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Renal Disease; Fluid and Electrolyte Disorders
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Aldosterone excess: Excess aldosterone can be caused by adrenal hyperplasia or a tumour (Conn's syndrome) or by excess renin and angiotensin II. Excess aldosterone promotes excess retention by the kidney of sodium and with it water. Enhanced potassium excretion causes hypokalaemia.
Micronutrients
Published in Chuong Pham-Huy, Bruno Pham Huy, Food and Lifestyle in Health and Disease, 2022
Chuong Pham-Huy, Bruno Pham Huy
Potassium plays a role in the maintenance of the balance of the physical fluid system and assisting nerve functions through its role in the transmittance of nerve impulses. It is also related to heart activity muscle contraction (7). However, potassium requirements are also dependent on the physiological or pathological environment. Hypokalemia is low level of blood potassium and this occurs in diarrhea, metabolic alkalosis, and familial periodic paralysis (8). It can be caused by a low dietary intake of K+ or by high salt in the diet, but also by medications like diuretics that increase water excretion. A potassium deficiency may result in fatigue, cramping legs, slow reflexes, muscle weakness, acne, dry skin, mood changes, and irregular heartbeat. Moreover, a reduced level of K+ produces alkalosis, which makes the kidney less able to retain this mineral (7). Other symptoms of potassium deficiency are cardiac arrythmias, impaired carbohydrate tolerance, and altered electrocardiogram in calves (8). Potassium deficiency affects the collecting tubules of the kidney, resulting in the inability to concentrate urine, and also causes alterations of gastric secretions and intestinal motility (8). Hyperkalemia (increased K+ level in blood) occurs in Addison’s disease, advanced chronic renal failure, shock and dehydration. Excessive potassium intake can be toxic systemically and can cause dilatation of the heart, cardiac arrest, cardiac arrhythmias, and oliguria (7–9).
Medicine
Published in Seema Khan, Get Through, 2020
For each presentation below, choose the SINGLE most likely cause from the list of options. Each option may be used once, more than once or not at all. A 30-year-old man with AIDS presents with profuse watery diarrhoea. Oocysts are detected in the stool.A 25-year-old man presents with fever, bloody diarrhoea and cramping for several weeks that does not resolve with antibiotic therapy. Proctosigmoidoscopy reveals red, raw mucosa and pseudopolyps.A 60-year-old man presents with fever, watery diarrhoea and crampy abdominal pain. He had completed antibiotic therapy for osteomyelitis a month ago. Proctosigmoidoscopy reveals yellowish-white plaques on the mucosa.A 20-year-old man, recently back from a holiday in the Far East, presents with an abrupt onset of severe diarrhoea. The diarrhoea is self-limiting and lasts only 3 days.A 20-year-old woman presents with chronic watery diarrhoea. She is emaciated. Stool electrolyte studies show an osmotic gap. Blood tests reveal hypokalaemia.
Molecular aspects of the altered Angiotensin II signaling in Gitelman’s syndrome
Published in Expert Opinion on Orphan Drugs, 2022
Verdiana Ravarotto, Giovanni Bertoldi, Lucia Federica Stefanelli, Laura Gobbi, Lorenzo A. Calò
However, a proper dietary approach should be also considered. Salt addition to foods is preferable to the available salty processed foods, further, the regular intake of foods naturally rich in potassium such as fruits, vegetables, poultry, meat, and fish should be assumed as it might allow patients to reach the recommended daily dose of 3.0 mmol/l potassium that recover hypokalemia [4,99]. A different approach might be the use of slow releasing sodium tablets with a starting dose of 2.4 to 4.8 g per day in four doses divided; however, this sort of supplement should be proposed only by an expert in order to adjust the perfect quantity [104,105]. Hypomagnesemia can be improved by introducing legumes, vegetables, nuts, seeds, bananas, whole grains, dark chocolate, and fish [99]. Administration of oral magnesium supplements is also recommended to prevent chondrocalcinosis; however, it should be carefully introduced by dividing the assumption into small frequent doses (3–4 times/day) to reduce/avoid the side effects of abdominal pain and diarrhea [4,106–108]. In case of poor tolerance to magnesium supplements, new formulation with liposomal magnesium (with sucrosomial technology) might be more suitable [109].
Sodium zirconium cyclosilicate for the management of chronic hyperkalemia in kidney disease, a novel agent
Published in Expert Review of Clinical Pharmacology, 2021
Anjay Rastogi, Ramy M. Hanna, Anita Mkrttchyan, Maham Khalid, Sinan Yaqoob, Kelly Shaffer, Puneet Dhawan, Niloofar Nobakht, Mohammad Kamgar, Ray Goshtaseb, Kristine Sarmosyan, Mariarosaria Gnarini, Olivia Wassef, Edgar Lerma
The DIALIZE study shows great promise in preventing hyperkalemia, which is associated with poor outcomes and sudden death in ESKD patients [52]. The use of SZC on non-dialysis days prevented hyperkalemia development, and with careful dose titration no evidence of hypokalemia was seen in studies, where less than 5–10 grams daily (usual dose) were used, rather hypokalemia was recorded in studies using 10 grams three times a day or 15 grams three times a day. The application of potassium binders in CKD and ESKD has the potential to allow a more liberal potassium (K) diet, without risk of hyperkalemia or iatrogenic hypokalemia with proper dosing. This can improve dietary fiber intake, prevent hypokalemia (as can proper dosing of SZC), and allow improved nutrition. All of these are crucial factors related to lower mortality in CKD and ESKD patients [10]. Using low potassium baths (also known as 1 K baths) in dialysis patients is a known risk for sudden death in dialysis populations [57]. This can now be avoided with the use of SZC on non-dialysis days [52].
A case of cannabinoid hyperemesis syndrome with Heliobacter pylori and preeclampsia during pregnancy
Published in Substance Abuse, 2018
Madeline Manning Meurer, Kalyan Chakrala, Dinesh Gowda, Charles Burns, Randall Kelly, Natalia Schlabritz-Loutsevitch
A 21-year-old primigravida patient was diagnosed with hyperemesis gravidarum at 6 weeks of gestation. The symptoms were treated by dietary adjustment, antiemetics, and intravenous (IV) fluid and required several hospitalizations, including emergency room admission at 13 weeks of gestation (Figure 1). At 21 weeks of gestation, the patient was referred to a board-certified gastroenterologist. The clinical work-up revealed hypokalemia. The patient did not adhere to the proposed treatment. At 30 weeks of gestation (Figure 1), a drug screen was performed and was positive for cannabis use, and a diagnosis of CHS was made.