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1.
BMC Infect Dis ; 21(1): 134, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33522907

RESUMO

BACKGROUND: The outbreak of COVID-19 has rapidly spread to Italy, including Pesaro-Urbino province. Data on young to middle age adults with COVID-19 are lacking. We report the characteristics, management and health-related quality of life (HRQoL) in patients with COVID-19 aging ≤50 years. METHODS: A retrospective analysis was performed in all patients ≤50 years with a confirmed diagnosis of COVID-19 admitted to Emergency department (ED) of San Salvatore Hospital in Pesaro from February 28th to April 8th, 2020. Data were collected from electronical medical records. HRQoL was investigated after 1 month from hospital discharge using the SF-36 questionnaire. Outcomes were evaluated between hospitalized and not hospitalized patients. RESULTS: Among 673 patients admitted to the ED and diagnosed with COVID-19, 104 (15%) were ≤ 50 years old: 74% were discharged at home within 48 h, 26% were hospitalized. Fever occurred in 90% of the cases followed by cough (56%) and dyspnoea (34%). The most frequent coexisting conditions were hypertension (11%), thyroid dysfunction (8%) and neurological and/or mental disorders [NMDs] (6%). Mean BMI was 27. Hypokalaemia and NMDs were significantly more common in patients who underwent mechanical ventilation. Regardless of hospitalization, there was an impairment in both the physical and mental functioning. CONCLUSIONS: Overweight and hypertension are frequent conditions in young to middle age adults with COVID-19. Hypokalaemia and NMDs are commonly associated with progressive disease. A significant impact on HRQoL in the early stage of post-discharge is common in this population.


Assuntos
/diagnóstico , Hospitalização/estatística & dados numéricos , Qualidade de Vida , Adulto , /virologia , Tosse/etiologia , Dispneia/etiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/complicações , Hipopotassemia/complicações , Itália , Masculino , Pessoa de Meia-Idade , Respiração Artificial , Estudos Retrospectivos , Adulto Jovem
2.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431440

RESUMO

A healthy multiparous woman presented at 35 weeks and 4 days' gestation with threatened preterm labour on multiple occasions. An incidental finding of severe hypokalaemia (2.4 mmol/L) was detected on routine blood tests. The cause of this hypokalaemia was not initially obvious. It was eventually linked to overuse of over-the-counter antacids for pregnancy-associated heartburn. The patient was managed with parenteral and then oral electrolyte replacement which corrected a pH of 7.55, bicarbonate of 36.7 mEq/L and a base excess 13.1. In this case report we consider whether hypokalaemia could be linked to uterine irritability and threatened preterm labour, whether antacids were being abused in the context of an eating disorder and the importance of taking a full drug history.


Assuntos
Antiácidos/envenenamento , Overdose de Drogas/diagnóstico , Hipopotassemia/diagnóstico , Medicamentos sem Prescrição/envenenamento , Nascimento Prematuro/etiologia , Adulto , Antiácidos/administração & dosagem , Cardiotocografia , Overdose de Drogas/sangue , Overdose de Drogas/etiologia , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Hipopotassemia/sangue , Hipopotassemia/induzido quimicamente , Hipopotassemia/complicações , Achados Incidentais , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Medicamentos sem Prescrição/administração & dosagem , Omeprazol/uso terapêutico , Potássio/sangue , Gravidez
3.
PLoS One ; 15(8): e0236934, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32750075

