperkalaemia in new users of sodium-glucose cotransporter 2 (SGLT2) inhibitors vs. dipeptidyl peptidase-4 (DPP-4) inhibitors among patients with type 2 diabetes mellitus (T2DM). METHODS AND RESULTS Patients with T2DM who commenced treatment with an SGLT2 or a DPP-4 inhibitor between 2015 and 2019 were collected. A multivariable Cox proportional hazards analysis was applied to compare the risk of central laboratory-determined severe hyperkalaemia, hyperkalaemia, hypokalaemia (serum potassium ≥6.0, ≥5.5, and <3.5 mmol/L, respectively), and initiation of a potassium binder in patients newly prescribed an SGLT2 or a DPP-4 inhibitor. A total of 28 599 patients (mean age 60 ± 11 years, 60.9% male) were included after 1:2 propensity score matching, of whom 10 586 were new users of SGLT2 inhibitors and 18 013 of DPP-4 inhibitors. During a 2-year follow-up, severe hyperkalaemia developed in 122 SGLT2 inhibitor users and 325 DPP-4 inhibitor users. Use of SGLT2 inhibitors was associated with a 29% reduction in incident severe hyperkalaemia [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.58-0.88] compared with DPP-4 inhibitors. Risk of hyperkalaemia (HR 0.81, 95% CI 0.71-0.92) and prescription of a potassium binder (HR 0.74, 95% CI 0.67-0.82) were likewise decreased with SGLT2 inhibitors compared with DPP-4 inhibitors. Occurrence of incident hypokalaemia was nonetheless similar between those prescribed an SGLT2 inhibitor and those prescribed a DPP-4 inhibitor (HR 0.90, 95% CI 0.81-1.01). CONCLUSION Our study provides real-world evidence that compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with lower risk of hyperkalaemia and did not increase the incidence of hypokalaemia in patients with T2DM.
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Affiliation(s)
- Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, 169609, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, 169857, Singapore
- School of Allied Health, University of Western Australia, Perth, 6009, Australia
| | - Christopher Tze-Wei Tsang
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Yap-Hang Chan
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Chi-Ho Lee
- Division of Endocrinology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Jia-Yi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Iok-Fai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu, 210029, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Xin-Li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu, 210029, China
| | - Xin Xu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
| | - Carolyn S P Lam
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, 169609, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, 169857, Singapore
- Department of Cardiology, University Medical Center Groningen, Groningen, 9713, The Netherlands
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 999077, China
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Lalley A, Bawa S, Harmouche E. Ramen noodle neuropathy: an atypical case of partial paralysis from malnutrition. Am J Emerg Med 2024; 75:198.e7-198.e10. [PMID: 37805367 DOI: 10.1016/j.ajem.2023.09.039] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/10/2023] [Accepted: 09/17/2023] [Indexed: 10/09/2023] Open
Abstract
INTRODUCTION Due to a COVID-related job loss resulting in financial and food insecurity, a 28-year-old woman initiated a diet consisting solely of one cup of ramen noodles daily for twenty-two months, leading to 27 kg of weight loss. Ramen noodles are low in calories and lack key nutrients, including potassium, chloride, and vitamin B12. CASE DESCRIPTION The patient presented to the emergency department with acute, worsening weakness and paresthesias in her left wrist and hand. Exam revealed no other abnormalities aside from a cachectic appearance. Labs revealed marked hypokalemia, hypochloremia, lactic acidosis, a mixed metabolic alkalosis with respiratory acidosis, and low levels of zinc and copper. An EKG revealed a prolonged QT interval. After a neurology and psychiatry consult, the patient was admitted for failure to thrive with malnutrition, peripheral neuropathy, hypokalemia, and an acid-base disorder. An MRI of the brain was unremarkable. Studies of other nutritional deficiencies, autoimmune conditions, and sexually transmitted infections were unremarkable. The patient received food and vitamin supplementation, was monitored for re-feeding syndrome, and had a significant recovery. DISCUSSION After stroke, spinal injury, multiple sclerosis, and the most common focal mononeuropathies were ruled out, the clinical focus turned to nutritional deficiencies, the most significant of which was hypokalemia. Prior research has shown that severe hypokalemia can lead to weakness. It has also shown that chronically insufficient dietary intake is a common cause of hypokalemia. This case, with its partial paralysis of a unilateral upper extremity, may add to the known clinical manifestations of hypokalemia. We review the role of hypokalemia and hypochloremia in acid-base dynamics. Etiologies and clinical manifestations of cobalamin, thiamine, pyridoxine, and copper deficiencies, along with lead toxicity, are also discussed. Diagnostic clarity of mononeuropathies in the context of malnutrition and hypokalemia can be aided by urine potassium levels prior to repletion, neuroimaging that includes the cervical spine, and follow-up electromyography.
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Affiliation(s)
- Adam Lalley
- Department of Emergency Medicine, Maimonides Medical Center, 965 48th St, Brooklyn, NY 11219 USA.
| | - Sabrina Bawa
- Department of Emergency Medicine, University of Connecticut, 263 Farmington Ave, Farmington, CT 06030 USA
| | - Elie Harmouche
- Department of Emergency Medicine, Maimonides Medical Center, 965 48th St, Brooklyn, NY 11219 USA
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Khan U, Afzal U, Kask L, Saeed N, Rajani R, Solheim E, Saeed S. "Ion-Flux": The natural course of ECG changes in severe hypokalemia. Curr Probl Cardiol 2024; 49:102158. [PMID: 37865301 DOI: 10.1016/j.cpcardiol.2023.102158] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
Whereas the electrocardiogram (ECG) changes in hypokalemia are well known, they often receive less attention than the more striking features of hyperkalemia. Furthermore, there is a need for further discussion as to the subtleties of ECG changes that can aid in the differential diagnoses. This case study presents the ECG changes of a patient with severe hypokalemia due to diarrhea. It highlights how bifid T-waves in hypokalemia can be distinguished from other conditions such as coronary artery disease or pericarditis. Furthermore, it also shows the gradual reversal of ECG changes in the same patient when potassium is normalized.
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Affiliation(s)
- Umael Khan
- Haukeland University Hospital, Department of Internal Medicine, Bergen, Norway
| | - Usman Afzal
- Haukeland University Hospital, Department of Internal Medicine, Bergen, Norway
| | - Lauri Kask
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - Nasir Saeed
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ronak Rajani
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Eivind Solheim
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - Sahrai Saeed
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
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5
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Silvestri I, Merigo G, Bonetti C, Guerra MB, Pignatelli S, Stirparo G, Ristagno G. Concomitant hypokalemia and hypocalcemia: a very rare but life-threating combination of reversible causes of cardiac arrest - an unusual first manifestation of coeliac disease. Acta Biomed 2023; 94:e2023264. [PMID: 38054675 PMCID: PMC10734231 DOI: 10.23750/abm.v94i6.15014] [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] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
The causes of cardiac arrest are extremely heterogeneous. Among these, both hypokalemia and hypocalcemia are known reversible factors that can lead to cardiac arrest. In this report, we present a unique case report of a patient with previously undiagnosed coeliac disease who experienced cardiac arrest due a combination of hypokalemia and hypocalcemia resulting from malabsorption. A 66-year-old male presented to the emergency department with symptoms of malaise, weakness, weight loss, and persistent diarrhea. The patient exhibited characteristic signs of hypokalemia and hypocalcemia, including fasciculations, weakness, and swelling. An electrocardiogram showed a normal rhythm, and blood tests confirmed the electrolyte imbalances. Despite initial treatment, the patient experienced sudden cardiac arrest. Prompt resuscitation efforts were successful in restoring spontaneous circulation. However, recurrent episodes of ventricular arrhythmias and cardiac arrest occurred. Large doses of intravenous potassium chloride, in conjunction with magnesium, were needed prior to restore electrolyte balance. The concomitant severe hypocalcemia required caution calcium supplementation, to avoid further decreases in serum potassium levels. Appropriate ion replacements ultimately led to successful resuscitation with good functional recovery. During the hospital stay, the patient was diagnosed with coeliac disease. This case is noteworthy for its uniqueness, as there are no documented instances in the scientific literature linking cardiac arrest directly to coeliac disease. It is important to emphasize the need for investigating potential reversible causes of cardiac arrest, such as hypokalemia and hypocalcemia, and implementing appropriate interventions to address these factors.
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Golbus AE, Freidin N. Treatment of hypokalemia with amiloride unmasked hypercalcemia and hyperparathyroidism: A case report. Clin Nephrol 2023; 100:290-292. [PMID: 37870265 DOI: 10.5414/cn111231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 10/24/2023] Open
Abstract
Colonic pseudo-obstruction, also called Ogilvie's syndrome, occurs due to impaired intestinal propulsion, and may be caused by electrolyte imbalances such as hypokalemia and some endocrine disorders such as hyperparathyroidism. Secretory diarrhea due to intestinal pseudo-obstruction can cause hypokalemia. Diuretics such as amiloride can be used to treat hypokalemia, however in this case, treatment with amiloride induced hypercalcemia and unmasked hyperparathyroidism. A 73-year-old female with a history of hypertension and parathyroid adenoma presented with recurrent colonic pseudo-obstruction and chronic hypokalemia. Her hypokalemia was treated with amiloride, causing hypercalcemia of 14.4 mg/dL, elevated PTH, and altered mental status. Amiloride was subsequently discontinued with improvement in her symptoms, and her hyperparathyroidism was treated with cinacalcet. To our knowledge, this is the first report of amiloride unmasking hyperparathyroidism and inducing hypercalcemia.
