Reacciones adversas por salbutamol en pacientes asmáticos: reflexiones acerca del uso en las exacerbaciones / Adverse reactions from salbutamol in asthmatic patients: reflections on its use and exacerbations / Reações adversas ao salbutamol em pacientes asmáticos: reflexões sobre o seu uso e exacerbações

Las afecciones respiratorias agudas son la primera causa de consulta e ingreso hospitalario en los meses de invierno, y entre ellas el asma ocupa un lugar preponderante. El salbutamol es un broncodilatador con eficacia demostrada en las exacerbaciones y se utiliza de primera línea en el tratamiento. El objetivo de la presente comunicación es analizar dos casos clínicos de niños asmáticos que presentaron efectos adversos al salbutamol y requirieron el ingreso en la Unidad de Terapia Intensiva. Se propone revisar los efectos adversos del salbutamol empleado en crisis asmáticas y analizar las alternativas terapéuticas en esta enfermedad. Los síntomas de los efectos secundarios pueden confundirse con los causados por la propia enfermedad, por lo que puede usarse el fármaco de modo excesivo y es importante conocer el perfil posológico y caracterizar los posibles efectos secundarios en los pacientes para usar de manera racional y segura este medicamento.

Acute respiratory conditions are the first cause of consultation and hospital admission in the Winter months, being asthma the most important. Salbutamol is a bronchodilator with proven efficacy in exacerbations used first-line in treatment. The objective of this paper is to analyze two clinical cases of asthmatic children who presented adverse effects to salbutamol and required admission to the Intensive Care Unit. It is proposed to review the adverse effects of salbutamol used in asthmatic crises and to analyze therapeutic alternatives in this disease. Symptoms of side effects can be confused with those caused by the disease itself, determining the excessive use of this drug, thus, it is important to know the dosage profile and characterize the possible side effects to make rational and safe use of this drug.

As doenças respiratórias agudas são a primeira causa de consultas e internações nos meses de inverno e a asma ocupa é a mais importante. O salbutamol é um broncodilatador com eficácia comprovada nas exacerbações e é usado como tratamento de primeira linha. O objetivo desta comunicação é analisar dois casos clínicos de crianças asmáticas que apresentaram efeitos adversos ao salbutamol e necessitaram de internação em Unidade de Terapia Intensiva. Propõe-se revisar os efeitos adversos do salbutamol utilizado na crise asmática e analisar as alternativas terapêuticas nessa doença. Os sintomas de efeitos colaterais podem ser confundidos com os causados pela própria doença, determinando o uso excessivo desse medicamento, sendo importante conhecer o perfil posológico e caracterizar os possíveis efeitos colaterais nos pacientes para fazer um uso racional e seguro desse medicamento.

Severe hypokalemia secondary to abuse of ß-adrenergic agonists in a pediatric patient: Case report / Hipocalemia grave secundária a abuso de agonistas ß-adrenérgicos em paciente pediátrico: relato de caso

ABSTRACT This study reports a case of a 13-year-old male with a 3-year history of severe and intermittent hypokalemia episodes of unknown origin, requiring admission to the intensive care unit (ICU) for long QT syndrome (LQTS), finally diagnosed of redistributive hypokalemia secondary to the abuse of β-adrenergic agonists in the context of a probable factitious disorder.

RESUMO O presente estudo relata o caso de um jovem de 13 anos de idade com histórico, há três anos, de episódios de hipocalemia grave intermitente de origem desconhecida, internado em unidade de terapia intensiva (UTI) por síndrome do QT longo (SQTL). O paciente foi diagnosticado com hipocalemia por redistribuição secundária ao abuso de agonistas β-adrenérgicos, em contexto de provável transtorno factício.

