Falciparum malaria treated with a chloroquine suspension administered rectally in Trinidad

A new mode of administering malaria chemotherapy to patients unable to tolerate oral medication is described. A patient with Plasmodium falciparum malaria, severe hyponatraemia and hypokalemia who regurgitated oral treatment of chloroquine phosphate and pyrimethamine and sulfadoxine (Fansidar) is presented. But neither chloroquine nor quinine intravenous formulations were available locally. As the patient was deteriorating, a suspension of chloroquine phosphate was prepared and administered rectally, resulting in a decline in the level of parasitaemia from ++++ to ++ within 48 hours. The patient improved, and further clinical management was uncomplicated (AU)

An epidemiological study of potassium status, hypertension and diabetes in Barbados

The relationships between hypertension, diabetes, potassium status and other factors were examined in a population-based sample of 464 Barbadians. A stratified random sample by gender and age (40-79 years) was obtained from enumeration registers and investigated over a three month period. The previously reported low potassium range for Barbadians was confirmed (2.9-4.7 mmol/l). Within-subject correlation of plasma potassium and 24-hour urine potassium was demonstrated by repeat investigation in 70 subjects one year later. A high prevalence of obesity, hypertension and diabetes was confirmed in this population with relatively good health care. The prevalence of hypertension (by history) was 36 percent in the whole sample. Twenty-six percent of subjects were receiving antihypertensives, yet a diastolic BP of >90 mmHg was found in 17 percent of the whole sample. Six percent of subjects had a fasting plasma glucose greater than that cited by WHO. Subjects not on thiazides, compared to those on thiazides did not show a significant difference in fasting glucose or potassium values, but did show higher uric acid and cholesterol values. Dietary analyses confirmed the traditional high starch, low fruit Barbadian diet. The major risk factors for hypertension were female gender, obesity in females and positive family history. In this study a high prevalence of hypokalemia and moderately low dietary potassium has been demonstrated, but neither potassium deficiency nor thiazide use appeared to be definitely linked to diabetes or hypertension.

Hypertension, diabetes mellitus and potassium status in a population sample of black Barbadians: a preliminary report - abstract

The aims of this study were to assess the previously reported hypokalaemia in black Barbadians and investigate relationships between hypertension (diastolic bloodpressue > 90mm Hg and/or systolic bloodpressure > 160mm Hg), diabetes mellitus (DM, fasting plasma glucose > 7.8 mmol/l), diet and potassium (K) status in Barbadians. A stratified random sample by sex and age (40-70 years) was obtained from enumeration registers of a geographically defined area. Of 955 persons invited, 464 (48.6 per cent) responded and they comprised 190 men and 274 women. A general and a food frequency questionnaire for 24-hr. diet recall were administered, and height, weight and bloodpressure (BP) were measured. Fasting plasma glucose, K and sodium levels were measured in blood, and urine volume, sodium and K were determined in a 24-hr. urine collection. The mean plasma of K was 3.8 mmol/l, S.D. 0.44, giving a range (mean ñ 2 S.D.) of 2.9 - 4.7 mmol/l which was almost identical to that previously reported. Both 24-hr. urinary K and sodium showed a weak negative correlation with systolic BP only. K deficiency was not clearly linked to hypertension and neither K deficiency nor current thiazide use was linked to DM. The prevalence of hypertension (25 per cent), DM (11 per cent), obesity, hypokalaemia and moderately low dietary K were high (AU)

Changes in red cell sodium content and blood pressure levels with potassium supplementation in black hypertensive patients

Red cell sodium and potassium content were measured in 24 black hypertensive patients while they were hypokalaemic on thiazide diuretic therapy and again after potassium supplements (48 meq elemental K+/day). Mean and diastolic blood pressure levels fell by 4.1-4.4 and 4.5-5.2 mm Hg respectively with potassium supplementation, while both urinary excretion of potassium and serum potassium rose. Urinary sodium excretion was unchanged. Red cell potasssium remained within the normal range but red cell sodium, initially high, fell with potassium therapy. This study confirms the importance of potassium supplementation where hypokalaemic results from diuretic therapy (AU)

Changes in red cell sodium content and blood pressure levels with potassium supplementation in black hypertensive patients

Red cell sodium and potassium content were measured in 24 black hypertensive patients while they were hypokalemic on thiazide diuretic therapy and again after potassium supplements (48 meq elemental K+/day). Mean and diastolic blood pressure levels fell by 4.1-4.4 and 4.5-5.2 mm. hg respectively with potassium supplementation, while both urinary excretion of potassium and serum potassium rose. Urinary sodium excretion was unchanged. Rd cell potassium remained within the normal range but red cell sodium, initially high, fell with potassium therapy. This study confirms the importance of potassium supplementation where hypokalemia results from diuretic therapy(AU)

Effect of potassium supplementation in hypertensive patients with diuretic-induced hypokalaemia: changes in bloodpressure and red cell sodium content - abstract

Hypokalaemia is a frequent accompaniment of chronic diuretic therapy of hypertension. It is associated with an increased risk of cardiac arrhythmias as well as several biochemical abnormalities. Potassium supplementation produces a rise in serum potassium level and a fall in the mean blood pressure. The mechanisms underlying the changes in blood pressure with changes in body potassium status are ill understood but might involve changes in cell electrolytes. We therefore measured red cell sodium and potassium content in hypertensive patients during diuretic-induced hypokalaemia and after potassium supplementation. Eleven patients were treated with bendrofluazide (10 mg daily) for a monthe before measurements of serum and urine potassium, blood glucose level, uric acid and red cell sodium and potassium concentrations were made. Potassium chloride (60 mmol/day) was added for another month and the same measurements repeated. Red cell electrolyte content was measured by flame photometry after isolating the cells by density centrifugation. Mean blood pressure fell (103 ñ 3 to 95 ñ 3mm hg, p<0.005) with the change in serum potassium level from 3.1 ñ 0.1 to 4.1 ñ 0.3 meq/l(p<0.05). Red cell sodium content fell from 13.8 ñ 1.4 to 10.8 ñ 1.3 mmol Na/l RBC while potassium content was unchanged 90.7 ñ 8.6 vs 81.1 ñ 7.2 (p>0.10). Insignificant reductions in blood glucose and uric acid levels occurred. The fall in cell sodium concentration could contribute to the fall in blood pressure if similar changes occurred in vascular smooth muscle cells. Potassium supplementation enhance blood pressure control in hypokalaemic hypertensives (AU)

The syndrome of inappropriate secretion of antidiuretic hormone, associated with cerebral aneurysm

The case is presented of a 69-year-old woman with a long standing lesion at the base of the brain who terminally developed the classical findings of the inappropriate secretion of antidiuretic hormone. It is postulated that the lesion, in close proximity to the pituitary stalk, could have acted as an irritative focus, resulting in over-production of antidiuretic hormone (AU)