Rhabdomyolysis following severe hypokalemia caused by familial hypokalemic periodic paralysis.

Rhabdomyolysis continues to appear with increasing frequency and represents a medical emergency requiring rapid appropriate treatment. One of the unusual causes of nontraumatic rhabdomyolysis is hypokalemic periodic paralysis without secondary causes. Primary hypokalemic periodic paralysis is a rare genetic disease characterized by episodic attacks of muscle weakness due to decreases in serum potassium. A 30-year-old woman who had 3 episodic attacks of hypokalemic periodic paralysis was admitted in emergency room with sudden onset symmetrical muscle weakness. After several hours, she started to complain myalgia and severe ache in both calves without any changes. Laboratory test showed markedly elevated creatine phosphokinase, lactic dehydrogenase levels with hypokalemia, rhabdomyolysis resulting from hypokalemia was diagnosed. Here, we report an unusual case of rhabdomyolysis caused by severe hypokalemia, which was suggested a result of familial hypokalemic periodic paralysis.

Efficacy of Body Weight Reduction on the SGLT2 Inhibitor in People with Type 2 Diabetes Mellitus.

BACKGROUND: Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, reduces hyperglycemia and body weight by inhibiting renal glucose reabsorption. However, only a few studies have demonstrated efficacy of dapagliflozin for type 2 diabetic patients in Korea. We evaluated the efficacy and safety of dapagliflozin for Korean type 2 diabetes patients. METHODS: This is a retrospective study that included data from 61 patients who received 12 months of dapagliflozin therapy and who visited a single medical center between January 2015 and July 2016. Patients were separated into three groups: dual combination of dapagliflozin and metformin, triple combination of dapagliflozin and metformin with sulfonylurea, or dipeptidyl peptidase IV inhibitors, and quadriple combination of dapagliflozin, metformin, and sulfonylurea with dipeptidyl peptidase IV inhibitors. Patients who achieved ≥5% body weight reduction were classified as responders, and those who achieved <5% body weight reduction were classified as non-responders. RESULTS: After 12 months, the mean change from baseline body weight was -3.4±2.6 kg (P<0.001) for all patients, -3.4±3.1 kg (P<0.001) for group 1, -2.7±2.0 kg (P=0.008) for group 2, and -4.0±2.3 kg (P<0.001) for group 3. Fasting C-peptide level was higher in the responder group than in the non-responder group (3.25±1.07 ng/mL vs. 2.62±1.02 ng/mL, P=0.023). In total, reductions in HbA1c, PP2, and FPG levels were -0.61±0.82% (P=0.000), -35.4±62 mg/dL (P=0.000), and -21.3±56.2 mg/dL (P=0.012), respectively. They had mild adverse events included orthostatic dizziness and urinary tract infection. CONCLUSION: SGLT2 inhibitor improved glycemic control and reduced body weight in a safe manner for patients with type 2 diabetes mellitus.

Acute ST Elevated Myocardial Injury due to Coronary Thrombosis during Thoracic Endovascular Aortic Repair in Patient with Protein S Deficiency.

A 71-year-old woman who had suffered from pulmonary thromboembolism with deep vein thrombosis for 12 years presented the hospital with a huge thoracic aortic aneurysm. During thoracic endovascular therapy, she had a sudden coronary artery occlusion without having organized stenosis or plaque rupture even under the dual antiplatelet treatment and heparinization. She turned out to be having a protein S deficiency. A procedure related thrombotic adverse event in patient with protein S deficiency is very rare, so we report a case with literature review.