An unusual recurrent ileocolonic injury

Potassium binders (Kayexalate® and Sorbisterit®) are commonly used to treat hyperkaliemia. They are made of sodium or calcium polystyrene sulfonate. Their use is associated with multiple adverse effects including ileocolonic (or more rarely upper digestive tract) injuries which can lead to necrosis or perforations. This side effect is mostly seen in patients with chronic kidney disease or constipation. It presents with abdominal pain, diarrhea or hematochezia. The diagnosis is made when the histo-logical analysis of samples from the erythematous or ulcerated digestive wall finds polystyrene sulfonate crystals embedded in the mucosa. This diagnosis can be suspected by taking a careful initial drug inventory, if the clinician is aware of this rare but serious adverse effect. The lack of specificity of clinical symptoms and endoscopic lesions makes this inventory even more essential. Treatment is mainly supportive and requires cessation of the drug, while surgery is inevitable in the most severe cases.

Incidence of hyperkalemic RTA in pediatric post-renal transplant patients and the role of fludrocortisone

BACKGROUND

One of the most common forms of post-transplant tubulopathy is hyperkalemic (RTA). The true incidence of hyperkalemic RTA in pediatric patients has not yet been studied. (CNIs) remain mostly blamed. Most cases are managed with sodium bicarbonate and potassium binding resins. Few studies have addressed the role of fludrocortisone in managing such patients. This study aimed to assess the efficacy and safety of fludrocortisone in the treatment of post-transplant hyperkalemic RTA.

METHOD

This is a retrospective cohort study of all pediatric (aged ≤16 years) post-kidney transplant patients who were followed up in KFSH-D, Saudi Arabia from January 2015 until September 2019. A total of 136 pediatric post-renal transplant patients were reviewed, of these, 39 patients who were commenced on fludrocortisone post-transplant treatment and were followed up for at least 6 months after fludrocortisone initiation were included in this study.

RESULTS

The incidence of hyperkalemic RTA in our center was 60.6%. The medication requirements decreased significantly after fludrocortisone initiation. The median sodium bicarbonate dose decreased from 1.2 mEq/kg/day (range, 0.0-4.7) prior to fludrocortisone treatment to 0.0 mEq/kg/day (range, 0.0-4.3) at 6-month follow-up (p < .001). Similarly, the median (SPS) dose decreased from 1.2 g/kg/day (range, 0.0-4.0) before fludrocortisone treatment to 0.0 g/kg/day (range, 0.0-3.6) (p < .001) at 6-month follow-up. The initial mean potassium level 5.17 mmol/L ± 0.61SD dropped to 4.60 mmol/L ± 0.46SD at 6-month follow-up (p < .001). The initial mean serum bicarbonate level 22.31 mmol/L ± 3.67SD increased to 24.5 mmol/L ± 2.8SD at 6-month follow-up (p < .01). No effect on systolic and diastolic blood pressure was observed during follow-up.

CONCLUSION

Hyperkalemic RTA incidence was high in our cohort. Fludrocortisone is safe and effective drug in the treatment of post-kidney transplant hyperkalemic RTA.

[Heparin-induced hyperkalaemia - a case report]

Heparins are drugs commonly used in the prevention and treatment of thromboembolic complications. It is also common to be aware of the complications of their use, such as increased risk of bleeding or induction of throbocytopenia. However, it should not be forgotten that in about 7% of patients the use of heparins may lead to the significant hyperkalaemia.

AIM

The aim of this study was to draw attention to the rare, but potentially fatal complication of heparin treatment.

CASE REPORT

Here we present the case of the 85-year-old man with the several co-morbid conditions, who developed hyperkalaemia during hospitalization. Hyperkalaemia was resistant to typical conventional treatment. It occured that the reason for this complication was hypoaldosteronism caused by the use of low molecular weight heparin in the prophylactic dose. Kaliaemia normalization was achieved not until the fludrocortisone was used. Heparin induced hyperkalaemia occurs in about 7-8% treated patients. Therefore, it is not a rare complication, but given the prevalence of heparin use and the potential number of patients with this complication, it is rarely diagnosed. Potentially because hyperkalaemia is usually asymptomatic and because heparin treatment is usually temporal. The reported case of a patient with asymptomatic heparin induced hyperkalaemia proves that in everyday practice we may face this complication, and its diagnosis and proper treatment is possible only if we remember about this risk.

Fatal cardiac arrhythmia caused by tumor lysis in a patient with diffuse large B-cell lymphoma upon start of R-CHOP

Tumor lysis syndrome is rare in diffuse large cell lymphoma, but it is important to recognize the risk in patients with massive tumor burden and reduced kidney function. Very intense vigilance can be necessary despite adequate prophylactic measures and certain drugs may exacerbate electrolyte derangements.