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1.
Rev Med Chil ; 149(2): 291-294, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34479277

RESUMO

Low molecular weight heparin-induced hyperkalemia is not an uncommon side effect. The development of hyponatremia is well described although it is less common. We report a 72-year-old woman with lumbar metastases who developed hyponatremia and hyperkalemia on the tenth day of hospitalization. Hyponatremia, with limited criteria for syndrome of inappropriate secretion of antidiuretic hormone, did not resolve with vigorous volume restriction. Hyperkalemia without an acid-base disorder or baseline renal failure, did not resolve after losartan was stopped. Enoxaparin-induced hypoaldosteronism was proposed and the drug was discontinued. After four days' persistence of the electrolyte disturbance, dexamethasone was changed to Hydrocortisone, and parameters normalized in 24 hours. The patient remained well until discharge and during outpatient control.


Assuntos
Hiperpotassemia , Hiponatremia , Síndrome de Secreção Inadequada de HAD , Idoso , Feminino , Heparina de Baixo Peso Molecular , Hospitalização , Humanos , Hiperpotassemia/induzido quimicamente , Hiponatremia/induzido quimicamente
2.
BMC Pediatr ; 21(1): 370, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465290

RESUMO

BACKGROUND: Betamimetics have been used for tocolysis extensively in the past, and one of them, ritodrine is widely used in Japan. Various adverse events have been reported for this agent, including newborn hypoglycemia and hypokalemia, as well as maternal hypokalemia and rebound hyperkalemia; however, cases of neonatal rebound hyperkalemia are not described in the literature. CASE PRESENTATION: A male infant born at 36 weeks of gestation by cesarean section at a local maternity clinic suddenly entered cardiopulmonary arrest with ventricular tachycardia and fibrillation due to hyperkalemia (K+, 8.7 mmol/L). No monitoring, examination of blood electrolyte levels, or infusions had been performed prior to this event. Maternal infusion of ritodrine (maximum dose, 170 µg/min) had been performed for 7 weeks prior to cesarean section. After resuscitation combined with calcium gluconate, the infant died at 4 months old due to serious respiratory failure accompanied by acute lung injury following shock. No cause of hyperkalemia other than rebound hyperkalemia associated with ritodrine was identified. CONCLUSIONS: This case report serves as a warning regarding the potential risk of neonatal rebound hyperkalemia in association with maternal long-term ritodrine administration.


Assuntos
Hiperpotassemia , Trabalho de Parto Prematuro , Ritodrina , Tocolíticos , Cesárea , Feminino , Humanos , Hiperpotassemia/induzido quimicamente , Lactente , Recém-Nascido , Masculino , Gravidez , Ritodrina/efeitos adversos , Tocolíticos/efeitos adversos
3.
Artigo em Chinês | MEDLINE | ID: mdl-34521171

RESUMO

Objective: To explore the influencing factors for serum potassium >4.4 mmol/L in the morning of parathyroidectomy in hemodialysis patients with secondary hyperparathyroidism (SHPT). Methods: The clinical data of 72 patients with SHPT who received regular hemodialysis and underwent parathyroidectomy in Guangdong Provincial People's Hospital from January 2012 to December 2018 were analyzed retrospectively. There were 37 males and 35 females, aged from 25 to 69 years, and the dialysis timespan was from 0.5 to 11 years. The levels of parathyroid hormone, serum potassium and serum calcium before hemodialysis were examined one day before operation, and hemodialysis time and dewatering volume after hemodialysis without heparin were recorded, and also the level of serum potassium in the morning of parathyroidectomy was detected. The occurrences of hyperkalemia during and after operation were studied. The factors related to hyperkalemia in the morning of parathyroidectomy were evaluated by Pearson or Spearman correlation analysis, and the cut-off values of risk factors were calculated by receiver operating characteristic (ROC) curve. Results: Serum potassium >4.4 mmol/L in the morning of parathyroidectomy existed in 23 of 72 patients. Correlation analysis showed that serum potassium one day before operation ((4.93±0.56)mmol/L, r=0.656, P<0.001) and dehydration volume ((2.37±0.75)L, r=0.261, P=0.027) were positively correlated with serum potassium in the morning of parathyroidectomy((4.16±0.54)mmol/L). Serum potassium before hemodialysis one day before operation was a main predictor for serum potassium in the morning of parathyroidectomy (AUC=0.791, P<0.001). The cut-off value of serum potassium before hemodialysis one day before operation was 5.0 mmol/L. Conclusion: Serum potassium before hemodialysis one day before operation in patients with SHPT can predict serum potassium in the morning of parathyroidectomy, offering imformation for the safety of operation.


