Correction Of Electrolyte Imbalance Research Articles

Potassium dynamics in sickle cell anemia: clinical implications and pathophysiological insights

Potassium dynamics are critical in the pathophysiology of sickle cell anemia (SCA), a genetic disorder characterized by the presence of abnormally shaped red blood cells that lead to various complications such as vaso-occlusive crises and hemolytic anemia. This review focuses on the clinical implications and pathophysiological insights of potassium regulation in SCA, highlighting its impact on disease progression and potential therapeutic strategies. The dysregulation of potassium transport in SCA leads to significant K+ efflux and cellular dehydration, exacerbating the sickling process. Dehydrated sickle cells, due to potassium loss, become more rigid and prone to causing blockages in small blood vessels, leading to painful vaso-occlusive crises and ischemia. Furthermore, chronic hemolysis in SCA, aggravated by potassium imbalance, contributes to severe anemia and systemic complications. These insights underscore the importance of maintaining potassium homeostasis to mitigate disease severity and improve patient outcomes. Therapeutic strategies targeting potassium regulation show promise in managing SCA. Inhibitors of the Gardos channel, such as senicapoc, have demonstrated potential in reducing sickling and hemolysis. Additionally, hydration therapy plays a crucial role in maintaining electrolyte balance and preventing RBC dehydration. A comprehensive approach that includes monitoring and correcting electrolyte imbalances, along with standard treatments like hydroxyurea and blood transfusions, is essential for effective disease management.

Prevalence of Hyperkalemia and Familial Hyperkalemic Hypertension in 5100 Patients Referred to a Tertiary Hypertension Unit.

Hyperkalemia is a frequent electrolyte alteration whose prevalence varies widely, depending on the adopted cutoff, the setting (inpatients versus outpatients), and the characteristics of the study population. Familial hyperkalemic hypertension (FHH) is a rare cause of hypertension, hyperkalemia, and hyperchloremic metabolic acidosis. In this retrospective observational study, we investigated the prevalence of hyperkalemia (serum K+ >5.2 mmol/L on 2 repeated measurements) in 5100 referred patients affected by arterial hypertension, the potential causes, and the associated cardiovascular risk profile. Overall, 374 (7.3%) patients had hyperkalemia. This was associated with drugs known to increase K+ levels (74.6%), chronic kidney disease (33.7%), or both (24.3%). Among the 60 patients with unexplained hyperkalemia, 3 displayed a clinical and biochemical phenotype suggestive of FHH that was genetically confirmed in 2 of them (0.04% in the entire cohort). FHH prevalence rose to 3.3% in patients with unexplained hyperkalemia and up to 29% (2/7) if they had serum K+>5.8 mmol/L. The genetic cause of FHH was a missense variant affecting the acidic motif of WNK1 in 1 family and a rare CUL3 splicing variant, whose functional significance was confirmed by a minigene assay in another. Finally, we observed a significant association between hyperkalemia and the occurrence of cardiovascular events, metabolic syndrome, and organ damage, independent of potential confounding factors. The identification of hyperkalemia in patients with hypertensive has prognostic implications. A timely diagnosis of FHH is important for effective management of hypertension, electrolyte imbalance correction with tailored treatment, and genetic counseling.

Intermittent hemodialysis as a rewarming strategy for severe hypothermia in patients without renal failure: a case report

