Normal Serum Potassium Levels Research Articles

FRI125 Recurrence Of Primary Aldosteronism Long-Term After Adrenalectomy For Aldosterone-Producing Adenoma With KCNJ5 Gene Mutation: A Two-Cases Report

Abstract Disclosure: K. Aiga: None. M. Kometani: None. D. Aono: None. S. Karashima: None. T. Yoneda: None. Primary aldosteronism (PA) is a major cause of secondary hypertension. PA is known to have higher prevalence of cerebral or cardiovascular complications, indicating the importance of early detection and treatment for PA. PA is caused by autonomous secretion of aldosterone in the adrenal glands. PA is characterized by high plasma aldosterone concentration, low plasma renin activity and hypokalemia. PA is classified into unilateral PA (aldosterone-producing adenoma [APA] or unilateral hyperplasia) and bilateral PA (bilateral adrenal hyperplasia). PA with aldosterone excess in bilateral adrenal glands is defined as bilateral PA. On the other hand, PA with aldosterone excess in unilateral adrenal gland is defined as unilateral PA. Strategies for PA treatment depends on the subtype of PA. Medication by mineralocorticoid receptor antagonists is a common treatment for bilateral PA. Adrenalectomy is the most efficient treatment for unilateral PA. In general, patients tend to maintain normal serum potassium level and blood pressure after adrenalectomy, and recurrence of PA is extremely rare. Recently, mutation in the gene named KCNJ5 was found to derive APA. Herein, we report two cases of PA recurrence more than 10 years after surgical treatment for APA. Somatic mutation in KCNJ5 was detected in the first occurrence of PA in both cases. First case, a 52-year-old woman was examined for hypertension 22 years after total adrenalectomy of the right adrenal gland. Recurrent PA was diagnosed based on high aldosterone-renin-ratio (ARR), identification of left adrenal gland tumor by computed tomography (CT), and a confirmatory test. Second case, a 65-year-old man was examined for hypertension 17 years after total adrenalectomy of the left adrenal gland. He had maintained his blood pressure using medication since the onset of hypertension 4 years after the surgery. A year later, a high ARR was observed. PA recurrence was determined by a right adrenal gland tumor noted on CT and a confirmatory test. Tissues of the adrenal gland were obtained from adrenalectomy in both cases. Histopathological analysis revealed presence of one adenoma in the first case, while two adenomas were confirmed in the second case. Somatic mutation in KCNJ5 gene was detected in both cases. To date, there are no specific guidelines established for the management of recurrent PA. Early detection is crucial for the prevention of severe cardiovascular diseases. Long-term follow-up is recommended after the treatment of PA. Presentation: Friday, June 16, 2023

Electrolyte profile in COVID-19 patients: insights into outcomes

BackgroundSome evidence has provided that electrolyte disorders may be present upon presentation of patients with COVID-19 infection. We investigated serum sodium, potassium, calcium, magnesium, and phosphorus levels in large numbers of critically ill COVID-19 patients to identify its possible prognostic value in these patients.MethodsThis retrospective study included patients confirmed with COVID-19 infection admitted to critical care units of Zagazig University Hospital all over 1 year, from May 1, 2020, to April 30, 2021. We analyzed the data for possible correlations between serum electrolytes and patients’ outcomes.ResultsAmong 600 patients included in the study with a mean age of 51.33 ± 16.5 years, 44.16% were mechanically ventilated, and 30.66% died during hospital admission. Serum sodium, potassium, phosphorus, magnesium, and calcium were 141.96 ± 5.4, 4.33 ± 0.66, 3.76 ± 1.26, 2.21 ± 0.52, and 8.55 ± 0.85 respectively, at admission to the ICU. Unfavorable admission course and mortality were significantly associated with high normal serum sodium, potassium, and phosphorus levels and a low normal calcium level.ConclusionAlthough mean serum sodium, potassium, calcium, magnesium, and phosphorus were within normal levels in patients with COVID-19 at presentation, serum sodium, potassium, and phosphorus were significantly higher in those with poor outcomes, whereas calcium was significantly lower in those with poor outcomes.

