scholarly journals Reverse pseudohyperkalemia in a newly diagnosed pediatric patient with acute T-cell leukemia and hyperleukocytosis: a case report and literature review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Muneera Alabdulqader ◽  
Hanaa Al Alawyat ◽  
Mohammed F. Kasem ◽  
Abdelfattah Ibrahim ◽  
Abdelwahab Omara
Keyword(s):  
Case Report ◽  
Potassium Level ◽  
Medical Condition ◽  
Incidental Finding ◽  
Venous Blood ◽  
Elevated Serum ◽  
Clinical Manifestations ◽  
Plasma Potassium ◽  
Newly Diagnosed ◽  
Blood Potassium

Abstract Background Hyperkalemia is a serious medical condition that requires immediate intervention. However, pseudohyperkalemia and reverse pseudohyperkalemia are misleading clinical manifestations that can result in incorrect diagnosis and consequent harmful intervention. Case presentation An 11-year-old girl manifested an incidental finding of hyperleukocytosis (WBC > 400 × 109/L), with 90% blast cells during routine pre-operative investigations for adenotonsillectomy. Initial investigations demonstrated elevated serum potassium levels (7.5 mmol/L), despite concomitantly normal levels in venous blood gas samples (3.9–4.4 mmol/L) and being clinically stable with normal 12-lead ECG. Surprisingly, plasma potassium level was exacerbated, in comparison to the serum level by > 1 mmol/L. This finding is consistent with reverse pseudohyperkalemia that is associated with hyperleukocytosis in acute leukemia that does not require any active intervention. Conclusion This case report emphasizes the significance of interpreting potassium levels accurately, preferably utilizing whole-blood potassium level over serum and plasma level in newly diagnosed leukemia cases with hyperleukocytosis. Additionally, having a high index for the possibility of reverse pseudohyperkalemia, secondary to leakage from fragile leukocytes, avoids unnecessary treatment that might cause harm to the patient.

scholarly journals Association between Blood Potassium Level and Recovery of Postoperative Gastrointestinal Motility during Continuous Renal Replacement Therapy in Patient Undergoing Open Abdominal Surgery

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Yi Yang ◽  
Jingjuan Yang ◽  
Xiner Yao ◽  
Yu Cui ◽  
Xiabing Lang ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Gastrointestinal Motility ◽  
Potassium Level ◽  
Potassium Concentration ◽  
Binary Logistic Regression ◽  
Plasma Potassium ◽  
Postoperative Recovery ◽  
Binary Logistic Regression Model ◽  
Open Abdominal Surgery ◽  
Blood Potassium

Background. The aim of this study was to identify the blood potassium level beneficial to the postoperative recovery of gastrointestinal motility during continuous renal replacement therapy (CRRT) in patient undergoing open abdominal surgery. Materials and Methods. 538 critically ill patients after open abdominal surgery and receiving CRRT were retrospectively recruited as the study cohort. Demographic and clinical data were recorded along with an evaluation of the postoperative gastrointestinal motility. Results. Correlation analysis was used to assess the correlation coefficient, and then the variables with correlation coefficient value less than 0.5 were included in the binary logistic regression model. Binary logistic regression model indicated that the postoperative blood potassium level was independently associated with the recovery of gastrointestinal motility (OR=0.109, 95% CI= 0.063 to 0.190, p<0.001). Based on the normal range of blood potassium level, we selected the cut-off point of blood potassium level via Weight of Evidence analysis, which was 4.00 mmol/L. Compared with the patients with insufficient blood potassium levels (plasma potassium concentration < 4.00 mmol/L), those with sufficient blood potassium levels (plasma potassium concentration≥ 4.00 mmol/L) conferred an increase in the rate of 4-day postoperative recovery of gastrointestinal motility (OR= 4.425, 95% CI = 2.933 to 6.667, p<0.001). Conclusions. Maintaining the blood potassium concentrations at a relatively high level of the normal blood potassium range during CRRT would be beneficial to postoperative recovery of gastrointestinal motility.

