scholarly journals Hyperemesis gravidarum induced refeeding syndrome causes blood cell destruction: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiyu Pan ◽  
Ran Chu ◽  
Jinyu Meng ◽  
Qiannan Wang ◽  
Yue Zhang ◽  
...  
Keyword(s):  
Blood Cell ◽  
Hyperemesis Gravidarum ◽  
Altered Mental Status ◽  
Electrolyte Imbalance ◽  
Refeeding Syndrome ◽  
Appetite Loss ◽  
Case Presentation ◽  
Cell Destruction ◽  
Electrolyte Disturbances ◽  
Electrolyte Abnormalities

Abstract Background Hyperemesis gravidarum (HG) is a common complication during pregnancy, however, HG associated simultaneous onset of blood cell destruction due to electrolyte abnormalities is rare. In this case, a woman with refeeding syndrome (RFS) secondary to electrolyte abnormalities caused by severe HG was diagnosed and managed in our hospital. Case presentation A 29-year old woman was sent to the local hospitals because of severe HG with appetite loss, weight reduction, general fatigue, and she was identified to have severe electrolyte abnormalities. However, the electrolyte abnormalities were not corrected promptly, and then she had the symptoms of stillbirth, altered mental status, visual hallucination, hemolytic anemia and thrombocytopenia. After transferred to our hospital, we continued to correct the electrolyte abnormalities and the labor induction was performed as soon as possible. The symptoms of blood cell destruction were relieved obviously, and the patient discharged four days later. The electrolyte disturbances and physio-metabolic abnormalities caused by HG helped us diagnose this case as RFS. Conclusions This case emphasizes that patients with RFS should be diagnosed appropriately and intervened promptly in order to prevent electrolyte imbalance induced blood cell destruction.

Electrolyte and acid-base disturbances in the management of leukemia

Blood ◽  
1977 ◽  
Vol 49 (3) ◽  
pp. 345-353 ◽  
Author(s):  
S O'Regan ◽  
S Carson ◽  
RW Chesney ◽  
KN Drummond
Keyword(s):  
Elevated Serum ◽  
Disease Process ◽  
Distal Tubule ◽  
Polymyxin B ◽  
Normal Serum ◽  
Leukemic Cells ◽  
Electrolyte Imbalance ◽  
Tubular Damage ◽  
Electrolyte Disturbances ◽  
Electrolyte Abnormalities

Abstract Electrolyte disturbances in leukemia can be the result of the disease process or drug therapy. One group of electrolyte abnormalities is related to the stage of the leukemic process. Included in this group are newly diagnosed patients who may show elevated serum potassium, phosphorus, and magnesium--a result of their release from malignant cells after cytotoxic therapy or their accumulation due to urate nephropathy. Patients in remission usually have normal serum electrolyte concentrations, but acute leukemia patients during relapse may have hypokalemia, hypophosphatemia, and hypomagnesemia. This imbalance may be related to cellular uptake of these electrolytes in the presence of inadequate dietary intake. Other factors contributing to electrolyte derangements, and related to the leukemic process, include hyponatremia and hypochloremia secondary to the SIADH, hypokalemia in acute monocytic or acute myelomonocytic leukemia due to lysozyme-induced tubular damage, hypercalcemia possibly secondary to leukemic infiltration of bone or parathyroid glands (with PTH release), or production of a PTH-like substance by leukemic cells. Nonspecific factors related to the disease process which may aggravate the electrolyte imbalance include gastrointestinal loss through nausea, vomiting, and malnutrition. The drug-related electrolyte abnormalities include cyclophosphamide- and vincristine-induced SIADH; decreased serum sodium, chloride, potassium, and calcium concentrations as a result of polymyxin B nephrotoxicity; hypokalemia and hypomagnesemia secondary to amphotericin B; hypocalcemia, hypophosphatemia, and hyperphosphaturia due to L-asparaginase-induced hypoparathyroidism; hypokalemia due to a nonreabsorbable anion effect of antibiotics in the distal tubule or changes in membrane ionic transport of all cells by large doses of antibiotics. Electrolyte disturbance in leukemia thus have a multifactorial pathogenesis which can best be delineated according to the stage of the leukemic process and the drugs being used. Recognition of the cause or causes in a particular patient is essential for an effective approach to management. This review emphasizes the need for routine measurement of serum electrolytes during all phases of the leukemic process.

