Edit concept Question Editor Create issue ticket

Drug-induced Hypokalemia

Decrease of Potassium in the Blood in Combination Formoterol with Desipramine Hypokalemia


Presentation

  • We describe a case of ATIN and Fanconi syndrome presenting as hypokalemic paralysis in a patient receiving rifampin. Case presentation A 42-year-old man was hospitalized with sudden-onset weakness in both lower extremities.[bmcnephrol.biomedcentral.com]
  • At presentation, he had ingested 8 mg of licorice daily for the previous 17 days. The patient presented with severe hypokalemia (1.8 mEq/L) and rhabdomyolysis. His renin activity was 0.44 ng/mL/h, and his aldosterone level was 6.0 pg/mL.[ekjm.org]
  • Patient 3 A 45-year-old woman, with a remote history of intravenous drug use, presented after 7 days of lethargy and anorexia.[mja.com.au]
  • Case Presentation A 69-year-old African-American man presented with a 1-month history of progressive generalized weakness, fatigue and anorexia. The patient denied a history of constipation, polyuria or polydipsia, nausea or vomiting.[karger.com]
Physician
  • These individual volumes are grouped by specialty to benefit the practicing physician or health care clinician. Each year, heart disease kills more people than cancer.[books.google.de]
  • Miller, with contributions from experts distinguished in their respective specialties, Drug-Induced Diseases is organized logically and is easy to use for pharmacists, physicians, nurses, and pharmacy students alike.[books.google.de]
  • J Coll Physicians Surg Pak 2010;20:419-20. [ PUBMED ] 2. Edwards IR, Aronson JK. Adverse drug reactions: Definitions, diagnosis and management. Lancet 2000;356:1255-9. [ PUBMED ] [ FULLTEXT ] 3. Kumar A, Choudhari G, Aggarwal R.[ijp-online.com]
  • VIERA, MD, MPH, and NOAH WOUK, MD, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina Am Fam Physician. 2015 Sep 15;92(6):487-495.[aafp.org]
  • Physician monograph. NIH Publication No. 97-3794 (September) 1997.[drugs.com]
Surgical Procedure
  • Typically, this is a consequence of diarrhea , excessive perspiration , or losses associated with muscle-crush injury, or surgical procedures. Vomiting can also cause hypokalemia, although not much potassium is lost from the vomitus.[en.wikipedia.org]
Steatorrhea
  • Seite 157 - Poley, JR: Role of bile acid malabsorption in pathogenesis of diarrhea and steatorrhea in patients with ileal resection. I. Response to cholestyramine or replacement of dietary long chain triglyceride by medium chain triglyceride. ‎[books.google.de]
Heart Disease
  • Each year, heart disease kills more people than cancer. Patients are treated by a variety of specialists and primary care practitioners, depending on the organ system involved.[books.google.de]
  • disease or cirrhosis. 7 , 15 Most cases of hypokalemia-induced rhythm disturbances occur in individuals with underlying heart disease. 10 Early identification of transcellular shifts is important because management may differ.[aafp.org]
  • Cholesterol lowering in the patient with coronary heart disease. Physician monograph. NIH Publication No. 97-3794 (September) 1997.[drugs.com]
  • disease, medullary cystic kidney disease, Alport syndrome, corticoresistant nephrotic syndrome, renal transplantation, amyloidosis, recurrent nephrolithiasis) Causes of distal RTA Primary Secondary Autoimmune diseases (eg, systemic lupus erythematosus[mja.com.au]
Muscle Spasticity
  • Seite 441 - Dantrolene: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in malignant hyperthermia, the neuroleptic malignant syndrome and an update of its use in muscle spasticity. ‎[books.google.de]
Suggestibility
  • The results of these studies may have important physiological and pathophysiological implications inasmuch as the results obtained could suggest a mechanistic link between cardiac diseases (substrate), hypokalemia (trigger), and TdP tachyarrhythmias.[circ.ahajournals.org]
  • Although the mechanisms responsible for the development of hypokalemia have not been fully delineated, current evidence suggests that it results from renal potassium wasting or intracellular movement of potassium.[annals.org]
  • These findings suggest that hypersensitive immune-mediated injury to the tubular membrane was the pathogenic mechanism of Fanconi syndrome, and anti-tubular basement membrane antibodies have been suggested to induce ATIN in such cases [ 10 – 14 ].[bmcnephrol.biomedcentral.com]
  • Urine potassium level below 20 mEq/L suggests poor intake, intracellular shifting, or GI loss. Serum magnesium levels may be decreased (severe hypokalemia).[quizlet.com]
  • Suggested algorithm for the evaluation of hypokalemia. Information from references 7 and 14 . Evaluation of Hypokalemia Figure 1. Suggested algorithm for the evaluation of hypokalemia. Information from references 7 and 14 .[aafp.org]
