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Fulltext Durian induced hyperkalaemia

Leo CL, Leong WS, Tieh CS, Liew CK

Med J Malaysia, 2011 Mar;66(1):66-7.
PMID: 23765149 MyJurnal

Hyperkalaemia is a life threatening acute medical emergency. Patients with end stage renal failure are more prone to get hyperkalaemia as potassium is normally excreted via the kidneys. Therefore, patients with end stage renal failure should avoid food with high potassium contents. Bananas are well known to have high potassium content. However, the 'king of fruits' the durian, has higher potassium content compared to bananas. We describe a case of life threatening hyperkalaemia in a lady with end stage renal failure who ate durians prior to her presentation.

Matched MeSH terms: Hyperkalemia*
NSAID-induced hyperkalaemia

Cheong IKS, Kee SA

Family Physician, 1991;3:74-75.

A case of NSAID-induced hyperkalaemia in a fifty year old man with chronic renal failure is presented. This paper highlighted the mechanism and clinical importance of this form of drug-induced hyperkalaemia. Keywords: NSAID, hyperkalaemia, chronic renal failure

Matched MeSH terms: Hyperkalemia
Fulltext Correlation of iatrogenic mild hyperkalaemia and bradyarrhythmia: a problem of polypharmacy in elderly

Ahmad, N. H., Tan, T. L.

Medicine & Health, 2017;12(2):329-334.
MyJurnal

Mild hyperkalaemia does not typically cause cardiac symptoms. However, for an elderly patient on atrio-ventricular (AV) nodal blocker, even mild hyperkalaemia may result in disastrous outcome. We report a case of persistent bradyarrythmia caused by iatrogenic hyperkalaemia in a patient who had concomitant use of AV nodal medication. An 81-year-old lady with multiple comorbidities and a long list of medications presented with symptomatic bradyarrhythmia. She, in fact, had two AV nodal blockers in her prescription, a beta-blocker and amiodarone. Her potassium level was found to be mildly elevated due to acute renal failure. She remained bradycardic despite initial treatment and was subsequently dependant on intravenous isoproterenol until her renal function improved. This case highlights the different threshold for manifestation of hyperkalaemic symptoms in a growing group of patients: elderly patients with multiple comorbidities and polypharmacy.
Keywords: bradyarrythmia, bradycardia, elderly, hyperkalaemia, polypharmacy

Matched MeSH terms: Hyperkalemia*
New Insights Into Dietary Approaches to Potassium Management in Chronic Kidney Disease

Sumida K, Biruete A, Kistler BM, Khor BH, Ebrahim Z, Giannini R, et al.

J Ren Nutr, 2023 Nov;33(6S):S6-S12.
PMID: 37610407 DOI: 10.1053/j.jrn.2022.12.003

Potassium disorders are one of the most common electrolyte abnormalities in patients with chronic kidney disease (CKD), contributing to poor clinical outcomes. Maintaining serum potassium levels within the physiologically normal range is critically important in these patients. Dietary potassium restriction has long been considered a core strategy for the management of chronic hyperkalemia in patients with CKD. However, this has been challenged by recent evidence suggesting a paradigm shift toward fostering more liberalized, plant-based dietary patterns. The advent of novel potassium binders and an improved understanding of gastrointestinal processes involved in potassium homeostasis (e.g., gastrointestinal potassium wasting) may facilitate a paradigm shift and incorporation of heart-healthy potassium-enriched food sources. Nevertheless, uncertainty regarding the risk-benefit of plant-based diets in the context of potassium management in CKD remains, requiring well-designed clinical trials to determine the efficacy of dietary potassium manipulation toward improvement of clinical outcomes in patients with CKD.

Matched MeSH terms: Hyperkalemia*
Fulltext Bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia: An important syndrome to recognize

Wong CK, Jaafar MJ

Turk J Emerg Med, 2021 02 12;21(2):86-89.
PMID: 33969246 DOI: 10.4103/2452-2473.309138

BRASH syndrome is a syndrome characterized by bradycardia, renal failure, usage of atrioventricular (AV) nodal blocker, shock, and hyperkalemia (BRASH). It is more common among patients with multiple comorbidities such as cardiac disease, kidney dysfunction, and hypertension requiring AV nodal blockers. Cardiac conduction abnormalities are frequently caused by severe hyperkalemia. However, it may also occur in mild-to-moderate hyperkalemia with concomitant use of AV nodal blockers due to the synergistic effects between these two factors in the presence of renal insufficiency. It is essential for the physician to identify BRASH syndrome as the treatment may differ from standard advanced cardiovascular life support (ACLS) protocol. We report the two cases of patient who presented with BRASH syndrome who failed to respond to standard ACLS protocol.

Matched MeSH terms: Hyperkalemia
Fulltext Two cases of pseudohyperkalemia that occurred after emergency splenectomy: what goes up, will come down

Tan, G.H., Nor Faezan, A.R., Hairol, A.O., Bong, J.J.

Journal of Surgical Academia, 2011;1(1):32-34.
MyJurnal

Pseudohyperkalemia is a spuriously high serum potassium measurement in a patient with no clinical evidence of hyperkalemia. It has been reported to occur in patients with leukocytosis and thrombocytosis. Only a few cases of pseudohyperkalemia have been reported in patients after splenectomy. Two cases of pseudohyperkalemia occurring after emergency splenectomy for abdominal trauma are presented to highlight their clinical presentation and sequalae. Consecutive patients who underwent emergency splenectomy for trauma and subsequently developed pseudohyperkalemia were monitored in Universiti Kebangsaan Malaysia Medical Centre for their clinical sequalae. Both the patients developed leukocytosis, thrombocytosis and high serum potassium level within 2-weeks of their splenectomies. They did not demonstrate any symptoms and signs of hyperkalemia. Their conditions resolved spontaneously without any specific treatment. Pseudohyperkalemia should be suspected in a similar clinical scenario to avoid unnecessary treatment that could lead to severe hypokalemia.

Matched MeSH terms: Hyperkalemia
Fulltext Refractory hypokalemia during barbiturate coma therapy used for treating refractory intracranial hypertension in traumatic brain injury

Wan Hassan WM, Najid NM, Muslim HS, Izaini Ghani AR

Asian J Neurosurg, 2015 3 15;10(1):59.
PMID: 25767595 DOI: 10.4103/1793-5482.151528

Barbiturate coma therapy (BCT) is a choice treatment for refractory intracranial hypertension after all surgical or medical managements have failed to control the intracranial pressure (ICP). It helps to reduce cerebral blood flow, cerebral metabolic rate of oxygen consumption and ICP. However, this therapy can also cause many complications. One of the underreported, but life-threatening complications is refractory hypokalemia, which can lead to subsequent rebound hyperkalemia after sudden cessation. We report our experience of managing unusual complication of refractory hypokalemia during BCT with thiopentone in postdecompressive craniectomy patient.

Matched MeSH terms: Hyperkalemia
Fulltext Life-Threatening Dyskalaemia after Barbiturate Coma Therapy: The Strategy of Management

Tat YB, Hassan WMNW, Chuen TY, Ghani ARI

Malays J Med Sci, 2017 Mar;24(2):100-105.
PMID: 28894410 MyJurnal DOI: 10.21315/mjms2017.24.2.13

Barbiturate coma therapy (BCT) is a treatment option that is used for refractory intracranial hypertension after all other options have been exhausted. Although BCT is a brain protection treatment, it also has several side effects such as hypotension, hepatic dysfunction, renal dysfunction, respiratory complications and electrolyte imbalances. One less concerning but potentially life-threatening complication of BCT is dyskalaemia. This complication could present as severe refractory hypokalaemia during the therapy with subsequent rebound hyperkalaemia after cessation of the therapy. Judicious potassium replacement during severe refractory hypokalaemia and gradual cessation of the therapy to prevent rebound hyperkalaemia are recommended strategies to deal with this complication, based on previous case series and reports. In this case report, we show that these strategies were applicable in improving severe hypokalaemia and preventing sudden, life-threatening rebound hyperkalaemia. However, even with use of these strategies, BCT patients could still present with mild, asymptomatic hyperkalaemia.

Matched MeSH terms: Hyperkalemia
Cardiac arrhythmia after succinylcholine administration in a patient with Guillain-Barré syndrome--a case report

Hor JY

Middle East J Anaesthesiol, 2010 Oct;20(6):881-3.
PMID: 21526679

We report a case of cardiac arrhythmia occurring in a Guillain-Barré syndrome (GBS) patient after succinylcholine administration during third endotracheal intubation, on day 13 of illness. The probable cause of arrhythmia is succinylcholine-induced hyperkalemia. Of interest, this case demonstrated in the same patient that arrhythmia only occurred during third intubation, when duration of illness is prolonged, and not during previous two intubation episodes, despite succinylcholine was also being used. In GBS, muscle denervation resulted in up-regulation of acetylcholine receptors at neuromuscular junctions, causing the muscle cell membrane to become supersensitive to succinylcholine, leading to severe hyperkalemia and arrhythmia when succinylcholine was administered.