RESUMO

BACKGROUND: Potassium disturbances are associated with adverse prognosis in patients with chronic conditions. Its prognostic implications in stable patients attending the emergency department (ED) is poorly described. AIMS: This study aimed to assess the prevalence of dyskalemia, describe its predisposing factors and prognostic associations in a population presenting the ED without unstable medical illness. METHODS: Post-hoc analysis of a prospective, cross-sectional, multicenter study in the ED of 11 French academic hospitals over a period of 8 weeks. All adults presenting to the ED during this period were included, except instances of self-drug poisoning, inability to complete self-medication questionnaire, presence of an unstable medical illness and decline to participate in the study. All-cause hospitalization or deaths were assessed. RESULTS: A total of 1242 patients were included. The mean age was 57.2±22.3 years, 51% were female. The distribution according to potassium concentrations was: hypokalemia<4mmol/L(n = 620, 49.9%), normokalemia 4-5mmol/L(n = 549, 44.2%) and hyperkalemia >5mmol/L(n = 73, 0,6%). The proportion of patients with a kalemia<3.5mmol/L was 8% (n = 101). Renal insufficiency (OR [95% CI] = 3.56[1.94-6.52], p-value <0.001) and hemoglobin <12g/dl (OR [95% CI] = 2.62[1.50-4.60], p-value = 0.001) were associated with hyperkalemia. Female sex (OR [95% CI] = 1.31[1.03-1.66], p-value = 0.029), age <45years (OR [95% CI] = 1.69 [1.20-2.37], p-value = 0.002) and the use of thiazide diuretics (OR [95% CI] = 2.04 [1.28-3.32], p-value = 0.003), were associated with hypokalemia<4mmol/l. Two patients died in the ED and 629 (52.7%) were hospitalized. Hypokalemia <3.5mmol/L was independently associated with increased odds of hospitalization or death (OR [95% CI] = 1.47 [1.00-2.15], p-value = 0.048). CONCLUSIONS: Hypokalemia is frequently found in the ED and was associated with worse outcomes in a low-risk ED population.


Assuntos
Serviços Médicos de Emergência , Hipopotassemia/epidemiologia , Idoso , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Hipopotassemia/complicações , Hipopotassemia/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Resultado do Tratamento
5.
Int J Clin Pract ; 74(1): e13421, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31532067

RESUMO

BACKGROUND AND OBJECTIVES: Despite the growing body of evidence characterising the association between serum potassium levels and adverse clinical outcomes, a contemporary summary of available evidence is currently lacking. The objective of this study, therefore, was to undertake a systematic literature review to identify all relevant evidence assessing risk factors associated with the incidence of hyperkalaemia (HK) and also quantifying the effect of serum potassium levels on risk of adverse clinical outcomes. METHODS: PubMed (Medline and Medline In-Process), Embase and the Cochrane Library were searched for studies published between January 2002 and November 2018. Search inclusion criteria included studies describing either the incidence of HK events and any associated risk factors, or associations between HK or serum potassium concentration and adverse clinical outcomes including mortality, hospitalisation, major adverse cardiac events (MACE) and renin-angiotensin-aldosterone system inhibitors (RAASi) discontinuation in adult patients with chronic kidney disease (CKD), heart failure (HF), type 2 diabetes (T2DM) or hypertension. RESULTS: The search identified 1,897 publications. From these, a total of 123 studies met the inclusion criteria and were included in the review. The most commonly identified risk factors associated with HK events were the presence of CKD or renal impairment, T2DM, HF, hypertension, RAASi use and mineralocorticoid receptor antagonist use. Potassium levels both above and below the normal range were consistently associated with adverse clinical outcomes, with relative and absolute risks of outcomes increasing with severity of hyper- or hypokalaemia. These associations were consistently reported across a broad range of patient population types and study types. CONCLUSION: The current body of published evidence is compelling in its confirmation of the associations between serum potassium levels and adverse clinical outcomes. This review further highlights the importance of avoiding both hyper- and hypokalaemia, in order to reduce risk of mortality, hospitalisation, MACE and RAASi discontinuation or down-titration.


Assuntos
Hiperpotassemia/sangue , Hiperpotassemia/epidemiologia , Potássio/sangue , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Diabetes Mellitus Tipo 2/epidemiologia , Insuficiência Cardíaca/epidemiologia , Humanos , Hiperpotassemia/complicações , Hipertensão/epidemiologia , Hipopotassemia/sangue , Hipopotassemia/complicações , Incidência , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Insuficiência Renal Crônica/epidemiologia , Sistema Renina-Angiotensina/efeitos dos fármacos , Fatores de Risco
6.
Crit Care ; 23(1): 415, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856891

