Life-threatening Electrolyte Abnormalities Research Articles

Metabolic Emergencies in the Child With Acute Leukemia

Acute leukemia is the most common malignancy in children. Children with acute lymphoblastic leukemia and acute myeloid leukemia are frequently diagnosed, evaluated, and treated in emergency departments. Children with acute leukemia may develop multiple life-threatening electrolyte abnormalities, either at the time of diagnosis or after initiation of therapy. Children with acute lymphoblastic leukemia or hyperleukocytosis are at high risk for developing tumor lysis syndrome, which includes hyperuricemia, hyperkalemia, hyperphosphatemia, or hypocalcemia. Clinical complications of tumor lysis syndrome include renal insufficiency or acute renal failure, seizures, altered mental status or coma, cardiac arrhythmias, and sudden death. Rarely, children with acute leukemia will present with hypercalcemia. After initiation of systemic chemotherapy, some children will develop hyponatremia due to excessive hydration, dehydration, or syndrome of inappropriate antidiuretic hormone. Prompt recognition and prevention or treatment of metabolic abnormalities by the treating physician is crucial to preventing end-organ damage or death.

Continuous infusion of a standard combination solution in the management of hyperkalemia

Hyperkalemia, due to its effect on cardiac conductivity, is a potentially life-threatening electrolyte abnormality. Multiple therapeutic agents may be used alone or in combination for its prompt management. We report on the safety and efficacy of continuous infusion of a solution containing fixed concentrations of calcium gluconate, insulin, dextrose and sodium acetate (HyperK-Cocktail) for the treatment of hyperkalemia. This solution is prepared at our institution and is infused parenterally until the plasma potassium level stabilizes. Twenty-one consecutive hyperkalemic patients managed with HyperK-Cocktail on 23 occasions are reported. None of the subjects had intravenous extravasation injuries, hypernatremia, hypocalcemia, hypercalcemia or alkalosis during HyperK-Cocktail infusion. Transient hyperglycemia developed in nine subjects and hypoglycemia in one subject. The decrease in serum potassium was similar in the initial hour when compared to prior studies using a beta-agonist and/or insulin and glucose; a larger decrease was present from 2 to 8 h with the HyperK-Cocktail. The plasma potassium decreased by a mean of 1.0, 1.7, 2.1 and 2.1 mmol/L at 1, 2, 4 and 8 h, respectively. The mean serum potassium at hours 1-8 was significantly lower than the initial level. The results of our study demonstrated that HyperK-Cocktail is a safe and effective combination therapy for children with hyperkalemia.

Instantaneous electrocardiographic changes and transient sinus rhythm restoration in severe hyperkalaemia

Severe hyperkalaemia is a life threatening electrolyte abnormality that if not treated urgently, might cause electric death. Hyperkalaemia induced electrocardiogram (ECG) alterations vary according to the levels and rate of increase of potassium concentration ([K +]) in the extracellular milieu but the paradox is that not all these cases provide ECG changes. We describe the first case in the literature of transient sinus rhythm (SR) recovery despite severe hyperkalaemia in a 57-year-old (yo) male patient with impressive ECG changes considering the heart rhythm and QRS morphology. We also review the literature for the mechanism of ECG alterations induced by hyperkalaemia.

Crise cœliaque associée à une tétraplégie par hypokaliémie de déplétion révélatrice d’une maladie cœliaque

Introduction Adult cœliac disease revealed by cœliac crisis and quadriplegia due to potassium depletion is an extremely rare situation. Case report A 26-year-old woman presented with a suddenly developed weakness of all four limbs and a severe diarrhea. Authors emphasize cœliac crisis, which is a presenting feature of cœliac disease, characterized by acute diarrhea with life-threatening acid base and electrolyte abnormalities. The patient improved with correction of hypokalemia and gluten-free diet. Conclusion A severe acute diarrhea with metabolic and systemic complications, the so-called cœliac crisis, is a possible presenting clinical feature of a previously undiagnosed adult celiac disease.