#4964 ASSOCIATION OF DIETARY INTAKE WITH SERUM LEVELS OF PHOSPHORUS AND POTASSIUM IN THE ELDERLY HEMODIALYSIS PATIENTS IN KOREA

Abstract Background and Aims Dietary management of elderly (>60 years old) hemodialysis(HD) patients is very important for solving health problems and improving quality of life. Hyperphosphatemia and hyperkalemia in elderly HD patients are closely related to intake of dietary phosphorus and potassium from Koreans’ unique eating patterns. It is very difficult to manage the diet of hemodialysis patients due to the unique eating patterns of elderly Koreans. In the daily meal pattern, sodium and potassium contents are high in grain-based foods, soups, stews, and seasoned vegetables. And, there are various recipes for meals using a range of condiments, which increase serum phosphorus level. For this reason, it is necessary to educate dietary management using real-time Apps for the elderly in Korea. This study was designed to provide the base data for the development of a self-dietary management App for Korean elderly HD patients. Method This study was conducted on 237 elderly HD patients (149 males and 88 females) at nationwide 18 university hospitals. We collected anthropometric data, biochemical parameters, and dietary data of the subjects. Dietary data for usual intake were obtained by use of a food-frequency questionnaire (FFQ) consisting of 23 food meal items based on the Korean usual diets. For this dietary status evaluation, a newly constructed potassium and phosphorus content DB was used. Results The average age of the patients was 69.7± 11.6 years for men and 69.2±6.9 years for women and the duration of HD was 5.4 ± 4.9 years for men and 5.5±4.2 for women. The mean body mass index (BMI) was 23.24 ± 2.99 kg/m2, mean serum phosphorus level was 5.03 ± 9.59 mg/dl, and mean serum potassium level was 5.41 ± 8.58 mEqL. Hyperphosphatemia (> 4.5 mg/dl) was found in 45.8% of the subjects, and hyperkalemia(> 5.0 mEq/L) in 35.4%. Energy and protein were significantly lower than recommended intakes of HD patients(P = .027, P = .015). Lower intake of energy and protein was more significant in women. The intake of sodium and potassium was significantly higher than recommendation(P = .014, P = .021), which was more excessive in men. Serum phosphorus levels showed positive correlation with intake frequency of mixed grains rice (P = .011), noodle without broth(P = .000), vegetable soup(P = .039), and roasted beef(P = .047) in male patients. In case of female patients, intake of sweet potatoes was correlated with hyperphosphatemia (P = .047). Serum potassium levels showed a positive correlation with intake of Kimchi(P = .000), noodle without broth(P = .000), and ham(P = .018) in men. In women, sweet potatoes(P = .027) and medium-potassium fruits(P = .047) were correlated with serum potassium level. On the other hand, intake of white rice showed negative correlation with serum potassium levels(P = .037) in both sex. Conclusion Dietary management along with medical treatment is essential for maintaining serum phosphorus and potassium levels within acceptable ranges because the composition of the daily routine diet is very unique and varies in Korea. The results of this study showed that the intake of white rice rather than mixed grains is an important factor in sustaining normal serum phosphorus and potassium levels in the elderly Korean HD patients. In addition, limiting intake of sweet potatoes, medium and high potassium vegetables & fruits to under three servings per week is recommended. Therefore, customized dietary management needs to be regulated according to each individual's dietary pattern for the Korean elderly HD patients. Major variables found in this study can be used in the development of new App for customized self-dietary management.

The Heavy Heart: An Unusual Cause of Ventricular Tachycardia

A 17-year-old female presented to the emergency department with a one-hour history of abdominal pain, nausea, vomiting and weakness. Physical examination on admission revealed a heart rate of 106 beats per minute, blood pressure of 136/88 mmHg and a respiratory rate of 25 breaths per minute. Her medical history was unremarkable with no prior medical comorbidities or surgical history. She denied taking any prescribed or over the counter medications. The initial ECG showed ventricular tachycardia (VT) (Figure 1), with investigations revealing a normal troponin I level of <0.03ng/ml (reference range <0.3 ng/mL), elevated N-terminal pro-brain natriuretic peptide level of 439.2 ng/L (reference range <300 ng/L) and normal serum potassium level of 4.0 mmol/L (reference range 3.5-5.3 mmol/L). Over the next hours, the patient developed shallow respirations, with rapid worsening of muscle weakness involving all four limbs. An arterial blood gas obtained on room air revealed severe acidosis (pH, 7.178) and hypoxemia (PaO2, 65.8 mmHg). A repeated blood test conducted four hours after admission noted profound hypokalemia (serum potassium, 1.9 mmol/L).

