Risk Factors Asscociated with Hypokalemia during Postanesthesia Recovery and Its Impact on Outcomes in Gynecological Patients:A Propensity Score Matching Study

Objective:This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological population.Methods:This retrospective cohort study included 208 patients who underwent gynecological surgery at our institution between January 2021 and March 2022.Data were collected for each patient,including demographics,disease status,surgical data,and clinical information.Preoperative bowel preparation,postoperative gastrointestinal function,and electrolyte levels were compared between the two groups using propensity score matching(PSM).Results:The incidence of hypokalemia(serum potassium level<3.5 mmol/L)during the recovery period from anesthesia was approximately 43.75%.After PSM,oral laxative use(96.4%vs.82.4%,P=0.005),the number of general enemas(P=0.014),and the rate of≥2 general enemas(92.9%vs.77.8%,P=0.004)were identified as risk factors for hypokalemia,which was accompanied by decreased PaCO2 and hypocalcemia.There were no significant differences in postoperative gastrointestinal outcomes,such as the time to first flatus or feces,the I-FEED score(a scoring system was created to evaluate impaired postoperative gastrointestinal function),or postoperative recovery outcomes,between the hypokalemia group and the normal serum potassium group.Conclusion:Hypokalemia during postanesthesia recovery period occurred in 43.75%of gynecological patients,which resulted from preoperative mechanical bowel preparation;however,it did not directly affect clinical outcomes,including postoperative gastrointestinal function,postoperative complications,and length of hospital stay.

One Case of Primary Thrombocythemia with Concealed Hypokalemia Complicated by Acute Myocardial Infarction

Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 109/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.

Studies on Hypokalemia Induced by Trimethyltin Chloride

Objectives To determine the possible relationship between plasma potassiumconcentration and severity of acute trimethyltin chloride (TMT) poisoning and to assess themechanism of TMT induced hypokalemia. Methods SD rats were treated with variousdosages of TMT (ip). All the indices were measured and analysed for determing theirpossible relations with plasma K+. Results With increase of dosage, the plasma K+ leveldropped rapidly, and deaths appeared more quickly. The LD50 of TMT (ip) was 14.7 mg/kgbw. In the low dosage group (10 mg/kgbw), the plasma K+ level dropped slowly with thelowest dosage on day 6 (4.85 mmol/L). It rose again on day 11 (5.06 mmol/L), and recoverdon day 28. The poisoning signs corresponded with decline of the span of K+ level. The plasmaNa+ level dropped half an hour after TMT treatment, but recovered 24 h later. In the highdosage group (46.4 mg/kgbw), the levels of plasma K+ and Na+ fell rapidly within half anhour (P<0.05), the intracellular potassium concentration of RBC did not decrerase obviously(P>0.05), the activities of Na+-K+-ATPase and Mg2+-ATPase in RBC membrane weredepressed remarkably (P<0.01, P<0.05, respectively), the plasma aldosterone concentrationsrose as high as tenfold (P<0.01), the arterial blood pH fell from 7.434 to 7.258 (P<0.01),pCO2 was raised from 29.62 to 45.33 mmHg (P<0.01). In the 24 h urine test, when rats weretreated with TMT (21.5 mg/kgbw, ip), urine volume, urinary potassium, sodium and chlorideincreased significantly in comparison with those in the controls (P<0.01). Conclusion TMTcould induce hypokalemia in SD rats. The available evidence suggests that TMT can induceacute renal leakage of potassium. At the same time, a significant rise of plasma aldosteronemay play an important role in promoting potassium leakage from kidney to result in severehypokalemia with inhaling acid-base abnormalities produced, which aggravate the poisoningsymptoms. In the end the rats would die of respiratory failure.