RESUMO

OBJECTIVES: Our objectives were (1) to characterize the distribution of serum potassium levels at ICU admission, (2) to examine the relationship between dyskalemia at ICU admission and occurrence of cardiac events, and (3) to study both the association between dyskalemia at ICU admission and dyskalemia correction by day 2 on 28-day mortality. DESIGN: Inception cohort study from the longitudinal prospective French multicenter OUTCOMEREA database (1999-2014) SETTING: 22 French OUTCOMEREA network ICUs PATIENTS: Patients were classified into six groups according to their serum potassium level at admission: three groups of hypokalemia and three groups of hyperkalemia defined as serious hypokalemia [K+] < 2.5 and serious hyperkalemia [K+] > 7 mmol/L, moderate hypokalemia 2.5 ≤ [K+] < 3 mmol/L and moderate hyperkalemia 6 < [K+] ≤ 7 mmol/L, and mild hypokalemia 3 ≤ [K+] < 3.5 mmol/L and mild hyperkalemia 5 < [K+] ≤ 6 mmol/L. We sorted evolution at day 2 of dyskalemia into three categories: balanced, not-balanced, and overbalanced. INTERVENTION: None MEASUREMENTS AND MAIN RESULTS: Of 12,090 patients, 2108 (17.4%) had hypokalemia and 1445 (12%) had hyperkalemia. Prognostic impact of dyskalemia and its correction was assessed using multivariate Cox models. After adjustment, hypokalemia and hyperkalemia were independently associated with a greater risk of 28-day mortality. Mild hyperkalemic patients had the highest mortality (hazard ratio (HR) 1.29, 95% confidence interval (CI) [1.13-1.47], p < 0.001). Adjusted 28-day mortality was higher if serum potassium level was not-balanced at day 2 (aHR = 1.51, 95% CI [1.30-1.76], p < 0.0001) and numerically higher but not significantly different if serum potassium level was overbalanced at day 2 (aHR = 1.157, 95% CI [0.84-1.60], p = 0.38). Occurrence of cardiac events was evaluated by logistic regression. Except for patients with serious hypokalemia at admission, the depth of dyskalemia was associated with increased risk of cardiac events. CONCLUSIONS: Dyskalemia is common at ICU admission and associated with increased mortality. Occurrence of cardiac events increased with dyskalemia depth. A correction of serum potassium level by day 2 was associated with improved prognosis.


Assuntos
Hiperpotassemia/complicações , Hipopotassemia/complicações , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estado Terminal/epidemiologia , Estado Terminal/mortalidade , Feminino , França/epidemiologia , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/epidemiologia , Hipopotassemia/sangue , Hipopotassemia/epidemiologia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Potássio/análise , Potássio/sangue , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Escala Psicológica Aguda Simplificada , Análise de Sobrevida
7.
Pediatr Ann ; 48(11): e448-e454, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31710364

RESUMO

Refeeding syndrome describes the metabolic disturbances and clinical sequelae that occur in response to nutritional rehabilitation of patients who are moderate to severely malnourished. When risk factors are not identified and nutrition therapy is not managed appropriately, devastating consequences such as electrolyte depletion and imbalances, fluid overload, arrhythmia, seizure, encephalopathy, and death may occur. As this entity is often unrecognized, especially in pediatrics, becoming familiar with the pathophysiology, clinical manifestations, and management strategies will help clinicians caring for children avoid unnecessary morbidity and mortality. [Pediatr Ann. 2019;48(11):e448-e454.].


Assuntos
Síndrome da Realimentação/diagnóstico , Síndrome da Realimentação/fisiopatologia , Criança , Diagnóstico Diferencial , Eletrólitos/administração & dosagem , Metabolismo Energético , Humanos , Hiperglicemia/complicações , Hipopotassemia/complicações , Hipopotassemia/diagnóstico , Hipofosfatemia/complicações , Hipofosfatemia/diagnóstico , Insulina/metabolismo , Deficiência de Magnésio/complicações , Deficiência de Magnésio/diagnóstico , Síndrome da Realimentação/terapia , Fatores de Risco , Sódio/metabolismo , Inanição/fisiopatologia , Deficiência de Tiamina/complicações , Deficiência de Tiamina/diagnóstico
8.
J Vet Emerg Crit Care (San Antonio) ; 29(6): 680-685, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637833