Amphotericin B induced hypokalemia in a diabetic patient with rhino-orbitocerebral mucormycosis

Rhino-orbito-cerebral mucormycosis is an aggressive and potentially lethal invasive fungal infection. Surgical debridement and amphotericin B remain the mainstay of treatment, however, associated side effects of amphotericin B like nephrotoxicity, hypokalemia, hypertension and arrhythmias need to be addressed. We discuss the anesthetic management of a 47 year old male with uncontrolled diabetes diagnosed with left sinoorbital mucormycosis posted for surgical debridement. The patient received amphotericin B and insulin preoperatively. Nephrotoxicity due to amphotericin B led to hypokalemia in this patient. We also discuss the role of liposomal formulation in preventing hypokalemia and other side effects associated with use of amphotericin

Severe hypokalemia due to combination use of dexamethasone and calcium gluconate for diabetics with infection: a case report / 法医学杂志

The combination use of dexamethasone and calcium gluconate can be applied to hypersensitivity. Severe hypokalemia is a usual complication of dexamethasone and calcium gluconate therapy, which occurs frequently with therapeutic use. Fatal cases, accidental and intentional, occur frequently in forensic practice. The current case report presented a 43-year-old man with diabetes mellitus with infection, to whom dexamethasone and calcium gluconate were administered in the private clinic. With the development of such clinical symptoms of severe hypokalemia as quadriplegia, he was confirmed to have severe hypokalemia through a biochemical test before dying of arrhythmia. And also it presented pathophysiologic mechanism underlying severe hypokalemia as well as suggestions for clinical practice regarding combination use of dexamethasone and calcium gluconate.

Influência do veículo na eficácia da reposição de potássio em ratos hipocalêmicos / Vehicle influence on potassium replacement effectiveness in hypokalemic rats

INTRODUÇÃO: Pacientes após cirurgia cardíaca são comumente tratados com diuréticos para controle de volume plasmático. A preocupação de distúrbios hipocalêmicos em adultos antes, durante ou após a cirurgia já foi ressaltada anteriormente, visto o risco de arritmias cardíacas. Clinicamente, a diluição da solução de potássio (K+) para administração por via intravenosa, em situações que requerem a sua reposição é realizada utilizando-se soro fisiológico (SF) ao invés de soro glicosado 5 por cento (SG5 por cento), possivelmente em vista de poder ocorrer estimulação da secreção de insulina, que interferiria sobre a qualidade da reposição de K+. Porém, não está comprovado experimentalmente se o SF e SG5 por cento poderiam realmente interferir na qualidade da reposição de potássio em ratos com hipocalemia. OBJETIVO: Analisar a influência da reposição de K+ diluído em diferentes veículos sobre as concentrações plasmáticas de K+([K+]p) em ratos submetidos a hipocalemia induzida por furosemida. MÉTODOS: Ratos Wistar adultos foram divididos em quatro grupos: K++SF, K++SG, SF e SG. Foi realizada a canulação da veia jugular para reposição e da veia femoral para coleta de sangue. O diurético furosemida na dose de 50mg/kg foi usado para induzir hipocalemia, foi analisado nível plasmático de potássio 24 h antes da injeção de furosemida, 24 h pós-indução e 30 minutos pós-reposição. RESULTADOS: Os níveis da [K+] pós-injeção de furosemida sofreram redução, comparado aos valores basais (pré-furosemida) em todos os grupos. Entretanto, os níveis [K+] retornaram aos valores basais tanto nos grupos que receberam K++SF ou K++SG, o que não foi observado nos grupos que receberam apenas SF e SG. Quanto ao Na+ plasmático, somente o grupo K+SF apresentou aumento após reposição. CONCLUSÃO: A reposição de K+ diluído tanto em SF quanto SG parece não afetar a qualidade da reposição de K+ plasmático em ratos

INTRODUCTION: Patients who undergo cardiac surgery are commonly treated with diuretic therapy for the management of volume overload. The concern of hypokalemia important in the adult population submitted to cardiac surgery has been described. Intravenous potassium (K+) replacement dilution is only recommended with sodium chloride 0.9 percent solution (SF0.9 percent), likely due to the putative effects of glucose solution 5 percent (SG5 percent) on insulin secretion, which influence K+ replacement quality. However, it is not yet experimentally proved the influence of SF0.9 percent and SG5 percent on K+ replacement quality. Objectives: To evaluate the effects of different vehicles of K+ replacement on blood K+ levels in furosemide hypokalemic rats. METHODS: Male Wistar rats divided into four groups: K+SF, K+SG, SF and SG. Jugular vein cannulation for K+ replacement and femoral vein cannulation for blood analysis. Furosemide (50mg/kg) to induce hypokalemia. We prepared the following solutions: vehicle 1.6mL (SF0.9 percent or SG5 percent) + 0.4 mL de K+ (19.1 percent) and for control groups only vehicle 2 mL. Furosemide (50 mg/kg) was used to induce hypokalaemia, it was analyzed potassium plasmatic levels 24 hours before furosemide injection, 24 hours after furosemide injection and 30 minutes after post-replacement. RESULTS: There was no significative difference in blood K+ levels before furosemide administration, after hypokalemic induction and after K+ replacement among all groups. Only SF+K presented blood Na+ levels increaseafter K+ replacement (P<0.05). CONCLUSION: K+ replacement in different vehicles did not affect blood K+ levels in rats