Withdrawn
  • Since the first edition of this book was published in 2005, numerous drugs have been withdrawn from the market in the United States as a result of morbidity and/or mortality associated with drug-induced diseases.[books.google.de]
  • Blood is withdrawn from a vein (like other blood tests). The potassium concentration of the blood is determined in the laboratory.[medicinenet.com]
Paresthesia
  • Cardiac arrhythmia Cardiac arrest Ileus Rhabdomyolysis Possibly asymptomatic if hypokalemia is mild Muscle weakness, cramps Paresthesia Abdominal cramps Anorexia Nausea, vomiting Constipation Polyuria, nocturia Excessive thirst Fatigue Palpitations Assessment-Physical[quizlet.com]
  • […] combination with an aminoglycoside than as a monotherapy. [5] Other adverse effects include hypersensitivity reactions, hepatotoxicity, neurotoxicity, delirium, bleeding manifestations, electrolyte and acid-base disorders, neutropenia and thrombocytopenia, paresthesia[ijp-online.com]
  • HISTORY AND PHYSICAL EXAMINATION Severe hyperkalemia (more than 6.5 mEq per L [6.5 mmol per L]) can cause muscle weakness, ascending paralysis, heart palpitations, and paresthesias.[aafp.org]
Confusion
  • Not familiar with these t waves see here pt is hypokalemia alle Registered Nurse Yup, I'm confused by the Himalayan t wave comment too MSar Registered Nurse This is a more pronounced version of it; kynu Registered Nurse Thanks for link that makes more[app.figure1.com]
  • The principal clinical manifestations of potassium depletion are profound skeletal muscle weakness with loss of deep tendon reflexes, smooth muscle weakness resulting in paralytic ileus, mental confusion, and, in the presence of marked metabolic alkalosis[jamanetwork.com]
  • Symptoms include: Constipation Muscle twitches Cramps during exercise Extreme muscle weakness Slow or shallow breathing Excessive urination (polyuria) Excessive thirst (polydipsia) Loss of appetite Distended belly Confusion Decreased mental activity Overall[curejoy.com]
Seizure
  • Infant seizures not so infantile: first-time seizures in children under six months of age presenting to the ED. Am J Emerg Med. 2002; 20 (6): 518-20[ PubMed ] 2. Davitt AM, Pollack Jr. CV.[traumamon.com]
  • Mefloquine – seizure potential Thioridazine – chloroquine increases its level. Aluminum Hydroxide, Ampicilin, Aspirin – increases GI binding Dapsone – methamoglobinaemia Influenza vaccine – pharmacodynamic antagonism.[slideshare.net]
Convulsions
  • Seite 13 - Arieff AI: Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. ‎[books.google.de]
Polyuria
  • A vasopressin-resistant polyuria and urinary acidification and concentration defects are the principal renal manifestations.[jamanetwork.com]
  • The administration of both has been shown to cause a metabolic alkalosis and hypokalemia with polyuria.[karger.com]
  • Potassium may be lost via urine because of: Diuretic drugs like loop diuretics and thiazide diuretics Polyuria (kidney disorder causing excessive urination) A deficiency of magnesium in the blood (a common side effect of alcohol withdrawal) Excessive[curejoy.com]
  • Cardiac arrhythmia Cardiac arrest Ileus Rhabdomyolysis Possibly asymptomatic if hypokalemia is mild Muscle weakness, cramps Paresthesia Abdominal cramps Anorexia Nausea, vomiting Constipation Polyuria, nocturia Excessive thirst Fatigue Palpitations Assessment-Physical[quizlet.com]
  • In addition to urinary losses from polyuria and volume contraction, also an obligate loss of potassium from kidney tubules occurs as a cationic partner to the negatively charged ketone , β-hydroxybutyrate .[en.wikipedia.org]
Polyuria
  • A vasopressin-resistant polyuria and urinary acidification and concentration defects are the principal renal manifestations.[jamanetwork.com]
  • The administration of both has been shown to cause a metabolic alkalosis and hypokalemia with polyuria.[karger.com]
  • Potassium may be lost via urine because of: Diuretic drugs like loop diuretics and thiazide diuretics Polyuria (kidney disorder causing excessive urination) A deficiency of magnesium in the blood (a common side effect of alcohol withdrawal) Excessive[curejoy.com]
  • Cardiac arrhythmia Cardiac arrest Ileus Rhabdomyolysis Possibly asymptomatic if hypokalemia is mild Muscle weakness, cramps Paresthesia Abdominal cramps Anorexia Nausea, vomiting Constipation Polyuria, nocturia Excessive thirst Fatigue Palpitations Assessment-Physical[quizlet.com]
  • In addition to urinary losses from polyuria and volume contraction, also an obligate loss of potassium from kidney tubules occurs as a cationic partner to the negatively charged ketone , β-hydroxybutyrate .[en.wikipedia.org]

