Electrolyte Imbalance Research Articles

Medical Complications of Anorexia Nervosa.

Anorexia nervosa (AN) is the most prevalent eating disorder, affecting almost 3 million people and having the highest mortality rate among psychiatric conditions. The hypometabolic state in AN, caused by an imbalance between energy intake and needs, leads to various medical complications, including gastrointestinal disorders, cardiovascular abnormalities, hematologic alterations, neurocognitive impairment, low bone mineral density, electrolyte imbalances, nephrological issues, and dermatological lesions. Some of these complications are life-threatening, necessitating prompt recognition and treatment by pediatricians and psychiatrists. Indeed, the unfavorable outcome of AN is primarily due to medical and psychiatric comorbidities; approximately one-third of deaths in cases with AN are attributed to cardiovascular complications. Hematological alterations and symptoms of medical instability, such as bradycardia, hypotension, orthostasis, and electrolyte derangements, occur in 1 out of 5 youths with AN requiring hospitalization, with nearly 40% needing repeated hospitalizations. Prompt comprehensive medical, psychiatric, and nutritional assessments, along with thorough physical examinations and laboratory tests, are crucial for early identification and management of these complications. Immediate hospitalization is essential in life-threatening cases to prevent further clinical deterioration or manage the suicide risk. This article reviews the acute and chronic medical consequences of AN, divided into common and rare, focusing on children and adolescents and summarizing the complications by organ/system and frequency.

Clomipramine potentially induced fatal torsades de pointes in a patient with acute decompensated heart failure: a case report

BackgroundWhile clomipramine is generally considered lower risk for QT prolongation among tricyclic antidepressants, its potential to induce torsades de pointes (TdP) remains poorly characterized, particularly in patients with multiple risk factors.Case presentationA 78-year-old male with a history of hypertension, atrial fibrillation, and post-stroke depression presented to the emergency department with a one-week history of chest distress. Initial evaluation revealed atrial fibrillation with a prolonged QTc interval of 550 ms on electrocardiogram (ECG) monitoring, and elevated B-type natriuretic peptide (1130 pg/mL). The patient was admitted for acute decompensated heart failure and treated with torasemide intravenously while continuing clomipramine (25 mg daily) for depression. Within 24 hours, he experienced multiple episodes of torsades de pointes (TdP), coinciding with hypokalemia (serum potassium: 3.21 mmol/L). Despite corrective measures, including potassium and magnesium supplementation, the patient developed ventricular fibrillation and cardiac arrest, leading to death.ConclusionThis case highlights the potential risk of clomipramine-induced QT prolongation and TdP, particularly in patients with acute heart failure and electrolyte imbalances, underscoring the need for careful risk assessment and monitoring in such populations.

A Case of Secondary Pseudohypoaldosteronism in a Neonate not Due to Urinary Tract Issues.

In this report, we present a case of a female infant diagnosed with secondary PHA who exhibited weight loss, hyponatremia, hyperkalemia, and metabolic acidosis without the presence of UTA or UTI. The patient was a female infant born at 35 weeks gestation who developed electrolyte abnormalities and was diagnosed with secondary pseudohypoaldosteronism (PHA). Initially managed for transient tachypnea of the newborn, she developed respiratory distress requiring mechanical ventilation. Subsequently, she exhibited persistent hyponatremia, hyperkalemia, and metabolic acidosis despite adequate fluid therapy, prompting consideration of adrenal insufficiency and congenital adrenal hyperplasia (CAH). Treatment with hydrocortisone and fludrocortisone was initiated empirically until hormonal analyses excluded CAH. Further evaluation excluded urinary tract anomalies and infections as underlying causes, implicating secondary PHA. The infant responded well to saline and electrolyte replacement therapy, with normalization of electrolyte levels and clinical improvement. Follow-up assessments demonstrated resolution of electrolyte imbalances, and the patient was discharged after 27 days without further complications. Secondary PHA, characterized by renal tubular resistance to aldosterone, typically presents with severe electrolyte disturbances in infancy. It can occur independently of urinary tract abnormalities or infections, highlighting the importance of considering this diagnosis in neonates and infants presenting with hyponatremia, hyperkalemia, and metabolic acidosis that do not respond to conventional therapies. Early recognition and appropriate management, including fluid-electrolyte correction and hormone replacement if indicated, are crucial to prevent life-threatening complications associated with salt-wasting syndromes in this vulnerable population.