Matched MeSH terms: Hyperkalemia/chemically induced
Fulltext Suxamethonium and cardiac arrest

Lee YM, Fountain SW

Singapore Med J, 1997 Jul;38(7):300-1.
PMID: 9339098

We report a case of cardiac arrest due to hyperkalaemia following administration of suxamethonium during a procedure to facilitate a change of endotracheal tube in a septic patient. The cause of this rare but fatal complication is briefly described and discussed. In view of this, suxamethonium should be used with great caution in patients with burns and other forms of physical injury, in a number of nervous system disorders, and in critically ill patients requiring prolonged ITU care.

Matched MeSH terms: Hyperkalemia/chemically induced*
Fulltext Potassium and massive blood transfusion

Reddy SV, Sein K

Singapore Med J, 1991 Feb;32(1):29-30.
PMID: 2017701

Sixty patients who received massive blood transfusion intraoperatively and/or in the immediate post-operative period were analysed. Six patients had hypokalemia and two had hyperkalemia. The multifactorial changes leading to electrolyte disturbances especially involving potassium are discussed in relation to hypotension, hypothermia, acidosis, pH, and release of catecholamine. Potassium changes in relation to anaesthesia are discussed. The danger of routine administration of calcium during massive blood transfusion is stressed.

Matched MeSH terms: Hyperkalemia/etiology
Fulltext Electrocardiographic case--electrocardiographic clinical diagnosis in a patient with post-chemotherapy emesis and oliguria

Fadilah SS

Singapore Med J, 1999 Aug;40(8):553-5.
PMID: 10572501
Matched MeSH terms: Hyperkalemia/chemically induced; Hyperkalemia/diagnosis*
Hyperkalemia measurement between Blood Gas Analyser and Main Laboratory Biochemistry Analyser

Ismail MH, Baharuddin KA, Suliman MA, Mohd Shukri MF, Che Has SN, Lo ZZ

Med J Malaysia, 2021 03;76(2):157-163.
PMID: 33742622

INTRODUCTION: Potassium level is measured for patients with high risk of hyperkalemia in the emergency department (ED) using both blood gas analyser (BGA) and biochemistry analyser (BCA). The study was conducted to evaluate the correlation and agreement of potassium measurement between BGA and BCA.
MATERIALS AND METHODS: This is a prospective cross-sectional study on the data obtained from Hospital Universiti Sains Malaysia (Hospital USM) from Jun 2018 until May 2019. Blood samples were taken via a single prick from venous blood and sent separately using 1ml heparinised syringe and were analysed immediately in ED using BGA (Radiometer, ABL800 FLEX, Denmark) and another sample was sent to the central laboratory of Hospital USM and analysed by BCA (Architect, C8000, USA). Only patients who had potassium levels ≥5.0mmol/L on blood gas results were included. A total of 173 sample pairs were included. The correlation and agreement were evaluated using Passing and Bablok regression, Linear Regression and Bland-Altman test.
RESULT: Of the 173 sample pairs, the median of potassium level based on BGA and BCA were 5.50mmol/L (IQR: 1.00) and 5.90mmol/L (IQR: 0.95) respectively. There was significant correlation between two measurements (p<0.001, r: 0.36). The agreement between the two measurements showed within acceptable mean difference which was 0.27 mmol/L with 95% limit of agreement were 1.21mmol/L to 1.73mmol/L.
CONCLUSION: The result of blood gas can be used as a guide for initial treatment of hyperkalaemia in critical cases where time is of the essence. However, BCA result is still the definitive value.

Matched MeSH terms: Hyperkalemia
Fulltext A case report on biochemical aberrations in disseminated histoplasmosis: the clues toward addison’s disease

Izzatul Aliaa Badaruddin, Dian Nasriana Nasuruddin, Hanita Othman, Munirah Mansor

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):348-350.
MyJurnal

The incidence of Addison’s disease (AD) is rare. One of the most common causes of AD in developed countries is autoimmune. On the other hand, in developing countries, infective causes still predominate. The symptoms are mostly insidious in onset and non-specific, making it challenging to diagnose AD. The delay in starting the right treatment predisposes to high mortality due to Addison’s crisis. Hence, biochemical parameters play a vital role in diagnosing AD since they usually will present with prominent hyponatraemia, hyperkalaemia and hypoglycaemia. Here, we report a case of a 66-year-old man with multiple co-morbidities and disseminated histoplasmosis who pre- sented with asymptomatic hyponatraemia and hyperkalaemia and was eventually diagnosed with Addison’s disease. Although the non-specific symptoms from his multiple co-morbidities obscured the diagnosis of AD, comprehensive biochemical tests have helped in establishing the diagnosis.