Assuntos
Hiperpotassemia , Hiperparatireoidismo Secundário , Cálcio , Feminino , Humanos , Hiperpotassemia/etiologia , Hiperparatireoidismo Secundário/complicações , Hiperparatireoidismo Secundário/cirurgia , Masculino , Hormônio Paratireóideo , Paratireoidectomia , Diálise Renal , Estudos Retrospectivos
5.
Adv Ther ; 38(10): 5238-5252, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34471991

RESUMO

INTRODUCTION: Although hyperkalemia and metabolic acidosis often co-occur in patients with chronic kidney disease (CKD), the prevalence of metabolic acidosis among patients with CKD and hyperkalemia is understudied. Therefore, we used medical record data from the Research Action for Health Network to estimate this prevalence. METHODS: Adult patients with CKD stage 3-5, ≥ 1 outpatient potassium value > 5.0 mEq/l, and ≥ 1 outpatient bicarbonate value available were identified. Patients with end stage kidney disease (ESKD) in the prior year were excluded. The prevalence of metabolic acidosis in each calendar year from 2014 to 2017 among patients with CKD and hyperkalemia was estimated using two definitions of hyperkalemia (potassium > 5.0 mEq/l and > 5.5 mEq/l) and metabolic acidosis (bicarbonate < 18 mEq/l and < 22 mEq/l). RESULTS: In the 2017 patient cohort and among patients with CKD and hyperkalemia, patients with metabolic acidosis were younger (69 versus 74 years), more likely to have advanced CKD (35% versus 13%), and use oral sodium bicarbonate (21% versus 4%) than patients without metabolic acidosis. The prevalence of metabolic acidosis (< 22 mEq/l) ranged from 25 to 29% when hyperkalemia was defined by potassium > 5.0 mEq/l and ranged from 33 to 39% when hyperkalemia was defined by potassium > 5.5 mEq/l. CONCLUSION: Results demonstrated that prevalence estimates of metabolic acidosis varied based on the definition of hyperkalemia and metabolic acidosis utilized.


Assuntos
Acidose , Hiperpotassemia , Insuficiência Renal Crônica , Acidose/epidemiologia , Humanos , Hiperpotassemia/epidemiologia , Potássio , Prevalência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia
6.
Medicina (Kaunas) ; 57(8)2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34441016

RESUMO

Severe hyperkalemia is a potentially life threatening cardiac emergency, especially in patients with renal failure, and can lead to fatal arrhythmias such as ventricular fibrillation or asystole, leading to cardiac arrest. We report a case of a 39-year-old woman who developed sudden cardiac arrest secondary to hyperkalemia (9.95 mEq/L) with renal insufficiency. Despite 20 min of cardiopulmonary resuscitation (CPR) and conventional treatment for hyperkalemia, the cardiac arrest persisted. Hemodialysis was then initiated via the right femoral vein during CPR, and the patient restored spontaneous heartbeat 40 min later. Hemodialysis should be considered in the course of CPR in severe hyperkalemia induced cardiac arrest if conventional therapies fail.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Hiperpotassemia , Adulto , Arritmias Cardíacas , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hiperpotassemia/complicações , Hiperpotassemia/terapia , Diálise Renal/efeitos adversos
7.
J Med Econ ; 24(1): 1025-1036, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34357841

