1/46. Acute hyperkalemia associated with intravenous epsilon-aminocaproic acid therapy.Epsilon-aminocaproic acid (Amicar) is used to treat severe hemorrhage refractory to usual medical management. This antifibrinolytic drug has been associated with a number of renal complications. However, there are no descriptions of this medication causing hyperkalemia. This report describes the development of hyperkalemia in a patient with underlying chronic renal insufficiency treated with intravenous epsilon-aminocaproic acid. The patient, who underwent coronary artery bypass grafting, had no other obvious cause for the acute increase in serum potassium concentration. Based on data in animals and humans, the cationic amino acids lysine and arginine have been shown to enter muscle cells in exchange for potassium and lead to hyperkalemia through a shift of potassium from the intracellular to the extracellular space. Epsilon-aminocaproic acid, a synthetic amino acid structurally similar to lysine and arginine, also has been noted to cause an acute increase in serum potassium in anephric dogs infused with this medication. It is probable that the mechanism underlying the increase in serum potassium with epsilon-aminocaproic acid is also based on the shift of potassium from the intracellular to the extracellular space. Hence, it appears that intravenous epsilon-aminocaproic acid can also cause hyperkalemia in humans.- - - - - - - - - - ranking = 1keywords = hyperkalemia (Clic here for more details about this article) |
2/46. Noni juice (morinda citrifolia): hidden potential for hyperkalemia?We report the case of a man with chronic renal insufficiency who self-medicated with an alternative medicine product known as noni juice (morinda citrifolia). The patient presented to the clinic with hyperkalemia despite claiming adherence to a low-potassium diet. The potassium concentration in noni juice samples was determined and found to be 56.3 mEq/L, similar to that in orange juice and tomato juice. Herbal remedies and alternative medicine products may be surreptitious sources of potassium in patients with renal disease.- - - - - - - - - - ranking = 0.625keywords = hyperkalemia (Clic here for more details about this article) |
3/46. Severe hyperkalemia in two renal transplant recipients treated with standard dose of trimethoprim-sulfamethoxazole.hyperkalemia is a serious electrolyte disorder and is a frequent finding in renal transplant recipients. trimethoprim-induced hyperkalemia has been increasingly reported in recent years. We describe two renal transplant recipients who developed end-stage renal disease secondary to familial mediterranean fever and presented with severe hyperkalemia secondary to the use of standard dose of trimethoprim. One of the patients had potential underlying adrenal insufficiency, which might be a contributing factor for the development of hyperkalemia. We concluded that renal transplant patients receiving even the standard dose of trimethoprim should be monitored closely for the development of hyperkalemia. They should be recognized as a group with increased risk in regard to their concurrent renal insufficiency, concomitant use of cyclosporine, and associated tubulointerstitial disease. patients with secondary amyloidosis are at even greater risk, and subclinical adrenal insufficiency may be an underlying risk factor for the development of severe, life-threatening hyperkalemia among this group of patients.- - - - - - - - - - ranking = 1.125keywords = hyperkalemia (Clic here for more details about this article) |
4/46. Electrocardiographic manifestations of hyperkalemia.hyperkalemia is one of the more common acute life-threatening metabolic emergencies seen in the emergency department. early diagnosis and empiric treatment of hyperkalemia is dependent in many cases on the emergency physician's ability to recognize the electrocardiographic manifestations of hyperkalemia. The electrocardiographic manifestations commonly include peaked T-waves, widening of the QRS-complex, and other abnormalities of altered cardiac conduction. Peaked T-waves in the precordial leads are among the most common and the most frequently recognized findings on the electrocardiogram. Other "classic" electrocardiographic findings in patients with hyperkalemia include prolongation of the PR interval, flattening or absence of the P-wave, widening of the QRS complex, and a "sine-wave" appearance at severely elevated levels. A thorough knowledge of these findings is imperative for rapid diagnosis and treatment of hyperkalemia.- - - - - - - - - - ranking = 1keywords = hyperkalemia (Clic here for more details about this article) |
