Potassium Administration Research Articles

LAPORAN KASUS: HIPOKALEMIA PERIODIK PARALISIS

Hypokalemic periodic paralysis is one form of rare periodic paralysis that can result in sudden weakness. Comprehensive examination is required to determine the management in such cases. This case report discusses a 26-year-old woman who presented to the hospital with a sudden complaint of weakness in all limbs and no neurological deficits. The patient had a history of being admitted three times in the past year with the same complaint. Laboratory results revealed significantly low potassium levels. Although rare, periodic paralysis must be promptly distinguished from other causes of weakness and paralysis. Immediate and appropriate actions are crucial. After rapid administration of potassium through a central vein, the limb weakness disappeared. The patient had a history of three admissions with severe hypokalemia. Abdominal ultrasound revealed mild right hydronephrosis. In this case, the patient fully recovered after receiving both oral and intravenous potassium supplementation with strict ECG monitoring in the ICU. The patient returned to the ward after 2 days in the ICU and was subsequently referred to a nephrology specialist for the management of the observed hydronephrosis. This is important to identify the underlying cause of recurrent hypokalemic paralysis

Formulation and In Vitro Evaluation of Niosomal Gel for The Topical Administration of Losartan Potassium

This study aims to develop and test a topical drug delivery system for antihypertensive activity using Losartan potassium-loaded niosomes. The niosomes were created using the traditional ether injection approach, with four formulations made using cholesterol as the lipid and varying quantities of surfactants such as span 80 and span 60. The different formulations underwent testing for FTIR, particle size, zeta potential, drug content, entrapment efficiency, and in vitro release. FTIR analysis revealed that the medication was incompatible with excipients. The study concludes by highlighting current obstacles and future possibilities for the development of niosomes as effective vehicles. Overall, this analysis provides insight into the potential of niosomes in medication delivery and encourages further research in this field.
 Keywords: Losartan potassium, Antihypertensive, Niosomes, Tween 80 and Span 20

Sweet taste receptors play roles in artificial sweetener-induced enhanced urine output in mice

Sweet taste receptors found in oral and extra oral tissues play important roles in the regulation of many physiological functions. Studies have shown that urine volume increases during the lifetime exposure to artificial sweeteners. However, the detailed molecular mechanism and the general effects of different artificial sweeteners exposure on urine volume remain unclear. In this study, we investigated the relationship between urinary excretion and the sweet taste receptor expression in mice after three artificial sweeteners exposure in a higher or lower concentration via animal behavioral studies, western blotting, and real-time quantitative PCR experiment in rodent model. Our results showed that high dose of acesulfame potassium and saccharin can significantly enhance the urine output and there was a positive correlation between K+ and urination volume. The acesulfame potassium administration assay of T1R3 knockout mice showed that artificial sweeteners may affect the urine output directly through the sweet taste signaling pathway. The expression of T1R3 encoding gene can be up-regulated specifically in bladder but not in kidney or other organs we tested. Through our study, the sweet taste receptors, distributing in many tissues as bladder, were indicated to function in the enhanced urine output. Different effects of long-term exposure to the three artificial sweeteners were shown and acesulfame potassium increased urine output even at a very low concentration.

Respiratory arrest following severe muscle weakness as initial presentation of Sjögren’s syndrome: diagnostic and therapeutic strategies: a case report

Background: SjÖgren’s syndrome refers to an autoimmune disorder defined by chronic inflammation as a consequence of the exocrine gland’s lymphocytic infiltration. Patients may present with heterogeneous clinical symptoms involving impairment in the lungs, kidneys, and nervous system. The most common renal involvement is tubulointerstitial nephritis (TIN) responsible for 20% of renal tubular acidosis. We report a case of respiratory failure resulting from severe hypokalemia in a patient with SjÖgren syndrome. Case presentation: A 46-year-old female who experienced progressive quadriplegia leading to respiratory distress caused by severe hypokalemia. Laboratory findings showed: sodium 128 mmol/L, potassium 1.1 mmol/L, Cloride 93 mmol/L, Calcium 7.3 mg/dL (corrected 7.5 mg/dL), albumin 3.3 g/dL, Magnesium 1.8 mg/dL with amylase 244 U/L, lipase 4168 U/L, The ANA test increased slightly and Ro-52, PM-Scl100 showed strong positive results, finally the patient was diagnosed with SjÖgren's syndrome with renal tubular acidosis (RTA). She was later diagnosed with renal tubular acidosis secondary to SjÖgren’s syndrome and treated using methylprednisolone, potassium, and alkali administration. Later, her potassium levels reached normal, muscle weakness improved, and she was extubated. Conclusion: This case emphasizes the concept of an uncommon form of SjÖgren's syndrome in the form of severe refractory hypokalemia due to renal tubular acidosis accompanied by acute pancreatitis disguised in patients without SICCA complaints. Renal tubular acidosis is a rare case, but SjÖgren's syndrome is a cause that must be considered in all patients who present with paralysis due to refractory hypokalemia so that there is no misinterpretation and management.