Immune Checkpoint Inhibitor - Associated Renal Tubular Acidosis and Nephrogenic Diabetes Insipidus - A Case Report

Introduction: Immunotherapy has significantly changed the landscape of cancer treatment, yet it can lead to immune-related adverse events (irAEs), including renal complications. This report highlights a unique case of tubular injury associated with Pembrolizumab in a patient with malignant melanoma. Case Presentation: A 42-year-old female patient with malignant melanoma received adjuvant Pembrolizumab treatment. Three months later, she presented with profound weakness, myalgia, abdominal pain, polyuria, and thirst. Laboratory tests revealed acute kidney injury (AKI), significant proteinuria, renal tubular acidosis (RTA) with severe electrolyte imbalances, and nephrogenic diabetes insipidus (NDI). Management involved withholding Pembrolizumab, initiating high-dose prednisone therapy, and correcting hypokalemia and metabolic acidosis. The patient showed rapid clinical improvement, with normalization of renal function and symptom resolution, allowing for discharge within a week. A follow-up visit confirmed no residual renal impairment. Conclusion: This case emphasizes the importance of recognizing renal complications in patients undergoing treatment with immune checkpoint inhibitors (ICIs). Awareness of potential adverse effects such as RTA and NDI is crucial for prompt identification and management to prevent lasting damage.

Relieving the discrimination dilemma of adult autoimmune enteropathy and common variable immunodeficiency disease: two rare causes of chronic diarrhea and small intestinal villous atrophy.

Autoimmune enteropathy (AIE) and common variable immunodeficiency (CVID) can both manifest as chronic diarrhea and small intestinal villous atrophy, making their differentiation challenging. To explore the similarities and differences in the clinical manifestations, laboratory tests, pathological features, and long-term prognoses between these two diseases. This retrospective study included 26 AIE patients and 29 CVID patients with gastrointestinal (GI) involvement who were admitted to our center from June 2012 to May 2024, with all their medical records reviewed. Differences between the two diseases were evaluated via statistical tests. Compared with CVID patients, AIE patients experienced a shorter duration of severe diarrhea, greater weight loss, and more severe hypoalbuminemia and electrolyte imbalances. Furthermore, CVID patients exhibited a notable history of recurrent respiratory infections; significantly lower serum levels of IgG, IgM, and IgA; a marked decrease in B-cell and CD4 + T-cell counts; and a significant inversion of the CD4 + /CD8 + ratio within peripheral blood lymphocyte subsets. Endoscopically, AIE patients are more likely to present with active inflammatory changes, such as erosions and hyperemia. On the basis of histopathological analysis of 23 AIE patients and 24 CVID patients, AIE patients presented with reduced goblet and Paneth cells, pronounced neutrophilic infiltration, and more frequent apoptotic bodies, while CVID patients demonstrated reduced plasma cells and deep crypt lymphocytosis. The diagnostic efficiency of the five pathological items in the duodenum (AUC 0.937), which includes goblet cell and Paneth cell reduction, was greater than that of the four-item combination (AUC 0.622). Long-term follow-up indicated that patients with both conditions were prone to diarrhea relapse, and CVID patients showed a slightly longer median relapse-free survival than did AIE patients. Although AIE patients and CVID patients share many similarities, they exhibit significant differences. A thorough medical history, laboratory tests, and endoscopic and histopathological results provide compelling evidence for their differential diagnosis. Key Points • Both AIE and CVID with gastrointestinal involvement are immune-mediated diseases characterized by chronic diarrhea and small intestinal villi atrophy, making clinical diagnosis difficult. • AIE and CVID have different characteristics that can be used to distinguish them, especially pathological findings.