This case report highlights the effective use of intermittent hemodialysis (IHD) in warming a 71-year-old female patient with severe hypothermia who presented with a rectal temperature of 25 °C and signs of hemodynamic instability. The patient, found unconscious after prolonged exposure to cold exacerbated by alcohol consumption, initially showed some improvement in core temperature through active external rewarming methods. However, soon, her temperature plateaued at 27 °C. Patient was deemed unsuitable for extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (CPB) due to her age, and urgent IHD was initiated. This approach resulted in a stable increase in core temperature at approximately 2.0 °C/hr, along with normalization of lactic acidosis, creatinine phosphokinase, and correction of electrolyte imbalances, culminating in her full recovery and discharge after seven days in the hospital.After reviewing this case alongside similar ones from before, this case report highlights the efficacy and safety of IHD as an efficient, readily available, and less invasive method for rewarming moderate to severe hypothermic patients who are hemodynamically unstable patients but do not have cardiac arrest or renal dysfunction. IHD is especially useful when less invasive cooling devices (Artic Sun/ CoolGard) are not available or more invasive extracorporeal life support options (ECMO/ CPB) are either not indicated or unavailable. IHD can also help improve concurrent electrolyte imbalances and/or toxin buildup. The report further emphasizes the necessity of monitoring for potential complications, such as post-dialysis hypophosphatemia and rebound hyperkalemia, following successful rewarming.

Terapi Non Farmakologi Terhadap Mual Muntah dan Hiperemesis Gravidarum Pada Ibu Hamil: a Literatur Review

The incidence of nausea and vomiting affects almost 50% to 80% of pregnant women and approximately 5% of pregnant women require treatment in the form of hospitalisation for fluid replacement and correction of electrolyte imbalances. Non-pharmacological therapy is needed as an alternative or complementary treatment if pharmacological therapy causes side effects. in some cases nausea, vomiting, and hyperemesis gravidarum. This literature review aims to identify non-pharmacological therapies to help mothers overcome nausea, vomiting, and hyperemesis gravidarum in pregnancy. Five electronic databases were used for literature review research: PubMed, ProQuest, Google Scholar, Wiley Online Library, and Science Direct between 2014 and 2024. Of the 3,070 articles, 12 articles met the inclusion criteria and were analysed. This literature review provides evidence of non-pharmacological therapy methods that can be used as an alternative to treat nausea, vomiting, and hyperemesis gravidarum in pregnant women, namely oral therapy (ginger, mint leaves, and dates), inhalation therapy (lemon aromatherapy, lavender aromatherapy, and ginger aromatherapy) and therapy through massage (P6 acupressure and ST36 acupressure). The most frequently used and effective therapeutic methods for treating nausea, vomiting, and hyperemesis gravidarum in pregnant women are ginger therapy, lemon aromatherapy, and P6 acupressure.

Complete Heart Block Secondary To Leptospirosis: A Case Report

Complete heart block (CHB) is a rare but potentially life-threatening complication of leptospirosis, a zoonotic bacterial infection caused by spirochetes of the genus Leptospira. While leptospirosis primarily affects the kidneys and liver, cardiac involvement, including CHB, can occur and has significant clinical implications. The pathogenesis of CHB in leptospirosis is multifactorial and may involve direct cardiac invasion by Leptospira organisms, systemic inflammatory response, autoimmune reactions, electrolyte imbalances, and hemodynamic effects. Prompt recognition and management of CHB are essential to prevent adverse outcomes, including hemodynamic instability and sudden cardiac death. Treatment strategies include supportive measures such as hemodynamic support and correction of electrolyte imbalances, temporary pacing for symptomatic bradycardia, antibiotic therapy for the underlying infection, and consideration of permanent pacemaker implantation in refractory cases. Cardiac manifestations may include myocarditis, pericarditis, arrhythmias, conduction blocks and cardiac failure. We are reporting a case of leptospirosis causing complete heart block in a previously healthy young gentleman.

Unusual presentation of Sjogren’s syndrome during pregnancy: a case report

BackgroundPregnancy imposes significant physiological changes, including alterations in electrolyte balance and renal function. This is especially important because certain disorders might worsen and make people more susceptible to electrolyte abnormalities. One such condition is Sjogren's syndrome (SS), an autoimmune disease that can cause distal renal tubular acidosis (dRTA). This case report offers a unique perspective on the intricate physiological interplay during pregnancy, emphasizing the critical importance of recognizing and managing electrolyte abnormalities, particularly in the context of autoimmune disorders such as Sjogren’s syndrome.Case presentationWe report a case of a 31-year-old pregnant Indian woman at 24 weeks gestation presenting with fever, gastrointestinal symptoms, and progressive quadriparesis followed by altered sensorium. Severe hypokalaemia and respiratory acidosis necessitated immediate intubation and ventilatory support. Investigations revealed hypokalaemia, normal anion gap metabolic acidosis, and positive autoimmune markers for SS. Concurrently, she tested positive for IgM Leptospira. Management involved aggressive correction of electrolyte imbalances and addressing the underlying SS and leptospirosis.ConclusionThis case underscores that prompt recognition and management are paramount to prevent life-threatening complications in pregnant patients with autoimmune disease. This report sheds light on the unique challenge of managing hypokalaemic quadriparesis in the context of Sjogren’s syndrome during pregnancy.

A 6-month-old patient with cleft lip palate, atrial septal defect, and presenting hyperkalemia: a case report

Introduction: Cleft Lip Palate (CLP) is a prevalent congenital anomaly in Indonesia. Gradual surgery is the gold standard treatment for the condition. However, screening for other comorbidities must be conducted before the surgery. Congenital heart Defects (CHDs) are one of the prevalent concurrent conditions of CLP patients. One of the CHD that can be found is Atrial Septal Defect (ASD). Moreover, electrolyte levels must also be assessed and treated if abnormal before surgery. Hyperkalemia is a type of electrolyte imbalance that can be found, possibly caused by increased potassium load or decreased excretion. Case description: A 6-month-old girl was admitted to our hospital with a fever and dehydration. She complained of persistent vomiting. She had a history of CLP and CHD since birth. The echocardiogram revealed Small Secundum ASD. Laboratory results showed an elevated potassium (5.52 mEq/l). The patient was planned to get primary cleft lip repair and tip rhinoplasty. The surgery was postponed due to the patient’s condition and laboratory findings. During hospitalization, she received electrolyte imbalance correction and symptomatic treatment. A 1-week follow-up assessment showed stable condition, and the patient continued to prepare for the surgery. Conclusion: ASD is frequently observed as one of the most prevalent comorbidities of a CLP patient. Dehydration can increase the potassium level of the blood, and it must be treated before the surgical procedure for CLP patients with ASD condition.

A Thai guideline summary in management of pediatric septic shock

Sepsis-associated organ dysfunction, particularly septic shock, is a prevalent critical illness characterized by increased morbidity and mortality, particularly in children. Recognizing the imperative to enhance outcomes, a septic shock guideline tailored for pediatric patients was formulated. This guideline strives to establish an evidence-based framework for the effective management of septic shock and sepsis-associated organ dysfunction in Thai children. Key components encompass the prompt identification and stabilization of patients, meticulous titration of fluids and vasoactive agents, initiation of empirical antimicrobial therapy, judicious infectious source control, respiratory support, administration of sedation and analgesia, blood and blood product transfusion, correction of electrolyte imbalances, management of metabolic derangements, renal replacement therapy, and the implementation of multimodal monitoring. The objective is to optimize management, achieving therapeutic goals while continuously reassessing the patient's condition. Additionally, this guideline demonstrates adaptability by tailoring its suggestions to the resources available in Thailand’s medical facilities. Recognizing the diverse capabilities of healthcare institutions, the guideline endeavors to ensure its implementation is practical and feasible.

Correction of Electrolyte Abnormalities in Critically Ill Patients

Abstract Introduction The majority of patients in the intensive care unit (ICU) are at risk for at least one electrolyte abnormality and critically ill patients are the most vulnerable population to the effects of suboptimal electrolyte levels. These patients have unique characteristics impacting implications of the electrolyte disturbances and management. Areas Covered In the ICU, magnesium, potassium, calcium, phosphorous, and sodium are the most commonly encountered electrolytes that can be abnormal in the critically ill. Critical illness both is affected by and affects disturbances of these electrolytes which can result in more severe illness, longer duration of mechanical ventilation, increased dialysis support, longer length of stay, and increased mortality. Often, patients have multiple imbalances that require correction. Removal or mitigation of the cause should be undertaken whenever possible and should be concurrent with any therapeutic management used to correct the electrolyte imbalance. Selection of medication to correct electrolyte imbalances should be undertaken according to available evidence and drug-specific characteristics that impact medication delivery in the critically ill. Electrolyte disturbances, measurements, and corrections are ubiquitous in the ICU. Published literature on the management of electrolytes in the critically ill is limited. Management should consider factors unique to the critically ill when selecting optimal treatment approach and it is essential to individualize treatment to a patient’s unique needs and adapt management to the patient’s chancing clinical situation.