Hipokalemia, hipovolemia y repercusión electrocardiográfica secundarias a ingesta prolongada de furosemida: Caso clínico / Hypokalemia, hypovolemia and electrocardiographic changes due to furosemide abuse: Report of one case

Hypokalemia (serum K+ < 3.5 mEq/1) is a potentially serious adverse effect of diuretic ingestión. We report a 27 year-old woman admitted with muscle weakness, a serum potassium of 2.0 mEq/1, metabolic alkalosis and EKG abnormalities simulating cardiac ischemia, that reverted with potassium chloride administration. She admitted high dose furosemide self-medication for edema. Glomerular filtration rate, tubular sodium reabsortion, potassium secretion, the renin-aldosterone system, total body water distribution and capillary permeability, were studied sequentially until 90 days after her admission. There was hyperactivity of the renin-aldosterone axis, reduction in extracellular and intracellular volumes, normal capillary permeability and high sodium tubular reabsorption, probably explained by a "rebound" salt retention associated with her decreased extracellular volume.

Barium carbonate poisoning mimicking Guillain-Barre syndrome.

Areflexic quadriplegia due to barium carbonate (rat poison) poisoning is described in two young patients. These cases very closely resembled Guillain-Barre syndrome. The various effects of barium carbonate along with the pathogenesis of hypokalaemic paralysis are highlighted.

Uso de anfotericina B en mezcla lipídica: ¿previene la toxicidad de la droga en pacientes críticos? / Use of amphotericin B as lipid emulsion: does it prevent drug toxicity in critical patients?

Background: Amphotericin B is efficacious for the treatment of systemic candidiasis, however it has potentially serious toxic effects. Administration as lipid emulsions has been advocated to decrease its toxicity. Aim: To compare the safety and tolerance of amphotericin B administered as lipid emulsion or dissolved in dextrose in water. Patients and methods: Forty five patients with confirmed or highly suspected systemic candidiasis were studied. Between January 1996 and June 1997 amphotericin B was administered in dextrose in water to 17 patients (group 1). Between July 1997 and December 1998, the drug was delivered in lipid emulsions (Intralipid, group 2). Clinical and laboratory parameters (serum creatinine, urea nitrogen and potassium), were assessed daily. Results: Both treatment groups were clinically comparable and had the same survival. Accumulative amphotericin B dose administered was 343.2 ñ 197 and 414.6 ñ 518 mg respectively. Hypokalemia was more frequent in group 2 (52 and 25 percent respectively, p < 0.05). There were no differences in the outcome of renal function or other adverse reactions. Conclusions: Administration of amphotericin B as lipid emulsions did not reduce its toxicity in critical patients

Hiponatremia e hipokalemia graves, recientes, asociadas a hidroclorotiazida, enalaprila y citalopram: caso clínico / Severe and recent hyponatremia and hypokalemia associated to the use of hydrochlorothiazide, enalapril and cytalopram: clinical case

We report a 72 years old hypertensive female, treated with enalapril 10 mg/day and hydrochlorothiazide 25 mg/day during three years. She presented a depressive disorder and cytalopram was prescribed in a dose of 10 mg/day. Two weeks before admission, a serum electrolyte analysis disclosed normal results and the cytalopram dose was increased to 20 mg/day. The patient was admitted with a hyponatremic encephalopathy with a plasma sodium of 100 mEq/L and a plasma potassium of 2.0 mEq/L. cytalopram, enalapril and hydrochlorothiazide were discontinued, hypertonic NaCl and KCl were administered. The patient had a favorable evolution with a remarkable improvement of her symptoms

