1/8. From profound hypokalemia to life-threatening hyperkalemia: a case of barium sulfide poisoning.We describe a 25-year-old man who was brought to the emergency department with skeletal muscle weakness, respiratory arrest, and rhabdomyolysis, as well as life-threatening hyperkalemia, after ingesting a depilatory containing barium sulfide (magic Shave; Carson Products Co, Savannah, Ga). The findings of his physical examination were significant for hyporeflexia with marked weakness. He was in respiratory distress and required intubation and ventilatory support owing to progressive weakness of the respiratory muscles. His serum potassium level was 1.5 mmol/L. He was treated with intravenous and oral potassium. His serum potassium level peaked at 8.3 mmol/L and his serum creatine kinase level at 8286 IU/L. His acute respiratory weakness resolved with correction of the potassium concentration; his rhabdomyolysis responded well to hydration; and his renal function returned to normal. We also discuss the various pathophysiological findings in this case and compare our patient with another who, despite ingesting a similar amount of the same hair remover, did not develop any of the above complications.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/8. Complex ventricular arrhythmia induced by overuse of potassium supplementation in a young male football player. Case report.People practising regular physical activity usually drink hydrosaline beverages. In this study is reported the case of a young football player suffering from premature ventricular beats. He used to take regularly an hydrosaline supplementation which gave him a daily intake of potassium of about 5 g. A stress test on a cycle ergometer showed many monomorphus premature ventricular beats which disappeared when the heart rate was higher than 110 beats/min. Moreover, 3629 polimorphus premature ventricular beats were recorded during a 24 hr ECG monitoring. At the time of the first examination, the plasma potassium concentration was 7,8 mEq x l(-1). The football player was then suspended from practicing sport and he was asked to stop his intake of potassium. The clinical examination was repeated after 3 and 6 months and no ventricular arrhythmias were observed during the stress test as well as during the 24 hours ECG monitoring. The plasma potassium concentration was normal again. The present case report is an example of how the misuse of saline supplementations could result in hyperkalemia and how this condition may lead to ventricular arrhythmias.- - - - - - - - - - ranking = 0.11433241232719keywords = physical (Clic here for more details about this article) |
3/8. electroconvulsive therapy complicated by life-threatening hyperkalemia in a catatonic patient.electroconvulsive therapy (ECT) requires brief general anesthesia, and succinylcholine is a depolarizing neuromuscular blocking agent that is frequently used for this procedure. Its use leads to intracellular potassium release into the extracellular space, usually increasing the serum potassium level by 0.5-1 mEq/L, with little clinical significance. However, long-term immobilization has been associated with changes at the neuromuscular junction (up-regulation of nicotinic cholinergic receptors) and subsequent serious hyperkalemia following succinylcholine administration. We report the case of a severely obese patient, immobilized due to her catatonic state, who developed life-threatening ventricular tachycardia after succinylcholine administration for ECT. Resumption of normal physical activity reverses these neuromuscular junctional changes, allowing subsequent safe succinylcholine administration. Current drug development may eliminate the need for succinylcholine use during ECT.- - - - - - - - - - ranking = 0.11433241232719keywords = physical (Clic here for more details about this article) |
4/8. pseudohypoaldosteronism: case report and discussion of the syndrome.A 41-year-old man, complaining of leg cramps, was found to have persistent hyperkalemia. Except for mild hypertension, his physical examination and laboratory values to exclude connective tissue diseases and diabetes mellitus were normal. Renal function testing revealed a normal glomerular filtration rate and tubular capacity to acidify and dilute, as well as near-normal ability to concentrate his urine. Hormonal evaluation revealed a normal cortisol, as well as normal resting and stimulated renin and aldosterone levels. A selective defect in tubular potassium secretion was demonstrated. In the absence of aldosterone deficiency or renal dysfunction, it was assumed that the patient had primary renal resistance to aldosterone, known as pseudohypoaldosteronism. Treatment with hydrochlorothiazide controlled his hyperkalemia and hypertension. His case emphasizes the diagnostic and therapeutic factors that should be considered in evaluating and treating a non-hospitalized patient with sustained hyperkalemia.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/8. Continuous arteriovenous hemofiltration as emergency procedure in severe hyperkalemia.Severe hyperkalemia due to acute renal failure occurred in a preterm infant of a diabetic mother. Despite infusions of calcium gluconate, sodium bicarbonate, glucose, and insulin, the rapidly increasing serum potassium concentration resulted in ventricular flutter. After cardiac resuscitation, continuous arteriovenous hemofiltration was started for potassium elimination. Within 3 h of extracorporeal renal replacement therapy, serum potassium was lowered from 9.4 to below 7 mEq/l. Because of persisting oliguria continuous arteriovenous hemofiltration was continued for 60 h. The infant was discharged from the hospital at the age of 4 weeks with normal physical and neurological findings.- - - - - - - - - - ranking = 0.11433241232719keywords = physical (Clic here for more details about this article) |
6/8. rhabdomyolysis and myoglobinuria as manifestations of child abuse.rhabdomyolysis should be suspected in cases of physical child abuse in which there is extensive soft tissue injury. It is easily investigated using the urinalysis and serum CPK levels. Renal failure is the most common complication and manifests itself as acute tubular necrosis, sometimes accompanied by the following specific laboratory abnormalities: elevated creatinine-to-BUN ratio, hyperkalemia, and myoglobinuria. Treatment is aimed at the preservation of renal function and the prevention of complications caused by electrolyte abnormalities. A full recovery can be expected for adults with this disorder, but information about the pediatric population is sparse. Our series suggests rapid improvement with appropriate therapy.- - - - - - - - - - ranking = 0.11433241232719keywords = physical (Clic here for more details about this article) |
7/8. Suxamethonium and cardiac arrest.We report a case of cardiac arrest due to hyperkalaemia following administration of suxamethonium during a procedure to facilitate a change of endotracheal tube in a septic patient. The cause of this rare but fatal complication is briefly described and discussed. In view of this, suxamethonium should be used with great caution in patients with burns and other forms of physical injury, in a number of nervous system disorders, and in critically ill patients requiring prolonged ITU care.- - - - - - - - - - ranking = 0.11433241232719keywords = physical (Clic here for more details about this article) |
8/8. A 42-year-old man with rhabdomyolysis from substance abuse and minor trauma.During initial assessment and care of this patient, an element of disbelief of the patient's inability to move his extremities was expressed. Manifestation of a severe injury such as that affecting the spinal cord after an extended period of time would be unusual. All other causes of altered motor function should be promptly investigated. The importance of listening and believing the patient was reinforced with this case. Many excellent clinicians will state that 80% of the diagnosis comes from the patient history. The physical examination and diagnostic tests should only validate what has been obtained from listening to the patient. Although we had cared for patients with hyperkalemia in the past, this case expanded our knowledge about a range of therapies available to treat this electrolyte abnormality and the physiologic mechanisms for each. We are impressed with the number of mechanisms and medications that can contribute to the development of rhabdomyolysis. caregivers are at risk of assuming that the patient's condition fits the category to which they have been triaged. Keeping an open mind concerning the range of rationale for patient signs and symptoms is important.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |