ANALYSIS OF POTENTIAL INTERACTIONS OF RAMIPRIL -AMBON BANANA (Musa paradisiaca var. sapientum (L.) Kunt.) ON HYPERKALEMIA RISK IN WHITE RATS

Introduction: Drug and food interaction is a condition in which nutritional factors present in food have an influence significant effect on drug therapy, both potentially increasing or decreasing the effect of drug therapy. Indonesian people have a habit of taking medicine by using food or drink. Bananas are the primadona that are often consumed to speed up the swallowing process and reduce the bitter taste of medicine. It turns out that the consumption of bananas together with ACE inhibitors can increase the risk of hyperkalemia. Lack of information about the effects caused by drug and food interactions, so it is necessary to do related research. Objective: This study aims to determine the interaction of giving ramipril together with Ambon banana on the risk of hyperkalemia. Methods: A real experimental study while still adhering to the Covid'19 health protocol. White rats were divided into 4 groups, conditioned by hypertension, then intervened with ramipril and Ambon banana. Blood serum was taken and analyzed using UV spectrophotometry to obtain serum potassium levels. The levels obtained were analyzed using the One Way Anova Test. Results: The mean serum potassium level of the positive control group was 4.93±0.58; negative control 4.13±0.60; normal control 4.76±0.59 and treatment 5.10±0.38. The highest serum potassium level was in the ramipril treatment group together with Ambon banana, but still in the normal range of 3.60–5.50 mmol/L. One Way Anova test results (p = 0.054). (p>0.05) showed no significant difference. Conclusion: There is no specific increase in levels of ramipril concurrently with Ambon banana so it does not have the potential to cause the risk of hyperkalemia. Keywords: Drug Interaction, Ramipril, Ambon Banana, Serum Potassium, Hyperkalemia

The Incidence And Risk Factors of Serum Hypokalemia After Primary Total Joint Arthroplasty

Background: Regular monitoring of serum potassium after total joint arthroplasty (TJA) is a routine examination, which can detect abnormal serum potassium and reduce adverse events timely caused by postoperative hypokalemia. In this study, we aimed to investigate the incidence and risk factors of hypokalemia after primary total hip and knee replacement.Methods: This study included patients who underwent unilateral total knee or hip arthroplasty in our department from April 2017 to March 2018. The serum potassium level before and after operation was collected and retrospectively analyzed. The differences in age, BMI and other factors between hypokalemia patients and non-hypokalemia patients at different time points after surgery were compared, and then the risk factors of postoperative hypokalemia were analyzed based on multiple logistic regression.Results: The total incidence of postoperative hypokalemia was 53.1%, while the respective rate on the first, third and fifth postoperative day was 12.5%, 40.7% and 9.6%. The serum potassium level on the first, third and fifth postoperative day was 3.84±0.32mmol/l, 3.59±0.34mmol/l and 3.80±0.32mmol/l, while among which, the level on the third day was the lowest (p=0.015). The independent risk factors for hypokalemia after total hip and knee replacement were the level of preoperative serum potassium (p=0.011), preoperative red blood cells (p=0.027), and a history of diabetes (p=0.007).Conclusion: Regular monitoring of serum potassium should be performed after TJA due to hypokalemia was a very common complication. We need to pay more attention to patients’ preoperative potassium and red blood cells, especially patients with diabetes.

Significance of Serum Potassium Level at Admission in Organophosphorus Poisoning and Impact on Outcome - A Hospital Based Study from North East India

BACKGROUND Organophosphorus (OP) pesticides are one of the most common cause of morbidity and mortality due to poisoning worldwide especially in agrarian countries like India. Hence it is prudent to undertake a detailed study of clinico-pathological evaluation of OP poisoning and assess the role of serum potassium as an alternative, easy and convenient prognostic indicator in estimating the severity of OP poisoning. This study was undertaken to assess serum potassium levels in patients of acute organophosphorus poisoning and determine association between serum potassium level and outcome in cases of acute organophosphorus poisoning. METHODS This was a prospective observational study conducted in Department of General Medicine, Silchar Medical College & Hospital for one year from 1st June 2019 to 31st May 2020 with a sample size of 100 after satisfying the inclusion and exclusion criteria. Peradeniya organophosphorus poisoning (POP) scale was used for categorizing study population according to severity. RESULTS Among patients who were admitted with organophosphorus poisoning, 72 % of the patients discharged were having normal serum potassium levels on admission, whereas 22 % (n = 22) patients who died had hypokalaemia at the time of admission. The chi-square value for the association between serum potassium and outcome is statistically significant [P value is 0.001 (P < 0.05)]. CONCLUSIONS The serum potassium level on the day of admission was significantly correlated with the severity of the acute organophosphate poisoning as determined by Peradeniya OP poisoning scale. The cases that had lower serum potassium levels on admission had poor outcome. Reduced serum potassium levels also had significant association with the need for ventilator support. Therefore, serum potassium can be used as a predictive marker of severity in organophosphorus poisoning. This can help in early triage of patients and will be helpful in reducing mortality and morbidity. KEYWORDS Organophosphorus Compound Poisoning, Serum Potassium, POP Scale