RESUMO

OBJECTIVE: To describe a case of mannitol overdose associated with acute kidney injury (AKI), hypertonic hyponatremia, and neurologic abnormalities in a dog. CASE SUMMARY: A 10-year-old intact male Shiba Inu dog was referred to the emergency service of a veterinary teaching hospital for inappetence and acute onset of seizures. The dog had received 2 IV boluses of 3 g/kg of mannitol in less than 24 hours for a glaucoma crisis. Twelve hours after the second injection, the dog became inappetant and developed 2 generalized seizures. Seizure activity was treated with diazepam (0.5 mg/kg IV). Serum biochemistry profile showed severe hyponatremia and hypochloremia, mild hypokalemia, marked increased creatinine (381 µmol/L [44-133 µmol/L]) and moderately increased BUN (13.8 mmol/L [1.6-10.9 mmol/L]). Urinalysis revealed a urine specific gravity of 1.018, glucosuria, proteinuria, pigmenturia and the presence of vacuolized tubular epithelial cells. A presumptive diagnosis of mannitol intoxication was made based on the high dose of mannitol, severe hyponatremia, neurological abnormalities suggestive of intracranial disease, AKI, and urine cytology. Initial calculated plasma osmolality was 263.4 mOsm/kg and measured plasma osmolality was 332 mOsm/kg with an osmolal gap of 68.6 mOsm/kg, confirming the presence of an unmeasured solute attributed to mannitol. Treatment consisted of fluid therapy and supportive care. On day 3, osmolal gap had resolved and serum creatinine concentration returned to normal within 12 days. NEW OR UNIQUE INFORMATION PROVIDED: Mannitol intoxication has been reported in human medicine. This case report is, to our knowledge, the first to describe AKI, hypertonic hyponatremia, and neurological abnormalities secondary to mannitol overdose in a dog.


Assuntos
Lesão Renal Aguda/veterinária , Doenças do Cão/induzido quimicamente , Hiponatremia/veterinária , Manitol/toxicidade , Convulsões/veterinária , Lesão Renal Aguda/induzido quimicamente , Animais , Anticonvulsivantes/uso terapêutico , Creatinina , Diazepam/uso terapêutico , Cães , Overdose de Drogas , Hipopotassemia/complicações , Hiponatremia/induzido quimicamente , Masculino , Manitol/administração & dosagem , Concentração Osmolar , Convulsões/induzido quimicamente , Urinálise
9.
J Vet Emerg Crit Care (San Antonio) ; 29(6): 653-661, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31482659

RESUMO

OBJECTIVE: To determine the severity, concurrent clinical signs, and disease processes associated with potassium abnormalities in dogs and cats presenting to a veterinary emergency department and associated mortality. DESIGN: Retrospective and descriptive study over 20 months. SETTING: University teaching hospital. ANIMALS: 1916 dog and 525 cat visits. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records from patients with a potassium concentration measured within 24 hours of admission were identified. Hypokalemia and hyperkalemia were defined as a potassium concentration <3.5 mmol/L [3.5 mEq/L] and >5 mmol/L [5 mEq/L], respectively. Associated disease processes and pathophysiologic risk factors for potassium abnormalities were reviewed for moderate to severe potassium abnormalities (<3 mmol/L or ≥6 mmol/L) [<3 mEq/L or ≥6 mEq/L]. Mortality associated with normokalemia, mild, and moderate to severe dyskalemia were evaluated. Overall prevalence of abnormal potassium concentration was 27% in dogs and 40% in cats. Moderate to severe hypokalemia and hyperkalemia were present in 3% of dogs and 8% of cats, and 2% of dogs and 7% of cats, respectively. Moderate to severe hypokalemia was most commonly associated with gastrointestinal disease (48% of dogs and 44% of cats) while moderate to severe hyperkalemia was most commonly associated with urinary tract disease (60% of dogs and 97% of cats). Dogs with hypokalemia and dogs and cats with hyperkalemia (P < 0.001) had significantly greater mortality than those with normokalemia. Dogs with mild hypokalemia and mild hyperkalemia (P < 0.0001) had higher mortality than dogs with normokalemia, but this was not found in cats. CONCLUSIONS: Dyskalemia was common in this population and was associated with greater mortality. Moderate to severe potassium abnormalities were uncommon in this population and occurred most frequently in animals with gastrointestinal and urinary tract disease.


Assuntos
Doenças do Gato/sangue , Doenças do Cão/sangue , Hiperpotassemia/veterinária , Hipopotassemia/veterinária , Potássio/sangue , Animais , Doenças do Gato/patologia , Gatos , Doenças do Cão/patologia , Cães , Serviço Hospitalar de Emergência , Feminino , Hiperpotassemia/complicações , Hipopotassemia/complicações , Masculino , Prognóstico , Estudos Retrospectivos
11.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413059

RESUMO

We present a 44-year-old female with an initial presentation with distal renal tubular acidosis (RTA) after she presented with hypokalaemia and normal anion gap acidosis. Three years following the diagnosis, she presented with progressive renal impairment. In the absence of any clinical, biochemical and radiological clues, she underwent a renal biopsy which showed severe tubulitis secondary to lymphocytic infiltration. Serological investigations subsequently revealed positive anti-nuclear, anti-Sjögren's syndrome related antigen A (SS-A), and anti-Sjögren's syndrome related antigen B (SS-B) antibodies, supporting the diagnosis of Sjögren's syndrome. This case is unique in that distal RTA was the presenting clinical manifestation of Sjögren's syndrome. We hope that a consideration for Sjögren's syndrome is made in patients with seemingly idiopathic RTA.


