Normalization Of Serum Potassium Research Articles

A treatment resistant hypokalemia case associated with leflunomide

Introduction: Leflunomide is a disease-modifying antirheumatic drug which is used in the treatment of rheumatoid arthritis. The most common side effect of leflunomide is diarrhea, however, hypokalemia may also develop during treatment with this drug. Here, we present a case with treatment resistant hypokalemia in a patient who has been on leflunomide treatment for approximately 8 weeks for treatment of rheumatoid arthritis. Case report: Fifty six years old woman was admitted to internal medicine outpatient clinic with complaints of weakness, constipation, loss of appetite, abnormal weight loss (approximately 10 kilograms) and arthralgias for 3 weeks. Laboratory analyse revealed hypokalemia on admission (serum potassium: 2.3 mmol/L). Potassium chloride was infused in isotonic solutions with close monitoring; a potassium value of 4.5 mmol/L was achieved on the fifth day of treatment. Her complaints such as nausea, constipation, lack of appetite were decreased with normalization of serum potassium. Conclusion: We suggest close electrolyte monitoring is important if leflunomide treatment was planning especially in patients whose treatment regimens include multiple medications.

Tall P waves associated with severe hypokalemia and combined electrolyte depletion

A 32-year-old woman with anorexia nervosa showing tall P waves on electrocardiogram (ECG) was reported. Her ECG showed tall P waves (5.5mm in voltage, lead II) at 2.2mEq/L of serum potassium. After the treatment, P waves decreased in voltage with the normalization of serum potassium. Tall P waves may be considered to be the so-called pseudo-P pulmonale, and added to the criteria of hypokalemia on ECG.

Cocaine And Hyperkalemia Unmasked The Electrocardiogram (EKG) Pattern Of Brugada Syndrome

A very few case reports have indicated that hyperkalemia can induce a Brugada pattern in the electrocardiogram (EKG). On the other hand, very rare case reports have indicated that cocaine has precipitated life-threatening arrhythmias associated with development of Brugada syndrome. We present a 26-year old patient with hyperkalemia secondary to muscle damage and renal insufficiency after a reported large intake of cocaine. The electrocardiogram showed a Brugada pattern. These EKG changes disappeared directly after normalization of serum potassium. We concluded that cocaine and the hyperkalemia were probably the culprit causes of the Brugada-pattern EKG. Unfortunately, the provided data in this case appear to be incomplete; the patient was found unresponsive at home, and we do not exactly whether or not he developed a cardiac arrest secondary to a malignant arrhythmia before the arrival of the Emergency medical services. This case highlights the importance of recognizing cocaine and hyperkalemia as potentialtriggers of the acquired Brugada-like electrocardiographic pattern.

Hyperkalemia and cocaine induced dynamic Brugada-type electrocardiogram

Brugada syndrome is a well-defined clinical entity with the typical electrocardiographic changes in the right precordial leads (V1 and V2), attributed to mutation in SCN5A gene. Brugada-like electrocardiographic pattern can be replicated by sodium channel-blocking drugs and electrolyte abnormalities. We describe a 46-year-old individual, who presented with hyperkalemia secondary to muscle damage and renal insufficiency, after abusing cocaine. The electrocardiogram showed Brugada sign. The electrocardiogram changes disappeared after sodium bicarbonate administration and normalization of serum potassium. The case highlights the importance of recognizing cocaine and hyperkalemia, as potential triggers of the acquired Brugada sign.