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Piner A, Spangler R. Disorders of Potassium. Emerg Med Clin North Am 2023; 41:711-728. [PMID: 37758419 DOI: 10.1016/j.emc.2023.07.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Abnormalities in serum potassium are commonly encountered in patients presenting to the emergency department. A variety of acute and chronic causes can lead to life-threatening illness in both hyperkalemia and hypokalemia. Here we summarize the relevant causes, risks, and treatment options for these frequently encountered disorders.
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Affiliation(s)
- Andrew Piner
- Department of Emergency Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th floor, Suite 200, Baltimore, MD 21201, USA
| | - Ryan Spangler
- Department of Emergency Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th floor, Suite 200, Baltimore, MD 21201, USA.
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Hanouneh M, Cervantes CE. A Young Man With Chronic Refractory Hypokalemia: A Quiz. Am J Kidney Dis 2023; 82:A11-A14. [PMID: 37739625 DOI: 10.1053/j.ajkd.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/01/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Mohamad Hanouneh
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Nephrology Center of Maryland, Baltimore, Maryland.
| | - Carmen Elena Cervantes
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Díaz-López EJ, Villar-Taibo R, Rodriguez-Carnero G, Fernandez-Pombo A, Garcia-Peino R, Blanco-Freire MN, Pena-Dubra A, Prado-Moraña T, Fernández-Xove I, Pérez-Béliz E, Cameselle-Teijeiro JM, Hermida-Ameijeiras A, Martinez-Olmos MA. Should we suspect primary aldosteronism in patients with hypokalaemic rhabdomyolysis? A systematic review. Front Endocrinol (Lausanne) 2023; 14:1257078. [PMID: 37810894 PMCID: PMC10558179 DOI: 10.3389/fendo.2023.1257078] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Severe hypokalaemia causing rhabdomyolysis (RML) in primary aldosteronism (PA) is a rare entity, and only a few cases have been reported over the last four decades. This systematic review and case report aims to gather all published data regarding a hypokalaemic RML as presentation of PA in order to contribute to the early diagnosis of this extremely rare presentation. With the use of PubMed Central, EMBASE, and Google Scholar, a thorough internet-based search of the literature was conducted to identify articles and cases with RML secondary to hypokalaemia due to PA between June 1976 and July 2023. The case study concerns a 68-year-old male patient with hypokalaemic RML at presentation of PA. In the systematic review of the literature, 37 cases of RML secondary to hypokalaemia due to PA have been reported to date. In summary, the median age was 47.5 years, the male/female ratio was 17/21, all patients presented symptoms (weakness and/or myalgia), all the patients were hypertensive, and only four patients had complications with acute kidney injury (AKI). Although PA rarely presents with RML, it should be suspected when marked hypokalaemia and hypertension are also present. Early detection and management are essential to reduce the frequency of manifestations such as AKI.
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Affiliation(s)
- Everardo Josué Díaz-López
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Unidad de Enfermedades Tiroideas e Metabólicas (UETeM)-Molecular Pathology Group. Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Health Research Institute of Santiago de Compostela (IDIS)-Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rocio Villar-Taibo
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gemma Rodriguez-Carnero
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Division of Epigenomics in Endocrinology and Nutrition Group-Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antia Fernandez-Pombo
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Unidad de Enfermedades Tiroideas e Metabólicas (UETeM)-Molecular Pathology Group. Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Health Research Institute of Santiago de Compostela (IDIS)-Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Roberto Garcia-Peino
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Alberto Pena-Dubra
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Teresa Prado-Moraña
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Unidad de Enfermedades Tiroideas e Metabólicas (UETeM)-Molecular Pathology Group. Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Health Research Institute of Santiago de Compostela (IDIS)-Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Irea- Fernández-Xove
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Edurne Pérez-Béliz
- Division of Pathology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Manuel Cameselle-Teijeiro
- Division of Pathology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Medical Faculty, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alvaro Hermida-Ameijeiras
- Division of Internal Medicine, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel Angel Martinez-Olmos
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Molecular Endocrinology Group-Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
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10
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Khanal P, Paudel S, Chapagain S, Thapa S, Gyawali M. Hypokalemic Paralysis Revealing Primary Sjogren's Syndrome: A Case Report. JNMA J Nepal Med Assoc 2023; 61:735-737. [PMID: 38289796 PMCID: PMC10579740 DOI: 10.31729/jnma.8266] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Indexed: 02/01/2024] Open
Abstract
Sjogren's syndrome is a rare chronic autoimmune disease characterised by dry eyes and dry mouth due to autoimmune destruction of the lacrimal and salivary glands, which can occur concurrently with other autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, or thyroiditis. It can lead to renal complications such as interstitial nephritis and glomerulonephritis, with distal/ type 1 renal tubular acidosis which may result in life-threatening electrolyte imbalance. We present a case of a 35-year-old female who presented with complaints of multiple episodes of muscle weakness. Type 1 renal tubular acidosis was discovered to be the cause of her symptoms which lead to the subsequent diagnosis of Sjogren's syndrome. This is rare presentation of Sjogren's syndrome, and it poses a challenge to diagnosis. Early detection and diagnosis of Sjogren's syndrome might be difficult due to existing diagnostic criteria, which contributes to a higher likelihood of missed diagnosis. Keywords case reports; hypokalemia; renal tubular acidosis; Sjogren's syndrome.
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Affiliation(s)
| | - Sandip Paudel
- Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
| | | | - Saurav Thapa
- National Academy of Health Sciences, Mahaboudha, Kathmandu, Nepal
| | - Madan Gyawali
- Department of Internal Medicine, Bakulahar Ratnanagar Hospital, Tandi, Chitwan, Nepal
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11
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Ting YH, Wang YF, Lin YC, Chen HT, Lin KH, Tarng DC, Tseng WC. The Case | Chronic hypokalemia and painful diffuse bone lesions. Kidney Int 2023; 104:207-208. [PMID: 37349055 DOI: 10.1016/j.kint.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/07/2023] [Accepted: 03/17/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Yu-Hsin Ting
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Feng Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chun Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Ting Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ko-Han Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Der-Cherng Tarng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Intelligent Drug Systems and Smart Bio-devices, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
| | - Wei-Cheng Tseng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Center for Intelligent Drug Systems and Smart Bio-devices, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
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12
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Williams DM, Shaikh A, Williams E, Maroof A, Michael T, Boregowda K. The Prevalence of Primary Aldosteronism in Screening Populations: Is Hypokalaemia Important? Exp Clin Endocrinol Diabetes 2023; 131:375-376. [PMID: 37160152 DOI: 10.1055/a-2075-0735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- David M Williams
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, SA6 6NL
| | - Ayesha Shaikh
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, SA6 6NL
| | - Ellen Williams
- Department of Acute Medicine, Morriston Hospital, Swansea, SA6 6NL
| | - Aiman Maroof
- Department of Acute Medicine, Morriston Hospital, Swansea, SA6 6NL
| | - Therese Michael
- Department of Laboratory Medicine, Morriston Hospital, Swansea, SA6 6NL
| | - Kusuma Boregowda
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, SA6 6NL
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Ying J, Wu H, Zhang R, Wu P, Sui F, Li Z. A case report of Gitelman syndrome in children. Medicine (Baltimore) 2023; 102:e33509. [PMID: 37058043 PMCID: PMC10101307 DOI: 10.1097/md.0000000000033509] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
RATIONALE Giltelman syndrome (GS) is an autosomal recessive infectious disease, which is caused by the mutation of SLC12A3 gene encoding thiazide diuretic sensitive sodium chloride cotransporter located in the distal convoluted tubule of the kidney. PATIENT CONCERNS A 7-year-old and 3-month-old male patient has poor appetite, slow growth in height and body weight since the age of 3, body weight: 16 kg (-3 standard deviation), height: 110 cm (-3 standard deviation), normal exercise ability and intelligence. One year ago, he was diagnosed with hypokalemia. After potassium supplement treatment, the blood potassium returned to normal. The patient developed abdominal pain, vomiting, limb weakness, and tetany 1 day before admission. DIAGNOSES After admission examination, the patient was found to have hypokalemia (2.27-2.88 mmol/L), hypomagnesemia (0.47 mmol/L), hypophosphatemia (1.17 mmol/L), hypocalcemia (1.06 mmol/24 hours), and metabolic alkalosis (PH 7.60). The blood pressure is normal, and the concentration of aldosterone is 791.63 pg/mL. The adrenocorticotropic hormone and cortisol detected at 8 am are 4.95 pmol/L and 275.09 nmol/L, respectively. Twenty-four hours of urine potassium is 32.52 mmol. Gene sequencing results showed 2 pathogenic variants in the GS-related SLC12A3 gene, which are related to the phenotype of the subject. INTERVENTIONS After admission, the patients were given potassium and magnesium supplements, as well as oral spironolactone. The symptoms of limb weakness and tetany were significantly relieved. After discharge, the patients continued to maintain treatment to keep the blood potassium at more than 3.0 mmol/L, and the blood magnesium at more than 0.6 mmol/L. OUTCOMES Follow-up at 1 month after discharge, in the patient's self-description, he had no symptoms such as limb weakness and tetany, and his height was increased by 1 cm and the body weight increased by 1.5 kg. LESSONS For patients with hypokalemia, hypomagnesemia, and metabolic alkalosis, the possibility of GS should be given priority. After the diagnosed by gene sequencing of SLC12A3 gene, potassium and magnesium supplementation could significantly improve symptoms.