RESUMO

AIMS: This study aimed to estimate the association of patiromer exposure vs. no potassium (K+) binder (NoKb) exposure with healthcare utilization and expenditures among a cohort of Medicare Advantage patients with hyperkalemia (HK). METHODS: Using Optum's Clinformatics Data Mart (study period 2016-2019), the authors assessed propensity score-matched patients (1:1) with a serum K+ concentration ≥5.0 mmol/L and an HK diagnosis that were exposed to patiromer or NoKb on baseline characteristics. The following outcomes were compared: (1) inpatient/emergency department (ED) encounters, (2) inpatient costs greater than or equal to mean Medicare Advantage inpatient cost (i.e. $14,900), and (3) the relative healthcare spending rate. Logistic regression and zero-inflated negative binomial regression were used to analyze the outcomes. RESULTS: The study cohort included 1,539 patiromer and NoKb matched pairs. Baseline characteristics were (patiromer/NoKb): age 74/75 years; female 42/40%; serum K+ 5.6/5.6 mmol/L; eGFR rate 36/36 mL/min/1.73 m2; low-income subsidy 42/41%, chronic kidney disease 96/96%; end-stage renal disease 12/12%; and congestive heart failure 37/36%. A total of 253 matched pairs (506 patients) remained uncensored and were analyzed at 6 months. Inpatient/ED encounters were observed for 25% (patiromer) and 37% (NoKb) (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.38-0.89). The relative odds of having inpatient costs ≥$14,900 were ∼50% less for patients exposed to patiromer vs. NoKb (OR [95% CI]: 0.47 [0.25-0.89]). The relative total healthcare spending rate (including inpatient, outpatient, ED, and pharmacy costs) was 19% less for patients exposed to patiromer vs. NoKb (spending rate ratio [95% CI]: 0.81 [0.67-0.98]). CONCLUSION AND LIMITATIONS: Among Medicare Advantage patients with HK, patiromer exposure (vs. NoKb) was associated with statistically significant reductions in the proportion with inpatient/ED encounters, inpatient costs ≥$14,900, and lower total healthcare spending. Further research, with larger sample size, is warranted to fully validate these findings.


Assuntos
Hiperpotassemia , Medicare Part C , Idoso , Inibidores da Enzima Conversora de Angiotensina , Feminino , Gastos em Saúde , Humanos , Hiperpotassemia/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Estados Unidos
8.
N Engl J Med ; 385(12): 1067-1077, 2021 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-34459569

RESUMO

BACKGROUND: Salt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain. METHODS: We conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia. RESULTS: A total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P = 0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P = 0.76). CONCLUSIONS: Among persons who had a history of stroke or were 60 years of age or older and had high blood pressure, the rates of stroke, major cardiovascular events, and death from any cause were lower with the salt substitute than with regular salt. (Funded by the National Health and Medical Research Council of Australia; SSaSS ClinicalTrials.gov number, NCT02092090.).


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dieta Hipossódica , Hipertensão/dietoterapia , Acidente Vascular Cerebral/prevenção & controle , Idoso , Doenças Cardiovasculares/epidemiologia , China , Dieta Hipossódica/efeitos adversos , Feminino , Humanos , Hiperpotassemia/complicações , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Potássio na Dieta/efeitos adversos , Prevenção Secundária , Acidente Vascular Cerebral/epidemiologia
9.
Nutrients ; 13(8)2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34444838

RESUMO

In the general population, an increased potassium (K) intake lowers blood pressure (BP). The effects of K have not been well-studied in individuals with chronic kidney disease (CKD). This randomized feeding trial with a 2-period crossover design compared the effects of diets containing 100 and 40 mmol K/day on BP in 29 adults with stage 3 CKD and treated or untreated systolic BP (SBP) 120-159 mmHg and diastolic BP (DBP) <100 mmHg. The primary outcome was 24 h ambulatory systolic BP. The higher-versus lower-K diet had no significant effect on 24 h SBP (-2.12 mm Hg; p = 0.16) and DBP (-0.70 mm Hg; p = 0.44). Corresponding differences in clinic BP were -4.21 mm Hg for SBP (p = 0.054) and -0.08 mm Hg for DBP (p = 0.94). On the higher-K diet, mean serum K increased by 0.21 mmol/L (p = 0.003) compared to the lower-K diet; two participants had confirmed hyperkalemia (serum K ≥ 5.5 mmol/L). In conclusion, a higher dietary intake of K did not lower 24 h SBP, while clinic SBP reduction was of borderline statistical significance. Additional trials are warranted to understand the health effects of increased K intake in individuals with CKD.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Potássio na Dieta/farmacologia , Potássio/sangue , Insuficiência Renal Crônica/dietoterapia , Idoso , Feminino , Humanos , Hiperpotassemia , Hipertensão/dietoterapia , Masculino , Pessoa de Meia-Idade
10.
Ann Palliat Med ; 10(7): 7428-7439, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34353035