Assuntos
Acidose Tubular Renal/diagnóstico , Síndrome de Sjogren/diagnóstico , Acidose Tubular Renal/sangue , Acidose Tubular Renal/complicações , Acidose Tubular Renal/urina , Adulto , Feminino , Humanos , Hipopotassemia/sangue , Hipopotassemia/complicações , Hipopotassemia/diagnóstico , Hipopotassemia/urina , Síndrome de Sjogren/sangue , Síndrome de Sjogren/complicações , Síndrome de Sjogren/urina , Urinálise
12.
Medicine (Baltimore) ; 98(34): e16738, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441846

RESUMO

RATIONALE: Bartter syndrome is an autosomal-recessive inherited disease in which patients present with hypokalemia and metabolic alkalosis. We present 1 case with Bartter syndrome, due to a novel compound heterozygous mutation in the KCNJ1 gene encoding the ATP-sensitive inward rectifier potassium channel in the thick ascending limb of the loop of Henle. PATIENT CONCERNS: A patient was admitted to our hospital because of weakness, polyuria, and polydipsia. At presentation to our hospital, the female Chinese patient was 34 years old and her physical examination was normal. Laboratory studies revealed hypokalemia, metabolic alkalosis, hypercalciuria, hyperparathyroidemia, and hyper-reninemia. In addition, urinary potassium was obviously higher. Computer tomography scan confirmed the patient had the bilateral medullary nephrocalcinosis. DIAGNOSIS: Blood samples were received from the patient and her parents, and deoxyribonucleic acid was extracted. The genetic analysis of SLC12A1, SLC12A3, KCNJ1, CLCNKB, BSND, and CASR was performed. The compound heterozygous KCNJ1 gene mutation was validated using conventional Sanger sequencing methods. INTERVENTIONS: The patient was treated with potassium supplementation. Her blood and urine chemistries improved over the next week. Serum potassium normalized with improvement in polyuria and polydipsia over the next month. OUTCOMES: Our patient was compound heterozygous for Thr234Ile and Thr71Met in the KCNJ1 gene. The c.701C>T variant predicted a change from a threonine codon to an isoleucine codon (p.Thr234Ile). The c.212C>T variant predicted a change from a threonine codon to a methionine codon (p.Thr71Met). The unaffected mother was heterozygous for the Thr234Ile mutation, whereas unaffected father was heterozygous for the Thr71Met mutation. LESSONS: The phenotypes of the patient were similar to other patients with Bartter syndrome. The phenotypes of the patient could eventually be explained by the presence of the novel compound heterozygous p.Thr234Ile/p.Thr71Met variants in the KCNJ1 gene.


Assuntos
Síndrome de Bartter/genética , Canais de Potássio Corretores do Fluxo de Internalização/genética , Adulto , Síndrome de Bartter/complicações , Feminino , Humanos , Hipopotassemia/complicações , Hipopotassemia/tratamento farmacológico , Potássio/uso terapêutico
13.
J Am Soc Nephrol ; 30(8): 1534-1545, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31285285