Matched MeSH terms: Hyperkalemia
Acute Ischemic Stroke and Acute on Chronic Kidney Disease

Aftab RA, Khan AH, AbdulRazzaq HA, Adnan AS

JNMA J Nepal Med Assoc, 2016 12 10;54(202):85-87.
PMID: 27935930

Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity.Here we present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden on set of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus (uncontrolled). He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis), acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and careful selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating condition.

Matched MeSH terms: Hyperkalemia/complications
Incidence of risk factors for developing hyperkalemia when using ACE inhibitors in cardiovascular diseases

Amir O, Hassan Y, Sarriff A, Awaisu A, Abd Aziz N, Ismail O

Pharm World Sci, 2009 Jun;31(3):387-93.
PMID: 19255869 DOI: 10.1007/s11096-009-9288-x

STUDY OBJECTIVE: To determine the incidence of and the risk factors associated with hyperkalemia, induced by ACEI-drug interactions among cardiac patients.
SETTING: Five medical and cardiology wards of a tertiary care center in Malaysia.
SUBJECTS: Five hundred cardiac inpatients, who received ACEIs concomitantly with other interacting drugs.
METHOD: This was a prospective cohort study of 500 patients with cardiovascular diseases admitted to Penang Hospital between January to August 2006, who received ACEIs concomitantly with other interacting drugs. ACEI-drug interactions of clinical significance were identified using available drug information resources. Drug Interaction Probability Scale (DIPS) was used to assess the causality of association between ACEI-drug interactions and the adverse outcome (hyperkalemia).
MAIN OUTCOME MEASURE: Hyperkalemia as an adverse clinical outcome of the interaction was identified from laboratory investigations.
RESULTS: Of the 489 patients included in the analysis, 48 (9.8%) had hyperkalemia thought to be associated with ACEI-drug interactions. Univariate analysis using binary logistic regression revealed that advanced age (60 years or more), and taking more than 15 medications were independent risk factors significantly associated with hyperkalemia. However, current and previous smoking history appeared to be a protective factor. Risk factors identified as predictors of hyperkalemia secondary to ACEI-drug interactions by multi-logistic regression were: advanced age (adjusted OR 2.3, CI 1.07-5.01); renal disease (adjusted OR 4.7, CI 2.37-9.39); hepatic disease (adjusted OR 5.2, CI 1.08-25.03); taking 15-20 medications (adjusted OR 4.4, CI 2.08-9.19); and taking 21-26 medications (adjusted OR 9.0, CI 1.64-49.74).
CONCLUSION: Cardiac patients receiving ACEIs concomitantly with potentially interacting drugs are at high risk of experiencing hyperkalemia. Old age, renal disease, hepatic disease, and receiving large number of medications are factors that may significantly increase their vulnerability towards this adverse outcome; thus, frequent monitoring is advocated.

Matched MeSH terms: Hyperkalemia/chemically induced*
Re-visiting pH-adjusted potassium to avoid hypokalemic crisis during management of diabetic ketoacidosis: A conceptual framework

Usman A, Shaikh MF, Dujaili JA, Mustafa N, Gan SH

Diabetes Metab Syndr, 2021 Mar 05;15(2):573-580.
PMID: 33706189 DOI: 10.1016/j.dsx.2021.03.001

BACKGROUND AND AIMS: Diabetic ketoacidosis (DKA) treatment guidelines recommend to initiate potassium-replacement when serum potassium (SK) drops within normal range, and to withhold insulin if SK is below normal. Despite strict recommendations, hypokalemia is frequently observed in DKA.
METHODS: Scientific literature was thoroughly searched to find 1) DKA treatment guidelines, 2) studies reporting hypokalemia in DKA, 3) and literature elaborating mechanisms involved in hypokalemia.
RESULTS: Acidosis affects SK and its regulators including insulin, catecholamines and aldosterone. Current conceptual framework is an argument to gauge the degree of hypokalemia before it strikes DKA patients utilizing SK level after adjusting it with pH. Suggested approach will reduce hypokalemia risk and its associated complications. The nomogram calculates pH-adjusted potassium and expected potassium loss. It also ranks hypokalemia associated risk, and proposes the potassium-replacement rate over given time period. The differences between current DKA treatment guidelines and proposed strategy are also discussed. Moreover, reasons and risk of hyperkalemia due to early initiation of potassium replacement and remedial actions are debated.
CONCLUSION: In light of proposed strategy, utilizing the nomogram ensures reduced incidence of hypokalemia in DKA resulting in improved clinical and patient outcomes. Pharmacoeconomic benefits can also be expected when avoiding hypokalemia ensures early discharge.