Urine Sodium and Urine Osmolality as Predictors for Non-Response to Treatment in Syndrome of Inappropriate Antidiuretic Hormone Secretion

Introduction Hyponatremia is a common electrolyte imbalance, often caused by the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). SIADH results from excessive water retention due to inappropriate ADH secretion. While fluid restriction is a standard treatment, responses vary, and there is a need to identify predictors of non-response. Methods This prospective observational study involved 171 patients with SIADH. Inclusion criteria included serum sodium <125 mmol/L and urine osmolality >100 mOsm/kg along with others. Patients received fluid restriction (1 litre/day) with or without hypertonic saline. Data collection included clinical features, laboratory parameters, and response to treatment at 12 and 24 hours. The association between urine sodium, urine osmolality, and treatment response was analysed. Results The median age was 69 years, with a male predominance (59.1%). Pneumonia (28.7%) and malignancies (14%) were common aetiologies. Significant predictors of non-response to fluid restriction included high urine sodium and urine osmolality at the specified time limit. The group that failed to achieve the 24-hour serum sodium target had higher urine osmolality and sodium levels than responders. These findings align with previous studies highlighting the predictive value of urine osmolality and urine sodium. Conclusion Elevated urine sodium and urine osmolality significantly predict non-response to fluid restriction in SIADH. Identifying these markers can guide personalized treatment strategies, improving outcomes and avoiding unnecessary interventions

Analysis on forensic pathology of water intoxication: A review.

Analysis on forensic pathology of water intoxication: A review.

Diabetic ketoalkalosis: a rare potentially dangerous condition in emergency endocrinology practice

Diabetic ketoalkalosis (DK) is a rare but potentially severe complication of diabetes mellitus, requiring emergency medical intervention. The main triggering factors for DK include infectious diseases, surgical procedures and trauma. The pathogenesis of DK involves processes related to reduced circulating blood volume due to persistent vomiting, leading to hydrogen ion loss and elevated blood bicarbonate levels, ultimately resulting in alkalemia. The clinical manifestations of DK resemble those of diabetic ketoacidosis (DKA), except for the presence of intractable vomiting, a symptom specific to DK patients. The diagnosis of DK is primarily confirmed through laboratory findings, including metabolic alkalosis (pH > 7,3 or blood bicarbonate > 18,0 mmol/L) and a delta ratio exceeding 2,0. Differential diagnosis should exclude classic DKA, euglycemic DKA, and hyperglycemic hyperosmolar state. The principles of intensive care for DK are similar to those for DKA and include: fluid resuscitation with isotonic crystalloid solutions to correct dehydration, electrolyte imbalance correction (primarily hypokalemia), intravenous short-acting insulin therapy. Despite its potential severity, DK can be successfully managed without serious complications or fatal outcomes if diagnosed and treated promptly and correctly.

Undersensing, R-on-T phenomenon, and hypokalemia: Hidden dangers of temporary transvenous pacing in a STEMI patient

Background: Temporary transvenous pacing is commonly used to manage bradyarrhythmias in patients with acute myocardial infarction (AMI), particularly those with complete heart block. However, pacing-induced ventricular arrhythmias, including ventricular fibrillation (VF), are rare but potentially fatal complications. The "R-on-T" phenomenon, where pacing stimuli coincide with the vulnerable phase of ventricular repolarization, may trigger VF, particularly in patients with myocardial ischemia or electrolyte imbalances. Case report: We report a case of a 68-year-old man with inferior ST-elevation myocardial infarction (STEMI) and complete heart block who underwent emergency percutaneous coronary intervention (PCI) and temporary transvenous pacing. Two days post-procedure, he experienced a syncopal episode with documented VF requiring multiple defibrillation attempts. Subsequent analysis revealed pacing-induced VF due to undersensing of the intrinsic rhythm. Additionally, severe hypokalemia (2.2 mmol/L) was identified as a contributing factor. The temporary pacemaker was turned off, and potassium levels were corrected, leading to resolution of arrhythmias. The patient remained stable and was later discharged in good condition. Conclusions: This case highlights the potential risk of pacing-induced VF in inferior STEMI patients, particularly when combined with hypokalemia. Proper pacemaker sensing adjustments, vigilant electrolyte monitoring, and prompt recognition of arrhythmogenic triggers are essential to prevent adverse outcomes. Awareness of this rare but serious complication can guide clinicians in optimizing pacing strategies and improving patient safety.