The characteristics and costs of severe theophylline toxicity in a tertiary critical care unit in Eastern Cape Province, South Africa.

Severe theophylline toxicityrequiring haemodialysisaccounts for approximately one-third of drug toxicity cases admittedto theLivingstone Tertiary Hospital (LTH) intensive care unit (ICU) in Gqeberha, South Africa, imposing a significant resource burden. To investigate the characteristics and burden of severe theophylline toxicity in an Eastern Cape Province tertiaryhospital adult ICU. A retrospective review of all severe theophylline toxicity admissions to the ICU from 1 January 2013 to 31 December 2018 was conducted. Demographic and clinical data were captured and analysed. The National Department of Health 2019 fees schedule was used to calculate costs based on duration of ICU stay and number of haemodialysis sessions received. Of the 57 patients included in the study, 84% were cases of deliberate self-harm. The majority were aged <40 years (77%) and female (79%). The mean (standard deviation (SD)) initial serum theophylline level was 612 (269) µmol/L. Complications included convulsions (n=12; 21%), arrhythmias (n=9; 16%), need for mechanical ventilation (n=7; 12%) and death (n=4; 7%). The main risk factors for these complications were age ≥30 years, an inappropriately normal or elevated initial serum potassium level, an elevated serum creatinine kinase level and an elevated initial serum theophylline level. Receiver operator characteristic curve analysis assessing the initial serum theophylline level as a discriminator for life-threatening complications produced an area under the curve of 0.71 for serum theophylline >400 µmol/L (sensitivity 88%, specificity 12%). All the 4 patients who died had an initial serum theophylline level >1 000 µmol/L. The mean (SD) cost per admission amounted to ZAR16 897 (10 718), with a mean of one 4-hour dialysis session per admission. Severe theophylline toxicity, usually in the context of deliberate self-harm, is a preventable yet life-threatening toxicity encountered at LTH. Demographic risk factors include young females from certain areas in and around Gqeberha. Risk factors for complications include olderage, paradoxically normal or elevatedserumpotassiumlevels, elevatedserumcreatinine kinaselevelsandan initial serum theophylline level >400 µmol/L.Patients with these clinical features should be closely monitored and treated timeously at an appropriate level of care.The need for ICU admission and dialysis, both limited resources, makes the treatment of severe theophylline toxicity costly. Further studies of the underlying psychosocial drivers, local prescribing practicesand preventive interventionsrelated to severe theophylline toxicityare required.

Soaking to Reduce Potassium and Phosphorus Content of Foods

To achieve and maintain normal serum potassium and phosphorus levels reducing potassium and phosphorus intake is frequently recommended for adults living with chronic kidney disease. Exploring food preparation methods to reduce potassium and phosphorus content appears warranted. The study aim is to determine the impact of soaking foods in hot water on potassium and phosphorus content in a variety of plant- and animal-based foods. Twenty foods were selected that are common staples in Brazilian diet patterns. Food was soaked for 5-10minutes in deionized water that had been brought to a boil and then removed from heat using a 5-part water to 1-part sample ratio. The potassium content was determined by flame photometry. The phosphorus content was determined by visible ultraviolet spectrophotometry. Soaking foods resulted in a reduction in potassium and phosphorus. Potassium reduction in beef, green leafy vegetables, and grains was 40-49%; in chicken, fish, and nonleafy vegetables30-39%; and tubers 10-20%. Phosphorus reduction in grains and beans was 30-39%; in nonleafy vegetables20-29%; and beef, chicken, and fish 10-20%. Soaking foods in hot water for 5-10minutes reduces potassium and phosphorus content. Using this technique to prepare foods may be a more acceptable alternative to longer demineralization periods making it easier for adults living with chronic kidney disease to follow diet recommendations.