Management of diabetic ketoacidosis in internal medicine: insulin protocols, electrolyte balance, and clinical outcomes

Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus (DM), characterized by hyper-glycemia, acidosis, and ketosis. It poses a substantial risk of morbidity and mortality, especially in type 1 DM patients. DKA can be triggered by various factors, including insulin deficiency, infections, alcohol abuse, and other medical conditions. Hospital admissions for DKA are increasing, with mortality rates of up to 5-9%, often linked to severe underlying illnesses and complications such as myocardial infarction and stroke. Effective DKA management involves rehydration, correction of electrolyte imbalances, insulin administration, and addressing precipitating factors. Fluid resuscitation with isotonic saline is vital to restore hydration, and continuous intravenous insulin infusion is the preferred method to control blood glucose and suppress ketone production. Electrolyte imbalances, particularly potassium, sodium, phosphate, and magnesium, require careful monitoring and correction. Clinical outcomes in DKA management include resolving acidosis, normalizing blood glucose, and restoring electrolyte balance, all while achieving and maintaining clinical stability. Complications like cerebral edema and acute respiratory distress syndrome can significantly impact the prognosis. Long-term considerations encompass diabetes management, patient education, and follow-up care.

Acute Colonic Pseudo-Obstruction: A Comprehensive Review

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a rare but potentially life-threatening condition characterized by a large dilation of the colon without any physical blockage. It predominantly affects elderly individuals with multiple underlying health conditions, postoperative patients, and those receiving medications that impact gastrointestinal motility. The exact underlying mechanisms leading to ACPO remain unclear, but it is believed to result from dysfunction in the autonomic neural system, causing impaired colonic motility. Patients with ACPO typically present with symptoms such as abdominal distension, pain, and constipation. The diagnosis of ACPO is established based on clinical assessment, X-ray imaging, and the exclusion of mechanical obstruction. Treatment for ACPO involves promptly identifying and addressing any underlying medical conditions that may contribute to its development, such as correcting electrolyte imbalances or discontinuing medications with gastrointestinal side effects. Non-invasive measures, such as decompressing the colon using a rectal tube or administering a medication called neostigmine, are often effective in relieving symptoms. In refractory cases where conservative measures fail, surgical intervention may be necessary. Despite the rarity of ACPO, its potential for significant morbidity and mortality emphasizes the importance of promptly recognizing and managing the condition. Healthcare providers should exercise caution in patients with risk factors and clinical features suggestive of ACPO. By understanding the pathophysiology and promptly initiating appropriate interventions, healthcare professionals can optimize outcomes and minimize the potential complications associated with ACPO.

A PROSPECTIVE STUDY OF ELECTROLYTE IMBALANCE AND ITS MANAGEMENT IN GASTROINTESTINAL SURGERY

Objective: The objective is to study electrolyte imbalance and its management in gastrointestinal (GI) surgery. Methods: The present study was carried out in the Department of Surgery, S.P. Medical College and P.B.M Hospital, Bikaner. This is a prospective descriptive study and was carried out between December 2021 and November 2022 including 100 cases operated for GI tract surgeries (both elective and emergency). Results: Out of 100 patients, 54% patient had electrolyte imbalance and required correction for same. 46% of patients had normal serum electrolytes post-operatively. The most common electrolyte imbalance observed is hyponatremia (30%) followed by both hypokalemia and hyponatremia (14%). We observed that the most common surgical interventions which had electrolyte imbalance were ileostomy patients (84%) followed by resection and anastomosis of bowel (70%). Conclusion: Patients who had electrolyte imbalance were found to have more post-operative complications, longer hospital stay, and probably had an association with mortality. Early diagnosis, aggressive resuscitation, and timely definitive surgical treatment along with correction of electrolyte imbalance are essential to decrease the incidence of morbidity and mortality associated with electrolyte imbalance.