Acute gastric dilatation after excessive consumption of traditional Chinese medicine: a case report

IntroductionAcute gastric dilatation (AGD) is a rare but clinically significant condition characterized by abnormal enlargement of the stomach. It can lead to serious complications such as gastric necrosis, perforation, and respiratory failure if not promptly managed. AGD has been associated with mechanical obstructions, binge eating, and systemic conditions like diabetes mellitus. However, AGD induced by excessive consumption of traditional Chinese medicine (TCM) has not been previously reported.Patient concernsA 40-year-old male with a history of chronic dyspepsia presented to the emergency department with recurrent vomiting. Over the 3 days prior to admission, he self-reported consuming approximately 3.5 liters of TCM liquid (about 1.1–1.3 liters per day). This attempt to alleviate his chronic dyspepsia symptoms failed to show the expected therapeutic effect. The patient denied experiencing headache, dizziness, chest pain, palpitations, abdominal pain, or diarrhea.DiagnosisAbdominal CT revealed significant gastric distension, and subsequent endoscopy showed pyloric ulcer with stenosis, gastric retention, chronic atrophic gastritis, and a relaxed cardia. Laboratory investigations indicated metabolic alkalosis, electrolyte imbalances, and signs of tissue hypoxia.InterventionsThe patient was immediately managed with nasogastric tube decompression, anti-infection therapy, gastric mucosal protection, fluid resuscitation, parenteral nutritional support, fasting, and gastrointestinal decompression.OutcomesThe patient’s symptoms and signs notably improved after these interventions. A follow-up CT scan demonstrated improved gastric dilation. At a 4-week follow-up, the patient reported complete resolution of vomiting and resumed normal oral intake. Repeat endoscopy showed healed pyloric ulcers and improved gastric motility. No adverse events (e.g., rehospitalization or medication intolerance) were reported during a 3-month follow-up period.ConclusionThis case highlights the necessity of including AGD in the differential diagnosis for patients presenting with frequent vomiting after excessive consumption of TCM. It underscores the importance of thorough evaluation to prevent misdiagnosis and severe complications. The case also emphasizes the need for caution when using TCM, especially in patients with organic lesions or pyloric obstruction.

Impact of mixed electrolyte imbalances at admission on adverse outcomes in patients with and without renal disease.

Impact of mixed electrolyte imbalances at admission on adverse outcomes in patients with and without renal disease.

Use of postbiotics and parabiotics from lactobacilli in the treatment of infectious diarrhea.

Use of postbiotics and parabiotics from lactobacilli in the treatment of infectious diarrhea.

Refeeding Syndrome in Children Aged 6 to 59 Months with Severe Acute Malnutrition.

To assess the frequency and factors of refeeding syndrome in children aged 6 to 59 months with severe acute malnutrition (SAM). Descriptive, cross-sectional study. Place and Duration of the Study: Department of Paediatric Medicine, Civil Hospital, Karachi, Pakistan, from April to September 2024. All children aged 6 to 59 months diagnosed with SAM, initially presenting with normal serum phosphate, potassium, and magnesium concentration and underwent nutritional rehabilitation within the initial 72 hours of hospital admission. Refeeding syndrome was defined as the sudden lowering of serum phosphate, potassium, and magnesium concentrations within 72 hours of initiating nutritional rehabilitation. Chi-square/Fisher's exact test and paired t-test were applied to assess associations and mean differences, considering p ≤0.05 as significant. The study included 185 children, with mean age of 23.94 ± 12.64 months, comprising of 104 (56.2%) boys and 81 (43.8%) girls. Refeeding syndrome was observed in 23 (12.4%) children. Children with refeeding syndrome showed significant declines in serum phosphate (3.68 ± 1.17 vs. 1.53 ± 0.49 mg/dL, p <0.001), potassium (3.92 ± 0.72 vs. 2.81 ± 0.66 mg/dL, p <0.001), and magnesium (2.02 ± 0.27 vs. 0.93 ± 0.22 mg/dL, p <0.001) levels from the baseline. Refeeding syndrome was significantly associated with younger age (p = 0.009), shorter height (p = 0.009), and the use of nasogastric or intravenous nutritional support (p = 0.012). Cardiac irregularities were more frequent in children with refeeding syndrome (p = 0.039). Refeeding syndrome occurred in 12.4% of SAM children and was linked to younger age, shorter height, and nasogastric or intravenous feeding. Refeeding syndrome, Severe acute malnutrition, Paediatrics, Electrolyte imbalance, Nutritional support.