A rare case report of Urinary Bladder Paraganglioma

Paragangliomas are extra-adrenal tumors of the autonomic nervous system which is termed pheochromoctyoma in adrenal gland. These tumors are found within the skull base, neck, mediastinum and periaortic region. Paragangliomas of the urinary bladder are rare, and non-functioning bladder paraganglioma is even rarer and not easily recognized. Histopathological examination of the tumor is essential to establish the diagnosis of paraganglioma. This is a case report of 67year male patient presenting with hematuria and passage of blood clots per urethra in emergency department. Cystoscopic examination revealed an exophytic growth in upper posterior wall of his bladder with areas of hemorrhagic blood clots within the vicinity of growth. His blood pressure was found 120/75 mm of Hg with normal serum sodium and potassium levels. Bipolar transurethral resection of the bladder mass was performed. Intraoperative procedure was uneventful and no rise in blood pressure during resection was found. Histopathological examination with immunohistochemistry confirmed diagnosis paraganglioma, urinary bladder. Patient is doing well and is kept on follow up.

Potassium Level Variation Following Packed Cell Transfusion in Critically Ill Adult Patients-How Alert Should We Be?

One of the most clinically important effects following the administration of packed cell transfusion (PCT) is hyperkalemia, which can cause severe life-threatening cardiac arrhythmias. This retrospective population-based cohort study included adults hospitalized between January 2007 and December 2019 in a general intensive care unit for 24 h or more, with normal levels of serum potassium on admission. We assessed changes in serum potassium levels after administration of one unit of packed cells and sought to identify clinical parameters that may affect these changes. We applied adjusted linear mixed models to assess changes in serum potassium. The mean increase in serum potassium was 0.09 mEq/L (C.U 0.04–0.14, p-value < 0.001) among the 366 patients who were treated with a single PCT compared to those not treated with PCT. Increased serum potassium levels were also found in patients who required mechanical ventilation, and to a lesser degree in those treated with vasopressors. Hypertension, the occurrence of a cerebrovascular accident, and increased creatinine levels were all associated with reduced serum potassium levels. Due to the small rise in serum potassium levels following PCT, we do not suggest any particular follow-up measures for critically ill patients who receive PCT.

Avoiding The Severe Gastrointestinal Side Effects Associated with High Dose Potassium and Magnesium Supplementation with Gitelman’s Syndrome Through Utilization of Canagliflozin, Aliskiren and Spironolactone

Gitelman’s Syndrome is an inherited renal tubulopathy that is characterized by renal potassium and magnesium wasting leading to hypokalemia and hypomagnesemia. Previously the only available therapies for the hypokalemia and hypomagnesemia associated with Gitelman’s Syndrome were high dose oral potassium and magnesium supplements. With the availability of the SGLT-2 receptor blocker canagliflozin the need for magnesium replacement therapy can be minimized. Similarly, utilizing blockade of the renin and mineralocorticoid receptors with aliskiren and spironolactone respectively the need for oral potassium replacement can be avoided. By eliminating or reducing the need for oral potassium and magnesium replacement therapy, gastrointestinal problems, particularly diarrhea, can be avoided and the quality of life improved while achieving normal serum potassium and magnesium levels. In addition, by normalizing serum potassium and particularly by correcting serum magnesium levels, the risk of a cardiac arrythmia is also reduced

Annals for Educators - December 2021.

Annals for Educators - December 2021.

THE EFFECT OF NEBULIZED SALBUTAMOL ON SERUM POTASSIUM AND BLOOD SUGAR LEVEL OF ASTHMATIC PATIENTS

Background: To evaluate the effect of nebulized salbutamol used in the management of patients with asthma who have normal serum potassium and blood glucose levels.&#x0D; Methods: Hospital based prospective study conducted on 30 children mild exacerbation of asthma who needed two doses of 2.5 mg nebulized salbutamol, 10 minutes apart for the relief of their symptoms will be include.&#x0D; Results: The potassium mean was significantly decreased after 1 hour of nebulizer administration. The random blood sugar mean was significantly increased after 1 hour of nebulizer administration (p&lt;0.001).&#x0D; Conclusions: The nebulizer applying salbutamol has a profound effect in lowering the Potassium level and increasing blood glucose level after 60 minutes of administration.&#x0D; Keywords: effect, nebulized, salbutamol, blood sugar, serum potassium