Successful management of severe bupropion toxicity with lipid emulsion therapy: a complex case report and literature review

This case report presents the management of a 53-year-old female with a complex psychiatric history who ingested multiple medications, resulting in severe cardiovascular compromise and subsequent respiratory failure. The patient’s ingestion included clonidine, fluoxetine, gabapentin, quetiapine and bupropion. Initial treatment involved supportive measures, including fluid resuscitation, bicarbonate infusion and correction of electrolyte imbalances. Despite these interventions, the patient remained haemodynamically unstable, requiring multiple vasopressors. Lipid emulsion therapy was initiated and led to a remarkable improvement in the patient’s cardiovascular status. However, she developed acute respiratory distress syndrome (ARDS) and required prolonged mechanical ventilation. Steroid therapy was initiated to manage the ARDS, and the patient was successfully extubated on day 6. The case highlights the potential effectiveness of lipid emulsion therapy in managing bupropion toxicity, but emphasises the need for further research to establish clear guidelines on dosing, timing and safety protocols. Adverse effects associated with lipid emulsion therapy must be carefully considered. Individualised decision-making and patient-centred care is crucial in optimising outcomes in cases of bupropion toxicity.

The hidden diagnosis: hypogonadotropic hypogonadism unveiled in a rare Fanconi syndrome case—a case report and literature review

Introduction and importance: Fanconi syndrome affects kidney function, whereas hypogonadotropic hypogonadism (HH) is gonadal failure due to deficient hormones. Diagnosis involves assays and imaging, whereas treatment targets cause and fluid balance. Here, there is a reported co-occurrence in Pakistan. Case presentation: A 14-year-old girl presented with joint pain and developmental delay. Physical examination revealed wrist widening, genu-varum, and underdeveloped secondary sexual characteristics. Laboratory findings confirmed Fanconi syndrome and coincidental ultrasound findings revealed HH. The patient received treatment in the form of oral medications and supplements to manage the condition. Clinical discussion: Fanconi syndrome is a complex disorder affecting the proximal tubule of the kidneys, leading to impaired reabsorption of various substances. In this case, potential genetic and acquired causes were ruled out, including inborn errors of metabolism and heavy metal intoxication. Prolonged valproic acid use was also considered but not confirmed as the cause. The patient also presented with HH, which is unrelated but coexisting. Treatment for Fanconi syndrome focuses on correcting electrolyte imbalances, whereas hormone replacement therapy is considered for HH. The patient’s progress and response to treatment are under careful monitoring. Conclusion: This case highlights the need for further research and comprehensive diagnostic evaluation to better understand the association between Fanconi syndrome and HH, emphasizing the importance of early diagnosis and management to prevent long-term complications.

Management of peritoneal dialysis in an adolescent with septic shock, AKI, multi-organ failure and COVID-19: a case report