RESUMO

BACKGROUND: The efficacy and safety of finerenone are unknown. Therefore, we performed this meta-analysis to investigate the efficacy and safety of finerenone in patients with chronic kidney disease (CKD). METHODS: We systematically searched for relevant studies in the PubMed, Embase and Cochrane Library databases from database inception until December 2020. We selected randomized controlled trials assessing finerenone treatment in patients with CKD. RESULTS: Four trials (n=7,048) met the inclusion criteria. Compared with placebo, finerenone significantly reduced the urine albumin-to-creatinine ratio (UACR) in patients with CKD {mean difference (MD), -0.30 [95% confidence interval (CI), -0.50, -0.11], P<0.05}, and trial sequential analysis (TSA) confirmed this result. No significant difference was observed in eGFR in patients with CKD between the finerenone and placebo groups [MD, -0.90 (95% CI, -3.84 to 2.04), P>0.05]. Overall, the frequency of adverse events was similar in the two groups [relative risk (RR), 1. 00 (95% CI, 0.98, 1.02), P>0.05], and TSA confirmed this result. However, the finerenone group exhibited a lower risk of cardiovascular disorders and a higher risk of hyperkalemia than the placebo group [RR, 0.92 (95% CI, 0.85, 0.99), P<0.05 and RR, 2.04 (95% CI, 1.77, 2.34), P<0.00001, respectively]. DISCUSSION: This meta-analysis indicated that finerenone confers an important antiproteinuric effect on patients with CKD and reduces the risk of cardiovascular disorders in these patients. Finerenone may be a promising therapy option for patients with CKD. TRIAL REGISTRATION: PROSPERO registration number: CRD42021222404.


Assuntos
Hiperpotassemia , Insuficiência Renal Crônica , Humanos , Naftiridinas , Insuficiência Renal Crônica/tratamento farmacológico
11.
Expert Rev Clin Pharmacol ; 14(9): 1055-1064, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34227913

RESUMO

INTRODUCTION: Hyperkalemia is a common finding in patients with advanced kidney disease for multiple reasons. Renin-Angiotensin-Aldosterone-System Inhibitors (RAASi) that are indicated for slowing down progression of kidney disease are often associated with hyperkalemia which becomes a limiting factor in their use and titration to the maximum dose. Having a safe, effective, tolerable, and affordable potassium binder can help optimize RAAS inhibition in the setting of kidney disease. AREAS COVERED: Although sodium polystyrene sulfonate has been a mainstay of acute management of hyperkalemia for decades, evidence regarding its efficacy is limited, and its chronic use is not routinely recommended for concerns regarding toxicity. The concern of gastrointestinal (GI) adverse effects with sodium polystyrene sulfonate has spurred the development of alternatives. Sodium zirconium cyclosilicate (SZC) is a promising agent that selectively binds potassium in the gut and eliminates it, while being safe for chronic use based on 1 year of data. Even though we do not have head-to-head studies among the three currently available binders, SZC stands out in rapidity of onset and efficacy. EXPERT OPINION: In this review, we summarize the general management of hyperkalemia, including new agents. We review the pre-clinical and clinical data relating to sodium zirconium cyclosilicate.


Assuntos
Hiperpotassemia/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Silicatos/administração & dosagem , Doença Crônica , Progressão da Doença , Relação Dose-Resposta a Droga , Humanos , Hiperpotassemia/etiologia , Resinas de Troca Iônica/administração & dosagem , Resinas de Troca Iônica/efeitos adversos , Resinas de Troca Iônica/farmacologia , Insuficiência Renal Crônica/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Silicatos/efeitos adversos , Silicatos/farmacologia
12.
J Infect Chemother ; 27(11): 1607-1613, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34301486