scholarly journals Hyperemesis gravidarum followed by refeeding syndrome causes electrolyte abnormalities induced rhabdomyolysis and diabetes insipidus

2019 ◽  
Vol 66 (3) ◽  
pp. 253-258 ◽  
Author(s):  
Tatsuya Kondo ◽  
Miwa Nakamura ◽  
Junji Kawashima ◽  
Takeshi Matsumura ◽  
Takashi Ohba ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Hyperemesis Gravidarum ◽  
Refeeding Syndrome ◽  
Electrolyte Abnormalities

scholarly journals Electrolyte and acid-base disturbances in the management of leukemia

Blood ◽  
1977 ◽  
Vol 49 (3) ◽  
pp. 345-353
Author(s):  
S O'Regan ◽  
S Carson ◽  
RW Chesney ◽  
KN Drummond
Keyword(s):  
Elevated Serum ◽  
Disease Process ◽  
Distal Tubule ◽  
Polymyxin B ◽  
Normal Serum ◽  
Leukemic Cells ◽  
Electrolyte Imbalance ◽  
Tubular Damage ◽  
Electrolyte Disturbances ◽  
Electrolyte Abnormalities

Electrolyte disturbances in leukemia can be the result of the disease process or drug therapy. One group of electrolyte abnormalities is related to the stage of the leukemic process. Included in this group are newly diagnosed patients who may show elevated serum potassium, phosphorus, and magnesium--a result of their release from malignant cells after cytotoxic therapy or their accumulation due to urate nephropathy. Patients in remission usually have normal serum electrolyte concentrations, but acute leukemia patients during relapse may have hypokalemia, hypophosphatemia, and hypomagnesemia. This imbalance may be related to cellular uptake of these electrolytes in the presence of inadequate dietary intake. Other factors contributing to electrolyte derangements, and related to the leukemic process, include hyponatremia and hypochloremia secondary to the SIADH, hypokalemia in acute monocytic or acute myelomonocytic leukemia due to lysozyme-induced tubular damage, hypercalcemia possibly secondary to leukemic infiltration of bone or parathyroid glands (with PTH release), or production of a PTH-like substance by leukemic cells. Nonspecific factors related to the disease process which may aggravate the electrolyte imbalance include gastrointestinal loss through nausea, vomiting, and malnutrition. The drug-related electrolyte abnormalities include cyclophosphamide- and vincristine-induced SIADH; decreased serum sodium, chloride, potassium, and calcium concentrations as a result of polymyxin B nephrotoxicity; hypokalemia and hypomagnesemia secondary to amphotericin B; hypocalcemia, hypophosphatemia, and hyperphosphaturia due to L-asparaginase-induced hypoparathyroidism; hypokalemia due to a nonreabsorbable anion effect of antibiotics in the distal tubule or changes in membrane ionic transport of all cells by large doses of antibiotics. Electrolyte disturbance in leukemia thus have a multifactorial pathogenesis which can best be delineated according to the stage of the leukemic process and the drugs being used. Recognition of the cause or causes in a particular patient is essential for an effective approach to management. This review emphasizes the need for routine measurement of serum electrolytes during all phases of the leukemic process.

scholarly journals The pathophysiology of “happy” hypoglycemia

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Thomas Loeb ◽  
Anna Ozguler ◽  
Geraldine Baer ◽  
Michel Baer
Keyword(s):  
Critical Care ◽  
Hemorrhagic Shock ◽  
Lactate Production ◽  
Severe Hypoglycemia ◽  
Altered Mental Status ◽  
Case Presentation ◽  
Energy Substrate ◽  
Tissue Hypoperfusion ◽  
The Brain ◽  
Critical Care Patients

