Caffeine-induced hypokalemia: a case report.

BACKGROUND: With an increase in the global popularity of coffee, caffeine is one of the most consumed ingredients of modern times. However, the consumption of massive amounts of caffeine can lead to severe hypokalemia. CASE PRESENTATION: A 29-year-old man without a specific past medical history was admitted to our hospital with recurrent episodes of sudden and severe lower-extremity weakness. Laboratory tests revealed low serum potassium concentration (2.6-2.9 mmol/L) and low urine osmolality (100-130 mOsm/kgH2O) in three such prior episodes. Urinary potassium/urinary creatinine ratio was 12 and 16 mmol/gCr, respectively. The patient was not under medication with laxatives, diuretics, or herbal remedies. Through an in-depth interview, we found that the patient consumed large amounts of caffeine-containing beverages daily, which included > 15 cups of coffee, soda, and various kinds of tea. After the cessation of coffee intake and concomitant intravenous potassium replacement, the symptoms rapidly resolved, and the serum potassium level normalized. CONCLUSIONS: An increased intracellular shift of potassium and increased loss of potassium in urine due to the diuretic action have been suggested to be the causes of caffeine-induced hypokalemia. In cases of recurring hypokalemia of unknown cause, high caffeine intake should be considered.

Preliminary results of using ALAnerv® in subacute motor incomplete paraplegics.

RATIONALE: To assess whether using ALAnerv® contributes to improvements of outcomes obtained in post SCI patients. OBJECTIVE: A prospective controlled clinical survey also to evaluate the safety and efficacy of ALAnerv® (2cps/ day for 28 days) in motor incomplete (AIS/ Frankel C) paraplegic subacute patients. METHODS AND RESULTS: 59 patients divided in study (treated with ALAnerv®) and control, groups. This survey's follow-up duration was of 28 days. Most of the studied patients were mid-aged (mean 43.75 years old) and respectively, men (64,29% in the study group; 58,06% in controls). We used descriptive statistics (functions: minimum, maximum, mean, median, standard deviation) and for related comparisons, parametric (Student t) and non-parametric (Mann-Whitney, Fisher's exact, chi-square) tests. The primary end-point: AIS motor values' evolution (P= 0.015 - Mann-Whitney), showed that patients treated with ALAnerv® - vs. controls - had a statistically significant better increase of such scores at discharge. Paraclinical parameters, mainly exploring systemic inflammatory status (secondary end-point): ESR dynamics (P=0.13) had no statistical significance; the plasma leucocytes number (P=0.018), the neutrophils' percentage (P=0.001) and fibrinogenemia (P= 0,017) proved in the treated group to have a statistically significant better evolution. We used "Statistical Package for Social Sciences" (SPSS). DISCUSSION: As there is actually no effective curative solution for the devastating pathology following SCI, any medical approach susceptible to bring even limited improvements, such as treatment with ALAnerv® seemed to have proven, is worth being surveyed, under strict circumstances of ethics and research methodology. Considering the necessity for more statistical power concerning primary, secondary end-points, and safety issues, as well, continuing this research is needed. ABBREVIATIONS: SCI = spinal cord injury, TSCI = traumatic spinal cord injury, BBB = blood brain barrier, CNS = central nervous system, SC = spinal cord, NSAIDs = non-steroidal anti-inflammatory drugs, SAIDs = steroidal anti-inflammatory drugs, AIS = American Spinal Injury Association Impairment Scale, SPSS = Statistical Package for Social Sciences, BATEH = Bagdasar-Arseni Teaching Emergency Hospital.

The effects of sauna on tetraplegic and paraplegic subjects.

Six tetraplegic (T) and 4 paraplegic (P) subjects underwent a 20-minute pre sauna phase (30 degrees C DB; 65% RH), and an up to 15-minute sauna (85 degrees C DB; less than 10% RH), followed by a 15 minute post sauna phase (30 degrees C DB; 65% RH). During all phases subjects wore a bathing suit and remained supine on a hospital trolley. Heart rate (HR) and blood pressure (BP) were recorded during all phases. Rectal temperature (Trec) was measured by a probe (AD590) inserted approximately 14 cm into the rectum. Oral temperature (Toral) also utilising (AD590) circuitry was recorded simultaneously with Trec. Skin temperature (Tsk) (AD590) was measured on the head, chest, right thigh and right calf. Forehead sweat rate (SR) was determined from dew point temperature (Tdp). A catheter was inserted into a dorsal hand or foot vein and venous blood was withdrawn at selected times and analysed for haemoglobin (Hb) and haematocrit (Hct), and the separated plasma was analysed for glucose (Glu), sodium (Na+), potassium (K+) and chloride (C1-). Venous blood sampled just prior to entering and just prior to leaving the sauna, was analysed for adrenalin (A) and noradrenalin (NA) using high performance liquid chromatography. For both groups HR rose significantly during the sauna with a significant decline in HR for the P group during the post sauna phase. There were no significant changes in systolic BP for either group. A significant decline in diastolic BP was found for the T group during the post sauna phase. There were no episodes of syncope.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood zinc in the spinal patient.

A rapid microspectrophotometric method was used to measure zinc concentrations in plasma and erythrocytes. A circadian variation in plasma zinc related to the ingestion of food was observed. Fasting plasma zinc concentrations were low in 20 out of 23 paraplegic patients with pressure sores, indicating that oral zinc supplementation may be expected to accelerate healing in such patients. Erythrocyte zinc levels did not differ between different groups of subjects and exhibited no circadian rhythm.