RESUMO

INTRODUCTION: Sulfamethoxazole/trimethoprim causes hyperkalemia; however, the effect of sulfamethoxazole/trimethoprim dose and co-administered glucocorticoids on hyperkalemia has not been clarified. METHODS: This single-center, retrospective, observational cohort, chart review study involving patients (>20 years) who were treated with sulfamethoxazole/trimethoprim was conducted at Tokyo Women's Medical University, Medical Center East from June 2015 to May 2019. Multivariate Cox proportional hazard model was used to identify risk factors for hyperkalemia (serum potassium level > 5.5 mEq/L). Additionally, Kaplan-Meier curve analyzed the cumulative incidence of hyperkalemia focusing on sulfamethoxazole/trimethoprim dose and concomitant use of glucocorticoids with mineralocorticoid activity. RESULTS: Among 333 patients, 44 (13%) patients developed hyperkalemia associated with sulfamethoxazole/trimethoprim use for over 49 (interquartile range; 17-233) days. We found associations between the time to hyperkalemia development and sulfamethoxazole/trimethoprim dose (hazard ratio 1.238, 95% confidence interval 1.147-1.338, p < 0.001) and glucocorticoid use (hazard ratio 0.678, 95% confidence interval 0.524-0.877, p = 0.003). Interestingly, the Kaplan-Meier curves revealed that the concomitant use of glucocorticoids did not attenuate the risk of hyperkalemia in patients receiving high-dose sulfamethoxazole/trimethoprim (p = 0.747), whereas concomitant use of glucocorticoids significantly reduced the risk of hyperkalemia in patients receiving non-high dose sulfamethoxazole/trimethoprim (p < 0.001). CONCLUSIONS: High-dose sulfamethoxazole/trimethoprim is a significant predictor of hyperkalemia. The effect of glucocorticoids on hyperkalemia varies depending on the sulfamethoxazole/trimethoprim dose.


Assuntos
Glucocorticoides , Hiperpotassemia , Feminino , Glucocorticoides/efeitos adversos , Humanos , Hiperpotassemia/induzido quimicamente , Hiperpotassemia/epidemiologia , Potássio , Estudos Retrospectivos , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos
14.
Am J Case Rep ; 22: e931639, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34262010

RESUMO

BACKGROUND Immune checkpoint inhibitors (ICIs) are anticancer medications that enhance the antitumor immune response. The clinical benefit afforded by ICIs, however, can be accompanied by immune-related adverse events (IRAEs). One of the common endocrine IRAEs is hypophysitis, which often causes hypopituitarism with secondary adrenal insufficiency (AI). Secondary AI, including isolated adrenocorticotropic hormone (ACTH) deficiency (IAD), is often associated with hyponatremia. Here, we report an unusual case of ICI-related IAD associated with severe hyperkalemia. CASE REPORT A 78-year-old woman who had an ileal conduit, chronic kidney disease, type 2 diabetes mellitus, and hypertension and was taking an angiotensin II receptor blocker began treatment for advanced ureteral cancer with the anti-programmed cell death protein 1 inhibitor pembrolizumab. The therapy effectively controlled the cancer, but 4 1/2 months after starting it, the patient developed anorexia, general weakness, and muscle pain and was diagnosed with IAD associated with severe hyperkalemia and hyperchloremic metabolic acidosis. She recovered after prompt administration of corticosteroids and treatment with sodium bicarbonate, glucose/insulin, and cation exchange resins. CONCLUSIONS Hyperkalemia is a common symptom of primary AI but is less common in patients with central AI because a lack of ACTH does not cause aldosterone deficiency and mineralocorticoid action is preserved. The present case demonstrates the need for physicians to be aware of severe hyperkalemia as a life-threatening complication of secondary AI induced by ICIs, particularly in patients with predisposing factors, such as kidney dysfunction, diabetes mellitus, an ileal conduit, and renin-angiotensin-aldosterone system inhibitor use.


Assuntos
Diabetes Mellitus Tipo 2 , Hiperpotassemia , Neoplasias Ureterais , Derivação Urinária , Insuficiência Adrenal , Hormônio Adrenocorticotrópico , Idoso , Anticorpos Monoclonais Humanizados , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Hiperpotassemia/induzido quimicamente
15.
Am J Case Rep ; 22: e932048, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34234096

