1/11. 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) |
2/11. Hypopotassemic paralysis: a rare presentation of proximal renal tubular acidosis.neurologic manifestations can accompany systemic diseases, and primary disease can be identified with a careful history, physical examination, and laboratory investigations. A 14-year-old girl with paraplegia and absence of deep tendon reflexes in the lower extremities after 2 days of vomiting and diarrhea was referred to our pediatric neurology department with a diagnosis of guillain-barre syndrome. Short stature, dehydration, motor and mental retardation, bilateral cataracts, glaucoma, and band keratopathy were detected on physical examination. Hypopotassemia and severe metabolic acidosis were found on biochemical examination. Her paraplegia improved after appropriate fluid and electrolyte replacement, but metabolic acidosis persisted after cessation of intravenous therapy, and isolated proximal renal tubular acidosis was detected. Because she had isolated proximal renal tubular acidosis and other abnormalities, she was diagnosed with Donckerwolcke-Winsnes syndrome.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
3/11. Fatal hypokalemic thyrotoxic periodic paralysis presenting as the sudden, unexplained death of a Cambodian refugee.For the last decade, death investigators have been aware of an unexplained syndrome of sudden death occurring among young adult Southeast Asian refugees. Presented here is a rare instance of fatal hypokalemic periodic paralysis associated with thyrotoxicosis masquerading as the sudden, unexplained death of a Cambodian refugee. The usual features of this syndrome were present, including relatively occult thyrotoxicosis, paralysis upon awakening following a high-carbohydrate meal, and hypokalemia. This case illustrates the value of thorough background death investigation and also illustrates the potential of misinterpreting traditional folk medicine coin rubbing (Cao Gio) as signs of physical abuse.- - - - - - - - - - ranking = 0.10541410782393keywords = physical (Clic here for more details about this article) |
4/11. Jack o'lantern mushroom poisoning.The cases of seven adults who ingested jack o'lantern mushrooms are presented. All patients experienced nausea and vomiting associated with abdominal cramping, and three reported diarrhea. Four of the seven complained of weakness and dizziness. Two were diaphoretic on physical examination. All seven were given IV fluids and oral activated charcoal in a local emergency department and admitted overnight for observation. Laboratory studies showed three of the seven patients to have mildly elevated liver function tests. One patient had hypokalemia requiring potassium supplementation. All were discharged the following day with normal follow-up examinations and laboratory studies. We recommend that all patients presenting with jack o'lantern mushroom poisoning be observed and rehydrated and have baseline liver function tests and potassium levels obtained.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/11. Severe hypokalaemic paralysis from an unusual cause mimicking the Guillain-Barre syndrome.We report a case of hypokalaemic quadriparesis occurring 37 years after a bilateral ureterosigmoidostomy. The history and physical signs as well as cerebrospinal fluid analysis initially led to a diagnosis of guillain-barre syndrome. acidosis and profound hypokalaemia were present and a dramatic improvement occurred after rapid correction of the potassium depletion. The underlying mechanism of potassium depletion which occurs after this mode of urinary diversion are briefly discussed.- - - - - - - - - - ranking = 0.10541410782393keywords = physical (Clic here for more details about this article) |
6/11. hypokalemic periodic paralysis.Generalized motor weakness is a common complaint in the emergency department and has a wide differential diagnosis that includes both organic and infectious etiologies. We report the case of a previously healthy young man with symptoms of muscular paralysis and associated hypokalemia. The clinical presentation of hypokalemic periodic paralysis, its differential diagnosis, and pertinent physical findings are discussed.- - - - - - - - - - ranking = 0.10541410782393keywords = physical (Clic here for more details about this article) |
7/11. Normotensive primary aldosteronism.A very unusual case of normotensive primary aldosteronism is described. A 25 year old woman first noticed numbness of both hands followed by a typical tetany attack. The blood pressure was within normal ranges. The results of other physical examinations were negative except for the findings of Trousseau's sign. Hypokalemi, increased potassium clearance, disturbed urine concentration and increased circulating plasma volume were noticeable. diagnosis was established by (1) increased levels of plasma aldosterone, (2) low plasma renin activity, (3) normal adrenocortical function and (4) typical aldosterone-producing adenoma. After removal of the adenoma, the abnormalities subsided. The lack of hypertension in primary aldosteronism is a rare condition. Several possible causes of normotension must be considered, such as the early phase of primary aldosteronism, essential hypotension associated with primary aldosteronism and lack of concomitant secretion of other mineralocorticoids from the adenoma, but these were all negligible. As blood pressure response to the administration of angiotensin ii was lower than is typical for primary aldosteronism, and the patient transiently suffered from frequent attacks of blackouts soon after the operation, the cause of normotension was thought to be due to the existence of a hypotensive mechanism which counteracts the increase in blood pressure in primary aldosteronism.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/11. Hypokalemic thyrotoxic periodic paralysis in a Caucasian male with Graves' disease.The case of a 34-yr-old Caucasian male with Graves' disease presenting with a flaccid quadriplegia and severe hypokalemia is reported. The weakness was prevalent at the lower extremities and began during nocturnal sleep, after a strenuous physical exertion performed during the day. Correction of hypokalemia promptly reversed the quadriplegia. The occurrence of hypokalemic thyrotoxic periodic paralysis several months after the beginning of thyrotoxic symptoms, and the normal insulin serum levels on admission differentiate this patient from most of the previously reported cases.- - - - - - - - - - ranking = 0.10541410782393keywords = physical (Clic here for more details about this article) |
9/11. Cushing's syndrome secondary to malignant lipoid cell tumor of the ovary.Malignant lipoid cell tumors of the ovary are rare lesions that are frequently associated with endocrinologic abnormalities. A case of a woman with this lesion who developed Cushing's syndrome with progression of tumor is presented. Neither aggressive medical therapy with ketoconazole nor multiagent chemotherapy was beneficial in controlling tumor growth or physical and biochemical manifestations of Cushing's syndrome.- - - - - - - - - - ranking = 0.10541410782393keywords = physical (Clic here for more details about this article) |
10/11. Adaptation to severe chronic hypokalemia in anorexia nervosa: a plea for conservative management.Severe hypokalemia may constitute a life-threatening medical emergency. In the group of purging eating disorder patients, potassium blood levels tend to be chronically low while physical signs and symptoms may be absent. Nevertheless, these patients are frequently subjected to vigorous supportive treatment and often an aggressive diagnostic workup. We present a chronic purging anorexia nervosa patient in whom potassium blood levels reach a low of 1.6 mmol/L in the absence of physical symptoms. Purging eating disorder patients adapt to chronic hypokalemia. We believe the clinical/medical approach to this electrolyte disturbance in chronic eating disorder patients should be different from the approach to patients suffering from acute hypokalemia.- - - - - - - - - - ranking = 0.21082821564787keywords = physical (Clic here for more details about this article) |
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