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Affiliation(s)
- Jing Ying
- Department of Pediatrics, Affiliated Shenzhen Longhua People’s Hospital, Southern Medical University, Longhua, Shenzhen, Guangdong, P. R. China
| | - Haixia Wu
- Department of Pediatrics, Affiliated Shenzhen Longhua People’s Hospital, Southern Medical University, Longhua, Shenzhen, Guangdong, P. R. China
| | - Ruizhong Zhang
- Department of Pediatrics, Affiliated Shenzhen Longhua People’s Hospital, Southern Medical University, Longhua, Shenzhen, Guangdong, P. R. China
| | - Pengmei Wu
- Department of Pediatrics, Affiliated Shenzhen Longhua People’s Hospital, Southern Medical University, Longhua, Shenzhen, Guangdong, P. R. China
| | - Fengxuan Sui
- Department of Pediatrics, Affiliated Shenzhen Longhua People’s Hospital, Southern Medical University, Longhua, Shenzhen, Guangdong, P. R. China
| | - Zilong Li
- Department of Pediatrics, Affiliated Shenzhen Longhua People’s Hospital, Southern Medical University, Longhua, Shenzhen, Guangdong, P. R. China
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Leventoğlu E, Kenan BU, Çakır EP, Hocoğlu Zİ, Eyüboğlu TŞ, Büyükkaragöz B, Aslan AT, Söylemezoğlu O. Chronic cough in an adolescent with infantile onset of hypokalemic hypochloremic metabolic alkalosis: Questions. Pediatr Nephrol 2023; 38:1027-1028. [PMID: 35723734 DOI: 10.1007/s00467-022-05641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Emre Leventoğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey.
| | - Bahriye Uzun Kenan
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Eylül Pınar Çakır
- Faculty of Medicine, Department of Pediatric Pulmonology, Gazi University, Ankara, Turkey
| | - Zeynep İlkşen Hocoğlu
- Faculty of Medicine, Department of Pediatric Pulmonology, Gazi University, Ankara, Turkey
| | | | - Bahar Büyükkaragöz
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Ayşe Tana Aslan
- Faculty of Medicine, Department of Pediatric Pulmonology, Gazi University, Ankara, Turkey
| | - Oğuz Söylemezoğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
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Ghumman GM, Haider M, Raffay EA, Cheema HA, Yousaf A. Hypercalcemia-induced hypokalemic metabolic alkalosis with hypophosphatemia in a multiple myeloma patient: lessons for the clinical nephrologist. J Nephrol 2023; 36:315-317. [PMID: 36269493 DOI: 10.1007/s40620-022-01467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/07/2022] [Indexed: 10/24/2022]
Affiliation(s)
| | - Marjan Haider
- Internal Medicine Resident, St. Joseph Mercy Ann Arbor, Ypsilanti, MI, USA
| | | | | | - Amman Yousaf
- Internal Medicine Resident, McLaren Flint, Flint, MI, USA
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16
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Wathanavasin W, Banjongjit A, Katavetin P. A case-based approach to profound hypokalemia with severe acidemia. J Nephrol 2023; 36:341-345. [PMID: 36327039 DOI: 10.1007/s40620-022-01500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Wannasit Wathanavasin
- Nephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand
| | - Athiphat Banjongjit
- Nephrology Unit, Department of Medicine, Vichaiyut Hospital, Phyathai, Bangkok, Thailand.
| | - Pisut Katavetin
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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17
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Nasir N, Mohanty D, Pande AK, Khanna D, Vishvakarma K, Gupta L. Acquired autoimmune Bartter syndrome in a patient with primary hypothyroidism. Rheumatol Int 2023; 43:567-574. [PMID: 34800134 DOI: 10.1007/s00296-021-05042-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/27/2021] [Indexed: 12/31/2022]
Abstract
We describe an unusual clinical presentation of autoimmune Bartter syndrome in a patient with primary hypothyroidism. A 65-year-old female patient was admitted with neuromuscular weakness associated with hypokalemia and metabolic alkalosis. She had a suboptimal response to potassium supplementation and potassium-sparing diuretic resulting in re-hospitalization with the same symptoms. A detailed serum and urinary biochemistry analysis in the absence of other causes of potassium wasting helped diagnose Bartter syndrome, a rare entity in adults. An autoimmune profile showed anti-Scl-70 antibody to be positive, although she did not develop other systemic features of the disease. Our patient responded to a steroid-based regimen potassium supplement, Indomethacin, and aldosterone antagonist with remarkable resolution of symptoms and correction of electrolyte derangement. We reviewed the literature to search for similar cases and included twenty-seven full-length publications on acquired and autoimmune causes of Bartter syndrome. Our case highlights the fact that hypokalemia with metabolic alkalosis in an adult patient should prompt clinicians to evaluate for common and uncommon conditions. While assessing for abnormal conditions, acquired Bartter syndrome should be considered if a patient has an underlying autoimmune, endocrine, or connective tissue disease.
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Affiliation(s)
- Noreen Nasir
- Section of Internal Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Arun Kumar Pande
- Department of Endocrinology, Sahara Hospital, Lucknow, India.
- Lucknow Endocrine and Diabetes Clinic, Lucknow, India.
| | - Dhanita Khanna
- Department of Rheumatology, Sahara Hospital, Lucknow, India
| | | | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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18
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Mareš Š, Filipovský J. Liddle syndrome. Vnitr Lek 2022; 68:8-11. [PMID: 36575060 DOI: 10.36290/vnl.2022.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Liddle syndrome is an inherited form of arterial hypertension with autosomal dominant pattern of inheritance. It is caused by activating mutation of genes coding of the epithelial sodium channel in distal nephron. Mutation leads to excessive reabsorbtion of sodium ions and volume expansion resulting in arterial hypertension. Antoher typical laboratory findings are hypokalaemia, low levels of serum aldosteron and metabolic alkalosis. Phenotypic variability makes it difficult to identify patients with Liddle syndrome, often resulting in misdiagnosis and severe complications at early age. Genetic studies should be done to confirm the diagnosis. Therapy of Liddle syndrome is based on administration of epithelial sodium channel blocker amilorid.
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La Bella S, Fiorentino R, Carabotta M, Lizzi M, Rosato T, Trotta D, Aricò M. A difficult case of hyponatremic and hypokalemic metabolic alkalosis: Questions. Pediatr Nephrol 2022; 37:3063-3064. [PMID: 35579759 DOI: 10.1007/s00467-022-05596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Saverio La Bella
- Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy.
- Department of Pediatrics, S. Spirito Hospital, Azienda Sanitaria Locale, Pescara, Italy.
| | - Riccardo Fiorentino
- Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy
- Department of Pediatrics, S. Spirito Hospital, Azienda Sanitaria Locale, Pescara, Italy
| | - Maura Carabotta
- Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy
- Department of Pediatrics, S. Spirito Hospital, Azienda Sanitaria Locale, Pescara, Italy
| | - Mauro Lizzi
- Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy
- Department of Pediatrics, S. Spirito Hospital, Azienda Sanitaria Locale, Pescara, Italy
| | - Teresa Rosato
- Department of Pediatrics, S. Spirito Hospital, Azienda Sanitaria Locale, Pescara, Italy
| | - Daniela Trotta
- Department of Pediatrics, S. Spirito Hospital, Azienda Sanitaria Locale, Pescara, Italy
| | - Maurizio Aricò
- Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy
- Department of Pediatrics, S. Spirito Hospital, Azienda Sanitaria Locale, Pescara, Italy
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20
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Hundemer GL, Clarke A, Akbari A, Bugeja A, Massicotte-Azarniouch D, Knoll G, Myran DT, Tanuseputro P, Sood MM. Analysis of Electrolyte Abnormalities in Adolescents and Adults and Subsequent Diagnosis of an Eating Disorder. JAMA Netw Open 2022; 5:e2240809. [PMID: 36346630 PMCID: PMC9644262 DOI: 10.1001/jamanetworkopen.2022.40809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
IMPORTANCE Eating disorders lead to increased mortality and reduced quality of life. While the acute presentations of eating disorders frequently involve electrolyte abnormalities, it remains unknown whether electrolyte abnormalities may precede the future diagnosis of an eating disorder. OBJECTIVE To determine whether outpatient electrolyte abnormalities are associated with the future diagnosis of an eating disorder. DESIGN, SETTING, AND PARTICIPANTS This population-level case-control study used provincial administrative health data for residents of Ontario, Canada aged 13 years or older from 2008 to 2020. Individuals without an eating disorder (controls) were matched 4:1 to individuals diagnosed with an incident eating disorder (cases) based on age and sex. Both groups had outpatient electrolyte measurements between 3 years and 30 days prior to index. Index was defined as the date of an eating disorder diagnosis in any inpatient or outpatient clinical setting for cases. Controls were assigned a pseudo-index date according to the distribution of index dates in the case population. Individuals with any prior eating disorder diagnosis were excluded. The data analyzed was from January 1, 2008, through June 30, 2020. EXPOSURES Any electrolyte abnormality, defined as abnormal test results for a composite of hypokalemia, hyperkalemia, hyponatremia, hypernatremia, hypomagnesemia, hypophosphatemia, metabolic acidosis, or metabolic alkalosis. OUTCOMES AND MEASURES Eating disorder diagnosis including anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. RESULTS A total 6970 eligible Ontario residents with an eating disorder (mean [SD] age, 28 (19) years; 6075 [87.2%] female, 895 [12.8%] male) were matched with 27 878 age- and sex-matched residents without an eating disorder diagnosis (mean [SD] age, 28 [19] years; 24 300 [87.2%] female, 3578 [12.8%] male). Overall, 18.4% of individuals with an eating disorder had a preceding electrolyte abnormality vs 7.5% of individuals without an eating disorder (adjusted odds ratio [aOR], 2.12; [95% CI, 1.86-2.41]). The median (IQR) time from the earliest electrolyte abnormality to eating disorder diagnosis was 386 (157-716) days. Specific electrolyte abnormalities associated with a higher risk of an eating disorder were: hypokalemia (aOR, 1.98; 95% CI, 1.70-2.32), hyperkalemia (aOR, 1.97; 95% CI, 1.48-2.62), hyponatremia (aOR, 5.26; 95% CI, 3.32-8.31), hypernatremia (aOR, 3.09; 95% CI, 1.01-9.51), hypophosphatemia (aOR, 2.83; 95% CI, 1.82-4.40), and metabolic alkalosis (aOR, 2.60; 95% CI, 1.63-4.15). CONCLUSIONS AND RELEVANCE In this case-control study, individuals with an eating disorder were associated with a preceding outpatient electrolyte abnormality compared with matched controls. Otherwise unexplained electrolyte abnormalities may serve to identify individuals who may benefit from screening for an underlying eating disorder.
