Presentation
Organized for ease of use and quick reference, each chapter presents a neurological disorder or key symptoms and systematically discusses the clinical syndrome and differential diagnosis, natural course, principles of therapy, and practical management [books.google.de]
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]
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]
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]
Entire Body System
- Chills
• c/o Fever with chills … 7 days. Generalised body pain … 7 days. 4 5. COURSE OF REACTION 11/10/2016 Patient started getting fever with chills. . Fever went on becoming high grade. 12/10/2016 Patient seek treatment from private practitioner. 5 6. [slideshare.net]
Patients also report that attacks can be triggered by becoming chilled or overheated, or by strong emotion. Attacks usually begin between one and 20 years of age. [hkpp.org]
Patients should avoid over-exertion and becoming chilled, and should take supplemental potassium. [wjgnet.com]
- Anemia
P74 ) Endocrine, nutritional and metabolic diseases E70-E88 2019 ICD-10-CM Range E70-E88 Metabolic disorders Type 1 Excludes androgen insensitivity syndrome ( E34.5- ) congenital adrenal hyperplasia ( E25.0 ) Ehlers-Danlos syndrome ( Q79.6 ) hemolytic anemias [icd10data.com]
[…] as a monotherapy. [5] Other adverse effects include hypersensitivity reactions, hepatotoxicity, neurotoxicity, delirium, bleeding manifestations, electrolyte and acid-base disorders, neutropenia and thrombocytopenia, paresthesia, and rarely hemolytic anemia [ijp-online.com]
- Malnutrition
In a recent cohort, 30 (68.2%) of 44 patients taking capreomycin developed hypokalaemia (defined as serum potassium 5 ] Capreomycin-induced hypokalaemia seems to be more common in patients with low initial body weight or malnutrition. [link.springer.com]
Patients at risk include those with malnutrition, sepsis, alcohol abuse, underlying liver disease, and/or renal insufficiency 96. [f1000research.com]
Gastrointestinal
- Vomiting
= diarrhoea >40mEq/L = Diureics Alkalosis = vomit, barter, gitlman, mineralocort excess 1. starvation, clay ingestion 2. [slideshare.net]
Vomiting (vomiting more than 4-5 times in a 24 hour period). Muscle weakness, or a poor appetite that does not improve. Shortness of breath, chest pain or discomfort, should be evaluated immediately. Feeling your heart beat rapidly (palpitations). [chemocare.com]
Metabolic alkalosis: Sharing common causes with hypokalemia like vomiting and diuretics, metabolic alkalosis (an increase in the pH of tissues) induces potassium loss from the body. [curejoy.com]
Vomiting leads to hypokalemia via a complex pathogenesis. Gastric fluid itself contains little potassium, approximately 10 mEq/L. [emedicine.medscape.com]
[…] especially potassium-wasting diuretics, steroids, and certain sodium-containing antibiotics (carbenicillin) (see Drugs causing hypokalemia) Chronic renal disease, with tubular potassium wasting Cushing's syndrome Excessive GI or urinary losses, such as vomiting [quizlet.com]
- Nausea
There were no associated symptoms such as nausea, vomiting, fever or abdominal pain. Patient denied history of sick contacts, travel and use of laxatives. [academic.oup.com]
Nausea that interferes with your ability to eat, and is unrelieved by any prescribed medications. Vomiting (vomiting more than 4-5 times in a 24 hour period). Muscle weakness, or a poor appetite that does not improve. [chemocare.com]
Hypercalcemia itself can contribute to other complications such as nausea, constipation, polyuria, polydipsia, nephrolithiasis and renal insufficiency. [karger.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]
• Nausea, Vomiting. • Muscle weakness, stomach cramps. • Retinopathy, accommodation problem, Headache. • Methemoglobinemia. • Haemolysis in G6PD deficiency. 19 20. [slideshare.net]
Cardiovascular
- Tachycardia
Association of serum potassium level with ventricular tachycardia after acute myocardial infarction. ARYA Atheroscler. 2012; 8 (2): 79-81[ PubMed ] 14. Cohn JN, Kowey PR, Whelton PK, Prisant LM. [traumamon.com]
Muscle weakness, cramps Paresthesia Abdominal cramps Anorexia Nausea, vomiting Constipation Polyuria, nocturia Excessive thirst Fatigue Palpitations Assessment-Physical Findings Hyporeflexia (See Clinical effects of hypokalemia) Weak, irregular pulse Tachycardia [quizlet.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]
Even moderate hypokalemia may inhibit the sodium-potassium pump in myocardial cells, promoting spontaneous early afterdepolarizations that lead to ventricular tachycardia/fibrillation. [8] Increased susceptibility to cardiac arrhythmias is observed with [emedicine.medscape.com]
Urogenital
- Polyuria
A vasopressin-resistant polyuria and urinary acidification and concentration defects are the principal renal manifestations. [jamanetwork.com]
During the first 24 hours of hospital stay, polyuria (urine output > 6 L/d) with minimal colostomy loss was noted. [jpgmonline.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]
Neurologic
- 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]
The seizures were attributed to severe hypocalcemia and/or hyponatremia. [jpgmonline.com]
Mefloquine – seizure potential Thioridazine – chloroquine increases its level. Aluminum Hydroxide, Ampicilin, Aspirin – increases GI binding Dapsone – methamoglobinaemia Influenza vaccine – pharmacodynamic antagonism. [slideshare.net]
For example, if a patient with problematic seizures is effectively controlled by topiramate, a mild degree of metabolic acidosis can be more tolerable than seizures. [f1000research.com]
Assessment and management should consider the following: hyponatraemia is often found in healthy and/or asymptomatic people most hyponatraemic patients have no symptoms or signs of hyponatraemia although neurological symptoms like restlessness, confusion, seizures [nps.org.au]
- 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]
- Tremor
Severe hypokalemia, with serum potassium concentrations of 2.5–3 meq/l (Nl: 3.5–5.0 meq/l), may cause muscle weakness, myalgia, tremor, and muscle cramps (owing to disturbed function of skeletal muscle ), and constipation (from disturbed function of smooth [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]
Cardiac evaluations using serial ECGs with measurements of the QTc interval are essential and should be performed on all patients undergoing workup for periodic paralysis. 23, 24, 25 References 1. [hkpp.org]
[…] 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]
Other ECG Findings
- Electrocardiogram Change
Diagnostic Test Results-Diagnostic Procedures Characteristic electrocardiogram changes may be seen, including flattened T wave and depressed ST segment and U wave. [quizlet.com]
Treatment
This comprehensive text reference seeks to assist physicians with treatment by providing an easy-to-use compendium covering the treatment and management of all neurological diseases along with details on the natural course of these diseases. [books.google.de]
Treatment of acute hyperkalaemia in adults. March 1, 2014. http://www.renal.org/guidelines/joint-guidelines/treatment-of-acute-hyperkalaemia-in-adults#sthash.o9MgdJbw.dpbs. Accessed September 1, 2014. 31. Smellie WS. Spurious hyperkalaemia. [aafp.org]
Treatment of hyperkalemia also includes treatment of any underlying causes (for example, kidney disease, adrenal disease, tissue destruction) of hyperkalemia. [medicinenet.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
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]
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]
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]