Case 40: Diarrhoea and vomiting after irregular eating
Barry Wright, Subodh Dave, Nisha Dogra in 100 Cases in Psychiatry, 2017
Hypokalaemia can be caused by the sudden uptake of potassium ions from the bloodstream by muscle or other organs or by an overall depletion of the body’s potassium. The most common cause of hypokalaemia is diuretics. Other common causes of hypokalaemia are excessive diarrhoea, enema abuse or vomiting. It can also occur in medical conditions such as diabetes (ketoacidosis), adrenal tumours, hyperaldosteronism and renal artery stenosis, although these can be ruled out by history and investigation. Up to 20% of people complaining of chronic diarrhoea practise laxative abuse. Laxative abuse is often part of eating disorders, such as anorexia nervosa or bulimia nervosa. Hypokalaemia in eating disorders may be life-threatening with symptoms ranging from lethargy and cloudy thinking to cardiac arrhythmias and death.
100 MCQs from Dr. David Browne and Colleagues
David Browne, Selena Morgan Pillay, Guy Molyneaux, Brenda Wright, Bangaru Raju, Ijaz Hussein, Mohamed Ali Ahmed, Michael Reilly in MCQs for the New MRCPsych Paper A, 2017
This woman presents with symptoms that are associated with hyponatraemia. She has several risk factors for hyponatraemia including being female, elderly and receiving co-therapy with a non-steroidal anti-inflammatory drug (NSAID). While she could have delirium as a consequence of hyponatraemia, this vignette does not describe symptoms associated with delirium such as confusion. Symptoms of serotonin syndrome could include restlessness, diaphoresis, tremor, shivering, myoclonus, confusion or convulsions leading to death. Symptoms of hypokalaemia could include muscle weakness, hypotonia, cardiac arrhythmias, cramps and tetany; they are often due to diuretics. The symptoms of neuroleptic malignant syndrome include fever, diaphoresis, rigidity, confusion, fluctuating consciousness, fluctuating blood pressure, tachycardia, elevated creatinine kinase, leucocytosis and altered liver function tests. (2, pp 210–1, 235, 103–5)
Medicine
Seema Khan in 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].
Severe hypokalemia with cardiac arrest as an unusual manifestation of alcoholism
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Omar Abdulfattah, Ebad Ur Rahman, Zainab Alnafoosi, Frances Schmidt
It is of worth to note that potassium deficit is correlated directly with the severity and duration of hypokalemia. In different studies, it has been estimated that for acute hypokalemia every 0.27 mEq/L reduction in serum potassium level corresponds to a 100 mEq deficit total body potassium stores [16,18], while in chronic hypokalemia, every 1 mEq/L decrease in serum potassium corresponds to a potassium deficit of 200 to 400 mEq [18]. Despite this rough estimation; serum potassium level doesn’t accurately reflect total body potassium deficit. Even mild hypokalemia can be associated with significant deficit that requires prolonged supplementation of potassium [19]. Parenteral potassium replacement is indicated for patients with severe hypokalemia (<2.5 mEq/L) or moderate hypokalemia accompanied by cardiac arrhythmias, familial periodic paralysis, or severe myopathy [20]. A saline rather than a dextrose solution should be used for initial therapy since the administration of dextrose stimulates the release of insulin which drives extracellular potassium into the cells. This can lead to a transient 0.2 to 1.4 mEq/L reduction in the serum potassium concentration, particularly if the solution contains only 20 mEq/L of potassium [16,21]. Replacement consists of 100 mEq of potassium chloride in one liter of normal saline infused at a rate of 100 to 200 mL/hr (10 to 20 mEq/hr). If the patient has any form of heart block or renal insufficiency, the initial infusion rate should be reduced to 5 mEq/hr. Although the recommended rate of administration is 10 to 20 mmol/hour; rates of 40 to 100 mmol/hour or even higher (for a short period) have been used in patients with life-threatening conditions [22–25].
Related Knowledge Centers
- Arrhythmia
- Bradycardia
- Cardiac Arrest
- Constipation
- Fatigue
- Potassium
- Diarrhea
- Serum
- Cramp
- Weakness