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Affiliation(s)
- Gregory L. Hundemer
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Ontario, Canada
| | - Anna Clarke
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Ontario, Canada
| | - Ayub Akbari
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Ann Bugeja
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - David Massicotte-Azarniouch
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel T. Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Ontario, Canada
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21
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Roumeliotou S, Theohari A, Tsamoulis D, Vafeidou K, Siountri I, Siomou E. Persistent mild hypokalemia in an otherwise healthy 6-year-old girl: Questions. Pediatr Nephrol 2022; 37:1789-1790. [PMID: 35118534 DOI: 10.1007/s00467-022-05423-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Sofia Roumeliotou
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece
| | - Anastasia Theohari
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece
| | - Donatos Tsamoulis
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece
| | - Kyriaki Vafeidou
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece
| | - Iliana Siountri
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece
| | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece.
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Roumeliotou S, Theohari A, Tsamoulis D, Vafeidou K, Siountri I, Siomou E. Persistent mild hypokalemia in an otherwise healthy 6-year-old girl: Answers. Pediatr Nephrol 2022; 37:1791-1794. [PMID: 35118535 DOI: 10.1007/s00467-022-05458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Sofia Roumeliotou
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece
| | - Anastasia Theohari
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece
| | - Donatos Tsamoulis
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece
| | - Kyriaki Vafeidou
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece
| | - Iliana Siountri
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece
| | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500, Ioannina, Greece.
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Latief M, Hassan Z, Shafi O, Abbas F, Farooq S. Paint-thinner-induced Acute Kidney Injury: A Case Series and Review. Saudi J Kidney Dis Transpl 2022; 33:487-491. [PMID: 37843148 DOI: 10.4103/1319-2442.385970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Occupational health hazards contribute significantly to the morbidity and mortality of workers in factories. Toluene has become a widely abused inhaled volatile drug. The spectrum of toluene-induced renal injury includes rhabdomyolysis, myoglobinemia, distal renal tubular acidosis (RTA), acute tubular necrosis, glomerulonephritis, and interstitial nephritis. We describe two patients with paint-thinner-induced kidney injury who were affected through different routes of exposure and recovered well, with one requiring dialysis support; the second patient, who had developed Type 1 distal RTA and mild kidney injury, was managed with conservative measures. Toluene can cause acute neurological symptoms, accompanied by severe metabolic alterations, as well as organ injury and dysfunction. A common association of the development of hypokalemic paralysis and metabolic acidosis with toluene intoxication was observed. Liver injury and rhabdomyolysis are also common. Vomiting, dehydration, tubular injury, and rhabdomyolysis are all possible additional causes of acute renal failure in toluene intoxication. Type 1 distal RTA, which is characterized by an inability to lower urine pH despite acidemia, results in hyperchloremic metabolic acidosis with hypokalemia. The management of acute toluene toxicity is largely conservative, consisting of correcting the electrolytes and the acid-base balance, fluid alterations, and renal replacement therapy in severe acute kidney injury. A clinical suspicion of organ failure and prompt supportive care leads to encouraging results. Adequate protective steps for workplaces involved in the use of such substances in confined spaces include prior risk assessment, using low-toxicity chemical products, ensuring adequate ventilation, safety training, and using appropriate personal protective equipment.
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Affiliation(s)
- Muzamil Latief
- Division of Nephrology Superspeciality Hospital, Government Medical College, Srinagar, India
| | - Zhahid Hassan
- Department of Medicine, Government Medical College, Srinagar, India
| | - Obeid Shafi
- Flushing Hospital Medical Center, New York, USA
| | - Farhat Abbas
- Division of Pathology, Government Medical College, Srinagar, Kashmir, India
| | - Summyia Farooq
- Division of Pathology, Government Medical College, Srinagar, Kashmir, India
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Nahar N, Nahar P. Hypokalemic Paralysis Due to Primary Sjögren's Syndrome: Case Series. J Assoc Physicians India 2022; 70:11-12. [PMID: 35436824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Sjögren's syndrome (SS) is autoimmune disorder charaterized by exocrine glandular involvement and extra-glandular manifestations. Associations between hypokalemic paralysis and SS have not been emphasized enough. Present study evaluates hypokalemic paralysis as presenting feature in PSS. METHODS A retrospective cross-sectional study from 2015 to 2020 was conducted to evaluate the clinical phenotype of primary Sjögren's syndrome (PSS) who presented to us with hypokalemic paralysis. RESULTS Data of 13 patients were evaluated. All were female patients and mean age was 38 years. 61.5% (n= 8) had more than one episode of hypokalemic paralysis; 61.5% (n= 8) patients had oral dryness and 69% (n= 9) had dryness of eyes. 23% (n= 3) patients had inflammatory arthritis and 1 patient had Raynaud's phenomenon, myopathy respectively. 1 patient had chronic constipation and hypothyroidism was present in 61.5% (n= 8) patients. Other co-morbidity included hypertension, renal calculi and situs inversus present in 15%, 15% and 7% respectively. The mean ESR at presentation was 64 mm/hr; average serum potassium level was 2.04meq/dl and distal renal tubular acidosis was present in all patients. Paralysis was completely recovered in all patients after supplementation with potassium. CONCLUSION The renal involvement in PSS can uncommonly present as hypokalemic paralysis in the absence of significant sicca symptoms or may precede sicca symptoms. A high index of suspicion for PSS should be kept in all patients with hypokalemic paralysis. This phenotype may represent a distinct subset. Serum electrolytes should be regularly monitored in all patients with SS.
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Affiliation(s)
- Naisar Nahar
- Consultant Rheumatologist, Arham Rheumatology Center, Nashik; Corresponding Author
| | - Prachi Nahar
- Clinical Associate, Arham Rheumatology Center, Nashik
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Sbruzzi ADR, Torres F, Sommaruga H, Ameri C, Yarcho M, Gonzalez MF. [Celiac crisis and acute tetany in pediatrics. Case report]. Rev Gastroenterol Peru 2022; 42:45-47. [PMID: 35896073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Celiac disease is an immune-mediated systemic disease with a wide spectrum of clinical presentations. The term celiac crisis describes the acute and potentially fatal form. Clinically it is characterized by severe diarrhea, dehydration, and metabolic disturbances. The case of a 7-year-old male patient attending the ward with tetany, lower limb edema, steatorrhea and weight loss of 8 months of evolution is reported, with analytical findings of hypocalcemia, hypomagnesemia, hypokalemia and coagulopathy. The diagnosis of celiac crisis was made on the basis of serological and clinical findings compatible with celiac disease in the context of severe metabolic abnormalities and acute malnutrition, later confirmed by pathological anatomy. The importance of this report lies in reviewing the characteristics of this serious entity, which requires a high index of suspicion for its diagnosis.
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Affiliation(s)
| | - Federico Torres
- Hospital General de Niños Pedro de Elizalde. Buenos Aires, Argentina
| | - Horacio Sommaruga
- Jefe del Servicio de Gastroenterología, Hospital General de Niños Pedro de Elizalde. Buenos Aires, Argentina
| | - Camila Ameri
- Hospital General de Niños Pedro de Elizalde. Buenos Aires, Argentina
| | - Maria Yarcho
- Hospital General de Niños Pedro de Elizalde. Buenos Aires, Argentina
| | - Maria Fernanda Gonzalez
- Sala de Internación CEM 2, Hospital General de Niños Pedro de Elizalde. Buenos Aires, Argentina
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Abstract
RATIONALE Thyrotoxic periodic paralysis (TPP) characterized by the triad of muscle paralysis, acute hypokalemia, and the presence of hyperthyroidism is often reported in young adults but rarely reported in age >60 year-old. PATIENT CONCERNS Two sexagenarian males (age 61 and 62) presenting to the emergency department with progressive muscle paralysis for hours. There was symmetrical flaccid paralysis with areflexia of lower extremities. Both of them did not have the obvious precipitating factors and take any drugs. DIAGNOSIS Their Wayne scores, as an objective index of symptoms and signs associated with thyrotoxicosis, were <19 (7 and 14, respectively). Their blood pressure stood 162/78 and 170/82 mm Hg, respectively. Their thyroid glands were slightly enlarged. Both of them had severe hypokalemia (1.8 and 2.0 mmol/L). Their presumptive diagnosis of mineralocorticoid excess disorders with severe potassium (K+) deficit were made. However, low urine K+ excretion and relatively normal blood acid-base status were suggestive of an intracellular shift of K+ rather than K+ deficit. Hormone studies confirmed hyperthyroidism due to Graves disease. INTERVENTIONS A smaller dose of K+ supplementation (only a total of 50 and 70 mmol K+, respectively) were prescribed for the patient. OUTCOMES After treatment, their serum K+ levels became normal with a full recovery of muscle strength. LESSONS Our 2 cases highlight the fact that thyrotoxic periodic paralysis must be still kept in mind as the underlying cause of hypokalemia with paralysis and hypertension in elderly patients to avoid missing curable disorders.
