Intraoperative management of potentially fatal arrhythmias after anesthesia induced by severe hypokalemia: A case report / 北京大学学报(医学版)

Severe hypokalemia is defined as the concentration of serum potassium lower than 2.5 mmol/L, which may lead to serious arrhythmias and cause mortality. We report an unusual case of potentially fatal ventricular arrhythmias induced by severe hypokalemia in a patient undergoing laparoscopic partial nephrectomy in Peking University Third Hospital due to irregular use of indapamide before operation. Indapamide is a sulfonamide diuretic with vasodilative and calcium antagonistic effects, which enhances sodium delivery to the renal distal tubules resulting in a dose-related increase in urinary potassium excretion and decreases serum potassium concentrations. The electrolyte disorder caused by the diuretic is more likely to occur in the elderly patients, especially those with malnutrition or long-term fasting. Hence, the serum potassium concentration of the patients under indapamide therapy, especially elderly patients, should be monitored carefully. Meanwhile, the potassium concentration measured by arterial blood gas analysis is different from that measured by venous blood or laboratory test. According to the previous research, the concentration of potassium in venous blood was slightly higher than that in arterial blood, and the difference value was 0.1-0.5 mmol/L. This error should be taken into account when rapid intravenous potassium supplementation or reduction of blood potassium level was carried out clinically. In the correction of severe hypokalemia, the standard approach often did not work well for treating severe hypokalemia. The tailored rapid potassium supplementation strategy shortened the time of hypokalemia and was a safe and better treatment option to remedy life-threatening arrhythmias caused by severe hypokalemia with a high success rate. Through the anesthesia management of this case, we conclude that for the elderly patients who take indapamide or other potassium excretion diuretics, the electrolyte concentration and the general volume state of the patients should be comprehensively measured and fully evaluated before operation. It may be necessary for us to reexamine the serum electrolyte concentration before anesthesia induction on the morning of surgery in patients with the history of hypokalemia. For severe hypokalemia detected after anesthesia, central venous cannulation access for individualized rapid potassium supplementation is an effective approach to reverse the life-threatening arrhythmias caused by severe hypokalemia and ensure the safety of the patients.

Asociación del nivel de albúmina séricay alteraciones de los electrolitos, gases sanguíneos y compuestos nitrogenados en pacientes adultos incidentes del servicio de emergencia de un hospital general / Association between serum albumin and abnormalities in serum electrolytes, blood gases and nitrogencompounds in adult patients attending an emergency room of a general hospital

Objetivos: Estudiar la asociación entre el nivel de albúmina sérica y las alteraciones de los electrolitos, gasessanguíneos y compuestos nitrogenados en adultos incidentes del servicio de emergencia de un hospital general.Material y métodos: Se incluyeron 275 pacientes que acudieron a la emergencia del Hospital Cayetano Herediaen Lima, Perú entre el 2013 y el 2015 a quienes el médico tratante solicitó al ingreso electrolitos séricos, gasessanguíneos y albúmina sérica. Se contrastó la albúmina como variable ordinal contra los electrolitos, gases arteriales,urea, calcio y fósforo séricos. También se analizó mediante análisis bivariado la albúmina normal (>3,5 g/dl) y lamuy baja (<2,5 g/dl) contra la variables antes mencionadas y la existencia de correlación lineal entre los valoresnuméricos continuos de las diferentes variables con la albúmina sérica...

Objectives: To evaluate the association between serum albumin and abnormalities in serum electrolytes, bloodgases and nitrogen compounds in adult patients attending an emergency room of a general hospital. Methods: 275patients who attended the emergency room of Hospital Cayetano Heredia en Lima, Peru between 2013 and 2015were included in the study. Serum albumin (ordinal values) was contrasted with serum electrolytes, blood gases,urea, and serum calcium and phosphorus. Normal albumin (>3.5 g/dl) and low albumin (<2.5 g/dl) were contrastedwith the above-mentioned variables using bivariate analysis, and numeric values of these variables were correlatedwith serum albumin with lineal correlation...