IFN-γ lowers tumor growth by increasing glycolysis and lactate production in a nitric oxide-dependent manner: implications for cancer immunotherapy.

Interferon-gamma (IFN-γ), the sole member of the type-II interferon family, is well known to protect the host from infectious diseases as well as mount anti-tumor responses. The amounts of IFN-γ in the tumor microenvironment determine the host responses against tumors; however, several tumors employ evasive strategies by responding to low IFN-γ signaling. In this study, the response of various tumor cell lines to IFN-γ was studied in vitro. IFN-γ-activation increases glycolytic flux and reduces mitochondrial function in a nitric oxide (NO)- and reactive oxygen species (ROS)-dependent manner in the H6 hepatoma tumor cell line. The higher glycolysis further fueled NO and ROS production, indicating a reciprocal regulation. These processes are accompanied by Hypoxia inducing factor (HIF)-1α stabilization and HIF-1α-dependent augmentation of the glycolytic flux. The IFN-γ enhancement of lactate production also occurred in other NO-producing cell lines: RAW 264.7 monocyte/macrophage and Renca renal adenocarcinoma. However, two other tumor cell lines, CT26 colon carcinoma and B16F10 melanoma, did not produce NO and lactate upon IFN-γ-activation. HIF-1α stabilization upon IFN-γ-activation led to lower cell growth of B16F10 but not CT26 cells. Importantly, the IFN-γ-activation of both CT26 and B16F10 cells demonstrated significant cellular growth reduction upon metabolic rewiring by exogenous administration of potassium lactate. Clinical studies have shown the crucial roles of IFN-γ for successful cancer immunotherapies involving checkpoint inhibitors and chimeric antigen receptor T cells. The positive implications of this study on the metabolic modulation of IFN-γ activation on heterogeneous tumor cells are discussed.

Case Report: Periodic Hypokalemic Paralysis

Hypokalemic periodic paralysis is characterized by muscle weakness or flaccid paralysis followed by low potassium levels (less than 3.5 mmol/L) during the attack. Proper initial management and patient education are mandatory for health workers to manage this case. This study was a descriptive study with a case report approach. This case report includes patients over 18 years receiving health care at the Negara General Hospital and having accessible medical record data. Data collection was carried out consecutively. A case from a 22-year-old man with complaints of weakness in both legs. The examination found lower extremity motor strength 2/2, normal physiological reflexes without pathological reflexes, and a laboratory potassium level of 2.5 mmol/L laboratory results. The patient was then given hypokalemia treatment with KCl intravenously. The patient, in this case, had no clinical condition contraindicated to give potassium. Within 24 hours after potassium administration, the patient showed a significant improvement. Hence, our therapy, in this case, was in line with the theory with a good clinical outcome. Symptomatic therapy in hypokalemic periodic paralysis provides a good clinical outcome. There were no complications or clinical emergencies during treatment.