Renale tubuläre Azidose mit schwerer hypokaliämischer Tetraparese nach Ibuprofeneinnahme

A 72-year-old woman was admitted because of severe acute tetraparesis, more marked proximally. For six months she had been taking ibuprofen, up to 4800 mg daily, for a painful ulcer of the lower leg. Biochemical tests revealed marked hypokalaemia (serum potassium 1.4 mmol/l) with a metabolic acidosis (pH 7.29). The ECG showed changes of hypokalaemia (ST-segment depression and U wave). Within two days of administering potassium and bicarbonate the pareses completely regressed. Transitorily abnormal renal functions also rapidly normalized after ibuprofen had been discontinued. The biochemical findings suggest renal tubular acidosis, type 2, most likely caused by the excess intake of ibuprofen, a drug which can cause renal dysfunctions with life-threatening electrolyte abnormalities.

Constipation and Diarrhea in Patients with Cancer

Constipation and diarrhea are both common problems in patients with advanced cancer. They are source of major morbidity and distress. Constipation is, overall, more common that diarrhea. Diarrhea may be severe and, in some cases, associated with life-threatening dehydration and electrolyte abnormalities. Indeed, with some of the newer chemotherapy agents, this is a problem seen with increasing frequency. Oncologists must be familiar with the common causes of constipation and diarrhea in cancer patients and the strategies to evaluate and manage these common and distressing symptoms. Both with constipation and diarrhea, there is a differential diagnosis. In many cases, management can be complex and challenging. Approaches to diagnosis, evaluation, and management are reviewed.

Work-related burns.

Work-related upper extremity burns often occur. The cause directs the course of action. Thermal burns should be assessed for system alterations, and depth of burn should be determined. Deep partial-thickness burns and more severe burns require a specialist evaluation. Chemical burns must be irrigated and the agent identified. Some chemical burns, such as those that involve phenols and metal fragments, require specific topical applications before water lavage. Hydrofluoric acid burns can cause life-threatening electrolyte abnormalities with a small, highly concentrated acid burn. The goal with any extremity burn is to provide the patient with a multidisciplinary team approach to achieve a functional, usable extremity.

Part 8: Advanced Challenges in Resuscitation : Section 1: Life-Threatening Electrolyte Abnormalities

Part 8: Advanced Challenges in Resuscitation : Section 1: Life-Threatening Electrolyte Abnormalities

Part 8: Advanced Challenges in Resuscitation: Section 1: Life-Threatening Electrolyte Abnormalities

Part 8: Advanced Challenges in Resuscitation: Section 1: Life-Threatening Electrolyte Abnormalities

Duchenne Muscular Dystrophy and Glycerol Kinase Deficiency

Duchenne muscular dystrophy (DMD), glycerol kinase deficiency (GKD), and adrenal hypoplasia congenita (AHC) can occur together as part of a contiguous gene syndrome located at chromosome Xp21, GKD can manifest with recurrent episodes of vomiting, acidemia, mental retardation, or stupor. Involvement of the AHC gene can produce life-threatening adrenal insufficiency, sexual ambiguity, and electrolyte abnormalities. These associated conditions can make the diagnosis of DMD difficult. Neuromuscular specialists need to be aware of this contiguous gene syndrome because the potential life-threatening complications of GKD and AHC can be treated.