5/46. Evidence for specialized atrioventricular conduction in hyperkalemia.A patient who had chronic coarse atrial fibrillation developed severe hyperkalemia accompanied by total loss of fibrillatory waves while an irregularly irregular ventricular rhythm persisted. Correction of hyperkalemia resulted in prompt return of coarse atrial fibrillation. This sequence of events renders strong support to direct atrioventricular conduction through the specialized internodal tracts.- - - - - - - - - - ranking = 0.75keywords = hyperkalemia (Clic here for more details about this article) |
6/46. life-threatening hyperkalemia after intravenous labetolol injection for hypertensive emergency in a hemodialysis patient.Intravenous labetolol, a nonselective alpha- and beta-blocking drug, is commonly used to treat severe hypertension. Nonselective beta-blockers can cause hyperkalemia, especially in patients with renal failure. One series reported 3 renal transplant patients who had hyperkalemia after labetolol infusion, but none of these patients developed any serious complication. We report a case of life-threatening hyperkalemia (serum [K ] 9.9 mEq/l) with ventricular tachycardia and hypotension in a patient on maintenance hemodialysis who received labetolol for a hypertensive emergency. physicians should be aware of this potentially lethal complication, which is easily preventable.- - - - - - - - - - ranking = 0.875keywords = hyperkalemia (Clic here for more details about this article) |
7/46. life threatening hyperkalemia and acidosis secondary to trimethoprim-sulfamethoxazole treatment.We present a 77-year-old male with moderate chronic renal insufficiency from diabetic nephropathy who developed severe metabolic acidosis and life threatening hyperkalemia on treatment with regular dose of trimethoprim-sulfamethoxazole (TMP-SMZ) for urinary tract infection. The metabolic acidosis and hyperkalemia resolved upon appropriate medical intervention and discontinuation of TMP-SMZ. While hyperkalemia has commonly been reported with high dose of TMP-SMZ, severe metabolic acidosis is quite uncommon with regular dose TMP-SMZ. We emphasize that patients with renal tubular acidosis (RTA), renal insufficiency, aldosterone deficiency, old age with reduced renal mass and function, and angiotensin converting enzyme (ACE)-inhibitor therapy are at high risk of developing these severe and potentially life threatening complications.- - - - - - - - - - ranking = 0.875keywords = hyperkalemia (Clic here for more details about this article) |
8/46. Severe rhabdomyolysis due to malignant hyperthermia during renal transplantation procedure can cause delayed graft function.A case of rhabdomyolysis from malignant hyperthermia occurred during renal transplantation surgery is presented. After the completion of vascular and uretherovesical anostomosis, the patient's heart rate began to rise, sweatiness was observed and body temperature increased to 41 degrees C. Additionally, metabolic and respiratory acidosis and hyperkalemia were detected. serum creatine kinase and lactic dehydrogenase levels were increased significantly. After external cooling and the administration of dantrolene sodium, body temperature and heart rate were decreased. During this period; furosemide, mannitol and sodium bicarbonate were given. Three hours after the completion of surgery, urine output was begun and urine myoglobin was found to be positive. Renal function improved gradually and serum creatinine level decreased to 1.6 mg/dl on the 14th postoperative day. malignant hyperthermia can lead to severe rhabdomyolysis and delayed graft function in renal transplant recipients. early diagnosis and intervention is crucial for protecting renal function.- - - - - - - - - - ranking = 0.125keywords = hyperkalemia (Clic here for more details about this article) |
9/46. The prominant T wave: electrocardiographic differential diagnosis.The prominent T wave is an abnormal T-wave morphology encountered in the earliest phase of ST-segment elevation acute myocardial infarction (AMI). Prominent T waves, however, are associated with other diagnoses, including hyperkalemia, early repolarization, and left ventricular hypertrophy (LVH). This article focuses on the electrocardiographic differential diagnosis of the prominent T wave with the presentation of 4 illustrative cases. We also recommend that the designation hyperacute should refer exclusively to the prominent T waves of ST-segment elevation AMI.- - - - - - - - - - ranking = 0.125keywords = hyperkalemia (Clic here for more details about this article) |
10/46. Intraoperative washing of long-stored packed red blood cells by using an autotransfusion device prevents hyperkalemia.IMPLICATIONS:Long-stored packed red blood cells (PRBCs) have a large potassium load. In patients with end-stage renal failure, the transfusion of such PRBCs may cause a critical increase in plasma potassium levels. Washing PRBCs with an autotransfusion device allows for a marked decrease in potassium load, thus preventing hyperkalemia.- - - - - - - - - - ranking = 0.625keywords = hyperkalemia (Clic here for more details about this article) |
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