Redo mitral surgery after coronary artery bypass grafts under hyperkalemic hypothermia using thoracotomy and axillary artery cannulation in a patient with functioning bilateral internal thoracic arteries and atheromatous aorta

BackgroundRedo mitral valve surgery using resternotomy after coronary artery bypass grafting (CABG) is challenging as previous CABG with patent internal thoracic artery (ITA) poses a risk of injury due to dense adhesion. It is paramount to have alternative method to minimize this risk.Case presentation: We report a case of redo mitral and tricuspid valve repair via right thoracotomy under hypothermia and systemic potassium administration with axillary artery cannulation in a patient after CABG with patent bilateral ITA grafts crossing over the sternum. Herein, critical dissection around the aorta and functioning ITA grafts was avoided by performing the procedure under systemic hypothermia via thoracotomy. Furthermore, considering the presence of atheroma in the aorta, the axillary artery was used as a perfusion route to prevent stroke events. Postoperative course was uneventful and echocardiography demonstrated preserved cardiac function.ConclusionPerforming axillary artery cannulation and right thoracotomy under hypothermic cardiac arrest with systemic hyperkalemia without clamping the patent bilateral ITAs and aorta allowed us to perform redo mitral valve surgery after CABG without major postoperative cardiac or cerebral complications.

Transient P′ waves in a hyperkalemic cat: artifact or dissociation?

A 15-year-old Sphynx cat was referred for cervical ventroflexion, ataxia, and lethargy associated with hypokalemia. After administration of supplemental potassium, the cat became severely hyperkalemic. Transient P′ (vs. pseudo P′ waves) were detected on the electrocardiogram. Over the course of hospitalization, the cat's potassium normalized, and the abnormal P′ waves did not recur. These images are presented to highlight the differential diagnoses for this type of electrocardiogram. Diagnostic considerations included complete or transient atrial dissociation (as a rare consequence of hyperkalemia), atrial parasystole, and various electrocardiographic artifacts. Definitive diagnosis of atrial dissociation requires an electrophysiologic study or echocardiographic documentation of two independent atrial rhythms with associated mechanical activity, but these were unavailable in this case.

Management of hyperkalemia in critically ill renal patients undergoing peritoneal dialysis

Hyperkalemia is defined as a plasma or serum potassium concentration above the established reference range and is frequently encountered in various pathologies. The potassium gradient between the intra- and extracellular compartments plays a key role in action potential generation by excitable cells. Serum potassium concentration in patients diagnosed with chronic kidney disease is usually balanced, but hyperkalemia may develop in patients with acute kidney injury in stage III and IV. According to recent studies, hyperkalemia is a serious complication in patients diagnosed with chronic kidney disease in IRIS stage II, III and IV. The occurrence and severity of hyperkalemia may also be aggravated by the inadequate administration of potassium in enteral or parenteral fluids, metabolic acidosis, and the use of angiotensin-converting enzyme inhibitors. Excess potassium is continuously excreted by the kidneys, and its concentrations in urine are higher than those in serum. Compromised excretion will predictably lead to both hyperkalemia and azotemia. The extent of these changes is variable and depends on the underlying etiology. Hyperkalemia can be treated by antagonizing its effects on cell membranes with calcium gluconate, or by introducing extracellular potassium into cells with sodium bicarbonate or glucose. Also, the removal of potassium from the body can be done through dialysis.

PS-R07-9: A CASE OF ADRENAL VEIN SAMPLING IN PRIMARY ALDOSTERONISM WITH DISCREPANT RESULTS OF ALDOSTERONE-OVERSECRETION-LATERALITY UNDER BASAL CONDITIONS AND COSYNTROPIN STIMULATION

Background: Adrenal venous sampling (AVS) is regarded as the gold standard for diagnosis of primary aldosteronism (PA) subtypes before surgery. Cosyntropin stimulation during AVS improves the success rate of bilaterally selective catheterization and outcome prediction for PA. However, in some cases cosyntropin stimulation may obscure the judgement of laterality of aldosterone oversecretion. Case presentation: A 66-year-old Japanese man was referred to our hospital for evaluation and management of hypertension and hypokalemia. His home blood pressure was 160/80 mmHg and poorly controlled with a calcium channel blocker, and a serum potassium level was 3.3 mEq/L under oral potassium administration. Plasma aldosterone concentration (PAC) was 249 pg/mL. Abdominal computed tomography scan revealed a 7 mm nodule on the left adrenal gland. Both captopril challenge test and saline infusion test revealed positive test results, which confirmed a diagnosis of PA. The AVS was performed both under basal conditions and during cosyntropin stimulation, which revealed discrepant results of laterality (Table 1). Since the absolute value of aldosterone secretion was significantly higher on the right adrenal gland, suggesting autonomous secretion from the right, AVS was performed again. The second procedure showed unilaterality in the right under basal AVS and bilaterality during cosyntropin stimulation (Table 2). Similarly, aldosterone levels were clearly higher on the right side, leading to the diagnosis of microadenoma of the right adrenal gland, and a laparoscopic right adrenalectomy was performed. Histopathology of the removed right adrenal gland revealed a diagnosis of a 2 mm adenoma. After adrenalectomy, his blood pressure control and hypokalemia improved. Conclusions: Cosyntropin stimulation during AVS is believed to increase the local diagnostic value of aldosterone oversecretion, but in rare cases, as in this case, basal and cosyntropin-stimulated AVS results yielded contrary findings. Cosyntropin-stimulated AVS should be interpreted with caution.