scholarly journals Clinical Manifestations of Hemochromatosis inHFEC282Y Homozygotes Identified by Screening

2008 ◽  
Vol 22 (11) ◽  
pp. 923-930 ◽  
Author(s):  
Gordon D McLaren ◽  
Christine E McLaren ◽  
Paul C Adams ◽  
James C Barton ◽  
David M Reboussin ◽  
...  
Keyword(s):  
Iron Overload ◽  
Serum Ferritin ◽  
Elevated Serum ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Joint Stiffness ◽  
Chronic Fatigue ◽  
Newly Diagnosed ◽  
Wild Type ◽  
Control Subjects

BACKGROUND: Patients with hemochromatosis may suffer organ damage from iron overload, often with serious clinical consequences.OBJECTIVE: To assess prevalences of self-reported symptoms and clinical signs and conditions in persons homozygous for the hemochromatosis gene (HFE)mutation (C282Y) identified by screening.METHODS: Participants were adults 25 years of age or older enrolled in the Hemochromatosis and Iron Overload Screening (HEIRS) Study. C282Y homozygotes (n=282) were compared with control participants without theHFEC282Y or H63D alleles (ie, wild type/wild type; n=364).RESULTS: Previously diagnosed C282Y homozygotes and newly diagnosed homozygotes with elevated serum ferritin levels had higher prevalences of certain symptoms such as chronic fatigue (OR 2.8; 95% CI 1.34 to 5.95, and OR 2.0; 95% CI 1.07 to 3.75, respectively), and had more hyperpigmentation on physical examination (OR 4.7; 95% CI 1.50 to 15.06, and OR 3.7; 95% CI 1.10 to 12.16, respectively) and swelling or tenderness of the second and third metacarpophalangeal joints (OR 4.2; 95% CI 1.37 to 13.03, and OR 3.3; 95% CI 1.17 to 9.49, respectively) than control subjects. Joint stiffness was also more common among newly diagnosed C282Y homozygotes with elevated serum ferritin than among control subjects (OR 2.7; 95% CI 1.38 to 5.30). However, the sex- and age-adjusted prevalences of self-reported symptoms and signs of liver disease, heart disease, diabetes and most other major clinical manifestations of hemochromatosis were similar in C282Y homozygotes and control subjects.CONCLUSIONS: Some symptoms and conditions associated with hemochromatosis were more prevalent among C282Y homozygotes identified by screening than among control subjects, but prevalences of most outcomes were similar in C282Y homozygotes and controls in this primary care-based study.

scholarly journals Grover’s disease in a patient with atopic dermatitis - a case report

2021 ◽  
Vol 74 (1-2) ◽  
pp. 33-37
Author(s):  
Sanja Jakovljevic ◽  
Ljuba Vujanovic ◽  
Dejan Ogorelica ◽  
Aleksandra Fejsa-Levakov ◽  
Jasmina Sekulic
Keyword(s):  
Case Report ◽  
Immunoglobulin E ◽  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Elevated Serum ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Complete Regression ◽  
Laboratory Findings ◽  
Topical Corticosteroids

Introduction. Grover?s disease is characterized by pruriginous polymorphic rash with a variable course and duration. Although the etiology is still unknown, the disease is often associated with other dermatoses, malignant diseases, use of certain medications, as well as immunosuppression. Case Report. We report a case of a 70-year-old male patient who was referred for examination to the Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, due to a rash that lasted for nine months. The first lesions on the skin appeared around the nipples as exudative eczematous plaques. A few months later, identical lesions appeared on the lower legs. During treatment with systemic antihistamines and topical corticosteroids, there were episodes of transient improvements and re-exacerbations. In the meantime, erythematous brownish, round and oval papules appeared on the abdomen and the back, accompanied by intense itch. Laboratory findings revealed eosinophilia and elevated serum immunoglobulin E levels. A skin biopsy of the back lesion was performed and the histopathological examination confirmed the diagnosis of Grover?s disease. After the systemic treatment using corticosteroids and antihistamines, with gradual dose reduction and application of topical corticosteroids and emollients, complete regression of the skin lesions was achieved. Conclusion. Since the clinical manifestations of the disease may be nonspecific and discrete, dermatopathological analysis is of crucial importance in making the correct diagnosis. In patients with atopy, the treatment with systemic corticosteroids, antihistamines and topical agents may lead to regression of skin lesions with a significant improvement in the quality of life.