Modificación en potasio sérico en niños asmáticos después de la administración de salbutamol nebulizado / Modification of potassium in asthmatic children after administration of nebulized albuterol

El salbutamol es un broncodilatador ß2 agonista utilizado para el tratamiento del asma. La hipokalemia es un efecto secundario que se ha descrito con el uso de salbutamol inhalado aun a dosis terapéuticas habituales. El objetivo del presente estudio fue comparar los niveles séricos de potasio al inicio y después de 60 minutos de la administración de salbutamol inhalado en niños que padecían una crisis asmática. Se realizó un estudio prospectivo, longitudinal, observacional y comparativo de 23 niños con edades entre dos y 16 años, que acudieron al servicio de Urgencia del Instituto Nacional de Pediatría con una crisis asmática. Se les administró salbutamol nebulizado, 1 mg en niños con peso menor de 10 kg y 2.5 mg en niños con peso mayor a 10 kg. Se les realizó determinación de potasio sérica y gasometría al ingreso y 60 minutos después de la administración del salbutamol. Los niveles séricos de potasio al ingreso fueron entre 3.7 y 5.7 mmol/L (promedio 4.46); 60 minutos después fueron entre 3.3 y 4.7 mmol/L (promedio 4.1), con una disminución significativa de 0.36 mmol/L (p=0.01). no se encontraron diferencias significativas en las determinaciones de pH. Se concluye que el salbutamol nebulizado disminuye los niveles séricos de potasio significativamente 60 minutos después de su administración en niños con crisis asmática

Hypouricemia, hypokalemia, proximal and distal tubular acidification defect following administration of outdated tetracycline: a case report.

A Thai female patient developed muscular weakness, hypouricemia, hypokalemia and hyperchloremic metabolic acidosis after taking outdated tetracycline. A pathophysiologic study shows a proximal tubular defect for reabsorption of urate and bicarbonate and a distal tubular acidification defect, probably caused by outdated tetracycline.

Diuretic induced hyponatraemia in the elderly.

Diuretics are an important cause of symptomatic hyponatraemia in the elderly. The hyponatraemia is often associated with hypokalaemia which may play a role in the aetiology. Diuretic induced hyponatraemia must be considered in the differential diagnosis of elderly patients presenting with altered sensorium or seizures. This is especially important in those known to be hypertensives since diuretics are frequently used to treat hypertension in the elderly.

Acute paralysis due to barium carbonate.

Poisoning due to barium carbonate (rat poison) resulting in areflexic quadriplegia and respiratory muscle paresis in a young patient is described. The various effects of barium salts on the human body and their treatment are highlighted.

Torsade de pointes: an unusual form of ventricular tachycardia

A 65-year-old man with hypertension and glaucoma developed diuretic-induced hypokalaemia complicated by torsade de pointes ventricular tachycardia. This arrhythimia requires accurate recognition so that appropriate therapy may be administered. When torsade de pointes is diagnosed, a careful search for underlying causes should be conducted as revesal of these may prove curative, as in this case

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

Red cell sodium and potassium content were measured in 24 hypertensive patients while they were hypokalaemic on thiazide diuretic therapy and agin after potassium supplements (48 meq elemental K+/day). Mean and diastolic blood levels fell by 4.1-4.4 and 44.5-5.2 mmHg respectively with potassium supplementation, while both urinary excretion of potassium and serum potassium rose. Urinary sodium excretion was unchanged. Red 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 hypokalaemia results from diuretic therapy

Hipokalemia inducida por diuréticos / Hypokalemia induced by diuretics

Los diuréticos producen hipokalemia desde la primera semana de tratamiento fundamentalmente por aumento de oferta de fluido del mecanismo de contrasporte Na-K2Cl. La hipokalemia debe ser corregida con sales como cloruro de potasio. La incidencia de arritmias ventriculares serias (taquicardia y fibrilación) se incrementan significativamente con valores de potasio sérico menores de 3.6 ó 3.5 mEq/lit