GROWTH OF RUBBER PLANT (Hevea Brasiliensis Muell. Arg) ON THE USE OF MATERIALS THAT CAN IMPROVE SOIL FERTILITY

This research was carried out at the PTPN III Sarang Giting plantation, Afdeling II, which is located in Sarang Giting Village, Dolok Masihul District, Serdang Bedagai Regency, North Sumatra Province. Venue Altitude 30m above sea level (asl) and flat land topography. The purpose of this study was to determine the effect of stem circumference and production of rubber plants (Hevea brasiliensis Muell. Arg) on ​​potassium (KCl) combined with agricultural lime (CaCO3) and magnesium (MgSO4) and their effect on the dynamics of soil K levels. This study used a factorial randomized block design (RBD) with 3 (three) factors studied, namely the agricultural lime application factor (C), which consisted of C0 = control and C1 = 1500g/tree/year. The second treatment factor was giving magnesium (M) which consisted of M0 = control, M1 = 1500g/tree/year, M2 = 3000g/tree/year, and M3 = 4500g/tree/year. The third treatment factor was the provision of potassium (K) consisting of K0 = control, K1 = 500g/tree/year, K2 = 1000g/tree/year, and K3 = 1500g/tree/year. The results showed that the administration of potassium combined with the application of agricultural lime and magnesium had a significant effect on the growth parameters of stem circumference. Potassium application combined with agricultural lime and kiserite also had a significant effect on the dynamics of K levels in the soil. However, it did not significantly affect the production of liquid latex

Diagnosis, management and outcomes of primary hypokalemic periodic paralysis during pregnancy

Primary hypokalaemic periodic paralysis during pregnancy has been rarely reported. Four pregnant women with the acute onset of flaccid paralysis presented between January 2018 and December 2021. Focussed history and physical examination helped an appropriate radiological and laboratory investigation plan to be made. All women recovered within 4–7 days of potassium supplementation. Supplemental potassium continued until delivery. A pain management plan with continuous epidural infusion helped in avoiding stress-induced hypokalaemia. None of the women developed an episode of muscle weakness during the intervening period. In conclusion, a focussed history and targeted laboratory investigation are needed to diagnose primary hypokalaemic periodic paralysis. Early administration of oral or intravenous potassium is crucial in improving fetomaternal outcomes.

Association of Intravenous Potassium and Magnesium Administration With Spontaneous Conversion of Atrial Fibrillation and Atrial Flutter in the Emergency Department

Whether the simultaneous intravenous administration of potassium and magnesium is associated with the probability of spontaneous conversion to sinus rhythm (SCV) in the acute treatment of atrial fibrillation (AF) and atrial flutter (AFL) is unknown. To assess potassium and magnesium administration and SCV probability in AF and AFL in the emergency department. A registry-based cohort study was conducted in the Department of Emergency Medicine of the Medical University of Vienna, Austria. All consecutive patients with AF or AFL were screened between February 6, 2009, and February 16, 2020. Intravenous administration of potassium, 24 mEq, and magnesium, 145.8 mg. The primary outcome was the probability of SCV during the patient's stay in the emergency department. Multivariable cluster-adjusted logistic regression was used to estimate the association between potassium and magnesium administration and the probability of SCV. A total of 2546 episodes of nonpermanent AF (median patient age, 68 [IQR, 58-75] years, 1411 [55.4%] men) and 573 episodes of nonpermanent AFL (median patient age, 68 [IQR, 58-75] years; 332 [57.9%] men) were observed. In AF episodes, intravenous potassium and magnesium administration vs no administration was associated with increased odds of SCV (19.2% vs 10.4%; odds ratio [OR], 1.98; 95% CI, 1.53-2.57). In AFL episodes, in contrast, no association was noted for the probability of SCV with potassium and magnesium vs no administration (13.0% vs 12.5%; OR, 1.05; 95% CI, 0.65-1.69). The findings of this registry-based cohort study on intravenous administration of potassium and magnesium suggest an increased probability of SCV in nonpermanent AF, but not AFL, during a patients' stay in the emergency department.