scholarly journals Pseudohyperkalaemia in essential thrombocytosis: an important clinical reminder

2021 ◽  
Vol 2021 ◽  
Author(s):  
Jean Marc Mizzi ◽  
Christopher Rizzo ◽  
Stephen Fava
Keyword(s):  
Venous Blood ◽  
Elevated Serum ◽  
Plasma Potassium ◽  
List Type ◽  
Limb Weakness ◽  
Clinical Reminder ◽  
Bilateral Lower Limb ◽  
Venous Blood Gas ◽  
Learning Points ◽  
Rule Out

Summary An 82-year-old female was admitted to a general hospital due to progressive bilateral lower limb weakness. A T8–T9 extramedullary meningioma was diagnosed by MRI, and the patient was referred for excision of the tumour. During the patient’s admission, she was noted to have persistent hyperkalaemia which was refractory to treatment. Following a review by an endocrinology team, a diagnosis of pseudohyperkalaemia secondary to thrombocytosis was made. This case demonstrates the importance of promptly identifying patients who are susceptible to pseudohyperkalaemia, in order to prevent its potentially serious consequences. Learning points Pseudohyperkalaemia should be considered in patients with unexplained or asymptomatic hyperkalaemia. It should also be considered in those patients who are resistant to the classical treatment of hyperkalaemia. A diagnosis of pseudohyperkalaemia is considered when there is a difference of >0.4 mmol/L of potassium between serum and plasma potassium in the absence of symptoms and ECG changes. In patients who are presenting with consistently elevated serum potassium levels, it may be beneficial to take venous blood gas and/ or plasma potassium levels to rule out pseudohyperkalaemia. Pseudohyperkalaemia may subject patients to iatrogenic hypokalaemia which can be potentially fatal. Pseudohyperkalaemia can occur secondary to thrombocytosis, red cell haemolysis due to improper blood letting techniques, leukaemia and lymphoma.

scholarly journals Hypokalemic myoplegia

2013 ◽  
Vol 94 (6) ◽  
pp. 933-938 ◽  
Author(s):  
T G Sakovets ◽  
E I Bogdanov
Keyword(s):  
Serum Potassium ◽  
Potassium Level ◽  
Potassium Concentration ◽  
Clinical Manifestations ◽  
Extracellular Fluid ◽  
Periodic Paralysis ◽  
The Body ◽  
Hydroxylase Deficiency ◽  
Potassium Loss ◽  
Blood Potassium

Acute generalized muscle weakness may have a different underlying cause. Among all urgently admitted patients, hypokalemia is observed in more than 20% of cases. Usually blood potassium concentration decrease is not fatal, but severe hypokalemia can be life-threatening for the patient suffering from cardiovascular diseases and respiratory disorders. Hypokalemia manifests clinically by muscle pain, weakness, the intestinal motility disorders, constipation, marked decrease in serum potassium levels can lead to fatal rhabdomyolysis. The key hormones that regulate the total stock of potassium in the body and its normal redistribution of intra- and extracellular fluid are insulin and catecholamines, interacting with β-adrenergic receptors. Regulation of blood potassium level is provided by insulin and it is a feedback (hyperkalemia stimulates insulin secretion, decreased potassium levels inhibits it). The level of catecholamines is not determined by potassium concentration, however, it influences the serum potassium level. Hypokalemia is usually the result of potassium loss due to abnormal renal (treatment with thiazides, high doses of corticosteroids, antibiotics, primary hyperaldosteronism due to adenoma, adrenal carcinoma, bilateral adrenal hyperplasia, Liddle, Bartter’s, Gitelman’s syndromes, 11β-hydroxysteroid dehydrogenase, 11β-hydroxylase, 17α-hydroxylase deficiency, Cushing’s syndrome) or extrarenal (intense vomiting, diarrhea due to excessive laxative use, salmonellosis, yersiniosis, HIV-infection, bowel tumors, chemotherapy, radiation therapy in cancer patients, celiac disease, jejunoileal bypass, a lack of potassium in food) potassium loss, an also a transmembrane shift of potassium (hypokalemic familial periodic paralysis, β2-agonist, bronchodilators, theophylline intake). Hypokalemic myoplegia may lead to fatal complications, requiring doctors of various specialties’ to know the clinical manifestations of hypokalemia, which may have different underlying cause.