English

BACKGROUND Organophosphorus (OP) pesticides are one of the most common cause of morbidity and mortality due to poisoning worldwide especially in agrarian countries like India. Hence it is prudent to undertake a detailed study of clinico-pathological evaluation of OP poisoning and assess the role of serum potassium as an alternative, easy and convenient prognostic indicator in estimating the severity of OP poisoning. This study was undertaken to assess serum potassium levels in patients of acute organophosphorus poisoning and determine association between serum potassium level and outcome in cases of acute organophosphorus poisoning. METHODS This was a prospective observational study conducted in Department of General Medicine, Silchar Medical College &amp; Hospital for one year from 1st June 2019 to 31st May 2020 with a sample size of 100 after satisfying the inclusion and exclusion criteria. Peradeniya organophosphorus poisoning (POP) scale was used for categorizing study population according to severity. RESULTS Among patients who were admitted with organophosphorus poisoning, 72 % of the patients discharged were having normal serum potassium levels on admission, whereas 22 % (n = 22) patients who died had hypokalaemia at the time of admission. The chi-square value for the association between serum potassium and outcome is statistically significant [P value is 0.001 (P &lt; 0.05)]. CONCLUSIONS The serum potassium level on the day of admission was significantly correlated with the severity of the acute organophosphate poisoning as determined by Peradeniya OP poisoning scale. The cases that had lower serum potassium levels on admission had poor outcome. Reduced serum potassium levels also had significant association with the need for ventilator support. Therefore, serum potassium can be used as a predictive marker of severity in organophosphorus poisoning. This can help in early triage of patients and will be helpful in reducing mortality and morbidity. KEYWORDS Organophosphorus Compound Poisoning, Serum Potassium, POP Scale

THE LEVEL OF INDICES OF ION COMPOSITION OF BLOOD IN INFANTS WITH CONGENITAL MALFORMATIONS IN SURGICAL CORRECTION

Newborns with severe congenital malformations need radical surgical correction as soon as possible for ensure the quality of life of the infant in the future. Pathological changes associated with the underlying pathology may be accompanied to severe disturbances of homeostasis in the postoperative period.&#x0D; The aim of the study. To assess the level of ionic composition of plasma in infants with congenital malformations during surgical correction and various types of combined anesthesia.&#x0D; Investigated problem: To prevent electrolyte peri- and postoperative complications, it is obligatory to perform preoperative preparation and stabilization of laboratory parameters, for a child with congenital malformations and to monitor they throughout the operation.&#x0D; The main scientific results: The electrolyte composition in the examined groups of infants did not show significant differences from age norms. The concentration of potassium was the lowest in group III of the examined in comparison with groups I and II at the stage of preparation for surgery (p=0.0041; p=0.0102), induction of anesthesia (p=0.0053; p=0.0054), while children of groups I and II were diagnosed with a tendency to the upper limit of normal serum potassium levels during all observation periods. Elevated sodium levels were diagnosed in group III at all stages of surgical treatment and in group II of infants with congenital malformations at the stage of the most painful and traumatic moment of surgery (159.94±4.89 – II, 139.27±3.043 – III, p=0.1857).&#x0D; The area of practical use of the research results: pediatric anesthesiology&#x0D; Innovative technological product: laboratory control&#x0D; Scope of the innovative technological product: neonatal intensive care unit, surgery

Potantial clinical application of potassium binders in patients with chronic heart failure in real life clinical practice: results from TREAT HF study