The Effects of Magnesium Coadminstration During Treatment of Hypokalemia in the Emergency Department

BackgroundHypokalemia is a common disorder that can negatively affect organ function. Magnesium supplementation is frequently recommended despite limited evidence to support its use. ObjectivesThe purpose of this study was to evaluate the clinical effects of magnesium coadministration in patients treated for hypokalemia in the emergency department (ED). MethodsThis retrospective, single-center study evaluated adults treated with intravenous (i.v.) potassium for hypokalemia (serum potassium <3.5 mMol/L) in the ED between July 1, 2016 and June 30, 2020. Patients given magnesium supplementation within 4 h of potassium administration (MG+) were compared with those not given concurrent magnesium (MG−). The primary outcome was time to potassium normalization (≥ 3.5 mMol/L). Secondary outcomes included clinical effects, adverse effects, and dosing of magnesium and potassium. ResultsTwo hundred patients were included (MG+ = 100; MG− = 100). Patients in the MG− group more frequently had history of myocardial infarction (16% vs. 6%; p = 0.02) and alcoholism (16% vs. 6%; p = 0.02). Patients in the MG+ group had higher incidence of symptomatic hypokalemia (34% vs. 19%; p = 0.02) and severe hypokalemia (serum potassium < 2.5 mMol/L) (15% vs. 8%; p = 0.03). There were no differences in time to serum potassium normalization, change in serum potassium after treatment, or incidence of potassium normalization within 24 h of treatment. MG+ patients required more potassium within 24 h of treatment and more frequently developed hypermagnesemia (serum magnesium >1.1 mMol/L). ConclusionsMagnesium coadministration during hypokalemia treatment did not affect time to serum potassium normalization but was associated with more hypermagnesemia.

Effects of Potassium Diformate (KDF) on Growth Performance and Some Physiological Parameters of Cultured Rainbow Trout (Oncorhynchus mykiss) in Commercial–Scaled Net Cages

This study was conducted to evaluate the feed utilization and protein effect ratios of combined and single diet administration of potassium di formate (KDF) in juvenile rainbow trout (Oncorhynchus mykiss). 600.000 trout fry were stocked as 50.000 in each cage and were fed 3 meals a day in the range of 25-80 grams and two meals a day up to 80-250 grams (until harvest time) and fed with commercial feeds until satiation. 3 kg/ton (T1), 5kg/ton (T2) and 7 kg/ton (T3) KDF were added to the diets and given to fish for 11 months. In the study, when the specific growth rates (SGR) of fish were compared, the results obtained in the T1, T2 and T3 groups were generally higher than in the control group. While no significant difference was found between T1 and T2 groups (p&gt;0.05), there is a significant difference between T3, the other experimental groups and the control (p&lt;0.05). In the study, a significant difference was found between the feed conversion rate (FCR of all groups, (p&lt;0.05)). When the protein efficiency ratio (PER) was compared to the control group and the other groups, a significant difference was detected, while the same situation was found among the KDF supplemented groups (p&lt;0.05). While the survival rate (SR) was significantly different between the control and experimental groups (p&lt;0.05), there was no statistical difference between the experimental groups (p&gt;0.05). The results of the study showed that the application of 7 kg/ton KDF can be considered a useful feed additive and a growth promoter for rainbow trout juveniles.

Measurement of α-Synuclein Dynamics In Vivo Using Microdialysis with a Novel Homogeneous Immunoassay.