Abstract Background Hypoglycemia usually includes various neurological symptoms, which are the consequence of neuroglycopenia. When it is severe, it is associated with altered mental status, even coma. Case presentation We report the case of a patient with severe hypoglycemia, completely asymptomatic, due to the increase of lactate production in response to tissue hypoperfusion following a hemorrhagic shock. This illustrates that lactate can substitute glucose as an energy substrate for the brain. It is also a reminder that this metabolite, despite its bad reputation maintained by its role as a marker of severity in critical care patients, has a fundamental role in our metabolism. Conclusions Following the example of the “happy hypoxemia” recently reported in the literature describing asymptomatic hypoxemia in COVID-19 patients, we describe a case of “happy hypoglycemia.”

scholarly journals Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19)

2020 ◽  
Vol 57 (3) ◽  
pp. 262-265 ◽  
Author(s):  
Giuseppe Lippi ◽  
Andrew M South ◽  
Brandon Michael Henry
Keyword(s):  
Weighted Mean Difference ◽  
Severe Disease ◽  
Total Sample ◽  
Pooled Analysis ◽  
Severe Form ◽  
Electrolyte Imbalance ◽  
Sodium Potassium ◽  
Impact Patient Care ◽  
Insight Into ◽  
Electrolyte Abnormalities

Background Early studies have reported various electrolyte abnormalities at admission in patients who progress to the severe form of coronavirus disease 2019 (COVID-19). As electrolyte imbalance may not only impact patient care, but provide insight into the pathophysiology of COVID-19, we aimed to analyse all early data reported on electrolytes in COVID-19 patients with and without severe form. Methods An electronic search of Medline (PubMed interface), Scopus and Web of Science was performed for articles comparing electrolytes (sodium, potassium, chloride and calcium) between COVID-19 patients with and without severe disease. A pooled analysis was performed to estimate the weighted mean difference (WMD) with 95% confidence interval. Results Five studies with a total sample size of 1415 COVID-19 patients. Sodium was significantly lower in patients with severe COVID-19 (WMD: –0.91 mmol/L [95% CI: –1.33 to –0.50 mmol/L]). Similarly, potassium was also significantly lower in COVID-19 patients with severe disease (WMD: –0.12 mmol/L [95% CI: –0.18 to –0.07 mmol/L], I2=33%). For chloride, no statistical differences were observed between patients with severe and non-severe COVID-19 (WMD: 0.30 mmol/L [95% CI: –0.41 to 1.01 mmol/L]). For calcium, a statistically significant lower concentration was noted in patients with severe COVID-19 (WMD: –0.20 mmol/L [95% CI: –0.25 to –0.20 mmol/L]). Conclusions This pooled analysis confirms that COVID-19 severity is associated with lower serum concentrations of sodium, potassium and calcium. We recommend electrolytes be measured at initial presentation and serially monitored during hospitalization in order to establish timely and appropriate corrective actions.

scholarly journals Melanosis coli in a peritoneal dialysis patient: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nor Fadhlina Zakaria ◽  
Nurul Izah Ahmad ◽  
Elmina Mokhtar ◽  
Wan Zul Haikal Hafiz Wan Zukiman ◽  
Anim Md Shah
Keyword(s):  
Peritoneal Dialysis ◽  
Chronic Diarrhea ◽  
Histopathological Examination ◽  
Hypovolemic Shock ◽  
Peritoneal Dialysis Patient ◽  
Electrolyte Imbalance ◽  
Case Presentation ◽  
Melanosis Coli ◽  
Life Threatening ◽  
Black Discoloration

Abstract Background Patients who undergo peritoneal dialysis (PD) are at risk of gut bacteria translocation leading to peritonitis when there is chronic diarrhea. Chronic diarrhea is defined as any course of diarrhea that lasts at least 4 weeks, which can be continuous or intermittent. Chronic diarrhea of any duration may cause dehydration, electrolyte imbalance, and life-threatening hypovolemic shock. In PD patients, excessive ultrafiltration from the exchanges, combined with severe gastrointestinal loss, may cause hypovolemic shock, electrolyte imbalance, and metabolic acidosis. There are multiple causes of chronic diarrhea in PD patients including infective causes, mitotic lesions, and rarely the regular and excessive use of laxatives, which is a diagnosis of exclusion. Case presentation We report a case of Melanau lady with chronic diarrhea secondary to laxative usage in a patient being treated with automated peritoneal dialysis (APD). The patient went into hypovolemic shock, but luckily did not contract peritonitis. A colonoscopy revealed brown to black discoloration of the colon, a feature suggestive of melanosis coli. A biopsy of the intestine further confirmed the diagnosis by histopathological examination. Withdrawal of laxatives and the introduction of probiotics improved the symptoms tremendously. Conclusions The chronic use of laxatives in PD patients can potentially lead to a devastating problem; thus, the management team must monitor treatment commencement appropriately.