scholarly journals Blood potassium level associated with recovery of post-operative gastrointestinal motility during continuous renal replacement therapy in critically ill patient undergoing open abdominal surgery

2018 ◽  
Author(s):  
P Yi Yang ◽  
Xin-Er Yao ◽  
Jing-Juan Yang ◽  
Yu Cui ◽  
Xia-Bing Lang ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Critically Ill ◽  
Gastrointestinal Motility ◽  
Potassium Level ◽  
Potassium Concentration ◽  
Plasma Potassium ◽  
Critically Ill Patient ◽  
Open Abdominal Surgery ◽  
Blood Potassium ◽  
Operative Recovery

Abstract Background: The purpose of the present study was to explore the potential therapeutic goal of blood potassium level beneficial to the post-operative recovery of gastrointestinal motility during continuous renal replacement therapy (CRRT) in critically ill patient undergoing open abdominal surgery. Methods: 538 critically ill patients after open abdominal surgery and receiving CRRT were retrospectively recruited as the study cohort. Demographic and clinical data including plasma potassium levels were recorded along with evaluation of post-operative gastrointestinal motility. The median of first gastrointestinal motility recovery time was 4 days of the present study cohort, and we used gastrointestinal motility recovery during 4-day period and un-recovery at 4 days after the completion of surgery as the primary endpoints. Results: The received operating characteristic (ROC) curve analysis demonstrated that the post-operative blood potassium level during CRRT was significantly associated with the recovery of gastrointestinal motility (AUC = 0.72, p<0.001), and plasma potassium concentration at the cut-off point of the ROC curve was 4.00 mmol/L. Kaplan–Meier analysis indicated that compared with the patients with insufficient blood potassium level (plasma potassium concentration < 4.00mmol/L), those with sufficient level (plasma potassium concentration ≥4.00mmol/L) had higher rate of 4-day post-operative recovery of gastrointestinal motility (p<0.001). Logistic regression analysis indicated that the post-operative blood potassium level was independently associated with the recovery of gastrointestinal motility, patients with a sufficient blood potassium level conferred an increase in the rate of 4-day post-operative recovery of gastrointestinal motility (OR= 4.36, 95% CI 2.92-6.52, p<0.001). Conclusions: Our data indicated that keeping the blood potassium concentration at a relative high level of the regular blood potassium range during CRRT, would be beneficial to post-operative recovery of gastrointestinal motility, and eventually implied the potential therapeutic goal of blood potassium level for the recovery of post-operative gastrointestinal motility during CRRT in critically ill patient undergoing open abdominal surgery.

scholarly journals PRIMARY PANCREATIC LYMPHOMA WITH HERPES ZOSTER ASSOCIATED ACUTE PANCREATITIS: A CASE REPORT AND REVIEW OF LITERATURE.