Abstract Purpose Hyperkalemia is increasingly prevalent and life-threatening condition in heart failure (HF). In clinical practice, hyperkalemia is also an important barrier to optimal application of RAASi. New potassium binders, sodium zirconium cyclosilicate and patiromer, were developed for the treatment of hyperkalemia. TREAT HF data were analyzed for the evaluation of potential clinical application of potassium binders in real life clinical care in HF patients. Methods TREAT HF is a network which undertakes multicenter, national, observational studies designed to evaluate HF patients' clinical characteristics and current treatment modalities. 1028 patients with the diagnosis of chronic HF, median age 64 years and median LVEF 30% who had potassium and GFR data were included in this analysis. In this patient population, 847 patients (82.6%) were receiving beta blockers, 739 (71.9%) were receiving ACE inhibitors or ARBs and 518 (50.4%) were receiving MRA. Patients with hyperkalemia (serum potassium ≥5.1 mEq/L) were considered candidate for potassium binders based on the criteria of HARMONIZE study. According to eGFR (mL/min) level, renal dysfunction was subclassified as: stage-1 (eGFR ≥90) (n=211), stage-2 (eGFR 60-&amp;lt;90) (n=398), stage-3 (eGFR 30-&amp;lt;60) (n=306) and stage 4–5 (eGFR &amp;lt;30) (n=113). Results In study population, median potassium level was 4.5 mEq/L, median creatinin level was 1.1 mg/dL and median eGFR was 65.5 mL/min. Overall, 82.9% of patients had normal serum potassium levels (≥3.5–5 mEq/l) and 14.3% of patients (n=147) were found to have hyperkalemia (≥5.1 mEq/L) and, hypokalemia was found in 2.8% of patients (n=30). Hyperkalemia was present in 10.9% (n=23) of patients with stage-1, 12.6% (n=50) of patients with stage-2, 17.0% (n=52) of patients with stage-3 and 19.5% (n=22) of patients with stage 4–5 renal dysfunction. In patients with eGFR &amp;lt;60 ml/min (n=419), hyperkalemia was much more prevalent than those with eGFR ≥60 ml/min (n=609) (17.6% and 11.9% respectively, p=0.011). In patients with stage 4–5 renal dysfunction who were receiving ACEI/ARB or combination of ACEI/ARB and MRA (RAASi), more patients had hyperkalemia than those not receiving RAASi therapy (23.4%, 20.0% and 12.5%, respectively). Conclusions This study suggested that in real life clinical practice, 14.3% of HF patients have hyperkalemia and seem to be eligible for the treatment of potassium binders. The risk of hyperkalemia increases with advanced stages of renal dysfunction and the use of RAASi, showing an increased clinical need for potassium binders in HF patients with renal dysfunction and in those receiving RAASi. Funding Acknowledgement Type of funding source: None

P0935ASSOCIATION OF DIETARY INTAKE WITH SERUM LEVELS OF PHOSPHORUS AND POTASSIUM IN KOREAN HEMODIALYSIS PATIENTS USING NEWLY DEVELOPED SEMI QUANTITATIVE FOOD FREQUENCY QUESTIONNAIRE(SEMI-FFQ)

Abstract Background and Aims Dietary intake patterns in hemodialysis (HD) patients in Korea are diverse and unique comparing with those of other countries. Hyperphosphatemia and hyperkalemia are closely related to intake of dietary phosphorus and potassium. Dietary intake of Korean HD patients was analyzed using newly developed semi-FFQ for Korean food in order to get the baseline data for improving a dietary management guide for Korean HD patients. Method We investigate the effects of consumed food on serum phosphorus and potassium levels of 128 HD patients(74 males and 54 females) in 6 tertiary referral hospitals using semi-FFQ consisting of 23 food meal items based on the Korean usual diets. Results The mean age was 59.7±11.6 years for males and 58.9± 9.3 years for females and the hemodialysis duration was 5.4±5.6 years for men and 5.4±3.9 years for women, respectively. Mean serum phosphorus level was 4.50±1.52 mg/dl and mean serum potassium level was 4.74±0.73 mEq/L. Hyperphosphatemia was found in 45.8% of the subjects, and hyperkalemia in 35.4%. Energy, protein and other nutrients intake were significantly lower than the recommended intakes for HD patients (p&amp;lt;0.05). Serum phosphorus levels showed positive correlation with intake of mixed grain meals (p&amp;lt;0.05). There was a significant difference in the daily intake frequency of cooked rice between males (2.5±0.76/day) and females (2.15±0.86/day)(p&amp;lt;0.001). The noodle intake frequency also showed a significant difference between males (0.09±0.14/day) and females (0.04±0.06/day) (p&amp;lt;0.001). Serum potassium level showed positive correlation with intake of potatoes, high-potassium vegetables &amp; fruits and Kimchi (p&amp;lt;0.05). There was a significant gender difference in the daily intake frequency of Kimchi between males (1.28±0.11/day) and females (1.07±0.99/day)(p&amp;lt;0.05). In case of medium and high potassium vegetables &amp; fruits, consumption was higher in females than in males (p&amp;lt;0.05). Intake of white rice showed negative correlation with serum potassium levels (p&amp;lt;0.05). Conclusion Intake of white rice meals rather than mixed grains meals is an important factor for maintaining normal serum phosphorus and potassium levels. Intake of potatoes, medium and high potassium vegetables &amp; fruits is recommended to be reduced to less than three serving per week. Considering abundance of potassium and phosphorus in Korean food pattern, customized dietary management as well as medical treatment is essential in all HD patients.

