General characteristics of patients with electrolyte imbalance admitted to emergency department

BACKGROUND:Fluid and electrolyte balance is a key concept to understand for maintaining homeostasis,and for a successful treatment of many metabolic disorders.There are various regulating mechanisms for the equilibrium of electrolytes in organisms.Disorders of these mechanisms result in electrolyte imbalances that may be life-threatening clinical conditions.In this study we defined the electrolyte imbalance characteristics of patients admitted to our emergency department.METHODS:This study was conducted in the Emergency Department(ED) of Uludag University Faculty of Medicine,and included 996 patients over 18 years of age.All patients had electrolyte imbalance,with various etiologies other than traumatic origin.Demographic and clinical parameters were collected after obtaining informed consent from the patients.The ethical committee of the university approved this study.RESULTS:The mean age of the patients was 59.28±16.79,and 55%of the patients were male.The common symptoms of the patients were dyspnea(14.7%),fever(13.7%),and systemic deterioration(11.9%);but the most and least frequent electrolyte imbalances were hyponatremia and hypermagnesemia,respectively.Most frequent findings in physical examination were confusion(14%),edema(10%) and rales(9%);and most frequent pathological findings in ECG were tachycardia in24%,and atrial fibrillation in 7%of the patients.Most frequent comorbidity was malignancy(39%).Most frequent diagnoses in the patients were sepsis(11%),pneumonia(9%),and acute renal failure(7%).CONCLUSIONS:Electrolyte imbalances are of particular importance in the treatment of ED patients.Therefore,ED physicians must be acknowledged of their fluid-electrolyte balance dynamics and general characteristics.

Sliding with the sines−fatal hyperkalemia:A case report

BACKGROUND Classic electrocardiographic manifestations of hyperkalemia starting with peaked symmetrical T-waves are widely recognized in daily clinical practice but little evidence is documented how quickly it can evolve in real-time.CASE SUMMARY An elderly diabetic and hypertensive male presented with acute renal failure and rhabdomyolysis.He experienced cardiac arrest with moderate hyperkalemia despite medical treatment and hemodialysis.Telemetry changes were retrospectively studied and found to have significant rhythm changes that occurred just less than 10 minutes prior to the cardiac arrest.CONCLUSION In hyperkalemia,telemetry rhythm can change instantaneously in a significant way.Rapidly rising potassium could be life threatening and may require more than medical treatment.

New perspectives of volemic resuscitation in polytrauma patients:a review

Nowadays,fluid resuscitation of multiple trauma patients is still a challenging therapy.Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the patient.Patients presenting with multiple trauma often develop hemorrhagic shock,which triggers a series of metabolic,physiological and cellular dysfunction.These disorders combined,lead to complications that significantly decrease survival rate in this subset of patients.Volume and electrolyte resuscitation is chal enging due to many factors that overlap.Poor management can lead to post-resuscitation systemic inflammation causing multiple organ failure and ultimately death.In literature,there is no exact formula for this purpose,and opinions are divided.This paper presents a review of modern techniques and current studies regarding the management of fluid resuscitation in trauma patients with hemorrhagic shock.According to the literature and from clinical experience,al aspects regarding post-resuscitation period need to be considered.Also,for every case in particular,emergency therapy management needs to be rigorously respected considering al physiological,biochemical and biological parameters.

High extracellular potassium ion concentration attenuates the blockade action of ketanserin on Kv1.3 channels expressed in xenopus oocytes

Background Ketanserin （KT）, a selective serotonin （5-HT） 2-receptor antagonist, reduces peripheral blood pressure by blocking the activation of peripheral 5-HT receptors. In this study electrophysiological method was used to investigate the effect of KT and potassium ion on Kv1.3 potassium channels and explore the role of blocker KT in the alteration of channel kinetics contributing to the potassium ion imbalances. Methods Kv1.3 channels were expressed in xenopus oocytes, and currents were measured using the two-microelectrode voltage-clamp technique. Results KCI made a left shift of activation and an inactivation curve of Kv1.3 current and accelerated the activation and inactivation time constant. High extracellular [K^＋] attenuated the blockade effect of KT on Kv1.3 channels. In the presence of KT and KCI the activation and inactivation time constants were not influenced significantly no matter what was administered first. KT did not significantly inhibit Kv1.3 current induced by tetraethylammonium （TEA）. Conclusions KT is a weak blocker of Kv1.3 channels at different concentrations of extracellular potassium and binds to the intracellular side of the channel pore. The inhibitor KT of ion channels is not fully effective in clinical use because of high [K^＋]. and other electrolyte disorders.