The kidneys is the most commonly injured organs in sepsis, which might manifest as acute kidney injury (AKI). Peritoneal dialysis (PD) is the preferred modality of renal replacement therapy (RRT), especially in the developing countries. Furthermore, the COVID-19 pandemic has made hemodialysis (HD) unavailable due to infection concerns. We present a critically-ill 16-year-old male with morbid obesity (BMI 43.3 kg/m2), diabetic ketoacidosis, acute pancreatitis, acute kidney injury, and COVID-19 pneumonia. The patient looked somnolent on admission with very high random blood glucose and hypernatremia. Blood gas analysis showed metabolic acidosis. The patient was treated with 1 g/day Meropenem, 0.5 µg/kg/min norepinephrine, 0.04 unit/kg/h vasopressin, and correction of electrolyte imbalance and metabolic acidosis. After 48 h, the diuresis and the creatinine levels worsened. We placed a Tenckhoff catheter and started PD. The patient showed improvement after 72 h of peritoneal dialysis.
 This case report highlighted the use of PD as a modality of RRT in sepsis-induced AKI, multi-organ failure, and COVID-19. Although it remains controversial, we observed an improvement in diuresis and creatinine levels following PD. PD is more cost-effective and provides a similar outcome compared to other modalities.
 Abbreviations: AKI - Acute Kidney Injury; BMI- Body Mass Index; CRRT- Continous Renal Replacement Therapu; GCS- Glasgow Coma Scale; HD- Hemodialysis; ICU- Intensive Care Unit; PD- Peritoenal Dialysis; RRT- Renal Replacement Therapy; S-AKI- Sepsis-Associated Acute Kidney Injury; SIRS- Systemic Inflammatory Response Syndrome
 Key words: Septic shock; Acute kidney injury; Peritoneal dialysis
 Citation: Andiantoro DS, Sedono R, Jennefer J. Management of peritoneal dialysis in an adolescent with septic shock, AKI, multi-organ failure and COVID-19: a case report. Anaesth. pain intensive care 2023;27(4):600−603.
 DOI: 10.35975/apic.v27i4.2163
 Received: February 14, 2023; Reviewed: April 17, 2023; Accepted: April 22, 2023

Enteral hydration in cows: Comparison between continuous flow and bolus administration.

Enteral hydration in cattle is most commonly performed as a bolus (B) via the ororuminal route, although continuous flow (CF) administration via the nasoesophageal route represents a viable alternative. Currently, no study has compared the effectiveness of these two methods. This study aimed to compare the efficiency of enteral hydration using CF and B to correct water, electrolyte and acid-base imbalances in cows. Protocols for the induction of dehydration were applied twice to eight healthy cows, with an interval of 1 week. In a crossover design, two types of enteral hydration were performed using the same electrolyte solution and volume equal to 12% of bodyweight (BW): CF (10mL/kg/h, between 0 and 12hours) and B (6% BW, twice, at 0 and 6hours). Clinical and blood variables were determined at -24, 0, 6, 12 and 24hours and compared using repeated-measures ANOVA. Induced moderate dehydration and hypochloremic metabolic alkalosis were corrected after 12 hours using the two hydration methods, with no differences observed between the methods. The study was conducted with induced rather than natural imbalances, so the findings should be interpreted cautiously. Enteral CF hydration is as effective as B hydration in reversing dehydration and correcting electrolyte and acid-base imbalances.

In patients with diabetes, is fluid replacement with balanced crystalloids more effective than normal saline when correcting electrolyte imbalances in diabetic ketoacidosis?

Southern Illinois University—Family and Community Medicine Decatur, Decatur, IL The corresponding author is Pooja Sheth-Dutt; [email protected] The authors declare no conflicts of interest.

Clinical outcome of intraoperative hemodialysis using a hemoconcentrator during cardiopulmonary bypass for dialysis-dependent patients.

The basic materials and structure of a hemoconcentrator incorporated into cardiopulmonary bypass (CPB) circuits are similar to those of hemodialyzers. Gravity drainage hemodiafiltration (GHDF) is an easy-to-use intraoperative renal replacement therapy (RRT) that utilizes a hemoconcentrator. This study aimed to verify whether GHDF can correct electrolyte imbalance and remove uremic toxins in dialysis-dependent patients and to evaluate the clinical outcomes of GHDF by comparing it with a conventional method of dilutional ultrafiltration (DUF). This study retrospectively compared perioperative clinical values of 41 dialysis-dependent patients (21 patients with GHDF and 20 patients with DUF) who underwent open-heart surgery. Changes in serum parameters before and after passing through the hemoconcentrator were also compared. Compared to DUF, GHDF significantly lowered potassium, blood urea nitrogen, and creatinine levels at the outflow of the hemoconcentrator. Less catecholamine was needed to wean CPB in GHDF than in DUF. The P/F ratio (arterial blood oxygen pressure/inhaled oxygen concentration) at the end of surgery was significantly higher in GHDF than in DUF (450.8 ± 149.7 vs. 279.3 ± 153.5; p < 0.001). Postoperative intubation time was shorter in GHDF than in DUF (8.3 ± 5.9 vs. 18.7 ± 16.1h; p = 0.006). The major morbidity and mortality rates were comparable in both groups. GHDF removed both potassium and uremic toxins more efficiently than DUF in dialysis-dependent patients. Less catecholamine was needed to wean CPB using GHDF. It improved the immediate postoperative respiratory function and enabled earlier extubation. GHDF is a novel and effective option for intraoperative RRT in dialysis-dependent patients undergoing open-heart surgery.