Intensive nursing care of kwashiorkor in Malawi

The case fatality rate for children with kwashiorkor in central hospitals in Malawi was 30.5% (275/901) in 1995. The purpose of this study was to determine whether improved case management with intensive nursing care could lower this case fatality rate. A total of 75 children admitted with kwashiorkor in Blantyre, Malawi, received intensive nursing care. This included nursing in individual clean beds with blankets, a nurse:child ratio of 1:3, supervised feedings every 2 h, a paediatrician with expertise in treating kwashiorkor always available for consultation, laboratory evaluation for systemic infection and empiric use of ceftriaxone. Nineteen of these children died (25%). The causes of death were life threatening electrolyte abnormalities (hypokalaemia, hyponatraemia, hypophosphataemia) in nine cases, overwhelming infection in eight cases and congestive heart failure in two children. Children infected with the human immunodeficiency virus were more likely to die (9/20), as were children with life threatening electrolyte abnormalities (9/15) and children with more severe wasting. When compared with 225 children treated in the same year at the same institution, who were carefully matched for severity of kwashiorkor, intensive nursing did not improve overall survival.

Life-threatening electrolyte abnormalities induced by hypertonic phosphate enema intoxication

We describe an elderly woman with a hyperphosphatemic hypocalcemic coma, hypernatremia, hypokalemia, metabolic acidosis, convulsions and respiratory and renal failure, following the administration of hypertonic sodium phosphate enemas. Physicians and pharmacists should be aware of the possible adverse effects that can be caused by these enemas.

Life-threatening electrolyte abnormalities induced by hypertonic phosphate enema intoxication

Life-threatening electrolyte abnormalities induced by hypertonic phosphate enema intoxication

Hypernatremia

Hypernatremia is a potentially life-threatening electrolyte abnormality. This problem develops most often because of loss of water from the animal, but in rare cases hypernatremia results from gain of sodium chloride. Important conditions predisposing to hypernatremia include diarrhea, vomiting, heat stroke, fever, limited access to water, excessive diuretic use, renal diseases, and pituitary diabetes insipidus. This condition rarely develops if animals have adequate access to water. Clinical signs relate to central nervous system derangements and can progress to seizures and coma. Diagnosis is based on the serum sodium concentration; treatment should be instituted if it is greater than 170 mEq per L. Treatment is based on knowledge of the volume status of the patient and the probable cause for the hypernatremia. In general, 5 per cent dextrose in water or other hypotonic fluids are given slowly intravenously. The rate of administration should be adjusted so the water deficit is replaced over 48 to 72 h. Too rapid correction of hypernatremia can lead to cerebral edema and worsening of the animal. In cases of salt intoxication, diuretics must be given in addition to slow water replacement to avoid the development of pulmonary edema.

Life-Threatening Fluid and Electrolyte Abnormalities Associated with Cancer

This article reviews the life-threatening fluid and electrolyte abnormalities that develop in association with, or as a result of neoplasms or their therapy. Ectopic hormone secretion by tumors and their resultant electrolyte aberrancies are also discussed. The emphasis of this article is on clinical phenomena encountered in the ICU that are specific to cancers and their therapy rather than being a review of electrolyte abnormalities in general. Each topic includes a discussion of the management of the abnormality.

Life-Threatening Fluid and Electrolyte Abnormalities in Patients with Cancer

PATIENTS WITH CANCER may develop abnormalities of fluid and electrolyte metabolism through many different mechanisms; these are (1) organ involvement with tumor; (2) obstruction by tumor; (3) release of tumor breakdown products; (4) ectopic hormone production by tumor;' (5) utilization of nutrients by tumor; or (6) in response to therapy. 2 In addition, they are subject to all of the nonneoplastic diseases that may afflict patients, particularly in the older age groups. 3 To avoid serious disturbances, we have set up a system at Memorial Sloan Kettering Cancer Center to monitor results from the routine biochemistry laboratory and to alert the medical staff to biochemical abnormalities that occur in their patients. Table 1-1 lists the parameters monitored, the limits outside of which values are considered life-threatening and the number of abnormalities noted in each category during 1976. More than 6,000 life-threatening biochemical derangements were reported during that year in our 562-bed hospital. This report will review fluid and electrolyte abnormalities that have been of most concern in our patient population, stressing the clinical situations in which derangements occur. For more extensive reviews of pathophysiology and therapy, the reader may consult the material referenced at the end of this article.