Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment opt...Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion,each carrying specific risks.AF may resolve spontaneously,but often recurs,making a“watch-andwait”strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.展开更多
Objectives To determine the possible relationship between plasma potassiumconcentration and severity of acute trimethyltin chloride (TMT) poisoning and to assess themechanism of TMT induced hypokalemia. Methods ...Objectives To determine the possible relationship between plasma potassiumconcentration and severity of acute trimethyltin chloride (TMT) poisoning and to assess themechanism of TMT induced hypokalemia. Methods SD rats were treated with variousdosages of TMT (ip). All the indices were measured and analysed for determing theirpossible relations with plasma K+. Results With increase of dosage, the plasma K+ leveldropped rapidly, and deaths appeared more quickly. The LD50 of TMT (ip) was 14.7 mg/kgbw. In the low dosage group (10 mg/kgbw), the plasma K+ level dropped slowly with thelowest dosage on day 6 (4.85 mmol/L). It rose again on day 11 (5.06 mmol/L), and recoverdon day 28. The poisoning signs corresponded with decline of the span of K+ level. The plasmaNa+ level dropped half an hour after TMT treatment, but recovered 24 h later. In the highdosage group (46.4 mg/kgbw), the levels of plasma K+ and Na+ fell rapidly within half anhour (P<0.05), the intracellular potassium concentration of RBC did not decrerase obviously(P>0.05), the activities of Na+-K+-ATPase and Mg2+-ATPase in RBC membrane weredepressed remarkably (P<0.01, P<0.05, respectively), the plasma aldosterone concentrationsrose as high as tenfold (P<0.01), the arterial blood pH fell from 7.434 to 7.258 (P<0.01),pCO2 was raised from 29.62 to 45.33 mmHg (P<0.01). In the 24 h urine test, when rats weretreated with TMT (21.5 mg/kgbw, ip), urine volume, urinary potassium, sodium and chlorideincreased significantly in comparison with those in the controls (P<0.01). Conclusion TMTcould induce hypokalemia in SD rats. The available evidence suggests that TMT can induceacute renal leakage of potassium. At the same time, a significant rise of plasma aldosteronemay play an important role in promoting potassium leakage from kidney to result in severehypokalemia with inhaling acid-base abnormalities produced, which aggravate the poisoningsymptoms. In the end the rats would die of respiratory failure.展开更多
Objective:To observe effects of hypokalemia on transmural heterogeneity of ventricular repolarization in left ventricular myocardium of rabbit,and explore the role of hypokalemia in malignant ventricular arrhythmia（...Objective:To observe effects of hypokalemia on transmural heterogeneity of ventricular repolarization in left ventricular myocardium of rabbit,and explore the role of hypokalemia in malignant ventricular arrhythmia（MVA）.Methods:A total of 20 rabbits were randomly divided into control group and hypokalemic group.Isolated hearts in the control group were simply perfused with modified Tyrode’s solution,and were perfused with hypokalemic Tyrode’s solution in hypokalemic group.Ventricular fibrillation threshold（VFT）,90%monophasic action potential repolarization duration(APD<sub>90</sub>) of subepicardial,midmyocardial and subendocardial myocardium,transmural dispersion of repolarization（TDR） and Cx43 protein expression in three layers of myocardium were measured in both groups.Results:VFT in the control group and the hypokalemic group were（13.40±2.95） V,and（7.00±1.49） V,respectively.There was a significant difference between two groups（P【0.01）.APD<sub>90</sub> of three myocardial layers in the hypokalemic group were significantly prolonged than those in the control group（/’【0.01）.△APD<sub>90</sub>in the hypokalemic group and the control group were（38.10±10\29） ms and（23.7015.68） ms,and TDR were（52.90<sub>r</sub> 14.55） ms and（36.10±12.44） ms,respectively.△APD<sub>90</sub> and TDR in the hypokalemic group were significantly higher than those in the control group(P【0.05|,and the increase in△APD<sub>90</sub> of midmyocardium was more significant in the hypokalemic group.Cx43 protein expression of all three myocardial layers were decreased significantly in the hypokalemic group（P【0.01）, and△APD<sub>90</sub> was significantly increased {P【0.05).Reduction of Cx43 protein expression was more significant in the midmyocardium.Conclusions:Hypokalemic can increase transmural heterogeneity of Cx43 expression and repolarization in left ventricular myocardium of rabbit,and decrease VFT and can induce MVA more easily.展开更多