Understanding the regulation of α-synuclein release could be important in better understanding Parkinson's disease development, progression, and treatment. Advances in such studies are hindered by technical challenges that limit the ability to monitor α-synuclein concentration in vivo. We developed a novel α-synuclein microdialysis method coupled with a specific and sensitive immunoassay that requires a small sample volume (1 μL). Using this method, basal α-synuclein level was estimated at 254 ± 78 pM in the striatum of freely moving mice. Additionally, we observed that potassium (75 mM) and nicotine (0.5 mg/kg) administration significantly increased α-synuclein in dialysates. These results provide evidence that the methods we report here can be useful to investigate the physiological roles of α-synuclein and support the idea that α-synuclein is secreted to the extracellular space in a neuronal activity-dependent manner.

Applicability of Ambulatory Cleft Lip Repair in North-western Nigeria

Objective: To report the applicability of ambulatory cleft lip repair (CLR) and to review the existing literature. Materials and Methods: This is a retrospective clinical case series study of ambulatory CLR in North-western Nigeria. The study was carried out in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, between January 2012 and December 2018. Relevant clinical data of the subjects obtained include sociodemographics, type of cleft, and complications. Protocol employed includes premedication with diazepam (0.5 mg/kg, IV) slowly, followed by administration of glycopyrrolate (0.005 mg/kg, IV) and diclofenac potassium (1 mg/kg, IV). Then, ketamine (0.1 mg/kg, IV) was infused slowly over a 5-min period to achieve procedural sedation (Ramsey sedation score of 3). The data were analyzed using (SPSS; Chicago, IL, USA) program, version 20. The results were presented in simple descriptive statistics. Results: The age ranged from 2 to 21 years with male preponderance (M: F = 4:1). All participants had unilateral clefts lip with or without alveolus. The left side was twice involved as the right. There were no perioperative complications nor mortality recorded and no patient required conversion to general anesthesia. All patients were successfully discharged home on the same day of the operation. No case of readmission was recorded and subsequent follow-up was uneventful. Conclusions: Parenteral use of ketamine and diazepam for outpatient pediatric cleft lip procedures is safe and of immense benefits in reducing the surgical cleft burden without compromising patients safety.

Changes in the degree of ventricular hypertrophy following administration of Losartan potassium compared to L-NAME (L – Arginine Methyl Ester)

Changes in the degree of ventricular hypertrophy following administration of Losartan potassium compared to L-NAME (L – Arginine Methyl Ester)

Serum potassium changes during hypothermia and rewarming: a case series and hypothesis on the mechanism.

Hypokalemia is known to occur in association with therapeutically induced hypothermia and is usually managed by the administration of potassium (K+). We reviewed data from 74 patients who underwent a therapeutic hypothermia protocol at our medical institution. In four patients in whom data on serum K+ and temperature were available, a strong positive correlation between serum K+ and body temperature was found. Based on the close positive relationship between serum K+ and total body temperature, we hypothesize that serum K+ decreases during hypothermia owing to decreased activity of temperature-dependent K+ exit channels that under normal conditions are sufficiently active to match cellular K+ intake via sodium/K+/adenosine triphosphatase. Upon rewarming, reactivation of these channels results in a rapid increase in serum K+ as a result of K+ exit down its concentration gradient. Administration of K+ during hypothermia should be done cautiously and avoided during rewarming to avoid potentially life-threatening hyperkalemia. K+ exit via temperature-dependent K+ channels provides a logical explanation for the rebound hyperkalemia. K+ exit channels may play a bigger role than previously appreciated in the regulation of serum K+ during normal and pathophysiological conditions.

Effect of electrolyte addition in fluids to reduce mortality in neonates.

Objective: To Monitor the effect of electrolyte addition in fluids to reduce mortality in neonates and reduce the days of hospital stay. Study Design: Case Control study. Setting: Aziz Bhatti Shaheed Hospital, Gujrat. Period: January 2017 to December 2018. Material &amp; Methods: Babies inborn during the study period of gestational age between 32 to 36 weeks and birth weight range from 1.5 to 2 kg were included in the study. To compare the effect of potassium in both groups, SPSS analysis was carried out. Results: The study resulted in decreased mortality rate with a p value of 0.006. The overall hospitalization time was also reduced presented with early discharge from the hospital setting. Conclusion: The study concluded that early administration of potassium through intravenous fluids demonstrated a rapid recovery and decreased hospitalization of the infants.