Effects of hypokalemia on transmural dispersion of ventricular repolarization in left ventricular myocardium

Objective:To observe effects of hypokalemia on transmural heterogeneity of ventricular repolarization in left ventricular myocardium of rabbit,and explore the role of hypokalemia in malignant ventricular arrhythmia（MVA）.Methods:A total of 20 rabbits were randomly divided into control group and hypokalemic group.Isolated hearts in the control group were simply perfused with modified Tyrode’s solution,and were perfused with hypokalemic Tyrode’s solution in hypokalemic group.Ventricular fibrillation threshold（VFT）,90%monophasic action potential repolarization duration(APD90) of subepicardial,midmyocardial and subendocardial myocardium,transmural dispersion of repolarization（TDR） and Cx43 protein expression in three layers of myocardium were measured in both groups.Results:VFT in the control group and the hypokalemic group were（13.40±2.95） V,and（7.00±1.49） V,respectively.There was a significant difference between two groups（P【0.01）.APD90 of three myocardial layers in the hypokalemic group were significantly prolonged than those in the control group（/’【0.01）.△APD90in the hypokalemic group and the control group were（38.10±10\29） ms and（23.7015.68） ms,and TDR were（52.90r 14.55） ms and（36.10±12.44） ms,respectively.△APD90 and TDR in the hypokalemic group were significantly higher than those in the control group(P【0.05|,and the increase in△APD90 of midmyocardium was more significant in the hypokalemic group.Cx43 protein expression of all three myocardial layers were decreased significantly in the hypokalemic group（P【0.01）, and△APD90 was significantly increased {P【0.05).Reduction of Cx43 protein expression was more significant in the midmyocardium.Conclusions:Hypokalemic can increase transmural heterogeneity of Cx43 expression and repolarization in left ventricular myocardium of rabbit,and decrease VFT and can induce MVA more easily.

Rhabdomyolysis following severe hypokalemia caused by familial hypokalemic periodic paralysis

Rhabdomyolysis continues to appear with increasing frequency and represents a medical emergency requiring rapid appropriate treatment. One of the unusual causes of nontraumatic rhabdomyolysis is hypokalemic periodic paralysis without secondary causes. Primary hypokalemic periodic paralysis is a rare genetic disease characterized by episodic attacks of muscle weakness due to decreases in serum potassium. A 30-year-old woman who had 3 episodic attacks of hypokalemic periodic paralysis was admitted in emergency room with sudden onset symmetrical muscle weakness. After several hours, she started to complain myalgia and severe ache in both calves without any changes. Laboratory test showed markedly elevated creatine phosphokinase, lactic dehydrogenase levels with hypokalemia, rhabdomyolysis resulting from hypokalemia was diagnosed. Here, we report an unusual case of rhabdomyolysis caused by severe hypokalemia, which was suggested a result of familial hypokalemic periodic paralysis.

Severe Hypokalemia ECG Changes Mimicking Those of Acute Coronary Syndrome (ACS) in Patient with Underlying Ischaemic Heart Disease: A Case Review

Background: Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. Aim: This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. Methods: We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. Outcomes: Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. Conclusions: Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.

Prevention of hospital-acquired hypokalemia in children receiving maintenance fluid therapy

Objective: It has been suggested that the use of hypotonic intravenous fluid (IVF) puts hospitalized children at a greater risk of developing hyponatremia in children with increased arginine vasopressin (AVP) production. To reduce its risk, the National Patient Safety Agency in UK issued alert 22 in 2007, of which recommendations were to use isotonic solutions for these children at risk of hyponatremia, instead of the previously most commonly used IVF (0.18% saline/ 4% dextrose) for maintenance fluid therapy. Recent observations, however, revealed that hypokalemia are also common in hospitalized patients who do not receive potassium in their IVF. This study was conducted to validate the potassium added IVF for the prevention of hospital-acquired hypokalemia in maintenance fluid therapy. Design: For maintenance fluid therapy, a commercially available IVF solution in Japan named as Solita-T2R (Na 84 mmol/L, K 20 mmol/L, Cl 66 mmol/L, glucose 3.2%) was infused for 41 sick children with a median age of 3.01 years. Its composition is close equivalent to 0.45% saline/5% dextrose (Na 77 mmol/L, K 0 mmol/L, Cl 77 mmol/L, dextrose 5%) except K content. The patients in states of AVP excess were excluded from the analysis. Results: Median serum potassium value did not drop significantly at a median interval of 48 hours (before IVF: 4.30 mmol/L, after IVF: 4.10 mmol/L, p > 0.05), whereas median serum sodium level significantly increased from 136.0 mmol/L to 139.0 mmol/L (p < 0.001). Conclusion: Potassium added (20 mmol/L) IVF solution reduces the risk of developing “hospital-acquired hypokalemia” in children who are not in states of AVP excess in maintenance fluid therapy. It is worthwhile to study prospectively in a larger number of sick children.