Rhabdomyolysis continues to appear with increasing frequency and represents a medical emergency requiring rapid appropriate treatment. One of the unusual causes of nontraumatic rhabdomyolysis is hypokalemic periodic p...Rhabdomyolysis continues to appear with increasing frequency and represents a medical emergency requiring rapid appropriate treatment. One of the unusual causes of nontraumatic rhabdomyolysis is hypokalemic periodic paralysis without secondary causes. Primary hypokalemic periodic paralysis is a rare genetic disease characterized by episodic attacks of muscle weakness due to decreases in serum potassium. A 30-year-old woman who had 3 episodic attacks of hypokalemic periodic paralysis was admitted in emergency room with sudden onset symmetrical muscle weakness. After several hours, she started to complain myalgia and severe ache in both calves without any changes. Laboratory test showed markedly elevated creatine phosphokinase, lactic dehydrogenase levels with hypokalemia, rhabdomyolysis resulting from hypokalemia was diagnosed. Here, we report an unusual case of rhabdomyolysis caused by severe hypokalemia, which was suggested a result of familial hypokalemic periodic paralysis.展开更多
<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potass...<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. <strong>Aim:</strong> This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. <strong>Methods:</strong> We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. <strong>Outcomes:</strong> Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. <strong>Conclusions:</strong> Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.展开更多
Objective:This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological population.Methods:This retrospective cohort study included 208 patien...Objective:This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological population.Methods:This retrospective cohort study included 208 patients who underwent gynecological surgery at our institution between January 2021 and March 2022.Data were collected for each patient,including demographics,disease status,surgical data,and clinical information.Preoperative bowel preparation,postoperative gastrointestinal function,and electrolyte levels were compared between the two groups using propensity score matching(PSM).Results:The incidence of hypokalemia(serum potassium level<3.5 mmol/L)during the recovery period from anesthesia was approximately 43.75%.After PSM,oral laxative use(96.4%vs.82.4%,P=0.005),the number of general enemas(P=0.014),and the rate of≥2 general enemas(92.9%vs.77.8%,P=0.004)were identified as risk factors for hypokalemia,which was accompanied by decreased PaCO_(2) and hypocalcemia.There were no significant differences in postoperative gastrointestinal outcomes,such as the time to first flatus or feces,the I-FEED score(a scoring system was created to evaluate impaired postoperative gastrointestinal function),or postoperative recovery outcomes,between the hypokalemia group and the normal serum potassium group.Conclusion:Hypokalemia during postanesthesia recovery period occurred in 43.75%of gynecological patients,which resulted from preoperative mechanical bowel preparation;however,it did not directly affect clinical outcomes,including postoperative gastrointestinal function,postoperative complications,and length of hospital stay.展开更多
Watery diarrhea, hypokalemia and achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP) -producing tumor only rarely occurs in patients with nonpancreatic disease. A 49-year-old woman was refer...Watery diarrhea, hypokalemia and achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP) -producing tumor only rarely occurs in patients with nonpancreatic disease. A 49-year-old woman was referred for evaluation of a right adrenal tumor incidentally diagnosed by abdominal ultrasound during the investigation of chronic watery diarrhea. Laboratory findings showed hypokalemia and excessive production of VIP and catecholamines. After surgical resection of the tumor, diarrhea subsided and both electrolytes and affected hormone levels normalized. Immunohistochemical examination confirmed a diagnosis of pheochromocytoma, which contained VIP-positive ganglion-like cells. We herein present the clinical and histogenetic implications of this rare clinical entity, with literature review.展开更多
BACKGROUND The tongue squamous cell carcinoma(TSCC)is an oral malignant tumor arising from the squamous epithelium of the tongue mucosa,characterized by a high malignant degree,invasive growth,early lymph node metasta...BACKGROUND The tongue squamous cell carcinoma(TSCC)is an oral malignant tumor arising from the squamous epithelium of the tongue mucosa,characterized by a high malignant degree,invasive growth,early lymph node metastasis,and poor prognosis.Paclitaxel,represented by docetaxel,is now the standard first-line treatment for head and neck squamous cell carcinoma.Docetaxel,which belongs to the class of drugs known as paclitaxel,is an antitumor drug that inhibits cell mitosis and proliferation.Its adverse effects include myelosuppression,hair loss,gastrointestinal reactions,fluid retention,and allergic reactions.However,hypokalemia is rare,most cases are mild or moderate,and severe hypokalemia is seldom reported.symptoms of adverse effects early.It is necessary to be considerate regarding individual differences between patients when selecting chemotherapy regimens and adhere to the principle of individualized treatment.Following multiple cycles of chemotherapy,patients should be aware of the accumulation of toxic side effects and receive blood tests reviewed within 24 hours of completion.It is essential to monitor electrolyte levels in patients suffering from severe gastrointestinal reactions to avoid complications that may result in death.展开更多