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Affiliation(s)
- Ang Lu
- Department of Medicine, Tri-Service General Hospital, 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
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Abstract
Thyrotoxic periodic paralysis (TPP) is a rare presentation of thyrotoxicosis most commonly associated with Graves' disease. It is rare in Caucasians, but it affects approximately 2% of Asians (occurring in those of Chinese, Japanese, Vietnamese, Filipino, and Korean descent) with thyrotoxicosis of any cause. Typical thyrotoxic features may be absent despite biochemical thyrotoxicosis. Hypokalemia and muscle paralysis are the result of an acute intracellular shift of potassium and not due to total body potassium deficiency. TPP is a self-limiting condition that is easily corrected by treatment of the thyrotoxicosis. We present a case of a Filipino man, aged 47 years, who presented to the emergency department with acute bilateral lower extremity weakness and hypokalemia who was subsequently diagnosed with TPP due to Graves' disease.
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Affiliation(s)
- Matthew Patel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karim Ladak
- Division of Education and Innovation, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Chalkia A, Giannou P, Thomas K, Vassilopoulos D, Petras D. Distal renal tubular acidosis and nephrocalcinosis as initial manifestation of primary sjögren's syndrome. Saudi J Kidney Dis Transpl 2021; 32:1470-1474. [PMID: 35532720 DOI: 10.4103/1319-2442.344770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
There is a well-established association between primary Sjögren's syndrome and distal renal tubular acidosis (dRTA). dRTA is a relatively infrequent manifestation of primary Sjögren's syndrome which can present with life-threatening electrolyte abnormalities while, in some patients, it could be the first manifestation of the syndrome. We report the case of a 35-year-old woman who presented with unexplained episodes of generalized weakness, severe hypokalemia, nephrocalcinosis, and normal anion gap metabolic acidosis. Subsequent evaluation revealed primary Sjögren's syndrome as her underlying condition. The patient responded well to potassium supplementation, sodium bicarbonate, and oral prednisolone. After four years of follow-up, there were no other extraglandular manifestations, the renal function remained stable and the acidosis was partially improved without the need for oral bicarbonate. This case demonstrates that dRTA could be the initial manifestation of primary Sjögren's syndrome and highlights the necessity for increased vigilance for patients presenting with persistent hypokalemia or nephrocalcinosis so that an early diagnosis can be made allowing for better control and prevention of disease progression.
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Affiliation(s)
- Aglaia Chalkia
- Department of Nephrology, Hippokration General Hospital, Athens, Greece
| | - Panagiota Giannou
- Department of Nephrology, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Thomas
- 2nd Department of Medicine, Joint Rheumatology Program, School of Medicine - Clinical Immunology - Rheumatology Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine, Joint Rheumatology Program, School of Medicine - Clinical Immunology - Rheumatology Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Petras
- Department of Nephrology, Hippokration General Hospital, Athens, Greece
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Shah NZ, Malik S, Sathyapalan T, Mohammed K. Refractory hypokalaemia and hypertension with metabolic alkalosis: an acute presentation of Cushing's disease secondary to a pituitary macroadenoma. BMJ Case Rep 2021; 14:e244850. [PMID: 34446523 PMCID: PMC8395277 DOI: 10.1136/bcr-2021-244850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/03/2022] Open
Abstract
A 68-year-old woman presented with right arm cellulitis, not responsive to oral antibiotics. Intravenous antibiotics were commenced, and an ultrasound scan confirmed a collection that was surgically drained. She developed refractory hypokalaemia with normal magnesium, no gastrointestinal losses and no iatrogenic cause. She was hypertensive, hyperglycaemic, alkalotic, clinically obese with proximal myopathy and skin bruising. These clinical findings and refractory hypokalaemic hypertension with metabolic alkalosis raised a suspicion of Cushing's syndrome (CS). 24-hour urinary free cortisol (24 hours) was grossly raised on two occasions. The adrenocorticotropic hormone (ACTH) was significantly raised at 154 ng/L, confirming ACTH-dependant CS. A CT scan of the thorax, abdomen and pelvis excluded an ectopic source of hypercortisolaemia. MRI pituitary revealed an invasive macroadenoma. Treatment with endoscopic debulking resulted in the resolution of hypokalaemia and metabolic alkalosis with significant improvement in hyperglycaemia and hypertension.
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Affiliation(s)
- Najeeb Zaheer Shah
- Diabetes and Endocrinology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Department of Academic Diabetes, Endocrinology and Metabolism, University of Hull, Hull, UK
| | - Shah Malik
- Diabetes and Endocrinology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Thozhukat Sathyapalan
- Diabetes and Endocrinology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Department of Academic Diabetes, Endocrinology and Metabolism, University of Hull, Hull, UK
| | - Kamrudeen Mohammed
- Diabetes and Endocrinology, Hull University Teaching Hospitals NHS Trust, Hull, UK
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Dandörfer A, Studhalter M. [An Unusual Case of Rhabdomyolysis]. Praxis (Bern 1994) 2021; 110:525-528. [PMID: 34231379 DOI: 10.1024/1661-8157/a003683] [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] [Indexed: 06/13/2023]
Abstract
An Unusual Case of Rhabdomyolysis Abstract. We present the case of a 52-year-old patient with accidental liquorice intoxication after consumption of liquorice tea. In the Arabic cultures the consumption of liquorice tea is very popular during Ramadan and is used to suppress thirst. In the described case this led to a severe case of pseudohyperaldosteronism. Because of the classic presentation of a hypertensive crisis, hypokalaemia and rhabdomyolysis, the patient needed intensive care. Typically, the symptoms last for up to seven days after discontinuation of liquorice and completely subside with time. The treatment consists only of supportive care.
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Affiliation(s)
- Artur Dandörfer
- Interdisziplinäre Intensivstation, Kantonsspital Olten, Olten
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31
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Lattey K, Quinn S, O'Brien K. Over-the-counter antacids linked to severe hypokalaemia in the context of threatened preterm labour. BMJ Case Rep 2021; 14:e236083. [PMID: 33431440 PMCID: PMC7802640 DOI: 10.1136/bcr-2020-236083] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 01/13/2023] Open
Abstract
A healthy multiparous woman presented at 35 weeks and 4 days' gestation with threatened preterm labour on multiple occasions. An incidental finding of severe hypokalaemia (2.4 mmol/L) was detected on routine blood tests. The cause of this hypokalaemia was not initially obvious. It was eventually linked to overuse of over-the-counter antacids for pregnancy-associated heartburn. The patient was managed with parenteral and then oral electrolyte replacement which corrected a pH of 7.55, bicarbonate of 36.7 mEq/L and a base excess 13.1. In this case report we consider whether hypokalaemia could be linked to uterine irritability and threatened preterm labour, whether antacids were being abused in the context of an eating disorder and the importance of taking a full drug history.
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Affiliation(s)
- Katherine Lattey
- Department of Obstetrics and Gynaecology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Sarah Quinn
- Department of Obstetrics and Gynaecology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Katherine O'Brien
- Department of Obstetrics and Gynaecology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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32
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Ferreira JP, Butler J, Rossignol P, Pitt B, Anker SD, Kosiborod M, Lund LH, Bakris GL, Weir MR, Zannad F. Abnormalities of Potassium in Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 75:2836-2850. [PMID: 32498812 DOI: 10.1016/j.jacc.2020.04.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Abstract
Potassium (K+) is the most abundant cation in humans and is essential for normal cellular function. Alterations in K+ regulation can lead to neuromuscular, gastrointestinal, and cardiac abnormalities. Dyskalemia (i.e., hypokalemia and hyperkalemia) in heart failure is common because of heart failure itself, related comorbidities, and medications. Dyskalemia has important prognostic implications. Hypokalemia is associated with excess morbidity and mortality in heart failure. The lower the K+ levels, the higher the risk, starting at K+ levels below approximately 4.0 mmol/l, with a steep risk increment with K+ levels <3.5 mmol/l. Hyperkalemia (>5.5 mmol/l) has also been associated with increased risk of adverse events; however, this association is prone to reverse-causation bias as stopping renin angiotensin aldosterone system inhibitor therapy in the advent of hyperkalemia likely contributes the observed risk. In this state-of-the-art review, practical and easy-to-implement strategies to deal with both hypokalemia and hyperkalemia are provided as well as guidance for the use of potassium-binders.
