Severe hypokalemia is defined as the concentration of serum potassium lower than 2.5 mmol/L, which may lead to serious arrhythmias and cause mortality. We report an unusual case of potentially fatal ventricular arrhythmias induced by severe hypokalemia in a patient undergoing laparoscopic partial nephrectomy in Peking University Third Hospital due to irregular use of indapamide before operation. Indapamide is a sulfonamide diuretic with vasodilative and calcium antagonistic effects, which enhances sodium delivery to the renal distal tubules resulting in a dose-related increase in urinary potassium excretion and decreases serum potassium concentrations. The electrolyte disorder caused by the diuretic is more likely to occur in the elderly patients, especially those with malnutrition or long-term fasting. Hence, the serum potassium concentration of the patients under indapamide therapy, especially elderly patients, should be monitored carefully. Meanwhile, the potassium concentration measured by arterial blood gas analysis is different from that measured by venous blood or laboratory test. According to the previous research, the concentration of potassium in venous blood was slightly higher than that in arterial blood, and the difference value was 0.1-0.5 mmol/L. This error should be taken into account when rapid intravenous potassium supplementation or reduction of blood potassium level was carried out clinically. In the correction of severe hypokalemia, the standard approach often did not work well for treating severe hypokalemia. The tailored rapid potassium supplementation strategy shortened the time of hypokalemia and was a safe and better treatment option to remedy life-threatening arrhythmias caused by severe hypokalemia with a high success rate. Through the anesthesia management of this case, we conclude that for the elderly patients who take indapamide or other potassium excretion diuretics, the electrolyte concentration and the general volume state of the patients should be comprehensively measured and fully evaluated before operation. It may be necessary for us to reexamine the serum electrolyte concentration before anesthesia induction on the morning of surgery in patients with the history of hypokalemia. For severe hypokalemia detected after anesthesia, central venous cannulation access for individualized rapid potassium supplementation is an effective approach to reverse the life-threatening arrhythmias caused by severe hypokalemia and ensure the safety of the patients.
Humans ; Aged ; Hypokalemia/complications* ; Indapamide/adverse effects* ; Arrhythmias, Cardiac/therapy* ; Diuretics/adverse effects* ; Potassium ; Electrolytes/adverse effects* ; Anesthesia, General/adverse effects*

Objective: To study the effect of Banaba on IOP among normals Methodology: A randomized blind study done on subjects IOP before and after intake of Banaba decoctions of different concentrations were taken Results: As early as 30 minutes, there was a gradual drop of IOP a maximum at 2 hours for the 2 percent and 3 percent decoctions Conclusion: Banaba is effective in lowering the IOP of individuals at a minimum concentration of 2 percent. (Author)
Human ; Male ; Female ; Adult ; Young Adult ; PLANTS, MEDICINAL/ADVERSE EFFECTS ; PLANTS/MEDICINAL/TOXICITY ; DIURETICS ; INTRAOCULAR PRESSURE ; HUMANS ; MALE ; FEMALE ; ;

The authors experienced two cases of hydrochlorothiazide (HCTZ)-induced acute-onset bilateral myopia and shallowing of the anterior chambers. Two middle-aged women taking HCTZ, a sulfa derivative, visited our clinic complaining of acute bilateral visual deterioration. Both had good visual acuity without corrective lenses before taking HCTZ. A complete ophthalmologic examination revealed bilateral myopic shift, intraocular pressure elevation, shallowing of the anterior chambers, choroidal effusions, radiating retinal folds, and conjunctival chemosis. Approximately one week after HCTZ discontinuance, all ocular changes disappeared completely. Physicians should be aware of the adverse ocular effects of HCTZ and should manage patients accordingly.
Acute Disease ; Adult ; Anterior Chamber/drug effects ; Choroid/drug effects/*metabolism ; Cilia/drug effects/*metabolism ; Diuretics/*adverse effects ; Exudates and Transudates/*metabolism ; Female ; Humans ; Hydrochlorothiazide/*adverse effects ; Intraocular Pressure/drug effects ; Middle Aged ; Myopia/*chemically induced

OBJECTIVEIn continuation to the growing evidence for therapeutical potential of Desmostachya bipinnata (Linn) Stapf, the current pharmacological study was carried out to evaluate the diuretic and laxative activity of its hydro-alcoholic extract in rats.

METHODSThe hydro-alcoholic extract of D. bipinnata whole plant was prepared by using Soxhlet extractor and subjected to analysis by standard preliminary phytochemical tests. Evaluation of both diuretic and laxative activity was carried out using standard methods as reported earlier. Frusemide (20 mg/kg) was served as positive control for diuretic activity and sennosides (10 mg/kg) served as negative control for laxative activity.

RESULTSThe hydro-alcoholic extract showed significant diuretic activity and was found to be the most potent in increasing the urinary output at 500 mg/kg when the effect was compared with that of the standard frusemide (P<0.01). Moreover, this extract was found to be most effective in increasing urinary electrolyte concentration (Na(+), K(+), and Cl(-)) at both doses tested. Whereas the results for laxative activity showed minimal increase of feces output at the dose of 500 mg/kg and the increase was negligible when compared with that of the standard drug sennosides.

CONCLUSIONAltogether, the above significant findings validate and support its folkloric diuretic use and lend pharmacological credence to the ethno-medical use of this plant in traditional system of medicine, which demands further studies to investigate its active constituents, as well as its use and safety.