Objective: It has been suggested that the use of hypotonic intravenous fluid (IVF) puts hospitalized children at a greater risk of developing hyponatremia in children with increased arginine vasopressin (AVP) producti...Objective: It has been suggested that the use of hypotonic intravenous fluid (IVF) puts hospitalized children at a greater risk of developing hyponatremia in children with increased arginine vasopressin (AVP) production. To reduce its risk, the National Patient Safety Agency in UK issued alert 22 in 2007, of which recommendations were to use isotonic solutions for these children at risk of hyponatremia, instead of the previously most commonly used IVF (0.18% saline/ 4% dextrose) for maintenance fluid therapy. Recent observations, however, revealed that hypokalemia are also common in hospitalized patients who do not receive potassium in their IVF. This study was conducted to validate the potassium added IVF for the prevention of hospital-acquired hypokalemia in maintenance fluid therapy. Design: For maintenance fluid therapy, a commercially available IVF solution in Japan named as Solita-T2R (Na 84 mmol/L, K 20 mmol/L, Cl 66 mmol/L, glucose 3.2%) was infused for 41 sick children with a median age of 3.01 years. Its composition is close equivalent to 0.45% saline/5% dextrose (Na 77 mmol/L, K 0 mmol/L, Cl 77 mmol/L, dextrose 5%) except K content. The patients in states of AVP excess were excluded from the analysis. Results: Median serum potassium value did not drop significantly at a median interval of 48 hours (before IVF: 4.30 mmol/L, after IVF: 4.10 mmol/L, p > 0.05), whereas median serum sodium level significantly increased from 136.0 mmol/L to 139.0 mmol/L (p < 0.001). Conclusion: Potassium added (20 mmol/L) IVF solution reduces the risk of developing “hospital-acquired hypokalemia” in children who are not in states of AVP excess in maintenance fluid therapy. It is worthwhile to study prospectively in a larger number of sick children.展开更多
Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest...Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 10<sup>9</sup>/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.展开更多
Hypokalemia, defined as serum potassium below 3.5 mEq/L, can lead to severe complications such as arrhythmias and muscle paralysis, potentially resulting in rhabdomyolysis. The etiology of hypokalemia is often multifa...Hypokalemia, defined as serum potassium below 3.5 mEq/L, can lead to severe complications such as arrhythmias and muscle paralysis, potentially resulting in rhabdomyolysis. The etiology of hypokalemia is often multifactorial, involving but not limited to gastrointestinal losses, renal losses, medication effects, and inadequate dietary intake. Chronic heavy alcohol use, obstructive sleep apnea (OSA), and the use of diuretics such as hydrochlorothiazide (HCTZ) are also significant contributing factors. Effective management requires thorough evaluation and investigation to effectively treat a patient. This case report aims to illustrate the diagnostic challenges and comprehensive treatment approach required in a patient with multiple comorbidities and severe hypokalemia, emphasizing the need for a multidisciplinary and comprehensive approach to address all underlying causes.展开更多
Irbesartan-hydrochlorothiazide is a commonly used antihypertensive drug,but potential adverse reactions such as hypokalemia should not be overlooked.This study analyzes a case of hypokalemia induced by irbesartan-hydr...Irbesartan-hydrochlorothiazide is a commonly used antihypertensive drug,but potential adverse reactions such as hypokalemia should not be overlooked.This study analyzes a case of hypokalemia induced by irbesartan-hydrochlorothiazide,exploring the drug’s association with hypokalemia and clinical treatment strategies.The patient experienced symptoms of muscle weakness and palpitations after taking irbesartan-hydrochlorothiazide and was diagnosed with hypokalemia through laboratory tests.Reviewing the patient’s medication history and disease progression,it was hypothesized that the drug’s potassium-wasting effect was the direct cause of the hypokalemia.After discontinuing the medication and initiating potassium supplementation,the patient’s potassium levels returned to normal,and symptoms significantly improved,further confirming the link between hypokalemia and the medication.This case suggests that clinicians should consider the risk of hypokalemia when treating hypertension,especially in patients with chronic kidney disease,the elderly,or those at risk for electrolyte disturbances.For patients who have already developed hypokalemia,potassium supplementation and adjustment of the treatment regimen are recommended to prevent further deterioration.Timely discontinuation of potential causative drugs is also advised.In summary,ensuring medication safety and preventing potential complications has significant clinical importance in recognizing and managing hypokalemia induced by irbesartan-hydrochlorothiazide.Future research should focus on optimizing treatment protocols and developing more effective strategies for preventing and managing related adverse reactions to improve patient quality of life.展开更多
