Acute kidney injury(AKI)and electrolyte disorders are important complications of hospitalized coronavirus disease 2019(COVID-19)patients.AKI is thought to occur due to multiple pathophysiological mechanisms,such as mu...Acute kidney injury(AKI)and electrolyte disorders are important complications of hospitalized coronavirus disease 2019(COVID-19)patients.AKI is thought to occur due to multiple pathophysiological mechanisms,such as multiple organ dysfunction(mainly cardiac and respiratory),direct viral entry in the renal tubules,and cytokine release syndrome.AKI is present in approximately one in every ten hospitalized COVID-19 patients.The incidence rates of AKI increase in patients who are admitted to the intensive care unit(ICU),with levels higher than 50%.Additionally,renal replacement therapy(RRT)is used in 7%of all AKI cases,but in nearly 20%of patients admitted to an ICU.COVID-19 patients with AKI are considered moderate-to-severe cases and are managed with multiple interdisciplinary conducts.AKI acts as a risk factor for mortality in severe acute respiratory syndrome coronavirus 2 infection,especially when RRT is needed.Electrolyte disorders are also common manifestations in hospitalized COVID-19 patients,mainly hyponatremia,hypokalemia,and hypocalcemia.Hyponatremia occurs due to a combination of syndrome of inappropriate secretion of antidiuretic hormone and gastrointestinal fluid loss from vomiting and diarrhea.When it comes to hypokalemia,its mechanism is not fully understood but may derive from hyperaldosteronism due to renin angiotensin aldosterone system overstimulation and gastrointestinal fluid loss as well.The clinical features of hypokalemia in COVID-19 are similar to those in other conditions.Hypocalcemia is the most common electrolyte disorder in COVID-19 and seems to occur because of vitamin D deficiency and parathyroid imbalance.It is also highly associated with longer hospital and ICU stay.展开更多
Electrolyte disorders are very common complications in cancer patients. They might be associated to a worsening outcome, influencing quality of life, possibility to receive anticancer drugs, and conditioning survival....Electrolyte disorders are very common complications in cancer patients. They might be associated to a worsening outcome, influencing quality of life, possibility to receive anticancer drugs, and conditioning survival. In fact, they might provoke important morbidity, with dysfunction of multiple organs and rarely causing life-threatening conditions. Moreover, recent studies showed that they might worsen cancer patients' outcome, while a prompt correction seems to have a positive impact. Furthermore, there is evidence of a correlation between electrolyte alterations and poorer performance status, delays in therapy commencement and continuation, and negative treatment outcomes. These alterations usually involve sodium, potassium, calcium, and magnesium serum levels. Several causes might contribute to electrolyte disorders in cancer patients: cancer effects, such as paraneoplastic syndrome of inappropriate antidiuresis and tumor lysis syndrome;anti-cancer therapies;and other concomitant clinical conditions or treatments. However, the origin of the electrolyte disorder is often multifactorial, thus identifying and correcting the causes is not always feasible. Furthermore, they are often not recognized or not considered in clinical practice, worsening these alterations and patient condition. An improvement of knowledge about the physiological mechanisms underlying electrolyte disorders is necessary to strengthen their identification and set up a prompt, adequate, and effective treatment. The aim of this systematic review is to provide an analysis of the pathophysiological mechanisms of electrolyte abnormalities in cancer patients to facilitate their identification, management, and therapy to improve patient outcome.展开更多
Hyponatremia is the most common electrolyte disorder in hospitalized patients. The incidence rate is about 15% to 22%. It is also the most common electrolyte disorder in cancer, like lung cancer, digestive tract cance...Hyponatremia is the most common electrolyte disorder in hospitalized patients. The incidence rate is about 15% to 22%. It is also the most common electrolyte disorder in cancer, like lung cancer, digestive tract cancer and central nervous system tumors. According to statistics, 1% - 2% of malignant tumor patients will have SIADH syndrome and most of them are small cell lung cancer patients.展开更多
Background:We present an atypical case of severe metabolic alkalosis,not reported in the literature to date.Case Presentation:Owing to concerns of apneas and desaturation,a 75-year-old man presented to the emergency d...Background:We present an atypical case of severe metabolic alkalosis,not reported in the literature to date.Case Presentation:Owing to concerns of apneas and desaturation,a 75-year-old man presented to the emergency department with significantly deranged physiology:bicarbonate level of 63.6 mmol/L,a base excess of 40.6,and a potassium concentration of 1.9 mmol/L.Primary diagnoses included metabolic alkalosis secondary to fludrocortisone therapy with respiratory compensation,hypokalemia,and hypochloremia.He initially received potassium replacement with cardiac monitoring,followed by permissive hypercapnia in the intensive care unit.He received acetazolamide to further improve his acid-base status.The patient had a good outcome with gradual return of his pH and bicarbonate levels to baseline.He was then discharged.Conclusion:Iatrogenic mineralocorticoid excess should be considered when the patient presents with significantly raised bicarbonate levels.When starting fludrocortisone,renal function needs to be diligently monitored due to risk of hypokalemia metabolic alkalosis.展开更多