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Affiliation(s)
- João Pedro Ferreira
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique, Nancy, France.
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi
| | - Patrick Rossignol
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique, Nancy, France
| | - Bertram Pitt
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri; The George Institute for Global Health, and University of New South Wales, Sydney, New South Wales, Australia
| | - Lars H Lund
- Department of Medicine Solna, Unit of Cardiology, Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - George L Bakris
- American Heart Association, Comprehensive Hypertension Center University of Chicago Medicine, Chicago, Illinois
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland, Baltimore, Maryland
| | - Faiez Zannad
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique, Nancy, France
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Negro A, Verzicco I, Tedeschi S, Campanini N, Zanelli M, Negri E, Farnetti E, Nicoli D, Palladini B, Santi R, Cunzi D, Calvi A, Coghi P, Gerra L, Volpi R, Graiani G, Cabassi A. Case Report: Irreversible Watery Diarrhea, Severe Metabolic Acidosis, Hypokalemia and Achloridria Syndrome Related to Vasoactive Intestinal Peptide Secreting Malignant Pheochromocytoma. Front Endocrinol (Lausanne) 2021; 12:652045. [PMID: 33815297 PMCID: PMC8010837 DOI: 10.3389/fendo.2021.652045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pheochromocytoma (PHEO) clinical manifestations generally mirror excessive catecholamines secretion; rarely the clinical picture may reflect secretion of other hormones. Watery diarrhea, hypokalemia and achlorhydria (WDHA) is a rare syndrome related to excessive secretion of vasoactive intestinal peptide (VIP). CLINICAL CASE A 73-year-old hypotensive man affected by adrenal PHEO presented with weight loss and watery diarrhea associated with hypokalemia, hyperchloremic metabolic acidosis (anion gap 15 mmol/l) and a negative urinary anion gap. Abdominal computed tomography scan showed a right adrenal PHEO, 8.1 cm in maximum diameter, with tracer uptake on 68GaDOTA-octreotate positron emission tomography. Metastasis in lumbar region and lung were present. Both chromogranin A and VIP levels were high (more than10 times the normal value) with slightly elevated urine normetanephrine and metanephrine excretion. Right adrenalectomy was performed and a somatostatin analogue therapy with lanreotide started. Immunostaining showed chromogranin A and VIP co-expression, with weak somatostatin-receptor-2A positivity. In two months, patient clinical conditions deteriorated with severe WDHA and multiple liver and lung metastasis. Metabolic acidosis and hypokalemia worsened, leading to hemodynamic shock and exitus. CONCLUSIONS A rare case of WDHA syndrome caused by malignant VIP-secreting PHEO was diagnosed. High levels of circulating VIP were responsible of the rapidly evolving clinical picture with massive dehydration and weight loss along with severe hyperchloremic metabolic acidosis and hypokalemia due to the profuse untreatable diarrhea. The rescue treatment with lanreotide was unsuccessful because of the paucity of somatostatin-receptor-2A on VIP-secreting PHEO chromaffin cells.
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Affiliation(s)
- Aurelio Negro
- Internal Medicine and Secondary Hypertension Center, Ospedale Sant’Anna di Castelnovo Ne’ Monti, Azienda Unità sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ignazio Verzicco
- Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, S.S. Fisiopatologia Medica, Clinica Medica Generale e Terapia Medica, Parma, Italy
| | - Stefano Tedeschi
- Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, S.S. Fisiopatologia Medica, Clinica Medica Generale e Terapia Medica, Parma, Italy
| | - Nicoletta Campanini
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Magda Zanelli
- Pathology Unit, Ospedale Sant’Anna di Castelnovo Ne’ Monti, Azienda Unità sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Emanuele Negri
- High Care Internal Medicine Unit, Ospedale Sant’Anna di Castelnovo Ne’ Monti, Azienda Unità sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Farnetti
- Molecular Biology Laboratory, Ospedale Sant’Anna di Castelnovo Ne’ Monti, Azienda Unità sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Nicoli
- Molecular Biology Laboratory, Ospedale Sant’Anna di Castelnovo Ne’ Monti, Azienda Unità sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Barbara Palladini
- Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, S.S. Fisiopatologia Medica, Clinica Medica Generale e Terapia Medica, Parma, Italy
| | - Rosaria Santi
- Internal Medicine and Secondary Hypertension Center, Ospedale Sant’Anna di Castelnovo Ne’ Monti, Azienda Unità sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
- High Care Internal Medicine Unit, Ospedale Sant’Anna di Castelnovo Ne’ Monti, Azienda Unità sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Cunzi
- Internal Medicine and Secondary Hypertension Center, Ospedale Sant’Anna di Castelnovo Ne’ Monti, Azienda Unità sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, S.S. Fisiopatologia Medica, Clinica Medica Generale e Terapia Medica, Parma, Italy
| | - Anna Calvi
- Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, S.S. Fisiopatologia Medica, Clinica Medica Generale e Terapia Medica, Parma, Italy
| | - Pietro Coghi
- Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, S.S. Fisiopatologia Medica, Clinica Medica Generale e Terapia Medica, Parma, Italy
| | - Luigi Gerra
- Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, S.S. Fisiopatologia Medica, Clinica Medica Generale e Terapia Medica, Parma, Italy
| | - Riccardo Volpi
- Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, S.S. Fisiopatologia Medica, Clinica Medica Generale e Terapia Medica, Parma, Italy
| | - Gallia Graiani
- Histology and Histopathology Unit, Dental School, University of Parma, Parma, Italy
| | - Aderville Cabassi
- Centro Ipertensione Arteriosa e Studio Malattie Cardiorenali, S.S. Fisiopatologia Medica, Clinica Medica Generale e Terapia Medica, Parma, Italy
- *Correspondence: Aderville Cabassi,
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Chmiel C, Giambarba C, Trachsler J. Sudden Paralysis in an American Football Player! Monster Football? Praxis (Bern 1994) 2021; 110:160-163. [PMID: 33653101 DOI: 10.1024/1661-8157/a003621] [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] [Indexed: 06/12/2023]
Abstract
This case of ascending paralysis, following an episode of diarrhea, was initially misinterpreted as Guillain-Barré syndrome. The prominent hypokalemia led to the search for other differential diagnoses, initially interpreted as a rare case of periodic hypokalemic paralysis, which usually occurs in Asians after intake of large amounts of starch foods, such as Spaghetti, or rest after heavy exercise. In this case, the reason for the hypokalemia with associated paralysis was caused by a hyperhyreosis factitia through denied intake of T3.
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Affiliation(s)
- Corinne Chmiel
- University Hospital of Zurich, Institute of Primary Care, Switzerland
- mediX praxis friesenberg, Zurich, Switzerland
- Private Practice Zurich, Switzerland
- City Hospital Waid, Zurich, Switzerland
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Paleń-Tytko JE, Przybylik-Mazurek EM, Rzepka EJ, Pach DM, Sowa-Staszczak AS, Gilis-Januszewska A, Hubalewska-Dydejczyk AB. Ectopic ACTH syndrome of different origin-Diagnostic approach and clinical outcome. Experience of one Clinical Centre. PLoS One 2020; 15:e0242679. [PMID: 33237923 PMCID: PMC7688153 DOI: 10.1371/journal.pone.0242679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Ectopic Cushing Syndrome (EAS) is a rare condition responsible for about 5–20% of all Cushing syndrome cases. It increases the mortality of affected patients thus finding and removal of the ACTH-producing source allows for curing or reduction of symptoms and serum cortisol levels. The aim of this study is to present a 20-year experience in the diagnosis and clinical course of patients with EAS in a single Clinical Centre in Southern Poland as well as a comparison of clinical course and outcomes depending on the source of ectopic ACTH production–especially neuroendocrine tumors with other neoplasms. Methods Twenty-four patients were involved in the clinical study with EAS diagnosed at the Department of Endocrinology between years 2000 and 2018. The diagnosis of EAS was based on the clinical presentation, hypercortisolemia with high ACTH levels, high dose dexamethasone suppression test and/or corticotropin-releasing hormone tests. To find the source of ACTH various imaging studies were performed. Results Half of the patients were diagnosed with neuroendocrine tumors, whereby muscle weakness was the leading symptom. Typical cushingoid appearance was seen in merely a few patients, and weight loss was more common than weight gain. Patients with neuroendocrine tumors had significantly higher midnight cortisol levels than the rest of the group. Among patients with infections, we observed a significantly higher concentrations of cortisol 2400 levels in gastroenteropancreatic neuroendocrine tumors. Chromogranin A correlated significantly with potassium in patients with neuroendocrine tumors and there was a significant correlation between ACTH level and severity of hypokalemia. Conclusion EAS is not common, but if it occurs it increases the mortality of patients; therefore, it should be taken into consideration in the case of coexistence of severe hypokalemia with hypertension and muscle weakness, especially when weight loss occurs. Because the diagnosis of gastroenteropancreatic neuroendocrine tumor worsens the prognosis-special attention should be paid to these patients.
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Affiliation(s)
- Elazer R Edelman
- From the Department of Medicine, Brigham and Women's Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School - all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.)
| | - Neel M Butala
- From the Department of Medicine, Brigham and Women's Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School - all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.)
| | - Laura L Avery
- From the Department of Medicine, Brigham and Women's Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School - all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.)
| | - Andrew L Lundquist
- From the Department of Medicine, Brigham and Women's Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School - all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.)
| | - Anand S Dighe
- From the Department of Medicine, Brigham and Women's Hospital (E.R.E.), the Departments of Medicine (N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Massachusetts General Hospital, and the Departments of Medicine (E.R.E., N.M.B., A.L.L.), Radiology (L.L.A.), and Pathology (A.S.D.), Harvard Medical School - all in Boston, and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (E.R.E.)