Vitamin K2: A promising new treatment for nocturnal leg cramps

Dear Editor, This letter aims to emphasise the potential role of Vitamin K2 in managing nocturnal leg cramps (NLCs). Our goal is to raise awareness about this emerging treatment for people suffering with nocturnal leg cramps. Nocturnal leg cramps (NLCs) are characterised by sudden, involuntary, and recurrent contractions of lower limb muscles, typically occurring during sleep or rest. These episodes can last from a few seconds to several minutes, often causing severe pain and sleep disturbances.1,2 Approximately 30% of adults experience NLCs at least five times per month, while around 6% report a frequency of 15 or more episodes per month, with prevalence increasing with age.3 Limited evidence supports the effectiveness of various pharmacological and non-pharmacological treatments, including exercise, magnesium supplements, and calcium channel blockers, in reducing NLC frequency.1 Moreover, quinine, previously used for NLC treatment, is no longer recommended due to severe adverse effects, including thrombocytopenia, cardiovascular complications, hearing loss, rash, electrolyte imbalances, headaches, orthostatic hypotension, and dizziness..1,4 Recent research published in October 2024 has demonstrated that Vitamin K2 treatment for NLCs has a favourable safety profile and effectively reduces cramp recurrence, severity, and duration.5 A placebo-controlled randomized clinical trial was conducted to determine the efficacy of Vitamin K2 in controlling NLCs which included people of 65 years and older with more than 2 recorded episodes of NLCs during 15 days of examination.5 The cramp frequency in the Vitamin K2 group was significantly reduced with a mean (SD) of [0.96 (1.41)], as compared to the placebo group with mean (SD) frequency of [3.63 (2.20)].5 NLC severity was also decreased in Vitamin K2 group with a mean (SD) of [-2.55 (2.12)] in contrast to the placebo group [-1.24 (1.16)].5 The reduction in mean (SD) NLC duration was also higher in vitamin K2 group [-0.90 (0.88)] minutes than the placebo group [-0.32 (0.78)] minutes.5 Furthermore, no adverse effects were reported in the Vitamin K2 group5 We encourage physicians and the broader community of practitioners to verify the efficacy of Vitamin K2 in cramp management and its effect on the living conditions and sleep of patients with NLCs, and to carry out larger scale clinical trials to further determine its effectiveness.

Pathogenesis and therapeutic strategy of heat stroke-induced acute kidney injury.

Pathogenesis and therapeutic strategy of heat stroke-induced acute kidney injury.

Anti vascular endothelial growth factor agents in nephrology clinical practice

The vascular endothelial growth factor (VEGF) is a subfamily of growth factors that play an essential role in vasculogenesis and angiogenesis. VEGFs stimulate the creation of new blood vessels during embryonic development and collaterals to bypass blood vessel obstruction and/or vascular injury. Anti-VEGF agents were approved as a new promising management for solid tumors and their metastasis, as well as retinal vascular disorders. Their use was associated with significant nephrotoxic effects. Hypertension, proteinuria, microscopic angiopathy, electrolyte imbalance, and chronic kidney disease were reported as common and serious VEGF inhibitors complications, which may affect the management plan. In this review, we tried as much as possible to summarize what has been discussed in the literature about the nephrotoxic effects of anti-VEGF agents.

Effect of Green Tea Extract on Renal Function Biomarkers in Rats: A Study of N-acetylglucosaminidase Levels, Electrolyte Imbalances, and Renal Health

Effect of Green Tea Extract on Renal Function Biomarkers in Rats: A Study of N-acetylglucosaminidase Levels, Electrolyte Imbalances, and Renal Health

Nutritional and dietary approach in the post-surgical follow-up of hirschsprung disease: a case report