Watery diarrhea,hypokalemia and achlorhydria syndrome due to an adrenal pheochromocytoma

Watery diarrhea, hypokalemia and achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP) -producing tumor only rarely occurs in patients with nonpancreatic disease. A 49-year-old woman was referred for evaluation of a right adrenal tumor incidentally diagnosed by abdominal ultrasound during the investigation of chronic watery diarrhea. Laboratory findings showed hypokalemia and excessive production of VIP and catecholamines. After surgical resection of the tumor, diarrhea subsided and both electrolytes and affected hormone levels normalized. Immunohistochemical examination confirmed a diagnosis of pheochromocytoma, which contained VIP-positive ganglion-like cells. We herein present the clinical and histogenetic implications of this rare clinical entity, with literature review.

17α-羟化酶缺乏症3家系临床分析

目的探讨并总结17α-羟化酶缺乏症的诊断及治疗。方法回顾性分析2015年11月至2023年2月儿童内分泌遗传代谢科收治的来自3个家系共5例17α-羟化酶缺乏症(17OHD)病例的临床资料,并复习相关文献。结果5例患儿均存在高血压、低血钾及性激素水平低下,4例无第二性征发育,2例46,XY患儿行性腺活检+双侧睾丸切除术,术后性腺病理结果为发育不良的睾丸。基因分析结果提示3例为CPY17A1基因c.985_987delinsAA纯合突变,另2例为CPY17A1基因c.785T>G与c.1193C>T复合杂合突变。5例患儿经糖皮质激素治疗,低血钾和高血压均得到控制。结论早期识别与诊断17α-羟化酶缺乏症,及时予糖皮质激素替代治疗,可获得满意的疗效,提高患儿生活质量。基因测序有助于明确该罕见病的分子学诊断。

Gitelman综合征临床特点及诊治方法

目的:分析Gitelman综合征的临床特点及诊治方法。方法:选取诊断为Gitelman综合征的3例患者作为研究对象,回顾性分析其临床表现、生化检查,并抽取患者的外周血进行全外显子高通量二代测序分析,结合文献报道讨论本疾病的临床特征与诊治经验。结果:3例患者均为成年发病,血压均正常。病例1无明显低钾症状,由体检时偶然发现而就诊;病例2和病例3均有低钾相关临床表现,补钾后症状可缓解。病例1和病例2表现为低钾、低镁、肾性失钾、低尿钙、代谢性碱中毒,病例3轻度低钾,血镁正常,也存在肾性失钾及低尿钙,3例患者均有肾素-血管紧张素-醛固酮系统的激活。基因检测结果示病例1和病例2为SCL12A3基因复合杂合突变,病例3仅发现单杂合突变,其中病例2的移码突变c.976delG既往未被报道,致病性软件预测该变异为可能致病。本文3例患者通过补充钾和镁后症状改善,血钾、血镁水平达到治疗目标。结论:Gitelman综合征的临床表现缺乏特异性,诊断有赖于实验室检查及基因检测,预后良好。