Objective： Hypokalemia is a frequent complication observed after traumatic brain injury （TBI）.We evaluated the effect of spironolactone on preventing hypokalemia following moderate to severe TBI.Methods： Patients ...Objective： Hypokalemia is a frequent complication observed after traumatic brain injury （TBI）.We evaluated the effect of spironolactone on preventing hypokalemia following moderate to severe TBI.Methods： Patients with moderate to severe TBI, whose Glasgow Coma Scale （GCS） scores of 9-12 and ＜9,respectively, were equally randomized into intervention and control groups, matching with severity of trauma and baseline serum level of potassium. For the intervention group, we administrated spironolactone （1 mg/kg per day）on the second day of admission or the first day of gavage tolerance and continued it for seven days. No additional intervention was done for controls. Hypokalemia （mild： 3-3.5 mg/L, moderate： 2.5-3 mg/L, and severe： ＜2.5 mg/L serum K＋） and other electrolyte abnormalities were compared between the two groups at the end of the intervention.Results： Sixty-eight patients （58 males and 10 females）were included with mean age=（33.1±11.8） years, and GCS=7.6±2.8. The two groups were similar in baseline characteristics.Patients who received spironolactone were significantly less likely to experience mild, moderate, or severe hypokalemia （8.8%, 2.9%, and 0） compared with controls （29.4%, 11.7%,and 2.9%, respectively, P＜0.05）. No significant difference was observed between the two groups in the occurrence of other electrolyte abnormalities, hyperglycemia or oliguria.Conclusion： Spironolactone within the first week of head injury could prevent the occurrence of late hypokalemia with no severe side effects.展开更多
Background:A deep learning model(DLM)that enables non-invasive hypokalemia screening from an electrocardiogram(ECG)may improve the detection of this life-threatening condition.This study aimed to develop and evaluate ...Background:A deep learning model(DLM)that enables non-invasive hypokalemia screening from an electrocardiogram(ECG)may improve the detection of this life-threatening condition.This study aimed to develop and evaluate the performance of a DLM for the detection of hypokalemia from the ECGs of emergency patients.Methods:We used a total of 9908 ECG data from emergency patients who were admitted at the Second Affiliated Hospital of Nanchang University,Jiangxi,China,from September 2017 to October 2020.The DLM was trained using 12 ECG leads(lead Ⅰ,Ⅱ,Ⅲ,aVR,aVL,aVF,and V1–6)to detect patients with serum potassium concentrations<3.5 mmol/L and was validated using retrospective data from the Jiangling branch of the Second Affiliated Hospital of Nanchang University.The blood draw was completed within 10 min before and after the ECG examination,and there was no new or ongoing infusion during this period.Results:We used 6904 ECGs and 1726 ECGs as development and internal validation data sets,respectively.In addition,1278 ECGs from the Jiangling branch of the Second Affiliated Hospital of Nanchang University were used as external validation data sets.Using 12 ECG leads(leads Ⅰ,Ⅱ,Ⅲ,aVR,aVL,aVF,and V1–6),the area under the receiver operating characteristic curve(AUC)of the DLM was 0.80(95%confidence interval[CI]:0.77–0.82)for the internal validation data set.Using an optimal operating point yielded a sensitivity of 71.4%and a specificity of 77.1%.Using the same 12 ECG leads,the external validation data set resulted in an AUC for the DLM of 0.77(95%CI:0.75–0.79).Using an optimal operating point yielded a sensitivity of 70.0%and a specificity of 69.1%.Conclusions:In this study,using 12 ECG leads,a DLM detected hypokalemia in emergency patients with an AUC of 0.77 to 0.80.Artificial intelligence could be used to analyze an ECG to quickly screen for hypokalemia.展开更多
临床药师参与2例利妥昔单抗致低钾血症患者的诊治过程,进行不良反应关联性评价;检索中国知网、维普、万方、PubMed、Web of Science等中英文数据库,对利妥昔单抗相关低钾血症的病例报道进行汇总分析。共纳入10例患者(含本文报道的2例患...临床药师参与2例利妥昔单抗致低钾血症患者的诊治过程,进行不良反应关联性评价;检索中国知网、维普、万方、PubMed、Web of Science等中英文数据库,对利妥昔单抗相关低钾血症的病例报道进行汇总分析。共纳入10例患者(含本文报道的2例患者),男性8例(80%),女性2例(20%),年龄(37.00±19.62)岁,18岁及18岁以上的有8例(80%)。低钾血症多发生在应用利妥昔单抗4 h内(70%),中位时间为用药后195(120,285)min。低钾血症临床表现为四肢无力、乏力、头晕、心悸、喉头紧张、胸闷、肌肉痉挛等。血钾中位值为2.29(1.86,2.72)mmol/L,最低值为1.3 mmol/L。急性低钾血症经停药和补钾等治疗后,低钾症状均好转,血钾恢复的中位时间为15(5,30)h。急性低钾血症为利妥昔单抗罕见的不良反应,起病隐匿。一旦患者出现乏力、肌肉无力等症状,临床应早判断、及时停药,并给予补钾等对症治疗,保障用药安全。展开更多
文摘Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion,each carrying specific risks.AF may resolve spontaneously,but often recurs,making a“watch-andwait”strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.