Cronkhite-Canada Syndrome Presenting with life-threatening protein-losing enteropathy: a case report

Background: Cronkhite Canada Syndrome (CCS) is a rare gastrointestinal polyposis syndrome. The diagnosis of CCS is made by clinical, endoscopic and histopathological findings. Chronic diarrhea, malnutrition, alopecia, skin hyperpigmentation, onychodystrophy, hypogeusia, protein loss due to chronic inflammatory changes in the intestinal mucosa are common findings.Nutritional support, high protein diet, antibiotics, correction of electrolyte imbalance, and corticosteroids are frequently used in CCS treatment. Aim of the study: Here we present a newly diagnosed Cronkhite Canada Syndrome patient who has suffered life-threatening protein loss. Material and methods: Medical documentation was used. Case report: A 62-year-old male patient presented with bloodless diarrhea, happening 8-10 times a day for 4 months, and general condition disorder. On admission, arterial blood pressure was 80/50 mm/hg, pulse was 110 per minute and body temperature was 38.8°C. In laboratory tests, total protein: 38 mg/dl and albumin: 20 g/L.Upper and lower gastrointestinal system (GIS) endoscopy revealed 2-20 mm polyps in the stomach, duodenum, colon, and a small amount in the distal esophagus. Pathological examination of polypectomy materials revealed edematous and inflamed lamina propria consisting of plasma cells, neutrophils and eosinophils.The patient benefited from total parenteral nutrition, high protein dietary supplementation, antibiotic therapy and was followed with upper and lower GIS endoscopy. Conclusions: CCS is a rare disease that can cause life-threatening hypoalbuminemia and requires close follow-up.

Hyperglycemic Crisis in Uncontrolled Diabetes Mellitus Type 2 Presenting as Breathlessness

Background&#x0D; Hyperglycemic crisis is emergency caused by metabolic problems due to uncontrolled diabetes mellitus. Hyperglycemic crisis consists of Hyperosmolar Hyperglycemic State (HHS) and Diabetic Ketoacidosis. Both are caused by relative or absolute deficiency of insulin; deficiency of insulin could be caused by type 1 and type 2 diabetes.&#x0D; Case presentation &#x0D; A 46-year-old woman came to the emergency room of Unggul Karsa Medika Hospital presenting with breathlessness which had occurred for a week. Her breathlessness was more severe on the day she presented to the emergency room. One week before, she went to a clinic nearby because of epigastric pain, but after returning home she felt breathless. After a few days, her breathlessness started to worsen, so she decided to go to emergency room. The patient had severe acidosis and high blood glucose. Hyperglycemia protocol of rehydration and insulin drip intravenously, accompanied by sodium bicarbonate and potassium chloride were given. Mechanical ventilation was used. The patient was healed and discharged safely after 9 days of hospitalization.&#x0D; Conclusion&#x0D; Hyperglycemic crisis is one of true emergency that can lead to mortality, thus prompt diagnosis and treatment should be done. It is important for clinicians to differ between HHS and DKA. HHS is caused by the relative or absolute deficiency of insulin while DKA is characterized by absolute insulin deficiency which prevents the body from metabolizing carbohydrates and results in severe hyperglycemia. In DKA and HHS the main goal of therapy is to rehydrate, correct hyperglycemia, and to correct electrolyte imbalances.