Electrolytes and Na+-K+-Atpase: potential risk factors for the development of diabetic nephropathy

Diabetic nephropathy is the leading cause of death that affects more than 40% of diabetic patients. Its metabolic derangements are frequently accompanied with electrolyte imbalances. This study was aimed to evaluate the electrolyte homeostasis during the progression of diabetic nephropathy in various stages of developing nephropathy. Patients admitted in diabetic wards of various hospitals of Karachi were selected and divided into 4 groups with 50 individuals each. Group I [healthy normotensive, non-diabetics with normal renal functions as control]. Group II [diabetic patients with normal blood pressure and renal functions]. Group III [diabetic hypertensive patients without renal disease]. Group IV [diabetic nephropathy patients with nephropathy]. Their fasting blood samples were drawn and analyzed for the estimations of intra erythrocyte and serum electrolytes and Na+-K+-ATPase activity. Group II patients showed a significant increase in intra erythrocyte sodium, serum potassium and calcium levels where as intra erythrocyte potassium, Na+-K+-ATPase, serum sodium and magnesium were significantly decreased as compared to control. Group III showed a significant rise in intra erythrocyte sodium levels but intra erythrocyte potassium, Na+-K+-ATPase, serum sodium, calcium and magnesium were significantly lowered as compared to control. Group IV revealed a significant increase in intra erythrocyte sodium and significant decrease in intra erythrocyte potassium, Na+-K+-ATPase, serum sodium, calcium and magnesium levels as compared to control. The results suggest the progressive trends in electrolyte abnormalities in diabetes mellitus leading to end stage renal disease along with the abnormality of their chief transport mechanism. It points towards the potentiality of electrolytes disturbances as indicators for the progression of diabetic nephropathy and also beneficial in prognosis and treatment of the disease

Hidratação pós-exercício – Recomendações e Fundamentação Científica / Hydration post-exercise – recommendation and scientific evidence

A performance e a saúde de praticantes de exercício podem ser melhoradas se o processo de recuperação iniciar logo após o término de uma sessão de treino ou competição. A hidratação pós-exercício é dos fatores responsáveis pela manutenção de fluídos e eletrólitos e pelo armazenamento de glicogênio muscular e hepático. Os principais objetivos da rehidratação pós-exercício incluem a reposição das perdas de água, de eletrólitos e de carboidratos. Para otimizar o processo de recuperação dos indivíduos a reposição de líquidos pós-exercício deve ser cerca de 150% da perda do peso corporal. O principal eletrólito perdido pelo suor é o sódio (Na+), por isso recomenda-se adicionar a uma bebida esportiva, para repor a perda e facilitar a retenção de líquidos, restaurando o volume plasmático. A ressíntese de glicogênio muscular pode ser favorecida pela ingestão de carboidrato (50-100g) no período de no máximo até 2 horas pós-exercício. A reposição adequada de água, eletrólitos e carboidratos pode igualmente beneficiar a recuperação em atividades intermitentes e de alta intensidade.

The performance and the health in subjects who practice exercise may be improved if the recovery process starts as soon as the end of a training session or competition. One of the factors responsible for the maintenance of fluids and electrolytes and the muscular and liver glycogen stores is the hydration post-exercise. The main objectives of rehydration post-exercise are the replacement of water loses electrolytes and carbohydrates. To optimize the recovery process of an individual the fluid replacement post-exercise should be about 150% of body weigh loss. The main electrolyte lost in sweat is sodium (Na+), therefore it is recommended to add it to a sport drink to replenish its lost and facilitate fluid retention, improving the plasmatic volume. The muscular glycogen resynthesis can be enhanced with the ingestion of carbohydrate (50-100g) by 2 hours post-exercise. An adequate replacement of water, electrolytes and carbohydrate can also help the recovery in intermittent high intensity activities.