RESUMO

BACKGROUND: Gitelman syndrome is a salt-losing tubulopathy caused by mutations in the SLC12A3 gene, which encodes the thiazide-sensitive sodium-chloride cotransporter. Previous studies suggested an intermediate phenotype for heterozygous carriers. METHODS: To evaluate the phenotype of heterozygous carriers of pathogenic SLC12A3 mutations, we performed a cross-sectional study of patients with Gitelman syndrome, heterozygous carriers, and healthy noncarriers. Participants measured their BP at home for three consecutive days before hospital admission for blood and urine sampling and an oral glucose tolerance test. RESULTS: We enrolled 242 participants, aged 18-75 years, including 81 heterozygous carriers, 82 healthy noncarriers, and 79 patients with Gitelman syndrome. The three groups had similar age, sex ratio, and body mass index. Compared with healthy noncarriers, heterozygous carriers showed significantly higher serum calcium concentration (P=0.01) and a trend for higher plasma aldosterone (P=0.06), but measures of home BP, plasma and urine electrolytes, renin, parathyroid hormone, vitamin D, and response to oral glucose tolerance testing were similar. Patients with Gitelman syndrome had lower systolic BP and higher heart rate than noncarriers and heterozygote carriers; they also had significantly higher fasting serum glucose concentration, higher levels of markers of insulin resistance, and a three-fold higher sensitivity to overweight. According to oral glucose tolerance testing, approximately 14% of patients with Gitelman syndrome were prediabetic, compared with 5% of heterozygous carriers and 4% of healthy noncarriers. CONCLUSIONS: Heterozygous carriers had a weak intermediate phenotype, between that of healthy noncarriers and patients with Gitelman syndrome. Moreover, the latter are at risk for development of type 2 diabetes, indicating the heightened importance of body weight control in these patients.


Assuntos
Síndrome de Gitelman/complicações , Síndrome de Gitelman/genética , Heterozigoto , Resistência à Insulina/genética , Adolescente , Adulto , Idoso , Remodelação Óssea , Estudos Transversais , Diabetes Mellitus Tipo 2/prevenção & controle , Eletrólitos , Feminino , Teste de Tolerância a Glucose , Hemodinâmica , Humanos , Hipopotassemia/complicações , Insulina/metabolismo , Masculino , Pessoa de Meia-Idade , Mutação , Fenótipo , Estado Pré-Diabético/complicações , Membro 3 da Família 12 de Carreador de Soluto/genética , Adulto Jovem
14.
BMJ Case Rep ; 12(5)2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31126931

RESUMO

A 43-year-old man presented with acute onset rapidly progressive weakness in all four limbs (proximal greater than distal), following an episode of binge alcohol ingestion, and was admitted for evaluation and management. There was a history of decreased urine output since 2 days with dark-coloured urine. He was found to have severe hypokalemia and renal dysfunction. Serum creatine kinase was significantly high, and further investigation revealed significantly elevated serum and urine myoglobin levels suggestive of rhabdomyolysis, which was secondary to severe hypokalemia. Following supplementation with intravenous and oral potassium and supportive care, the weakness improved significantly, and he was subsequently discharged. This case describes severe hypokalemia, resulting in rhabdomyolysis and generalised lower motor neuron weakness, in a setting of binge alcohol ingestion, which is an entity rarely described in literature.


Assuntos
Bebedeira , Hipopotassemia/diagnóstico , Potássio/uso terapêutico , Rabdomiólise/diagnóstico , Administração Oral , Adulto , Diagnóstico Diferencial , Humanos , Hipopotassemia/sangue , Hipopotassemia/complicações , Hipopotassemia/tratamento farmacológico , Infusões Intravenosas , Masculino , Potássio/administração & dosagem , Rabdomiólise/complicações
15.
J Hypertens ; 37(7): 1493-1499, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31033727

RESUMO

OBJECTIVES: Because of the influence on the renin-angiotensin-aldosterone system, it is recommended to avoid, if possible, the use of angiotensin-converting-enzyme inhibitors, angiotensin II type 1 receptor blockers, diuretics, ß-blockers, and mineralocorticoid receptor antagonists during the diagnostic period of primary aldosteronism. A laterality index more than 4 in adrenocorticotropic hormone (ACTH)-stimulated adrenal venous sampling (ACTH-AVS) is a widely used classification of the unilateral subtype that can benefit from adrenalectomy. Here, we revealed clinical features of patients taking drugs that could affect the primary aldosteronism diagnosis (DAPD) and investigated whether the classification with laterality index more than 4 in ACTH-AVS is applicable to these patients. PATIENTS AND METHODS: Using a large database of primary aldosteronism patients in Japan, we analyzed 2122 patients with successful ACTH-AVS. RESULTS: Patients who received any DAPD (n = 209) showed higher prevalence of comorbidity burdens and took more antihypertensive drugs compared with patients without DAPD. In patients taking DAPD, those with laterality index more than 4 had a higher prevalence of hypokalemia, a higher aldosterone-to-renin ratio and a higher prevalence of adrenal mass than those with laterality index of 4 or less. Adrenalectomy was performed in 76% patients with laterality index more than 4 and 20% with laterality index of 4 or less. Patients who underwent adrenalectomy showed biochemical cure in 89% with laterality index more than 4 and 50% with laterality index of 4 or less (P = 0.001). Multivariate regression analysis showed that laterality index more than 4 was an independent predictor of a biochemical cure. Biochemical cure rate in patients with laterality index more than 4 was consistently high, irrespective of the potential effect of individual DAPD on laterality index. CONCLUSION: Our findings suggest that in primary aldosteronism patients to whom DAPD were administrated due to severe clinical features, laterality index more than 4 in ACTH-AVS could accurately predict a biochemical cure after adrenalectomy.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Aldosterona/farmacologia , Anti-Hipertensivos/farmacologia , Hiperaldosteronismo/sangue , Hiperaldosteronismo/diagnóstico , Glândulas Suprarrenais/efeitos dos fármacos , Adrenalectomia , Adulto , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Comorbidade , Feminino , Humanos , Hipopotassemia/complicações , Japão , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/farmacologia , Prevalência , Sistema Renina-Angiotensina/efeitos dos fármacos , Estudos Retrospectivos
16.
Eur J Intern Med ; 60: 24-30, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30722845