Matched MeSH terms: Hyperkalemia
Fulltext Case Report: Severe Hyponatremia in Infants With Urinary Tract Infection

Abu Bakar K, Jalaludin MY, Zainal N, Woon SL, Mohd Zikre N, Samingan N, et al.

Front Pediatr, 2021;9:655010.
PMID: 34026690 DOI: 10.3389/fped.2021.655010

Introduction: Many reports on investigations and treatments in UTI, however little, have been mentioned with regard to electrolyte abnormalities. Secondary pseudohypoaldosteronism (PHA) in UTI, though less common, is a known association. Features include hyponatremia and concomitant hyperkalemia. Objectives: We aim to highlight these uncommon sequelae in UTI to avoid incorrect diagnosis and unnecessary investigations. Study Design: Clinical data of patients admitted and referred to a pediatric nephrologist at the University Malaya Medical Center between May 2019 and October 2020 were collated and elaborated. Results and Discussion: We report three infants with hyponatremia and hyperkalemia during UTI episodes. Two infants were known to have posterior urethral valve (PUV) before the onset of UTI and one infant had UTI, which led to investigations confirming the diagnosis of bladder vaginal fistula. The electrolyte derangements were temporary and resolved within 48 to 72 h of treatment with intravenous fluid and appropriate antibiotic therapy. Out of three, only one had a hormonal study, which confirms PHA. Reduced aldosterone activity could be due to absolute reduction in aldosterone titer or lack of aldosterone responsiveness at tubular (other tissues) level. In the latter, aldosterone titer is elevated. The infant in our cohort who had hormonal evaluation had the mentioned electrolyte abnormalities with a markedly elevated aldosterone titer. This demonstrated defective action of the hormone at the level of mineralocorticoid receptor. Although the remaining two infants had no confirmatory hormonal study, all of them recovered within 48 h of hospital admission, after receiving appropriate management for the primary problem, which was UTI. We observed a slower recovery of hyponatremia in relation to hyperkalemia, but none of these infants required salt replacement upon discharge. Conclusion: Infants with severe UTI and deranged electrolytes should be screened for structural abnormality and vice versa. Not all infants require hormonal screening, but those who required prolonged salt replacement or showed involvement of other systems warrant further evaluation.

Matched MeSH terms: Hyperkalemia
Fulltext A Rare Cause of Acute Kidney Injury: Primary Renal Lymphoma in a Patient with Human Immunodeficiency Virus

Mustafar R, Kamaruzaman L, Chien BH, Yahaya A, Mohd Nasir N, Mohd R, et al.

Case Rep Med, 2018;2018:8425985.
PMID: 30186328 DOI: 10.1155/2018/8425985

We reported a case of primary renal lymphoma (PRL) presented with non-oliguric acute kidney injury and bilateral kidney infiltrates in an individual with human immunodeficiency virus (HIV) disease. Acute kidney injury secondary to lymphoma infiltrates is very rare (less than 1% of hematological malignancy). A 37-year-old gentleman with underlying human immunodeficiency virus (HIV) disease was on combined antiretroviral therapy since diagnosis. He presented to our center with uremic symptoms and gross hematuria. Clinically, bilateral kidneys massively enlarged and were ballotable. Blood investigations showed hemoglobin of 3.7 g/L, urea of 65.6 mmol/L, and serum creatinine of 1630 µmol/L with hyperkalemia and metabolic acidosis. An urgent hemodialysis was initiated, and he was dependent on regular hemodialysis subsequently. Computed tomography renal scan showed diffuse nonenhancing hypodense lesion in both renal parenchyma. Diagnosis of diffuse large B cell lymphoma with germinal center type, CD20 positive, and proliferative index 95% was confirmed via renal biopsy, and there was no bone marrow infiltrates. Unfortunately, the patient succumbs prior to initiation of chemotherapy.

Matched MeSH terms: Hyperkalemia

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