基金This work was supported by Goungdong Provincial Health Bureau P. R. China (B1999010).
文摘Objectives To determine the possible relationship between plasma potassiumconcentration and severity of acute trimethyltin chloride (TMT) poisoning and to assess themechanism of TMT induced hypokalemia. Methods SD rats were treated with variousdosages of TMT (ip). All the indices were measured and analysed for determing theirpossible relations with plasma K+. Results With increase of dosage, the plasma K+ leveldropped rapidly, and deaths appeared more quickly. The LD50 of TMT (ip) was 14.7 mg/kgbw. In the low dosage group (10 mg/kgbw), the plasma K+ level dropped slowly with thelowest dosage on day 6 (4.85 mmol/L). It rose again on day 11 (5.06 mmol/L), and recoverdon day 28. The poisoning signs corresponded with decline of the span of K+ level. The plasmaNa+ level dropped half an hour after TMT treatment, but recovered 24 h later. In the highdosage group (46.4 mg/kgbw), the levels of plasma K+ and Na+ fell rapidly within half anhour (P<0.05), the intracellular potassium concentration of RBC did not decrerase obviously(P>0.05), the activities of Na+-K+-ATPase and Mg2+-ATPase in RBC membrane weredepressed remarkably (P<0.01, P<0.05, respectively), the plasma aldosterone concentrationsrose as high as tenfold (P<0.01), the arterial blood pH fell from 7.434 to 7.258 (P<0.01),pCO2 was raised from 29.62 to 45.33 mmHg (P<0.01). In the 24 h urine test, when rats weretreated with TMT (21.5 mg/kgbw, ip), urine volume, urinary potassium, sodium and chlorideincreased significantly in comparison with those in the controls (P<0.01). Conclusion TMTcould induce hypokalemia in SD rats. The available evidence suggests that TMT can induceacute renal leakage of potassium. At the same time, a significant rise of plasma aldosteronemay play an important role in promoting potassium leakage from kidney to result in severehypokalemia with inhaling acid-base abnormalities produced, which aggravate the poisoningsymptoms. In the end the rats would die of respiratory failure.
文摘Objective:To observe effects of hypokalemia on transmural heterogeneity of ventricular repolarization in left ventricular myocardium of rabbit,and explore the role of hypokalemia in malignant ventricular arrhythmia（MVA）.Methods:A total of 20 rabbits were randomly divided into control group and hypokalemic group.Isolated hearts in the control group were simply perfused with modified Tyrode’s solution,and were perfused with hypokalemic Tyrode’s solution in hypokalemic group.Ventricular fibrillation threshold（VFT）,90%monophasic action potential repolarization duration(APD<sub>90</sub>) of subepicardial,midmyocardial and subendocardial myocardium,transmural dispersion of repolarization（TDR） and Cx43 protein expression in three layers of myocardium were measured in both groups.Results:VFT in the control group and the hypokalemic group were（13.40±2.95） V,and（7.00±1.49） V,respectively.There was a significant difference between two groups（P【0.01）.APD<sub>90</sub> of three myocardial layers in the hypokalemic group were significantly prolonged than those in the control group（/’【0.01）.△APD<sub>90</sub>in the hypokalemic group and the control group were（38.10±10\29） ms and（23.7015.68） ms,and TDR were（52.90<sub>r</sub> 14.55） ms and（36.10±12.44） ms,respectively.△APD<sub>90</sub> and TDR in the hypokalemic group were significantly higher than those in the control group(P【0.05|,and the increase in△APD<sub>90</sub> of midmyocardium was more significant in the hypokalemic group.Cx43 protein expression of all three myocardial layers were decreased significantly in the hypokalemic group（P【0.01）, and△APD<sub>90</sub> was significantly increased {P【0.05).Reduction of Cx43 protein expression was more significant in the midmyocardium.Conclusions:Hypokalemic can increase transmural heterogeneity of Cx43 expression and repolarization in left ventricular myocardium of rabbit,and decrease VFT and can induce MVA more easily.