文摘Acute kidney injury(AKI)and electrolyte disorders are important complications of hospitalized coronavirus disease 2019(COVID-19)patients.AKI is thought to occur due to multiple pathophysiological mechanisms,such as multiple organ dysfunction(mainly cardiac and respiratory),direct viral entry in the renal tubules,and cytokine release syndrome.AKI is present in approximately one in every ten hospitalized COVID-19 patients.The incidence rates of AKI increase in patients who are admitted to the intensive care unit(ICU),with levels higher than 50%.Additionally,renal replacement therapy(RRT)is used in 7%of all AKI cases,but in nearly 20%of patients admitted to an ICU.COVID-19 patients with AKI are considered moderate-to-severe cases and are managed with multiple interdisciplinary conducts.AKI acts as a risk factor for mortality in severe acute respiratory syndrome coronavirus 2 infection,especially when RRT is needed.Electrolyte disorders are also common manifestations in hospitalized COVID-19 patients,mainly hyponatremia,hypokalemia,and hypocalcemia.Hyponatremia occurs due to a combination of syndrome of inappropriate secretion of antidiuretic hormone and gastrointestinal fluid loss from vomiting and diarrhea.When it comes to hypokalemia,its mechanism is not fully understood but may derive from hyperaldosteronism due to renin angiotensin aldosterone system overstimulation and gastrointestinal fluid loss as well.The clinical features of hypokalemia in COVID-19 are similar to those in other conditions.Hypocalcemia is the most common electrolyte disorder in COVID-19 and seems to occur because of vitamin D deficiency and parathyroid imbalance.It is also highly associated with longer hospital and ICU stay.
文摘Electrolyte disorders are very common complications in cancer patients. They might be associated to a worsening outcome, influencing quality of life, possibility to receive anticancer drugs, and conditioning survival. In fact, they might provoke important morbidity, with dysfunction of multiple organs and rarely causing life-threatening conditions. Moreover, recent studies showed that they might worsen cancer patients' outcome, while a prompt correction seems to have a positive impact. Furthermore, there is evidence of a correlation between electrolyte alterations and poorer performance status, delays in therapy commencement and continuation, and negative treatment outcomes. These alterations usually involve sodium, potassium, calcium, and magnesium serum levels. Several causes might contribute to electrolyte disorders in cancer patients: cancer effects, such as paraneoplastic syndrome of inappropriate antidiuresis and tumor lysis syndrome;anti-cancer therapies;and other concomitant clinical conditions or treatments. However, the origin of the electrolyte disorder is often multifactorial, thus identifying and correcting the causes is not always feasible. Furthermore, they are often not recognized or not considered in clinical practice, worsening these alterations and patient condition. An improvement of knowledge about the physiological mechanisms underlying electrolyte disorders is necessary to strengthen their identification and set up a prompt, adequate, and effective treatment. The aim of this systematic review is to provide an analysis of the pathophysiological mechanisms of electrolyte abnormalities in cancer patients to facilitate their identification, management, and therapy to improve patient outcome.
文摘Hyponatremia is the most common electrolyte disorder in hospitalized patients. The incidence rate is about 15% to 22%. It is also the most common electrolyte disorder in cancer, like lung cancer, digestive tract cancer and central nervous system tumors. According to statistics, 1% - 2% of malignant tumor patients will have SIADH syndrome and most of them are small cell lung cancer patients.
文摘Background:We present an atypical case of severe metabolic alkalosis,not reported in the literature to date.Case Presentation:Owing to concerns of apneas and desaturation,a 75-year-old man presented to the emergency department with significantly deranged physiology:bicarbonate level of 63.6 mmol/L,a base excess of 40.6,and a potassium concentration of 1.9 mmol/L.Primary diagnoses included metabolic alkalosis secondary to fludrocortisone therapy with respiratory compensation,hypokalemia,and hypochloremia.He initially received potassium replacement with cardiac monitoring,followed by permissive hypercapnia in the intensive care unit.He received acetazolamide to further improve his acid-base status.The patient had a good outcome with gradual return of his pH and bicarbonate levels to baseline.He was then discharged.Conclusion:Iatrogenic mineralocorticoid excess should be considered when the patient presents with significantly raised bicarbonate levels.When starting fludrocortisone,renal function needs to be diligently monitored due to risk of hypokalemia metabolic alkalosis.