吉特曼综合征合并低钙血症1例报道

吉特曼综合征(gitelman syndrome,GS)又称家族性低钾-低镁血症,大多数GS病例与位于16q13染色体上的SLC12A3基因的双等位基因失活突变有关,该染色体编码位于远曲小管顶膜的噻嗪敏感氯化钠共转运体,少部分是由编码氯通道CLCNKB基因突变所致[1]。GS临床表现隐匿,与巴特综合征(bartter syndrome,BS)临床表现极为相似,临床难以区分[2]。

青年女性,乏力,低血钾,高血糖

本文报道1例合并乏力、低血钾、高血糖的青年女性患者。其既往合并糖尿病,因乏力、发现血钾低5年而就诊,辅助检查示低血钾、低血镁、代谢性碱中毒、低尿钙,SLC12A3致病性突变,确诊为Gitelman综合征。予以氯化钾、镁剂治疗后,患者乏力得到改善,血钾、血镁基本正常,口服降糖药物后血糖控制达标。本文梳理该患者的诊疗历程,并结合文献复习,以期为临床诊疗提供参考。

男性酒依赖患者合并贫血影响因素分析及预测模型构建

目的:探讨男性酒依赖患者合并贫血影响因素,并构建相应预测模型。方法:回顾性收集155例男性酒依赖患者临床资料,包括一般临床特征、饮酒情况以及实验室指标等。根据血红蛋白是否<130g/L(男性)将患者分为贫血组(n=63)与非贫血组(n=92),通过单因素及逐步多因素Logistic回归分析筛选男性酒依赖患者合并贫血的影响因素,并建立预测模型,最后采用ROC曲线评估模型预测能力。结果:155例男性酒依赖患者中有63例合并贫血,发生率为40.65%。逐步多因素Logistic回归分析显示,年龄、饮酒量、低钾血症、低蛋白血症、低淋巴细胞与单核细胞比值(LMR)均是男性酒依赖患者合并贫血的影响因素(P均<0.05)。Logistic回归方程为Logit(p)=-9.421+0.055×年龄+0.046×饮酒量+1.386×低钾血症+1.950×低蛋白血症+1.003×低LMR。联合预测因子曲线下面积为0.815,灵敏度为77.8%,特异度为75.0%%,截断值为0.382。结论:年龄、饮酒量、低钾血症、低蛋白血症、低LMR是男性酒依赖患者合并贫血的影响因素;本研究构建预测模型可为临床早期评估男性酒依赖患者合并贫血提供借鉴。

Development and validation of a deep learning model to screen hypokalemia from electrocardiogram in emergency patients

Background:A deep learning model(DLM)that enables non-invasive hypokalemia screening from an electrocardiogram(ECG)may improve the detection of this life-threatening condition.This study aimed to develop and evaluate the performance of a DLM for the detection of hypokalemia from the ECGs of emergency patients.Methods:We used a total of 9908 ECG data from emergency patients who were admitted at the Second Affiliated Hospital of Nanchang University,Jiangxi,China,from September 2017 to October 2020.The DLM was trained using 12 ECG leads(lead Ⅰ,Ⅱ,Ⅲ,aVR,aVL,aVF,and V1–6)to detect patients with serum potassium concentrations<3.5 mmol/L and was validated using retrospective data from the Jiangling branch of the Second Affiliated Hospital of Nanchang University.The blood draw was completed within 10 min before and after the ECG examination,and there was no new or ongoing infusion during this period.Results:We used 6904 ECGs and 1726 ECGs as development and internal validation data sets,respectively.In addition,1278 ECGs from the Jiangling branch of the Second Affiliated Hospital of Nanchang University were used as external validation data sets.Using 12 ECG leads(leads Ⅰ,Ⅱ,Ⅲ,aVR,aVL,aVF,and V1–6),the area under the receiver operating characteristic curve(AUC)of the DLM was 0.80(95%confidence interval[CI]:0.77–0.82)for the internal validation data set.Using an optimal operating point yielded a sensitivity of 71.4%and a specificity of 77.1%.Using the same 12 ECG leads,the external validation data set resulted in an AUC for the DLM of 0.77(95%CI:0.75–0.79).Using an optimal operating point yielded a sensitivity of 70.0%and a specificity of 69.1%.Conclusions:In this study,using 12 ECG leads,a DLM detected hypokalemia in emergency patients with an AUC of 0.77 to 0.80.Artificial intelligence could be used to analyze an ECG to quickly screen for hypokalemia.