P0750ASSOCIATION OF SERUM POTASSIUM LEVELS WITH RAPID KIDNEY FUNCTION DECLINE IN PATIENTS WITH CONGENITAL SINGLE KIDNEY

Abstract Background and Aims Hypokalemia is associated with progression of chronic kidney disease (CKD), although the possible underlying mechanisms are not well established. Several observational studies showed that low or even low to normal serum potassium levels predict the decline of kidney function in the general population. However, this hypothesis has not been yet investigated in patients with reduced nephron number as are congenital single kidney (cSK) patients. Our aim was to prospectively examine the association of plasma potassium with risk of rapid kidney function decline in a cSK patients’ cohort. Method A cohort of 67 consecutive patients with cSK (mean age = 44.4+/-15.7 years; males 29p (43.28%)), with a mean estimated glomerular filtration rate (eGFR) = 65.2+/-28 ml/min/1.73m2, were enrolled in this longitudinal observational study. We evaluated the associations of plasma potassium levels with longitudinal kidney function decline by estimated glomerular filtration rate (eGFR). The eGFR was assessed with CKD-EPI formula. The rapid kidney function decline was defined as a fall in eGFR of more than 5 ml/min/1.73 m2/year, according to the KDIGO guidelines. Results During a mean follow-up time of 20.16+/-9.3 months, 31.34% (21p) of patients presented decline of eGFR, with a fall of mean – 11.6+/-5.43 ml/min/1.73m2/year. In univariable regression analysis, the decline of eGFR was associated with baseline eGFR (R2=0.09, p=0.013), age (R2=0.31, p&amp;lt;0.001), male gender (R2=0.14, p=0.001), arterial hypertension (R2=0.17, p=0.001), diabetes mellitus (R2=0.13, p=0.003), coronary artery disease (R2=0.12, p=0.005), uric acid (R2=0.23, p&amp;lt;0.001), C-reactive protein (R2=0.09, p=0.011), proteinuria/24h (R2=0.14, p=0.002) and serum potassium (R2=0.29, p&amp;lt;0.001). The serum potassium levels were significantly lower in the group with rapid decline of eGFR, with a mean of 3.62+/-0.41 mmol/L vs. 4.51+/-0.74 mmol/L, p&amp;lt;0.001. In multivariable regression analysis, the association between lower serum potassium levels and risk of rapid eGFR decline remained significant (HR=1.65; 95%CI, 1.105-2.49; p=0.015). Conclusion These results suggest that lower serum potassium levels may play a role in rapid kidney function decline in the cSK population. Further research is required to assess whether the higher risk of kidney function decline in cSK individuals could be diminished when optimised serum potassium levels strictly.

ST-Segment Elevation and Normokalemia in Acute Diabetic Ketoacidosis: Case Report and Brief Literature Review

Background: Diabetic Ketoacidosis (DKA) is a life-threatening complication of Diabetes Mellitus Type 1 (DM1) and requires prompt management; however, benign transient electrocardiographic (ECG) abnormalities with normal serum potassium levels can be seen in diabetic patients secondary to metabolic changes. Understanding the varying presentation among patients provides valuable insight into the management of this seemingly uncommon and benign diagnosis.&#x0D; The Case: A 24-year-old male with a history of DM1 presented to the Emergency Department (ED) with ST-segment elevation, normal potassium levels and metabolic acidosis. The patient was found to be in DKA with benign cardiac manifestations.&#x0D; Conclusion: The correction of underlying metabolic abnormalities in DKA and the awareness of the benign cardiac pseudo pathology on ECG allows for effective management and personalized patient care.

