Pseudohyperkalemia in chronic lymphocytic leukemia and diabetic ketoacidosis.

Pseudohyperkalemia can lead to inaccurate hyperkalemia diagnosis, inappropriate initiation of potassium-lowering therapies, and overall unnecessary treatment possibly inducing iatrogenic hypokalemia. Patients with leukocytosis and thrombocytosis should raise clinical suspicion that hyperkalemic laboratory results in the absence of other traditional signs of hyperkalemia may be indicative of pseudohyperkalemia. Here we present a case of severe leukocytosis with chronic lymphocytic leukemia (CLL) found to have critically elevated potassium levels on admission to the intensive care unit (ICU). The patient was also diagnosed with diabetic ketoacidosis (DKA) at admission, requiring an increased frequency of electrolyte monitoring. The events leading to the prompt recognition of pseudohyperkalemia in this patient will be delineated alongside our recommendations for revising the institutional protocol to avoid false hyperkalemia diagnoses in patients with CLL.

Therapeutic cyproheptadine regimen in serotonin syndrome: Complications after cardiovascular surgery.

Serotonin syndrome can be a life-threatening condition that occurs from the overactivity of serotonin in the central nervous system. This report describes the use of cyproheptadine for the management of serotonin syndrome in a patient taking fluoxetine and bupropion, who received methylene blue for vasoplegia syndrome. A 61-year-old female taking fluoxetine and bupropion preoperatively was given a total of three doses of methylene blue 100 mg IV within a brief time frame during and after a planned coronary artery bypass graft surgery. Postoperatively, the patient was not following commands, was agitated and confused, febrile with diaphoresis, tachycardic, had muscle rigidity, and horizontal ocular clonus. The patient's presentation was most consistent with serotonin syndrome due to a drug-drug interaction. Cyproheptadine and supportive care were used successfully to treat serotonin syndrome, and the patient was discharged home 14 days postoperatively. Based on the literature, there is no standardized method of weaning cyproheptadine when used for serotonin syndrome. The patient in our case received a total of 188 mg of cyproheptadine over the course of 10 days and did not experience any side effects. This case highlights a potential dosing regimen that can be used for other patients.

Use of tocilizumab, remdesivir, and high-dose methylprednisolone prevents intubation in an ESRD patient with COVID-19 pneumonia.

Coronavirus disease 2019 (COVID-19) has affected over 200 million patients worldwide. COVID-19 is transmitted through respiratory droplets from patient to patient or by touching a surface that has been contaminated by an infected patient. Many COVID-19 patients have other comorbidities, such as end-stage renal disease. Currently, management of COVID-19 in patients with end-stage renal disease is unclear. Some studies have shown improvement in this population with the use of tocilizumab, a humanized interleukin-6 monoclonal antibody, in addition to the standard therapy as per guidelines published by the National Institutes of Health. In this case report, we present a patient case where the use of remdesivir, tocilizumab, and pulse-dose methylprednisolone significantly improved symptoms and inflammatory biomarkers associated with COVID-19 in a patient with end-stage renal disease.