Hirschsprung disease (HD) is a congenital condition caused by abnormal development of the enteric nervous system during the embryonic period, characterized by colonic aganglionosis. Total Colonic Aganglionosis (TCA) refers to the involvement of the entire colon extending to the terminal ileum, accounting for 3–12% of all HD cases. A 45-month-old male patient presented to the clinic with complaints of frequent vomiting and more than 10 watery diarrhea episodes per day. The patient's medical history revealed the development of short bowel syndrome (SBS) following Total Colonic Aganglionosis. Physical examination indicated a poor general condition, decreased skin turgor and tonus, along with growth and developmental delay. Laboratory findings demonstrated low sodium (Na) and potassium (K) levels with electrolyte imbalances. A low-carbohydrate, high-protein diet was planned alongside hydration therapy. Additionally, the family was educated on nutritional management and avoiding harmful foods. Following 17 days of treatment and dietary interventions, the patient's weight increased by 1.5 kg, and complaints of diarrhea and vomiting subsided. During a two-year follow-up period, a reduction in hospitalization frequency and improvements in the patient’s overall clinical condition were observed. The individualized treatment and nutritional plan significantly enhanced the patient’s quality of life. The management of short bowel syndrome, which may develop after HD surgery, requires individualized nutritional plans, a multidisciplinary approach, and continuity in patient-family education, all of which are critically important.

The comparative diagnostic efficacy of BNP &amp; proBNP in Chronic kidney disease patients with complications

Objective: To study the differences between the B-type Natriuretic Peptide (BNP) and the N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) values in CKD patients due to diabetes and hypertension and without CKD. Another objective was to to observe what correlation the variables of age showed with the parameters of BNP, NT-proBNP values, and with Glomerular Filtration Rate (GFR). Methods: A case-control study was performed for six months between January to June 2024. In total 254 individuals took part in the study, with ages between 30-75 years, of which 85 were healthy controls and 169 CKD cases. CKD patients were recruited from the Department of Nephrology Jinnah Postgraduate Medical Centre (JPMC), Karachi. Diagnosis was made on the basis of raised serum urea, creatinine levels, and electrolyte imbalance. The following were excluded from participation: individuals with coronary artery disease, pregnancy, more than twice-weekly dialysis, or on steroid therapy. CKD cases were also staged according to National Kidney Foundation GFR guidelines. Results: Among the &lt;50-year-old participants, BNP was abnormal in 92.7% of patients (p = 0.001), while NT-proBNP was abnormal in 38.5% (p = 0.01). When BNP and NT-proBNP were compared between the same individuals, BNP detected more abnormal cases, with a statistically significant difference (p = 0.01), indicating its better diagnostic yield in this group. Conclusion: BNP was identified as a more authentic marker than NT-proBNP in order to detect cardiovascular stress in CKD patients. Its close correlation with increasing age and decreasing GFR highlights its prognostic significance and potential role in routine cardiovascular risk assessment in CKD populations. doi: https://doi.org/10.12669/pjms.41.7.11826 How to cite this: Shaikh SU, Yasmeen G, Rehman R, Junejo AM. The comparative diagnostic efficacy of BNP &amp; NT-proBNP in Chronic kidney disease patients with complications. Pak J Med Sci. 2025;41(7):1913-1917. doi: https://doi.org/10.12669/pjms.41.7.11826 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Risk Factors in Neuroleptic Malignant Syndrome: A 10-year Case-control Study of Neuroleptic Use in Patients in Charoenkrung Pracharak Hospital

Objective: To identify the risk of using high doses of neuroleptics in the development of neuroleptic malignant syndrome (NMS). Additionally, we examined other potential risk factors, including age, psychiatric diagnosis, route of neuroleptic administration, dose escalation over a short period, psychomotor agitation, dehydration, and electrolyte imbalance. Materials and Methods: A case-control study was performed, comprising 26 NMS cases matched with 52 controls by sex and time of admission to the hospital over a 10-year data-collection period. A retrospective chart review was conducted to compare the two groups using conditional logistic regression analysis. Results: The maximum neuroleptic dose (adjusted OR 10.70, 95%CI 1.79–64.00 for a neuroleptic dose of 200–400 mg/day and adjusted OR 61.58, 95%CI 6.87–552.19 for a neuroleptic dose &gt; 400 mg/day) and dehydration (adjusted OR 18.52, 95%CI 3.22–106.62) were found to be significant risk factors for developing NMS. Conclusion: The risk factors for developing NMS were found to be receiving a high dose of neuroleptics per day and dehydration.