合并骨质疏松且无低血镁的Gitelman综合征1例

目的探讨Gitelman综合征(GS)合并重度骨质疏松的临床特点、诊断和治疗,加深对该病的认识。方法2017年2月海南医学院第二附属医院内分泌科住院的GS合并重度骨质疏松且无低血镁1例,复习文献,总结该病特点。结果该病主要表现为严重低钾血症、多处骨关节疼痛,易误诊。予积极补钾、抗醛固酮、抗骨质疏松治疗,有效缓解了病情。结论GS虽然尿钙低,无低血镁,但也可以合并骨质疏松。因此,对存在多关节疼痛的GS病人,应及时进行双能X线骨密度检查早期筛查骨质疏松。对于此类病人,积极给予补钾、抗醛固酮及抗骨质疏松治疗可提高疗效。

一例Gitelman综合征合并扁桃体炎的病例报告

Gitelman综合征(GS)是一种失盐性肾小管疾病,呈常染色体隐性遗传,以慢性低钾血症、代谢性碱中毒和继发性醛固酮增多症为主要表现。本研究报道了1例GS患者合并扁桃体炎的诊治过程,同时通过文献复习的方式探讨GS的临床表现、诊断方法、治疗及随访策略,并强调基因检测在本病诊断过程中的重要性。临床医师在工作中应提高对GS的认识水平,做到早期诊断并治疗GS。

播散性隐球菌病并发消化道大出血患儿的护理

总结1例以黄疸为首发症状的儿童播散性隐球菌病并发消化道大出血的护理体会。针对患儿以全身皮肤黄染伴瘙痒起病、抗真菌药物毒副作用大、并发消化道大出血和低钾血症危象等并发症,采取重症肝病皮肤管理、抗真菌药物特殊用药护理、消化道大出血及低钾血症危象急诊处置等措施。经过91 d的治疗与护理,患儿病情好转回当地医院继续治疗,出院1个月后皮肤黄染消退,出院8个月后再次电话随访,患儿健康状况良好。

在已行肾上腺静脉取血的患者中探讨醛固酮/血钾在预测原发性醛固酮增多症分型中的作用

目的研究盐水负荷试验后醛固酮(PAC)/血钾在预测原发性醛固酮增多症(PA)分型方面的作用。方法选取郑州大学第一附属医院2020年8月至2022年3月收治的完成肾上腺静脉采血(AVS)检查的PA患者共计113例。按照AVS结果分为双侧PA组和单侧PA组。研究两组间血钾、PAC等指标的差异,并分析单侧PA与血钾、PAC等检测指标的相关性。logistic回归分析探讨预测单侧PA的独立因素。受试者工作特征(ROC)曲线分析上述指标对单侧PA的预测价值。结果与双侧PA组相比,单侧PA组的血钾水平较低,年龄较轻,醛固酮相关指标均较高。相关分析显示,血钾与单侧PA呈负相关;和醛固酮有关的指标,与单侧PA均呈正相关。logistic回归分析显示血钾和(OR=0.091,95%CI 0.021~0.388,P=0.001)盐水后PAC(OR=1.004,95%CI 1.000~1.008,P=0.040)是预测单侧PA的独立预测因子。ROC分析相关因素对单侧PA预测价值:血钾曲线下面积0.765(0.691~0.827)、盐水后PAC曲线下面积0.828(0.785~0.932)、盐水后PAC/血钾曲线下面积0.872(0.803~0.942)。结论盐水后PAC/血钾在预测单侧PA方面,可能是一项简单有效的指标。若该比值>8.7(ng·dL^(-1))/(mmol·L^(-1)),预示单侧PA可能性大。