This patient is a 38 year old housewife who has been hypertensive and hypokalemic since age 23. She suffered her first stroke at age 32 and a seizure just one week prior to admission. This paper will discuss the clues to the diagnosis of secondary hypertension.
Human ; Female ; Adult ; HYPERTENSION ; CARDIOVASCULAR DISEASES ; VASCULAR DISEASES ; HYPOKALEMIA ; NUTRITIONAL AND METABOLIC DISEASES ; METABOLIC DISEASES ; WATER-ELECTROLYTE IMBALANCE ; MUSCLE WEAKNESS ; SIGNS AND SYMPTOMS ; PATHOLOGICAL CONDITIONS, SIGNS AND SYMPTOMS ;

BACKGROUND AND OBJECTIVES. Several reports have shown that coexistence of diabetes mellitus and COVID-19 is one of the risk factors for poor outcome and increased mortality. Rapid metabolic deterioration with development of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS) may result due to the acute insulin secretory capacity loss, stress condition and the cytokine storm. In this review, we aim to describe the prevalence of hyperglycemic crises(DKA/HHS) in patients with COVID-19 infection as well as their clinical outcomes. METHODS. An intensive search was done using the WebMD, PubMed, Medline and Google Scholar databases for articles published between December 2019 to October 2020 that identified the number of patients who developed DKA and/or HHS among those who were admitted for COVID-19. Their clinical outcomes were likewise described. RESULTS. This review included 4 articles in which individual quality was assessed. A total of 1282 patients were admitted for COVID-19 and the prevalence of DKA was 1.32%. HHS was not reported in any of the studies. Five (29.4%) of the patients with DKA and COVID-19 died and 12 (70.6%) recovered. CONCLUSIONS. A significant number of COVID-19 patients developed DKA and it is associated with a high mortality rate. This reimposes the need for an appropriate algorithm for the optimal management of concomitant COVID 19 and hyperglycemic crises to avoid morbidity and mortality. Additionally, there is paucity of large-scale studies describing the prevalence of DKA/HHS in patients with COVID-19.
Diabetic Ketoacidosis ; COVID-19 ; Water-Electrolyte Imbalance ; Acid-Base Imbalance ; Coma

OBJECTIVE: To investigate the perioperative electrolyte imbalance in patients undergoing gastrointestinal surgery. METHODS: Retrospective case analysis was used in this study. Patients who underwent gastrointestinal surgery under general anesthesia at the Sixth Affiliated Hospital of Sun Yat-sen University from January to April 2018 were selected through electronic medical records system. Blood gas analysis during surgery must be carried out in the enrolled patients. Patients with excessive fluid infusion, critical conditions or patients who had been enrolled in other clinical trials were excluded. A total of 999 patients were enrolled. The preoperative, intraoperative and postoperative concentrations of serum sodium, potassium and calcium were collected by the last biochemical examination before surgery, arterial blood gas analysis within 1 h after anesthesia and another biochemical examination within 24 hours after surgery respectively. The type and incidence of electrolyte imbalance were then analyzed, and logistic regression analysis was used to investigate the risk factors. RESULTS: In the 999 patients, 683 cases were male (63.9%) and 361 cases were female(36.1%), with an average age of (56.9±14.6) years old. Fifty-eight patients (5.8%) underwent emergency surgery and 941 patients (94.2%) underwent elective surgery; Sixty-two patients were treated with laxatives at least 3 times and 115 patients were treated with enema at least 3 times before operation. The incidence of hypokalemia was 49.6%(496/999) intraoperatively and decreased to 15.2%(152/999) postoperatively. No hyperkalemia cases were found. The incidence of hypocalcemia was 53.8%(537/999) intraoperatively and increased to 79.7% (796/999) postoperatively. The incidence of hypokalemia in ileus patients was 33.3%(17/51) before surgery, which was higher than that in patients with colorectal cancer [12.3%(86/703)], patients with gastric cancer [7.8%(8/104)] and patients with other gastrointestinal diseases[10.6%(15/141)] (all P<0.05). Similarly, the preoperative and intraoperative incidence of hyponatremia in ileus patients were both 15.7%(8/51), which were higher than those in patients with colorectal cancer [3.0% (21/703) and 2.3% (16/703)] and patients with gastric cancer [2.9%(3/104) and 1.9%(2/104)]. The incidence of hypocalcemia in ileus patients was 31.4%(16/51) preoperatively, which were also higher than those in patients with colorectal cancer [7.4%(52/703)] and patients with gastric cancer [8.7%(9/104)] (all P<0.05). Logistic regression analysis showed that ileus and emergency surgery were risk factors for patients with preoperative electrolyte imbalance; preoperative electrolyte imbalance was a risk factor for intraoperative electrolyte imbalance; intraoperative electrolyte imbalance was a risk factor for postoperative electrolyte imbalance; preoperative electrolyte imbalance was a risk factor for postoperative imbalance of sodium and potassium. CONCLUSIONS The incidence of electrolyte imbalance is high in patients undergoing gastrointestinal surgery, especially hypocalcemia and hypokalemia. It is necessary to recognize the electrolyte abnormality timely and give active intervention and correction.
Adult ; Aged ; Digestive System Surgical Procedures ; Electrolytes ; Female ; Humans ; Hyponatremia ; Ileus ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Risk Factors ; Water-Electrolyte Imbalance