RESUMO

BACKGROUND Brugada syndrome is a rare ion channelopathy that can lead to sudden cardiac death and lethal arrhythmias in patients without a structural cardiac defect, the most common of which being the gain-of-function mutation of the SCN5a sodium ion channel involving phase 0 of the cardiac action potential. In 2012, BrS electrocardiogram findings were redefined and classified as either congenital Brugada syndrome (BrS) or Brugada phenocopies (BrP). Several etiologies of BrP have been reported, such as metabolic derangements, electrolyte abnormalities, cardiovascular diseases, and pulmonary embolism. CASE REPORT A 28-year-old man presented to the Emergency Department unresponsive. An initial ECG taken by Emergency Medical Services (EMS) was interpreted as a STEMI. An initial ECG in the ED showed a Brugada type I ECG pattern in leads V1-V2 and hyperacute T wave abnormalities, among other findings. Additionally, the patient had a serum potassium level of 9 mmol/L, glucose level of 1375 mmol/L, and peak cardiac troponin-I of 20.452 µg/L. All underlying medical conditions were stabilized, electrolyte and metabolic abnormalities were corrected, and subsequent normalization of electrocardiographic findings was achieved. CONCLUSIONS Distinguishing congenital Brugada syndrome from Brugada phenocopies can be difficult, especially when patients present to the ED with severe underlying conditions. Several factors can be used to direct clinical suspicion towards one or the other; however, confirmation may require EP studies and further tests. In this case, the following findings were suggestive of BrP: presence of an identifiable underlying abnormality, correction of the underlying condition resolves the ECG pattern, and the absence of family history of sudden cardiac death.


Assuntos
Intoxicação Alcoólica , Síndrome de Brugada , Cetoacidose Diabética , Hiperpotassemia , Adulto , Síndrome de Brugada/diagnóstico , Cetoacidose Diabética/complicações , Cetoacidose Diabética/diagnóstico , Eletrocardiografia , Humanos , Hiperpotassemia/diagnóstico , Hiperpotassemia/etiologia , Masculino
16.
Intern Med ; 60(13): 2093-2095, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34193775

RESUMO

Hyperkalemia is a challenging comorbidity to manage in patients with heart failure and chronic kidney disease, particularly when administering renin-angiotensin-aldosterone system inhibitors. We encountered an 88-year-old woman with hypertensive heart failure and chronic kidney disease. A mineralocorticoid receptor antagonist was able to be safely administered despite persistent hyperkalemia when sodium zirconium cyclosilicate, a non-absorbed, non-polymer zirconium silicate compound that preferentially exchanges hydrogen and sodium for potassium and ammonium ions in the gastrointestinal tract, was concomitantly administered. Sodium zirconium cyclosilicate might be a promising therapeutic tool to use in order to administer mineralocorticoid receptor antagonist safely in patients with heart failure, chronic kidney disease, and hyperkalemia.


Assuntos
Insuficiência Cardíaca , Hiperpotassemia , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hiperpotassemia/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Potássio , Sistema Renina-Angiotensina , Silicatos/uso terapêutico
18.
Nutrients ; 13(6)2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34063969

RESUMO

Potassium (K), the main cation inside cells, plays roles in maintaining cellular osmolarity and acid-base equilibrium, as well as nerve stimulation transmission, and regulation of cardiac and muscle functions. It has also recently been shown that K has an antihypertensive effect by promoting sodium excretion, while it is also attracting attention as an important component that can suppress hypertension associated with excessive sodium intake. Since most ingested K is excreted through the kidneys, decreased renal function is a major factor in increased serum levels, and target values for its intake according to the degree of renal dysfunction have been established. In older individuals with impaired renal function, not only hyperkalemia but also hypokalemia due to anorexia, K loss by dialysis, and effects of various drugs are likely to develop. Thus, it is necessary to pay attention to K management tailored to individual conditions. Since abnormalities in K metabolism can also cause lethal arrhythmia or sudden cardiac death, it is extremely important to monitor patients with a high risk of hyper- or hypokalemia and attempt to provide early and appropriate intervention.