RESUMO

BACKGROUND: Abnormal serum potassium levels (K+) in patients with heart failure (HF) relate to worse prognosis. We evaluated whether admission K+ levels predict 1-year outcomes in elderly patients admitted for acute HF. METHODS: We evaluated 2865 patients aged >74 years from the RICA Spanish Heart Failure Registry, classified according to admission serum K+ levels: hyperkalemia (>5.5 mmol/L), normokalemia (3.5-5.5 mmol/L) and hypokalemia (<3.5 mmol/L). We explored whether K+ levels were significantly associated with one-year all-cause mortality or hospital readmission and their combination. RESULTS: Mean admission K+ value was 4.3 ±â€¯0.6 mmol/L; 97 patients (3.38%) presented with hyperkalemia and 174 (6.06%) with hypokalemia. Overall, 43% of the patients died or were readmitted for HF during the follow-up period; the risk was higher for those with hyperkalemia (59% vs 41% in hypokalemic patients). The HR for one-year mortality was 1.43 (p = .073) and 1.67 for readmissions (p = .007) when K+ was >5.5 mmol/L and 1.08 (p = .618) and 0.90 (p = .533) respectively for K+ < 3.5 mmol/L. The HR for the combined outcome was 1.59 (1.19-2.13); p = .002 in hyperkalemic patients and 0.96 (0.75-1.23); p = .751in hypokalemic patients. Multivariate analysis showed a significant association of admission K+ values >5.5 mmol/L with the combined outcome of mortality and readmission (HR 1.15 [95% CI 1.04-1.27], p = .008). CONCLUSION: In patients hospitalized for decompensated HF, admission hyperkalemia predicts a higher mid-term risk for HF readmission and mortality, probably related to the significant higher risk of readmission.


Assuntos
Insuficiência Cardíaca/mortalidade , Hiperpotassemia/epidemiologia , Hipopotassemia/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Potássio/sangue , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/sangue , Humanos , Hiperpotassemia/complicações , Hipopotassemia/complicações , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Análise Multivariada , Prognóstico , Estudos Prospectivos , Sistema de Registros , Espanha/epidemiologia
17.
Arch Argent Pediatr ; 117(1): e37-e40, 2019 02 01.
Artigo em Espanhol | MEDLINE | ID: mdl-30652453

RESUMO

Acute hypokalemic paralysis is a rare cause of acute weakness. Thyrotoxic periodic paralysis (TPP) is an unusual complication of hyperthyroidism. It is characterized by sudden onset of hypokalemia condition resulting from a shift of potassium into cells and paralysis that primarily affects the lower extremities. Failure to recognize TPP may lead to improper management. Treatment of TPP includes replacing potassium rapidly, using nonselective beta-blockers and correcting the underlying hyperthyroidism as soon as possible. TPP is curable once euthyroid state is achieved. We describe a 13-year-old male with Down syndrome who presented with acute onset of lower extremity weakness secondary to acute hypokalemia and was found to have new onset Graves' disease.