OBJECTIVETo determine the relationship between DNP level after human severe brain injury and hyponatremia as well as isorrhea.

METHODSThe peripheral venous plasma as control was collected from 8 volunteers. The peripheral venous plasma from 14 severe brain injury patients were collected in the 1, 3, 7 days after injury. Radioimmunoassay was used to detect the DNP concentration. Meanwhile, daily plasma and urine electrolytes, osmotic pressure as well as 24 h liquid intake and output volume were detected.

RESULTSThe normal adult human plasma DNP level was 62.46 pg/ml+/-27.56 pg/ml. In the experimental group, the plasma DNP levels were higher from day 1 to day 3 in 8 of the 14 patients than those in the control group (P(1)=0.05, P(3)=0.03). Negative fluid balance occurred in 8 patients and hyponatremia in 7 patients. The increase of plasma DNP level was significantly correlated with the development of a negative fluid balance (r =-0.69, P<0.01) and hyponatremia (chi(2) =4.38, P<0.05).

CONCLUSIONSThe increase of plasma DNP level is accompanied by the enhancement of natriuretic and diuretic responses in severe brain-injured patients, which is associated with the development of a negative fluid balance and hyponatremia after brain injury.

Adult ; Brain Injuries ; blood ; complications ; Elapid Venoms ; blood ; Female ; Humans ; Hyponatremia ; etiology ; Intracranial Hypertension ; blood ; etiology ; Male ; Middle Aged ; Peptides ; blood ; Reagent Kits, Diagnostic ; Water-Electrolyte Imbalance ; blood

Hypercalcemia is a common electrolyte imbalance in patients with malignancy. Approximately 80% of hypercalcemia is associated with humoral hypercalcemia of malignancy (HHM), but occurs rarely in colorectal carcinomas. A 72-year-old man was admitted with abdominal pain and bowel habit change. Colonoscopy showed a malignant tumor in the transverse colon. Laboratory data showed an elevated serum calcium level (11.6 mg/dL) and elevated parathyroid hormone-related peptide level (12.2 pmol/L). Histology showed poorly differentiated adenocarcinoma. We infused intravenous normal saline, furosemide and pamidronate. The serum calcium level was subsequently normalized. However, the patient died from cancer progression 10 days later. With a review of the relevant literature, we report a case of adenocarcinoma of the transverse colon with HHM.
Abdominal Pain ; Adenocarcinoma ; Aged ; Calcium ; Colon, Transverse ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Diphosphonates ; Furosemide ; Humans ; Hypercalcemia ; Paraneoplastic Syndromes ; Parathyroid Hormone-Related Protein ; Water-Electrolyte Imbalance

Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology. Fluid resuscitation should be aimed at restoration of normal hemodynamics and tissue perfusion. Early goal-directed therapy has been shown to be effective in patients with severe sepsis or septic shock. On the other hand, liberal fluid administration is associated with adverse outcomes such as prolonged stay in the ICU, higher cost of care, and increased mortality. Development of hyponatremia in critically ill patients is associated with disturbances in the renal mechanism of urinary dilution. Removal of nonosmotic stimuli for vasopressin secretion, judicious use of hypertonic saline, and close monitoring of plasma and urine electrolytes are essential components of therapy. Hypernatremia is associated with cellular dehydration and central nervous system damage. Water deficit should be corrected with hypotonic fluid, and ongoing water loss should be taken into account. Cardiac manifestations should be identified and treated before initiating stepwise diagnostic evaluation of dyskalemias. Divalent ion deficiencies such as hypocalcemia, hypomagnesemia and hypophosphatemia should be identified and corrected, since they are associated with increased adverse events among critically ill patients.
Central Nervous System ; Critical Illness ; Dehydration ; Delivery of Health Care ; Electrolytes ; Hand ; Hemodynamics ; Humans ; Hyperkalemia ; Hypernatremia ; Hypocalcemia ; Hypokalemia ; Hyponatremia ; Hypophosphatemia ; Intensive Care Units ; Perfusion ; Plasma ; Resuscitation ; Sepsis ; Shock, Septic ; Vasopressins ; Critical Care

Objective, rapid, and accurate assessment of volume status is important in the early management of acute, critical illnesses, as inappropriate therapy may lead to interventions with fatal outcomes. Traditionally, the history and physical examinations have been used for this assessment, but have limitations. Radioisotopic measurement or invasive hemodynamic monitoring is impractical, complicated, and expensive. Recently developed technologies offer rapid, accurate estimation of volume status with the potential to improve clinical outcome. This review discusses the methods available for volume assessment, including ultrasound, bioimpedance, and the historical tools.
Critical Illness ; Fatal Outcome ; Hemodynamics ; Physical Examination ; Technology Assessment, Biomedical ; Water-Electrolyte Imbalance

Congenital Hypothyroidism ; diagnosis ; Diagnostic Errors ; Humans ; Infant, Newborn ; Male ; Water-Electrolyte Imbalance ; complications

OBJECTIVETo evaluate a calculating method of wound water loss (WWL) in hospitalized burn patients.

METHODSEighty-five adult burn patients with total burn area over 50% were enrolled in the study. The WWL formula after shock stage (after 3rd postburn day) was given as: WWL (ml/%/kg/24 h) = [input (ml/24 h)-urine output (ml/24 h)-500 ml] / actual burn wound area(%) / body weight (kg). The result was compared with that determined by other formulas such as Davies, S.M.S.P and Lamke and palm rule.

RESULTSThe calculated daily WWL in burn patients after shock stage was found out to be 0.9 +/- 0.1 ml/%/kg/24 h by this method. This figure is comparable with that calculated by several different methods. Palm rule could be simply applied in the patients with body weight around 60 kg.

CONCLUSIONThis method and palm rule were proved to be simple and practical for the calculation of WWL in burn patients, which could be applied in clinical work.

Adolescent ; Adult ; Algorithms ; Body Water ; metabolism ; Burns ; metabolism ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Water Loss, Insensible ; Water-Electrolyte Imbalance

OBJECTIVETo summarize early diagnosis and treatment methods of 20 patients with compartment syndrome caused by landslides during coal mine accidents in order to improve the level of diagnosis and treatment of compartment syndrome and reduce disability.

METHODSFrom September 2006 to April 2010,20 patients with compartment syndrome were treated with the methods of early decompression, systemic support. All the patients were male with an average age of 42 years (ranged, 23 to 54). All the patients with high tension limb swelling, pain, referred pain passive positive; 5 extremities feeling diminish or disappear and the distal blood vessel beat were normal or weakened or disappeared; myoglobinuria, hyperkalemia, serum urea nitrogen and creatinine increased in 5 cases and oliguria in occurred 1 case. The function of affected limbs was observed according to disability ratings.

RESULTSThree cases complicated with infection of affected limb and 6 cases occurred with renal function insufficiency. Total recovery was in 16 cases, basically recovery in 3, amputation in 1 case. All patients were followed up for 6-15 months with an average of 12 months. The ability to work according to national standard identification--Employee work-related injuries and occupational disability rating classification (GB/T16180-2006) to assess, grade 5 was in 1 case, grade 8 in 2 cases, grade 10 in 1 case, no grade in 16 cases.

CONCLUSIONArteriopalmus of dorsalis pedis weaken and vanished can not be regard as an evidence in early diagnosis of compartment syndrome. Early diagnosis and decompression, systemic support and treatment is the key in reducing disability.

Adult ; Compartment Syndromes ; diagnosis ; surgery ; Decompression, Surgical ; methods ; Early Diagnosis ; Humans ; Landslides ; Male ; Middle Aged ; Water-Electrolyte Imbalance ; therapy