Animals ; Constipation ; drug therapy ; Diuretics ; administration & dosage ; adverse effects ; Drug Evaluation, Preclinical ; Female ; Humans ; Laxatives ; administration & dosage ; adverse effects ; Male ; Plant Extracts ; administration & dosage ; adverse effects ; Poaceae ; chemistry ; Rats ; Rats, Wistar

A 54-year-old female patient who had been undergoing anti-cancer chemotherapy and radiotherapy for seven years after surgery for left breast cancer visited our clinic for visual disturbance in the right eye at nine months after paclitaxel administration. The best-corrected visual acuity was 0.5 in the right eye and 1.0 in the left eye. The patient was diagnosed with maculopathy due to paclitaxel administration based on the finding of cystoid macular edema in the right eye on fundus examination and optical coherence tomography; however, no leakage was detected on fluorescein angiography. Thus, drug replacement was planned. On the other hand, no abnormal finding was observed in the left eye. However, as the anti-cancer effect of paclitaxel is significant, replacing paclitaxel with another agent was not warranted; therefore, maintenance therapy with methazolamide was performed before and after administering the anti-cancer agent. Aggravation of cystoid macular edema was prevented, and vision improvement was achieved by oral maintenance therapy with methazolamide. In addition, the same fundus findings as shown in the right eye were detected in the left eye at 16 months after paclitaxel administration. After administering methazolamide, macular thickness was reduced, and vision was improved in the left eye. Paclitaxel administration was discontinued due to cutaneous metastasis from the breast cancer, and another anti-cancer agent was then administered. No subsequent cystoid macular edema has occurred.
Antineoplastic Agents, Phytogenic/*adverse effects ; Breast Neoplasms/drug therapy ; Diuretics/*therapeutic use ; Female ; Humans ; Macular Edema/*chemically induced/*drug therapy ; Methazolamide/*therapeutic use ; Middle Aged ; Paclitaxel/*adverse effects ; Visual Acuity

OBJECTIVETo assess the efficacy and safety of azosemide in patients with edema and ascites.

METHODSA multicentral, randomized, double-blind, controlled clinical trial was applied. All 223 patients (cardiac edema 92, hepatogenic edema 63, renal edema 68) were randomized to azoesmide and furosemide group, and all patients were treated for 2 weeks. Patients with cardiac or renal edema took azosemide (30 mg/d) or furosemide (20 mg/d); patients with hepatogenic edema took azosemide (60 mg/d) or furosemide (40 mg/d). The dosage were adjusted to azosemide 60 mg/d (cardiac, renal edema), 90 mg (hepatogeic edema); or furosemide 40 mg/d (cardiac, renal edema), 60 mg (hepatogeic edema), if diuretic effects were not obtained at the end of third day.

RESULTSAt the end of the study, the weight changes were (2.87+/-3.10) kg and (2.81 +/-2.84) kg; the total effective rate of edema lessen was 89.19% and 89.81%; the total effective rate of heart function improvement was 64.44% and 66.66%; the 24 h urine output increased (321.85 +/-669.52) ml and (273.80 +/-645.72) ml for azosemide and furosemide, respectively. The total effective rate of ascites lessen (tested by B-ultrasound) was 89.28% and 86.66%; abdominal girth decreased (5.20 +/-3.58) cm and (5.03 +/-3.74) cm for azosemide and furosemide, respectively. The adverse event rate was 23.01% in azosemide group and 21.01% in furosemide group; the main adverse effects were hypokalemia, hyperuricemia, hypertriglyceridemia and thirsty.

CONCLUSIONAzosemide could effectively lessen edema, improve heart function and decrease ascitesûit is well tolerated and is particularly useful for the diuretic treatment.

Adolescent ; Adult ; Aged ; Ascites ; drug therapy ; etiology ; Diuretics ; adverse effects ; therapeutic use ; Double-Blind Method ; Edema ; drug therapy ; etiology ; Edema, Cardiac ; drug therapy ; etiology ; Female ; Heart Failure ; complications ; Humans ; Kidney Diseases ; complications ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Sulfanilamides ; adverse effects ; therapeutic use

OBJECTIVETo analyze the treatment of acute renal failure caused by irrational drug use.

METHODData of 41 cases of acute renal failure seen from July 2008 to June 2012 in our hospital were reviewed. Bilateral renal parenchymas diffuse echo was found enhanced by ultrasound in all cases. Calculus image was not found by X-ray. All children had medical history of using cephalosporins or others. Alkalinization of urine and antispasmodic treatment were given to all children immediately, 17 children were treated with hemodialysis and 4 children accepted intraureteral cannula placement.

RESULTIn 24 children who accepted alkalinization of urine and antispasmodic treatment micturition could be restored within 24 hours, in 11 children micturition recovered after only one hemodialysis treatment and 2 children gradually restored micturition after hemodialysis twice, 4 children who accepted intraureteral cannula immediately restored micturition. In all children micturition recovered gradually after a week of treatment. Ultrasound examination showed that 39 children's calculus disappeared totally and renal parenchymas echo recovered to normal. The residual calculi with diameter less than 5 mm were found in 2 children, but they had no symptoms. The children received potassium sodium hydrogen citrate granules per os and were discharged from hospital. Ultrasound showed calculus disappeared totally one month later.

CONCLUSIONIrrational drug use can cause children urolithiasis combined with acute renal failure, while renal dysfunction can reverse by drug withdrawal and early alkalinization of urine, antispasmodic treatment, intraureteral cannula or hemodialysis when necessary, most calculus can be expelled after micturition recovered to normal.

Acute Kidney Injury ; chemically induced ; diagnosis ; therapy ; Ceftriaxone ; administration & dosage ; adverse effects ; Child ; Child, Preschool ; Diuretics ; therapeutic use ; Female ; Fluid Therapy ; Humans ; Infant ; Kidney ; pathology ; physiopathology ; Male ; Potassium Citrate ; therapeutic use ; Renal Dialysis ; Retrospective Studies ; Treatment Outcome ; Urinary Calculi ; chemically induced ; diagnosis ; therapy