Assuntos
Estado Nutricional/fisiologia , Potássio/metabolismo , Insuficiência Renal Crônica/metabolismo , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Hiperpotassemia/etiologia , Hiperpotassemia/metabolismo , Hipopotassemia/etiologia , Hipopotassemia/metabolismo , Rim/metabolismo , Masculino , Pessoa de Meia-Idade , Recomendações Nutricionais , Insuficiência Renal Crônica/complicações
19.
Transfusion ; 61(8): 2439-2449, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33960432

RESUMO

BACKGROUND: Familial pseudohyperkalemia (FP) is characterized by an increased rate of potassium leakage in refrigerated red cells and is associated with the minor allele of the single nucleotide polymorphism rs148211042 (R723Q) in the ABCB6 gene. The study aims were to obtain the minor allele frequencies of ABCB6 variants and to measure supernatant potassium accumulation, and other red cell storage parameters, in red cell concentrates (RCC) from carriers of variant rs148211042 under standard blood bank conditions. STUDY DESIGN: Whole blood units were collected from 6 FP individuals and 11 controls and processed into RCC in additive solution. RCC were sampled and tested over cold storage for full blood count, extracellular potassium, glucose, lactate, microvesicle release, deformability, hemolysis, pH, adenosine triphosphate, and 2,3-diphosphoglycerate. RESULTS: Screening of genotyped cohorts identified that variant rs148211042 is present in 1 in 394 British citizens of European ancestry. FP RCC had significantly higher supernatant potassium at all time points from day 3 onwards (p < .001) and higher mean cell volume (p = .032) than controls. The initial rate of potassium release was higher in FP RCC; supernatant potassium reached 46.0 (23.8-57.6) mmol/L (mean [range]) by day 5, increasing to 68.9 (58.8-73.7) mmol/L by day 35. Other quality parameters were not significantly different between FP RCC and controls. CONCLUSION: These data suggest that if a blood donor has FP, reducing the RCC shelf-life to 5 days may be insufficient to reduce the risk of hyperkalemia in clinical scenarios such as neonatal large volume transfusion.


Assuntos
Preservação de Sangue/métodos , Eritrócitos/citologia , Hiperpotassemia/congênito , Potássio/análise , Transportadores de Cassetes de Ligação de ATP/genética , Eritrócitos/metabolismo , Feminino , Frequência do Gene , Humanos , Hiperpotassemia/genética , Masculino , Polimorfismo de Nucleotídeo Único
20.
Hosp Pract (1995) ; 49(4): 273-279, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34038312

RESUMO

OBJECTIVES: Patients with hyperkalemia are commonly treated in the inpatient setting; however, real-world evidence is limited. The purpose of this study was to describe the inpatient management and post-discharge outcomes among patients with hyperkalemia. METHODS: Electronic medical record data (2012-2018) were used to analyze US adult patients with an inpatient stay with hyperkalemia (≥1 potassium value >5.0mEq/L). Patient characteristics, treatments, and monitoring six months prior to and during the inpatient stay, and hyperkalemia recurrence and inpatient readmissions post-discharge were summarized and compared among patients with mild (>5.0-5.5mEq/L), moderate (>5.5-6.0), and severe (>6.0) hyperkalemia. RESULTS: Of the 21,793 patients, 69.2% had mild, 19.0% had moderate, and 11.8% had severe hyperkalemia during inpatient care. The most common inpatient treatments were temporizing agents (mild: 28.9%; moderate: 46.0%; severe: 73.0%), diuretics (32.7%; 37.1%; 34.6%), and sodium-polystyrene sulfonate (11.7%; 27.8%; 45.3%). Almost no patients (0.1%) received a potassium binder at discharge. Most patients (86.8%) had their potassium levels return to ≤5.0mEq/L during the inpatient stay. Death during the inpatient stay occurred in 12.3% of mild, 15.5% of moderate, and 19.5% of severe hyperkalemic patients. Within 30 days of discharge, hyperkalemia recurred in 13.3%, 15.4%, and 18.4% of patients with mild, moderate, and severe hyperkalemia, respectively. Additionally, 19.7%, 21.5%, and 19.6% of patients were readmitted to inpatient care within 30 days post-discharge. CONCLUSION: Among patients with hyperkalemia in the inpatient setting, treatment and normalization of serum potassium levels were common. However, death, readmission, and hyperkalemia recurrence were also fairly common across all cohorts. Future studies examining measures to reduce inpatient death, readmission, and hyperkalemia recurrence among patients with hyperkalemia in inpatient care are warranted.


Assuntos
Hospitalização , Hiperpotassemia/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Registros Eletrônicos de Saúde , Feminino , Mortalidade Hospitalar , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/mortalidade , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente , Recidiva , Índice de Gravidade de Doença , Fatores Socioeconômicos , Estados Unidos
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