文摘Rhabdomyolysis continues to appear with increasing frequency and represents a medical emergency requiring rapid appropriate treatment. One of the unusual causes of nontraumatic rhabdomyolysis is hypokalemic periodic paralysis without secondary causes. Primary hypokalemic periodic paralysis is a rare genetic disease characterized by episodic attacks of muscle weakness due to decreases in serum potassium. A 30-year-old woman who had 3 episodic attacks of hypokalemic periodic paralysis was admitted in emergency room with sudden onset symmetrical muscle weakness. After several hours, she started to complain myalgia and severe ache in both calves without any changes. Laboratory test showed markedly elevated creatine phosphokinase, lactic dehydrogenase levels with hypokalemia, rhabdomyolysis resulting from hypokalemia was diagnosed. Here, we report an unusual case of rhabdomyolysis caused by severe hypokalemia, which was suggested a result of familial hypokalemic periodic paralysis.
文摘<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. <strong>Aim:</strong> This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. <strong>Methods:</strong> We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. <strong>Outcomes:</strong> Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. <strong>Conclusions:</strong> Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.
文摘Objective:This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological population.Methods:This retrospective cohort study included 208 patients who underwent gynecological surgery at our institution between January 2021 and March 2022.Data were collected for each patient,including demographics,disease status,surgical data,and clinical information.Preoperative bowel preparation,postoperative gastrointestinal function,and electrolyte levels were compared between the two groups using propensity score matching(PSM).Results:The incidence of hypokalemia(serum potassium level<3.5 mmol/L)during the recovery period from anesthesia was approximately 43.75%.After PSM,oral laxative use(96.4%vs.82.4%,P=0.005),the number of general enemas(P=0.014),and the rate of≥2 general enemas(92.9%vs.77.8%,P=0.004)were identified as risk factors for hypokalemia,which was accompanied by decreased PaCO_(2) and hypocalcemia.There were no significant differences in postoperative gastrointestinal outcomes,such as the time to first flatus or feces,the I-FEED score(a scoring system was created to evaluate impaired postoperative gastrointestinal function),or postoperative recovery outcomes,between the hypokalemia group and the normal serum potassium group.Conclusion:Hypokalemia during postanesthesia recovery period occurred in 43.75%of gynecological patients,which resulted from preoperative mechanical bowel preparation;however,it did not directly affect clinical outcomes,including postoperative gastrointestinal function,postoperative complications,and length of hospital stay.
文摘Watery diarrhea, hypokalemia and achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP) -producing tumor only rarely occurs in patients with nonpancreatic disease. A 49-year-old woman was referred for evaluation of a right adrenal tumor incidentally diagnosed by abdominal ultrasound during the investigation of chronic watery diarrhea. Laboratory findings showed hypokalemia and excessive production of VIP and catecholamines. After surgical resection of the tumor, diarrhea subsided and both electrolytes and affected hormone levels normalized. Immunohistochemical examination confirmed a diagnosis of pheochromocytoma, which contained VIP-positive ganglion-like cells. We herein present the clinical and histogenetic implications of this rare clinical entity, with literature review.
基金Supported by the Chongqing medical scientific research project(a joint project of the Chongqing Health Commission and Science and Technology),No.2020ZY023716.
文摘BACKGROUND The tongue squamous cell carcinoma(TSCC)is an oral malignant tumor arising from the squamous epithelium of the tongue mucosa,characterized by a high malignant degree,invasive growth,early lymph node metastasis,and poor prognosis.Paclitaxel,represented by docetaxel,is now the standard first-line treatment for head and neck squamous cell carcinoma.Docetaxel,which belongs to the class of drugs known as paclitaxel,is an antitumor drug that inhibits cell mitosis and proliferation.Its adverse effects include myelosuppression,hair loss,gastrointestinal reactions,fluid retention,and allergic reactions.However,hypokalemia is rare,most cases are mild or moderate,and severe hypokalemia is seldom reported.symptoms of adverse effects early.It is necessary to be considerate regarding individual differences between patients when selecting chemotherapy regimens and adhere to the principle of individualized treatment.Following multiple cycles of chemotherapy,patients should be aware of the accumulation of toxic side effects and receive blood tests reviewed within 24 hours of completion.It is essential to monitor electrolyte levels in patients suffering from severe gastrointestinal reactions to avoid complications that may result in death.