Severe altered mentation due to cervicothoracic intrathecal pump after correction of cervical stenosis: a case report

2021 ◽  
pp. rapm-2021-103041
Author(s):  
Chinar Sanghvi ◽  
Tiffany Su ◽  
Tony L Yaksh ◽  
David J Copenhaver ◽  
Eric O Klineberg ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Mental Status ◽  
Clinical Evidence ◽  
Chronic Neck Pain ◽  
Altered Mental Status ◽  
Cord Compression ◽  
Cervical Stenosis ◽  
Csf Flow ◽  
Case Presentation ◽  
Cervical Spinal Stenosis

BackgroundCerebral spinal fluid (CSF) dynamics are complex and changes in spinal anatomy may influence the rostrocaudal movement of intrathecal medications. We present the first reported case demonstrating that acute cervical spinal stenosis may impede the distribution of adjacent intrathecal medications, and that correction of such stenosis and the resulting changes in CSF flow may necessitate significant adjustments in the intrathecal infusates.Case presentationWe present a case of a 60-year-old male patient with a cervicothoracic intrathecal pump (ITP) infusing morphine, bupivacaine, and baclofen for chronic neck pain. The alert and oriented patient had a recent fall resulting in an acute severe cervical stenosis and cord compression which required urgent surgical decompression. Postoperatively, after the cervical decompression, the patient had significant altered mental status requiring a naloxone infusion. Multiple attempts to reduce the naloxone infusion were initially not successful due to worsened somnolence. The previously tolerated ITP medications were continuously reduced over the next 14 days, allowing concomitant decrease and eventual cessation of the naloxone infusion while maintaining patient mental status. The only opioids the patient received during this period were from the ITP.ConclusionsThis case presents clinical evidence that severe spinal stenosis may impede the rostral CSF distribution of intrathecal medications. Intrathecal medications previously tolerated by patients prior to decompression may need to be significantly reduced in the postoperative period.

scholarly journals Storms and silence: a case report of catatonia and paroxysmal sympathetic hyperactivity following cerebral hypoxia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dallas Wolfgang Hamlin ◽  
Nuzhat Hussain ◽  
Aum Pathare
Keyword(s):  
Gold Standard ◽  
Neuropsychiatric Symptoms ◽  
Altered Mental Status ◽  
Symptom Clusters ◽  
Opioid Overdose ◽  
Cerebral Hypoxia ◽  
Case Presentation ◽  
Sympathetic Hyperactivity ◽  
Paroxysmal Sympathetic Hyperactivity ◽  
Related Symptom

Abstract Background Delayed Post Hypoxic Leukoencephalopathy (DPHL) is a syndrome that occurs after hypoxia, and can present with a variety of neuropsychiatric symptoms, including catatonia and paroxysmal sympathetic hyperactivity (PSH). The gold standard for the treatment of catatonia is electroconvulsive therapy (ECT). However, ECT can exacerbate the paroxysms of sympathetic hyperactivity and complicate recovery from DPHL. The treatment of PSH is not well established. Case presentation We present a case of a patient with multiple opiate overdoses who presented with altered mental status. He was diagnosed with catatonia and subsequently treated with ECT. His clinical condition worsened, and a revised diagnosis of PSH was established. The patient’s condition improved with medical management. Conclusion This case highlights the need to distinguish between these two related symptom clusters, as the incidence of DPHL and opioid overdose related neuropsychiatric problems increase. This distinction can greatly influence the course of treatment, and the need to consider alternative treatments.

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