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Lee J, Kang B, Ha J, Kim MH, Choi B, Hong TH, Kang MI, Lim DJ. Clinical outcomes of primary aldosteronism based on lateralization index and contralateral suppression index after adrenal venous sampling in real-world practice: a retrospective cohort study. BMC Endocr Disord 2020; 20:114. [PMID: 32727424 PMCID: PMC7388450 DOI: 10.1186/s12902-020-00591-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We investigated whether the contralateral suppression index in aldosterone-producing adrenal adenoma could be used as a diagnostic criterion when catheterization in either right or left adrenal vein fails or when a discrepancy in the adrenal vein sampling (AVS) results and imaging findings occurs in the real-world practice. METHODS We retrospectively reviewed 48 patients who had resistant hypertension (HTN) or hypokalemia with a biochemical diagnosis of primary aldosteronism and who underwent AVS from January 2009 to June 2017 at a tertiary referral hospital. Selection index (SI), lateralization index (LI), and contralateral suppression index (CSI) were calculated based on AVS results and the final clinical outcomes were evaluated. RESULTS The catheterization of both adrenal veins was successful in 43 of 48 (89.6%) patients. The lateralization based only on LI was performed in 23 out of 43 (53.5%) patients. When CSI and LI were combined in decision making, the concordance between adrenal computed tomography scan and AVS for unilateral lesion improved from 59.3% (19/32) to 75.0% (24/32). CSI also correlated well with unilateral adrenal disease in the catheterization failure group. The final outcomes of HTN were better in the contralateral suppression group. CONCLUSION CSI combined with LI could be a supplementary diagnostic tool in patients with non-lateralization or catheterization failure and predict the clinical outcomes of HTN in patients with primary aldosteronism.
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Affiliation(s)
- Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Borami Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byungil Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Ho Hong
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moo Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Abstract
RATIONALE The typical clinical presentations of patients with primary aldosteronism (PA) include generalized weakness, fatigue, high blood pressure, and potassium deficiency. However, normotensive PA is rare. Therefore, an atypical presentation of normal blood pressure is a challenge for the diagnosis and treatment of PA. PATIENT CONCERNS A 43-year-old, thin, and tall woman (body mass index, 18.6 kg/m) with generalized weakness for 1 day presented to our emergency department, where hypokalemia was a significant finding. The initial diagnosis was anorexia nervosa with the evidence of renal potassium wasting with low urinary sodium and chloride levels, metabolic alkalosis, normal blood pressure, and low body mass index. However, neither vomiting features nor other specific induced vomiting features were noted. DIAGNOSES The laboratory examination revealed high plasma aldosterone level, low plasma renin activity, and extremely high aldosterone-to-renin ratio indicating the diagnosis of PA, confirmed via adrenal computed tomography. INTERVENTIONS Surgical adrenalectomy was performed. Pathological diagnosis was a benign cortical adenoma. OUTCOMES Patient's serum potassium level and hormonal status became normalized after surgical removal of adrenal adenoma. She fully recovered without any further sequelae. LESSONS It is too early to rule out PA based on the presence of normal blood pressure in a patient with metabolic alkalosis and renal wasting hypokalemia. Moreover, PA should be considered in a normotensive patient with an unknown hypokalemic etiology to avoid delayed diagnosis and treatment.
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Affiliation(s)
- Yen-Chu Huang
- Division of General Medicine, Department of Internal Medicine
| | - Ming-Hsien Tsai
- Division of General Medicine, Department of Internal Medicine
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital
- Fu-Jen Catholic University School of Medicine, Taipei, Taiwan (ROC)
| | - Yu-Wei Fang
- Division of General Medicine, Department of Internal Medicine
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital
- Fu-Jen Catholic University School of Medicine, Taipei, Taiwan (ROC)
| | - Mei-Lan Tu
- Division of General Medicine, Department of Internal Medicine
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital
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Sakhamuri S, Goji S, Teelucksingh S. Case Report: Flavored Vaping-Associated Hypokalemia. Am Fam Physician 2020; 102:74-76. [PMID: 32667173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Choi DS, Shin SD, Ro YS, Lee KW. Relationship between serum potassium level and survival outcome in out-of-hospital cardiac arrest using CAPTURES database of Korea: Does hypokalemia have good neurological outcomes in out-of-hospital cardiac arrest? ADV CLIN EXP MED 2020; 29:727-734. [PMID: 32608580 DOI: 10.17219/acem/122178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sudden cardiac arrest is a major cause of death worldwide. Serum potassium level is an initial laboratory test that serves as part of an electrolyte panel easily obtainable by most emergency departments (EDs). OBJECTIVES To evaluate the relationship between serum potassium level and the survival outcome for out-of-hospital cardiac arrest (OHCA) patients. MATERIAL AND METHODS We used the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiological Surveillance (CAPTURES) database, which made up the OHCA cohort of 27 EDs in Korea from January to December 2014. The inclusion criteria were all OHCA patients in the cohort who had received cardiopulmonary resuscitation (CPR) in the hospital. The patients were excluded if they were transferred from another hospital, had a pre-hospital return of spontaneous circulation (ROSC), or if the potassium level and clinical outcome data were missing or not captured. The main parameter was serum potassium level on ED arrival. According to the serum potassium level, the patients were divided into a hypokalemia group (K+ < 3.5 mEq/L), a normokalemia group (K+ = 3.5-5.4 mEq/L) and a hyperkalemia group (K+ ≥ 5.5 mEq/L). The primary outcome was neurologically favorable survival discharge. RESULTS Among the 1,616 patients in the CAPTURES cohort, 913 patients were included in the analysis, of whom 46 patients (5.9%) were assigned to the hypokalemia group, 370 patients (40.5%) were assigned to the normokalemia group and 497 patients (54.4%) were assigned to the hyperkalemia group. The hypokalemia group has a significantly higher percentage of good neurological outcomes (26.1%). There was a significant positive correlation with neurologically favorable survival (odds ratio (OR) = 4.45; 95% confidence interval (95% CI) = 1.67-11.91) and a significant positive correlation with survival discharge (OR = 2.25; 95% CI = 1.05-4.82). CONCLUSIONS In OHCA patients, serum potassium level measured in the hospital showed a significant association with survival outcome. Hypokalemia had a significant association with good neurological outcome and survival discharge.
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Affiliation(s)
- Dong Sun Choi
- Department of Emergency Medicine, Seoul National University Hospital, South Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, South Korea
| | - Young Sun Ro
- Biomedical Research Institute, Seoul National University Hospital, South Korea
| | - Kyung Won Lee
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, South Korea
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41
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Penev D, Rotering C, Pusl T. Sudden Night Palsy in a Young Man: Thyrotoxic Periodic Paralysis as a First Manifestation of Hyperthyroidism. Am J Med 2020; 133:e300-e301. [PMID: 31862328 DOI: 10.1016/j.amjmed.2019.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Damyan Penev
- Department of Cardiology, Respiratory Medicine, Intensive Care, and Endocrinology, University Hospital Augsburg, University of Augsburg, Germany.
| | - Christine Rotering
- Ambulatory Healthcare Center for Applied Diabetology and General Medicine, Asbach-Bäumenheim GmbH, Asbach-Bäumenheim, Germany
| | - Thomas Pusl
- Department of Cardiology, Respiratory Medicine, Intensive Care, and Endocrinology, University Hospital Augsburg, University of Augsburg, Germany
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42
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Zhang Z, Wood KN, Mao MA. 53-Year-Old Man With Hypokalemia and Renal Injury. Mayo Clin Proc 2020; 95:581-586. [PMID: 32138884 DOI: 10.1016/j.mayocp.2019.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Zhenmei Zhang
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Kathryne N Wood
- Resident in Neurology, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Michael A Mao
- Advisor to residents and Consultant in Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL.
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Ravn Jacobsen M, Jabbari R, Glinge C, Kjær Stampe N, Butt JH, Blanche P, Lønborg J, Wendelboe Nielsen O, Køber L, Torp‐Pedersen C, Pedersen F, Tfelt‐Hansen J, Engstrøm T. Potassium Disturbances and Risk of Ventricular Fibrillation Among Patients With ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2020; 9:e014160. [PMID: 32067598 PMCID: PMC7070188 DOI: 10.1161/jaha.119.014160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Potassium disturbances per se increase the risk of ventricular fibrillation (VF). Whether potassium disturbances in the acute phase of ST-segment-elevation myocardial infarction (STEMI) are associated with VF before primary percutaneous coronary intervention (PPCI) is uncertain. Methods and Results All consecutive STEMI patients were identified in the Eastern Danish Heart Registry from 1999 to 2016. Comorbidities and medication use were assessed from Danish nationwide registries. Potassium levels were collected immediately before PPCI start. Multivariate logistic models were performed to determine the association between potassium and VF. The main analysis included 8624 STEMI patients of whom 822 (9.5%) had VF before PPCI. Compared with 6693 (77.6%) patients with normokalemia (3.5-5.0 mmol/L), 1797 (20.8%) patients with hypokalemia (<3.5 mmol/L) were often women with fewer comorbidities, whereas 134 (1.6%) patients with hyperkalemia (>5.0 mmol/L) were older with more comorbidities. After adjustment, patients with hypokalemia and hyperkalemia had a higher risk of VF before PPCI (odds ratio 1.90, 95% CI 1.57-2.30, P<0.001) and (odds ratio 3.36, 95% CI 1.95-5.77, P<0.001) compared with normokalemia, respectively. Since the association may reflect a post-resuscitation phenomenon, a sensitivity analysis was performed including 7929 STEMI patients without VF before PPCI of whom 127 (1.6%) had VF during PPCI. Compared with normokalemia, patients with hypokalemia had a significant association with VF during PPCI (odds ratio 1.68, 95% CI 1.01-2.77, P=0.045) after adjustment. Conclusions Hypokalemia and hyperkalemia are associated with increased risk of VF before PPCI during STEMI. For hypokalemia, the association may be independent of the measurement of potassium before or after VF.