Assuntos
Síndrome de Down/complicações , Hipertireoidismo/complicações , Hipopotassemia/complicações , Debilidade Muscular/etiologia , Adolescente , Humanos , Masculino
18.
Pan Afr Med J ; 34: 208, 2019.
Artigo em Francês | MEDLINE | ID: mdl-32180882

RESUMO

Osmotic demyelination syndrome is characterized by the loss of myelin in the center of the basis pontis and other areas of the central nervous system. We report a case of osmotic demyelination syndrome in a 55-year-old female, with a past medical history of arterial hypertension and multi-level cervical spondylosis, hospitalized for acute altered mental status complicating an array of acute gastroenteritis, the patient was afebrile. The course was marked by neurologic aggravation with confusion, aphasia, tetraplegia and osteo-tendinous areflexia. Initial cerebral magnetic resonance imaging did not show any specific abnormalities. The diagnosis of Central pontine myelinolysis and extrapontine myelinolysis was confirmed by a cerebral magnetic resonance imaging done after 20 days of the first. The rapid correction of hyponatremia was the main cause of this syndrome, without neglecting the very likely role of the associated hypokalemia. The evolution of centropontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) is variable. The treatment is primarily preventive based on the careful correction of severe hyponatraemia and contributing factors.


Assuntos
Hipopotassemia/complicações , Hiponatremia/terapia , Mielinólise Central da Ponte/diagnóstico , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Mielinólise Central da Ponte/etiologia , Síndrome
19.
J Ayub Med Coll Abbottabad ; 31(4): 619-621, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31933322

RESUMO

Thyrotoxic periodic paralysis is an uncommon disorder characterized by hypokalaemia, thyrotoxicosis and paralysis, most commonly seen in South Asian males. Aim of our case series is to highlight the significance of this reversible cause of patients presenting with neuromuscular paralysis. We present case series of 1 Asian and three Caucasian patients with thyrotoxic periodic paralysis who came with neuromuscular weakness secondary to thyrotoxicosis. All made a swift and uneventful recovery with no recurrence. Thyrotoxic periodic paralysis (TPP) is an infrequent condition having recurrent episodes of muscle weakness as main feature. Hypokalaemia is a common finding seen in these patients. Resolution of the attacks is achieved with correction of hypokalaemia and hyperthyroidism.


Assuntos
Hipertireoidismo/complicações , Hipopotassemia/complicações , Debilidade Muscular/etiologia , Paralisia/etiologia , Tireotoxicose/etiologia , Adulto , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Adulto Jovem
20.
Saudi J Gastroenterol ; 25(1): 40-45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30479322

RESUMO

Background/Aims: Approximately 20-30% of small bowel capsule endoscopies (SBCEs) do not reach the cecum at the completion of the examination. We aimed to determine whether hypokalemia influences the completion rate and small bowel transit time (SBTT) of SBCE. Patients and Methods: From January to December 2017, 112 patients (18-75 years old) who underwent SBCE were assessed consecutively for enrolment in our study. On the day of the procedure, a blood test was performed prior to capsule ingestion. The completion rate, gastric transit time (GTT), SBTT, and diagnostic yield were recorded for each SBCE. Results: The SBCE completion rate was lower in the hypokalemia group than that in the normal potassium group (55.6% (15/27) vs. 76.5% (65/85), P = 0.036). The median GTT was 55.5 ± 47.1 min in the hypokalemia group and 46.7 ± 44.5 min in the normal potassium group (P > 0.05). The median SBTT was 412.8 ± 123.3 min in the hypokalemia group and 367.3 ± 172.5 min in the normal potassium group (P > 0.05). The diagnostic yields of the hypokalemia and normal potassium groups were 74.1% and 78.8%, respectively (P = 1.00). Conclusion: Hypokalemia may decrease the SBCE completion rate. Physicians should consider the possibility of hypokalemia after bowel preparation because this condition is not rare. Potassium deficiencies should be rectified prior to performing SBCE procedures to increase the SBCE completion rate.


Assuntos
Endoscopia por Cápsula/métodos , Trânsito Gastrointestinal/fisiologia , Hipopotassemia/complicações , Intestino Delgado/diagnóstico por imagem , Deficiência de Potássio/terapia , Potássio/sangue , Adolescente , Adulto , Idoso , Catárticos/normas , China/epidemiologia , Feminino , Humanos , Hipopotassemia/diagnóstico , Intestino Delgado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Deficiência de Potássio/epidemiologia , Deficiência de Potássio/prevenção & controle , Estudos Prospectivos
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