文摘Objective: It has been suggested that the use of hypotonic intravenous fluid (IVF) puts hospitalized children at a greater risk of developing hyponatremia in children with increased arginine vasopressin (AVP) production. To reduce its risk, the National Patient Safety Agency in UK issued alert 22 in 2007, of which recommendations were to use isotonic solutions for these children at risk of hyponatremia, instead of the previously most commonly used IVF (0.18% saline/ 4% dextrose) for maintenance fluid therapy. Recent observations, however, revealed that hypokalemia are also common in hospitalized patients who do not receive potassium in their IVF. This study was conducted to validate the potassium added IVF for the prevention of hospital-acquired hypokalemia in maintenance fluid therapy. Design: For maintenance fluid therapy, a commercially available IVF solution in Japan named as Solita-T2R (Na 84 mmol/L, K 20 mmol/L, Cl 66 mmol/L, glucose 3.2%) was infused for 41 sick children with a median age of 3.01 years. Its composition is close equivalent to 0.45% saline/5% dextrose (Na 77 mmol/L, K 0 mmol/L, Cl 77 mmol/L, dextrose 5%) except K content. The patients in states of AVP excess were excluded from the analysis. Results: Median serum potassium value did not drop significantly at a median interval of 48 hours (before IVF: 4.30 mmol/L, after IVF: 4.10 mmol/L, p > 0.05), whereas median serum sodium level significantly increased from 136.0 mmol/L to 139.0 mmol/L (p < 0.001). Conclusion: Potassium added (20 mmol/L) IVF solution reduces the risk of developing “hospital-acquired hypokalemia” in children who are not in states of AVP excess in maintenance fluid therapy. It is worthwhile to study prospectively in a larger number of sick children.
文摘Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 10<sup>9</sup>/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.
文摘Hypokalemia, defined as serum potassium below 3.5 mEq/L, can lead to severe complications such as arrhythmias and muscle paralysis, potentially resulting in rhabdomyolysis. The etiology of hypokalemia is often multifactorial, involving but not limited to gastrointestinal losses, renal losses, medication effects, and inadequate dietary intake. Chronic heavy alcohol use, obstructive sleep apnea (OSA), and the use of diuretics such as hydrochlorothiazide (HCTZ) are also significant contributing factors. Effective management requires thorough evaluation and investigation to effectively treat a patient. This case report aims to illustrate the diagnostic challenges and comprehensive treatment approach required in a patient with multiple comorbidities and severe hypokalemia, emphasizing the need for a multidisciplinary and comprehensive approach to address all underlying causes.
文摘Irbesartan-hydrochlorothiazide is a commonly used antihypertensive drug,but potential adverse reactions such as hypokalemia should not be overlooked.This study analyzes a case of hypokalemia induced by irbesartan-hydrochlorothiazide,exploring the drug’s association with hypokalemia and clinical treatment strategies.The patient experienced symptoms of muscle weakness and palpitations after taking irbesartan-hydrochlorothiazide and was diagnosed with hypokalemia through laboratory tests.Reviewing the patient’s medication history and disease progression,it was hypothesized that the drug’s potassium-wasting effect was the direct cause of the hypokalemia.After discontinuing the medication and initiating potassium supplementation,the patient’s potassium levels returned to normal,and symptoms significantly improved,further confirming the link between hypokalemia and the medication.This case suggests that clinicians should consider the risk of hypokalemia when treating hypertension,especially in patients with chronic kidney disease,the elderly,or those at risk for electrolyte disturbances.For patients who have already developed hypokalemia,potassium supplementation and adjustment of the treatment regimen are recommended to prevent further deterioration.Timely discontinuation of potential causative drugs is also advised.In summary,ensuring medication safety and preventing potential complications has significant clinical importance in recognizing and managing hypokalemia induced by irbesartan-hydrochlorothiazide.Future research should focus on optimizing treatment protocols and developing more effective strategies for preventing and managing related adverse reactions to improve patient quality of life.