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Affiliation(s)
- Mia Ravn Jacobsen
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Reza Jabbari
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Charlotte Glinge
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Niels Kjær Stampe
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Jawad Haider Butt
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Paul Blanche
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of BiostatisticsUniversity of CopenhagenDenmark
| | - Jacob Lønborg
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Olav Wendelboe Nielsen
- Department of CardiologyBispebjerg and Frederiksberg University HospitalCopenhagenDenmark
| | - Lars Køber
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | | | - Frants Pedersen
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Jacob Tfelt‐Hansen
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of Forensic MedicineFaculty of Medical ScienceUniversity of CopenhagenDenmark
| | - Thomas Engstrøm
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of CardiologyUniversity of LundSweden
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44
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Di Filippo L, Bosi E, Martinenghi S. A complete flaccid quadriparesis as early presentation of Graves' disease. J Endocrinol Invest 2020; 43:255-256. [PMID: 31529390 DOI: 10.1007/s40618-019-01115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- L Di Filippo
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, Milan, Italy
| | - E Bosi
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, Milan, Italy
- Diabetes Research Institute, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milan, Italy
| | - S Martinenghi
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, Milan, Italy.
- Diabetes Research Institute, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milan, Italy.
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45
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Keerthana T, Sridhar C, Raja K. Acute fl accid quadriplegia: it is Hypokalemia or hyperkalemia..? J Assoc Physicians India 2020; 68:75. [PMID: 31979740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - C Sridhar
- Stanley medical college and hospital
| | - K Raja
- Stanley medical college and hospital
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46
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Barathidasan GS, Krishnamurthy S, Karunakar P, Rajendran R, Ramya K, Dhandapany G, Ramamoorthy JG, Ganesh RN. Systemic lupus erythematosus complicated by a Gitelman-like syndrome in an 8-year-old girl. CEN Case Rep 2019; 9:129-132. [PMID: 31853802 DOI: 10.1007/s13730-019-00440-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/10/2019] [Indexed: 12/18/2022] Open
Abstract
An 8-year-old girl with recently diagnosed Systemic Lupus Erythematosus (SLE) (class 4 lupus nephritis with autoimmune hemolytic anemia) presented to the pediatric nephrology clinic with polyuria, tiredness and cramps; laboratory investigations revealed refractory hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria and hyperchloriuria. There was no history of diuretic administration. These features were consistent with the Gitelman syndrome. She required large doses of potassium and magnesium supplementation along with spironolactone, for normalization of the serum potassium and magnesium levels. Immunosuppressive therapy was continued with cyclophosphamide pulses administered on a monthly basis. The doses of potassium and magnesium supplements were tapered off over the next 6 months. The clinical exome sequencing was negative for any mutations in the SLC12A3 gene. An 'acquired' form of Gitelman syndrome has been reported earlier in association with Sjogren syndrome and systemic sclerosis. Though tubular disorders such as renal tubular acidosis have been reported in association with SLE, a Gitelman-like syndrome has not been reported earlier. This case adds Gitelman-like tubulopathy to the clinical spectrum of tubular disorders complicating SLE.
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Affiliation(s)
- Gowri Shankar Barathidasan
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
| | - Pediredla Karunakar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Ranjitha Rajendran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Kagnur Ramya
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Gunasekaran Dhandapany
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | | | - Rajesh Nachiappa Ganesh
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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47
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Abstract
Refeeding syndrome describes the metabolic disturbances and clinical sequelae that occur in response to nutritional rehabilitation of patients who are moderate to severely malnourished. When risk factors are not identified and nutrition therapy is not managed appropriately, devastating consequences such as electrolyte depletion and imbalances, fluid overload, arrhythmia, seizure, encephalopathy, and death may occur. As this entity is often unrecognized, especially in pediatrics, becoming familiar with the pathophysiology, clinical manifestations, and management strategies will help clinicians caring for children avoid unnecessary morbidity and mortality. [Pediatr Ann. 2019;48(11):e448-e454.].
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48
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Turczyn A, Skrzypczyk P, Mizerska-Wasiak M, Brzewski M, Pańczyk-Tomaszewska M. [Accidentally diagnosed distal renal tubular acidosis with nephrocalcinosis - a case report]. Pol Merkur Lekarski 2019; 46:146-148. [PMID: 30912526] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
UNLABELLED Distal renal tubular acidosis is a defect of acidification of urine in distal tubule. Full-blown form is characterized by polyuria, growth deficiency, nephrolithiasis or nephrocalcinosis. Mutations in genes encoding Cl-/HCO3 - exchanger (autosomal dominant) or H+-ATPase (autosomal recessive) are the most frequent in children. A CASE REPORT In a boy aged 2,5 years, healthy, with proper development, metabolic acidosis with hyperchloremia, hypokalaemia, normal glomerular filtration rate and alkaline urine was discovered during hospitalization because of pneumonia. USG showed normal length kidney with nephrocalcinosis type IIB. The family history revealed nephrocalcinosis on the part of the boy's father. He also had metabolic acidosis in blood gas test. Genetic test in a boy and his father showed mutation of SLC4A1(17q21-q22) gene encoding Cl-/HCO3 - exchanger. The boy was treated with 8,4% NaHCO3 - orally (1mEq/kg/24h) and KCl (0,3 mEq/kg/24h). We obtained normalization of blood gas test and potassium concentration. CONCLUSIONS Every child, with accidentally discovered metabolic acidosis, even with normal development, should be diagnosed in case of renal tubular acidosis. Electrolytes, gas blood test, urinalysis and USG are needed in the closest family members of child with diagnosed renal tubular acidosis.
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Affiliation(s)
- Agnieszka Turczyn
- Medical University of Warsaw, Poland: Department of Pediatrics and Nephrology
| | - Piotr Skrzypczyk
- Medical University of Warsaw, Poland: Department of Pediatrics and Nephrology
| | | | - Michał Brzewski
- Medical University of Warsaw, Poland: Department of Pediatric Radiology
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Vergine G, Ravaioli E, Palazzo V, Gambaro G, Giglio S. [A child with severe growth delay and renal cysts]. G Ital Nefrol 2019; 36:36-1-2019-5. [PMID: 30758150] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We describe the case of a 5-year-old who came to our attention for a growth delay. Among the investigations planned because of the child's short stature, we performed an abdominal ultrasound showing normal-sized kidneys with signs of cortico-medullar de-differentiation, diffuse medullary hyperechogenicity with reduction of cortical thickness and cortical-medullary cysts. The ultrasound findings, also confirmed in MRI, led us to suspect a genetically determined cystic nephropathy of the nephronophthisis or medullary cystic disease type. No mutation was identified in NPHP1, HNFb1 and UMOD genes. Interestingly, laboratory investigations revealed a severe metabolic acidosis with normal renal function and hypokalemia. These findings are not characteristics of a nephronophthisis. We therefore also performed molecular analysis for distal tubular acidosis (dRTA) that showed the association of two genetic variants of ATP6V1B1 and SLC4A genes. These "double mutations" have been inherited from the mother, which however does not have the classic dRTA phenotype. These variants do not currently meet the criteria for a conclusive molecular diagnosis of dRTA but represent variants of uncertain clinical significance. However, considering the clinical and laboratory data one can reasonably conclude that the child has a "probable" diagnosis of distal tubular acidosis. The rapid recovery of staturo-ponderal growth after the start of alkalizing treatment supports our diagnostic hypothesis. The association between distal tubular acidosis and renal cysts is well described in the literature. The hypothesis is that chronic hypokalemia may play a possible role in the formation of renal cysts.
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Affiliation(s)
| | | | | | - Giovanni Gambaro
- UO Nefrologia, Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Roma
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50
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Diebold M, Kistler AD. [CME: Evaluation of Hypokalemia]. Praxis (Bern 1994) 2019; 108:207-213. [PMID: 30838955 DOI: 10.1024/1661-8157/a003191] [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] [Indexed: 06/09/2023]
Abstract
CME: Evaluation of Hypokalemia Abstract. Hypokalemia is a common electrolyte abnormality in clinical practice. While often asymptomatic, it can be associated with severe adverse outcomes. The etiology is often obvious or can be established based on clinical history. In other cases, a systematic approach and knowledge of the physiologic and pathophysiologic key players are necessary. Pathophysiologically, inadequate intake, extra- to intracellular shift and potassium loss (renal, gastrointestinal, sweat) or a combination thereof can contribute to hypokalemia. In this article we discuss the differential diagnosis and the diagnostic approach to this common electrolyte abnormality.
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