Workup

  • The workup to elucidate the etiology of his hypercalcemia revealed his intact PTH level to be appropriately suppressed to 0.95 pmol/l (normal range: 1.06-6.9 pmol/l) and his PTH-related peptide level to be 27 ng/l (normal range: 14-27 ng/l). 25-hydroxy[karger.com]
  • […] more practical approach is calculation of the urine potassium-to-creatinine ratio from a spot urine specimen; a ratio greater than 1.5 mEq per mmol (13 mEq per g) is indicative of renal potassium wasting. 18 If no cause is identified with the initial workup[aafp.org]
Prolonged QT Interval
  • SIDE EFFECTS • Prolonged QT interval. • Diarrhoea. • Loss of appetite. • Nausea, Vomiting. • Muscle weakness, stomach cramps. • Retinopathy, accommodation problem, Headache. • Methemoglobinemia. • Haemolysis in G6PD deficiency. 19 20.[slideshare.net]
  • Due to prolonged repolarization of ventricular Purkinje fibers , prominent U wave occurs (usually seen at V2 and V3 leads), frequently superimposed upon the T wave and therefore produces the appearance of a prolonged QT interval when serum potassium reduces[en.wikipedia.org]
Torsades De Pointes
  • ., torsades de pointes; TdP) induced by QT-prolonging drugs. Thus understanding the hypokalemia-induce cardiac arrhythmia is of great importance both clinically and in new drug screening.[circ.ahajournals.org]
  • Diuretic-induced hypokalaemia inducing torsades de pointes. Can J Anaesth. 1995; 42 (12): 1137-9[ DOI ][ PubMed ][traumamon.com]
  • Arrhythmias associated with hypokalemia include sinus bradycardia, ventricular tachycardia or fibrillation, and torsade de pointes. 19 Although the risk of ECG changes and arrhythmias increases as serum potassium concentration decreases, these findings[aafp.org]

Treatment

  • Thoroughly covers hot topics in this fast-changing field, including ongoing clinical research and changing treatment protocols.[books.google.de]
  • […] and enable practitioners to prescribe preventative treatments with medications such as blood pressure reducers, aspirin, and cholesterol-lowering drugs, as well as drugs used for more aggressive therapy.[books.google.de]
  • Therefore, although ECG changes should trigger urgent treatment, treatment decisions should not be based solely on the presence or absence of ECG changes. 32 Peaked T waves are the prototypical, and generally the earliest, ECG sign of hyperkalemia.[aafp.org]
  • Treatment of hyperkalemia also includes treatment of any underlying causes (for example, kidney disease , adrenal disease, tissue destruction) of hyperkalemia.[medicinenet.com]
  • Hypertension Initial treatment —In the sixth report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), a varied selection of antihypertensive agents is recommended for the initial treatment of[drugs.com]

Etiology

  • The workup to elucidate the etiology of his hypercalcemia revealed his intact PTH level to be appropriately suppressed to 0.95 pmol/l (normal range: 1.06-6.9 pmol/l) and his PTH-related peptide level to be 27 ng/l (normal range: 14-27 ng/l). 25-hydroxy[karger.com]
  • […] as with ongoing diuretic therapy or hyperaldosteronism, 20 mmol per day is usually sufficient. 15 Causes of Hyperkalemia Hyperkalemia is caused by excess potassium intake, impaired potassium excretion, or transcellular shifts ( Table 2 ) . 8 , 24 The etiology[aafp.org]

Pathophysiology

  • Profound potassium depletion may also cause muscle vacuolation and rhabdomyolysis, and renal tubular vacuolation.1 The pathophysiologic events[jamanetwork.com]
  • Well organized and highly readable, it covers every relevant topic in the field, from anatomy, physiology, and pathophysiology, to diagnosis and management of kidney disease, to fluid and electrolyte disorders, hypertension, dialysis, and renal transplantation[books.google.de]
  • The results of these studies may have important physiological and pathophysiological implications inasmuch as the results obtained could suggest a mechanistic link between cardiac diseases (substrate), hypokalemia (trigger), and TdP tachyarrhythmias.[circ.ahajournals.org]
  • The pathophysiology of common causes of syncope. Postgrad Med J. 2000; 76 (902): 750-3 5. Yealy DM, Delbridge TR. Rosen's Emergency Medicine: Concepts and Clinical Practice. 2010; 6. Dubin D.[traumamon.com]
  • Riccardi D, Brown EM: Physiology and pathophysiology of the calcium-sensing receptor in the kidney. Am J Physiol Renal Physiol 2010;298:F485-F499.[karger.com]

Prevention

  • Now in its second edition, this popular and essential comprehensive resource provides a detailed analysis of how to identify, prevent, and manage drug-induced diseases. Edited by James E. Tisdale and Douglas A.[books.google.de]
  • […] adverse effects of the complete range of drugs used in cardiovascular medicine, including antihypertensive drugs, and drugs used in the treatment of heart failure, angina, angina pectoris, and cardiac arrhythmia and enable practitioners to prescribe preventative[books.google.de]
  • Prevention and Treatment of Diuretic Induced Hypokalemia The first approach to preventing diuretic-induced hypokalemia is to use the lowest dose possible (Table 1).[barnardhealth.us]
  • In normal individuals, healthy kidneys can adapt to excessive oral intake of potassium by increasing urine excretion of potassium, thus preventing the development of hyperkalemia.[medicinenet.com]
  • To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes.[aafp.org]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!