Giant asymmetrically peaked T-waves in a child with raised intracranial pressure due to acute central nervous system infection: A case report and review of the literature

Although various changes in electrocardiogram (ECG) were reported with normal serum potassium levels in acute intracranial pathology, giant asymmetrical T-wave change has not been reported. We report a case of a previously healthy male child who presented with acute febrile illness and features of raised intracranial pressure. Full standardized ECG shows normal sinus rhythm and tall, broad, and giant asymmetrically peaked T-wave. Serum potassium, echocardiography, and cardiac injury marker were normal. The child managed with supportive care and antimicrobials and showed recovery in 7 days.

Real-World Associations of Renin-Angiotensin-Aldosterone System Inhibitor Dose, Hyperkalemia, and Adverse Clinical Outcomes in a Cohort of Patients With New-Onset Chronic Kidney Disease or Heart Failure in the United Kingdom.

BackgroundDosing of renin–angiotensin–aldosterone system inhibitors (RAASi) may be modified to manage associated hyperkalemia risk; however, this approach could adversely affect cardiorenal outcomes. This study investigated real‐world associations of RAASi dose, hyperkalemia, and adverse clinical outcomes in a large cohort of UK cardiorenal patients.Methods and ResultsThis observational study included RAASi‐prescribed patients with new‐onset chronic kidney disease (n=100 572) or heart failure (n=13 113) first recorded between January 2006 and December 2015 in Clinical Practice Research Datalink and linked Hospital Episode Statistics databases. Odds ratios associating hyperkalemia and RAASi dose modification were estimated using logistic generalized estimating equations with normal (<5.0 mmol/L) serum potassium level as the reference category. Patients with serum potassium ≥5.0 mmol/L had higher risk of RAASi down‐titration (adjusted odds ratios, chronic kidney disease: 1.79 [95% CI, 1.64–1.96]; heart failure: 1.33 [95% CI, 1.08–1.62]). Poisson models were used to estimate adjusted incident rate ratios of adverse outcomes based on total RAASi exposure (<50% and ≥50% of the guideline‐recommended RAASi dose). Incidence of major adverse cardiac events and mortality was consistently higher in the lower dose group (adjusted incident rate ratios: chronic kidney disease: 5.60 [95% CI, 5.29–5.93] for mortality and 1.60 [95% CI, 1.55–1.66] for nonfatal major adverse cardiac events; heart failure: 7.34 [95% CI, 6.35–8.48] for mortality and 1.85 [95% CI, 1.71–1.99] for major adverse cardiac events).ConclusionsThe results of this real‐world analysis highlight the potential negative impact of suboptimal RAASi dosing and the need for strategies that allow patients to be maintained on appropriate therapy, avoiding RAASi dose modification or discontinuation.

New frontiers for management of hyperkalaemia: the emergence of novel agents.

Hyperkalaemia is a common electrolyte abnormality, associated with higher risk of morbid events, and increasing in prevalence—in part, due to increasing rates of comorbidities such as heart failure, chronic kidney disease, diabetes mellitus, and the use of renin-angiotensin-aldosterone system inhibitors (RAASi). In spite of this growing problem, the existing treatments for chronic hyperkalaemia have been limited, and are typically confined to dietary potassium restrictions and cessation or modification of RAASi, with latter option being potentially problematic given the known morbidity and mortality benefit of RAASi therapy in certain disease states, such as heart failure. The use of sodium polystyrene sulfonate (SPS/Kayexelate) for chronic hyperkalaemia has been low, due to poor tolerability, potential gastrointestinal safety concerns, and remaining uncertainty in regards to its efficacy. Given the shortcomings of existing therapies, novel treatments are clearly needed. There are now two novel treatment options, patiromer and sodium zirconium cyclosilicate (SZC), both approved by the FDA and EMA for treatment of chronic hyperkalaemia. These novel compounds have been demonstrated in multiple studies to be efficacious in achieving and maintaining normal serum potassium levels, over an extended time period, in patients with hyperkalaemia; and appear to be relatively safe and well-tolerated. Whether the correction of hyperkalaemia with these agents will allow optimization of RAASi, which could theoretically lead to improvement in clinical outcomes, especially in patients with heart failure, remains to be determined. Several clinical trials are ongoing to address these important knowledge gaps.