文摘Objective： Hypokalemia is a frequent complication observed after traumatic brain injury （TBI）.We evaluated the effect of spironolactone on preventing hypokalemia following moderate to severe TBI.Methods： Patients with moderate to severe TBI, whose Glasgow Coma Scale （GCS） scores of 9-12 and ＜9,respectively, were equally randomized into intervention and control groups, matching with severity of trauma and baseline serum level of potassium. For the intervention group, we administrated spironolactone （1 mg/kg per day）on the second day of admission or the first day of gavage tolerance and continued it for seven days. No additional intervention was done for controls. Hypokalemia （mild： 3-3.5 mg/L, moderate： 2.5-3 mg/L, and severe： ＜2.5 mg/L serum K＋） and other electrolyte abnormalities were compared between the two groups at the end of the intervention.Results： Sixty-eight patients （58 males and 10 females）were included with mean age=（33.1±11.8） years, and GCS=7.6±2.8. The two groups were similar in baseline characteristics.Patients who received spironolactone were significantly less likely to experience mild, moderate, or severe hypokalemia （8.8%, 2.9%, and 0） compared with controls （29.4%, 11.7%,and 2.9%, respectively, P＜0.05）. No significant difference was observed between the two groups in the occurrence of other electrolyte abnormalities, hyperglycemia or oliguria.Conclusion： Spironolactone within the first week of head injury could prevent the occurrence of late hypokalemia with no severe side effects.
基金supported by the National Natural Science Foundation of China(No.81360025).
文摘Background:A deep learning model(DLM)that enables non-invasive hypokalemia screening from an electrocardiogram(ECG)may improve the detection of this life-threatening condition.This study aimed to develop and evaluate the performance of a DLM for the detection of hypokalemia from the ECGs of emergency patients.Methods:We used a total of 9908 ECG data from emergency patients who were admitted at the Second Affiliated Hospital of Nanchang University,Jiangxi,China,from September 2017 to October 2020.The DLM was trained using 12 ECG leads(lead Ⅰ,Ⅱ,Ⅲ,aVR,aVL,aVF,and V1–6)to detect patients with serum potassium concentrations<3.5 mmol/L and was validated using retrospective data from the Jiangling branch of the Second Affiliated Hospital of Nanchang University.The blood draw was completed within 10 min before and after the ECG examination,and there was no new or ongoing infusion during this period.Results:We used 6904 ECGs and 1726 ECGs as development and internal validation data sets,respectively.In addition,1278 ECGs from the Jiangling branch of the Second Affiliated Hospital of Nanchang University were used as external validation data sets.Using 12 ECG leads(leads Ⅰ,Ⅱ,Ⅲ,aVR,aVL,aVF,and V1–6),the area under the receiver operating characteristic curve(AUC)of the DLM was 0.80(95%confidence interval[CI]:0.77–0.82)for the internal validation data set.Using an optimal operating point yielded a sensitivity of 71.4%and a specificity of 77.1%.Using the same 12 ECG leads,the external validation data set resulted in an AUC for the DLM of 0.77(95%CI:0.75–0.79).Using an optimal operating point yielded a sensitivity of 70.0%and a specificity of 69.1%.Conclusions:In this study,using 12 ECG leads,a DLM detected hypokalemia in emergency patients with an AUC of 0.77 to 0.80.Artificial intelligence could be used to analyze an ECG to quickly screen for hypokalemia.
文摘临床药师参与2例利妥昔单抗致低钾血症患者的诊治过程,进行不良反应关联性评价;检索中国知网、维普、万方、PubMed、Web of Science等中英文数据库,对利妥昔单抗相关低钾血症的病例报道进行汇总分析。共纳入10例患者(含本文报道的2例患者),男性8例(80%),女性2例(20%),年龄(37.00±19.62)岁,18岁及18岁以上的有8例(80%)。低钾血症多发生在应用利妥昔单抗4 h内(70%),中位时间为用药后195(120,285)min。低钾血症临床表现为四肢无力、乏力、头晕、心悸、喉头紧张、胸闷、肌肉痉挛等。血钾中位值为2.29(1.86,2.72)mmol/L,最低值为1.3 mmol/L。急性低钾血症经停药和补钾等治疗后,低钾症状均好转,血钾恢复的中位时间为15(5,30)h。急性低钾血症为利妥昔单抗罕见的不良反应,起病隐匿。一旦患者出现乏力、肌肉无力等症状,临床应早判断、及时停药,并给予补钾等对症治疗,保障用药安全。