2020 ◽  
pp. 49-51
Author(s):  
Vikram Chaturvedi ◽  
Rituparna Chaturvedi ◽  
Sharmistha Debnath ◽  
Abhishek Mishra
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Case Report ◽  
Herpes Zoster ◽  
Rare Disease ◽  
Elevated Serum ◽  
Clinical Manifestations ◽  
First Case ◽  
Pancreatic Lymphoma ◽  
Primary Pancreatic Lymphoma

Primary pancreatic lymphoma (PPL) is an extremely rare disease, with few cases reported in literature. Clinical manifestations are usually nonspecific and mimic other pancreatic diseases. Owing to paucity of data and experience of PPL, clinico-pathological features, differential diagnosis, optimal treatment and overall outcomes are not well known. Varicella zoster virus (VZV) is known to cause varicella in children and herpes zoster in adults. Acute pancreatitis caused by VZV is a rare and serious complication, with immunocompromised individuals being primarily affected. We report a case of VZV associated acute pancreatitis in a patient who was diagnosed and treated for primary pancreatic lymphoma, thus rendering her immunocompromised and susceptible to developing infectious pancreatitis. A 56 year old female patient presented with recurrent vomiting, upper abdominal pain and hyperaesthesia in the right upper quadrant of 2 days duration. Following admission her right sided abdominal pain worsened (stabbing pain) and a diagnosis of acute pancreatitis was confirmed based on elevated serum amylase levels and CT scan findings of pancreatic enlargement. The patient was managed conservatively with intravenous fluids, antibiotics, analgesics and topical acyclovir ointment. The patient continues to be asymptomatic after 5 years of follow up. Though extremely rare, a diagnosis of herpes zoster pancreatitis should be considered in such patients, and prompt treatment initiated to prevent further deterioration and to minimize mortality. Core tip: Primary pancreatic lymphoma is in itself a very rare disease, and our patient having presented with herpes zoster associated acute pancreatitis in a background of PPL makes this case even rarer. This is probably the first case report of herpes zoster associated acute pancreatitis in an immunocompromised patient due to primary pancreatic lymphoma.

scholarly journals Case Report: The first familial hCG syndrome in a Chinese family

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 458
Author(s):  
Ling-Yin Hung ◽  
Mei-Tik Leung ◽  
Toby Chun-Hei Chan ◽  
Hoi-Ning Cheung ◽  
Wai-Hon Li ◽  
...  
Keyword(s):  
Hong Kong ◽  
Case Report ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Incidental Finding ◽  
Elevated Serum ◽  
Hong Kong Chinese ◽  
Chinese Family ◽  
Beta Human Chorionic Gonadotropin ◽  
Work Up

Familial hCG syndrome is a rare and benign cause of elevated serum beta human chorionic gonadotropin (hCG). We present here a case of familial hCG syndrome diagnosed in a Hong Kong Chinese family, which we believe to be the first reported in Chinese. A 38-year-old woman presented with incidental finding of persistently elevated hCG, analytically confirmed both in urine and blood. Extensive radiological and biochemical work-up were performed but were negative for pregnancy and malignancy. Testing of another asymptomatic family member revealed unexplained elevation of serum hCG, confirming the diagnosis of familial hCG syndrome. Knowledge and awareness of this entity among clinicians are important to avoid unnecessary investigations and treatment in affected families.

Clinical case of lung lesions in patient with newly diagnosed systemic lupus erythematosus

2019 ◽  
Vol 1 (9) ◽  
pp. 53-57
Author(s):  
T. N. Gavva ◽  
L. V. Kuzmenkova ◽  
Yu. N. Fedulaev ◽  
T. V. Pinchuk ◽  
D. D. Kaminer ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Clinical Case ◽  
Clinical Manifestations ◽  
Lung Damage ◽  
Newly Diagnosed ◽  
Systemic Lupus ◽  
Lung Lesions ◽  
Laboratory Parameters ◽  
Clinical Interest

A case of lung damage in systemic lupus erythematosus (SLE) in a 33-year-old woman is described. This case is of clinical interest due to the complexity of diagnosis due to the fact that SLE is a disease with diverse clinical manifestations involving many organs and systems, which often makes it difficult to timely recognize the onset of the disease. SLE still remains a challenge and requires special attention to the patient s history, clinical and laboratory parameters of the patient, as well as specific immunological examinations.

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