Surgical Outcomes of Aldosterone-Producing Adenoma on the Basis of the Histopathological Findings

IntroductionPrevious studies on the surgical outcomes of aldosterone-producing adenoma (APA) patients were mainly based on the histopathological diagnosis of HE staining or adrenal venous sampling (AVS) instead of the functional pathology. The aim of the present study was to evaluate the surgical outcomes of APA patients based on the functional pathological diagnosis of APA according to HISTALDO (histopathology of primary aldosteronism) consensus.MethodsClinical data of 137 patients with suspected APA were analyzed retrospectively. All patients had hypertension and spontaneous hypokalemia. In all patients, CT showed a unilateral solitary hypodense adrenal lesion, and a contralateral adrenal gland of normal morphology. Tumors were removed and immunostained for CYP11B2, and their pathology were identified based on HISTALDO consensus. Patients were followed up 6 to 24 months after operation.ResultsAmong 137 cases of presumptive APA diagnosed by CT, 130 (95%) cases were pathologically diagnosed with classical pathology, including 123 APA(90%) and 7 aldosterone-producing nodule (APN) (5%). 7 cases (5%) had non-functioning adenoma (NFA) with aldosterone-producing micronodule (APM) or multiple aldosterone-producing micronodule (MAPM) in the surrounding adrenal tissue. In all 137 patients, hypertension was complete or partial clinical success postoperatively. Complete clinical success was achieved in 73 (53%), and partial clinical success was achieved in 64 (47%) cases. Serum potassium level recovered to normal in all. In 123 patients with APA, complete clinical success was reached in 67 (54%), and partial clinical success was reached in 56 (46%) cases. Gender, duration of hypertension and the highest SBP were significant independent predictors for cure of APA after surgery. A multiple logistic regression model integrating the three predictors was constructed to predict the outcome, which achieved a sensitivity of 72.4% and a specificity of 73.1%.ConclusionThe specificity of CT in the diagnosis of APA and APN patients with hypokalemia was 95%. All patients achieved complete or partial clinical success after surgery. Gender, duration of hypertension and the highest SBP were independent predictors for the postoperative cure of APA.

Extent of Fall in Serum Potassium by Medical Therapy in End Stage Renal Disease

Aim: To observe the mean alteration in potassium levels one-hour post-antihyperkalemic treatment in end stage renal disease patients presenting with hyperkalemia. Study design: Quazi interventional (experimental) study. Place and duration of study: Department of Medicine, Sir Ganga Ram Hospital Lahore from 28th June 2018 to 27th December 2018. Methodology: Sixty patients of both genders with age range between 14 to 70 years having stage 5 CKD (thrice-weekly dialysis dependent) for at least 6 months with raised serum potassium (>5.5 mEq/L). These patients were given medical treatment in the form of salbutamol nebulization, injectable calcium gluconate, and 100ml 25% dextrose water solution neutralized with Humulin R Insulin 12 units. Serum potassium was reassessed 1 hour after the treatment. Mean change in serum potassium was observed and was compared across various subgroups of patients. A written informed consent was taken from each patient. Results: In the current study, mean age of our studied population was 50.6±10.4 years with male-gender dominance (81.7%). Mean ESRD duration was 11.8±3.7 months while the mean BMI was 27.6±3.6Kg/m2. 15 (25.0%) patients were obese. The serum potassium level at presentation ranged from 5.6mEq/L to 6.9mEq/L with a mean of 6.25±0.39mEq/L. The serum potassium level 1 hour after medical treatment ranged from 4.8mEq/L to 6.3mEq/L with a mean of 5.58±0.43mEq/L. This change in mean serum potassium was significant (p-value<0.001) on paired sample t-test. The change in serum potassium level ranged from 0.5-0.9mEq/L with a mean of 0.676±0.123mEq/L. Similar mean change in serum potassium level was observed when stratified for age, gender, BMI and duration of ESRD. Keywords: End Stage Renal Disease, Hemodialysis, Hyperkalemia, Medical Treatment

Hypokalemia in patients with anorexia nervosa during refeeding is associated with binge–purge behavior, lower body mass index, and hypoalbuminemia

Background Hypokalemia is frequently found in patients with anorexia nervosa and sometimes leads to life-threatening conditions. Although their serum potassium levels are considered to further decrease during refeeding, no previous studies have addressed actual changes in the serum potassium levels and potential mechanisms underlying hypokalemia during the refeeding period of patients with anorexia nervosa. In this study, we investigated factors associated with hypokalemia during refeeding of patients with anorexia nervosa. Methods We recruited 52 independent patients from 89 admissions with anorexia nervosa (body mass index, 13.0 ± 3.3) from the psychiatry unit in Ashikaga Red Cross Hospital during the period from April 2003 to March 2018 and analyzed serum potassium levels at admission. Of the 89 admissions, 66 admissions with > 1-week hospitalization were recruited to determine the lowest potassium levels during the refeeding period. We analyzed these levels with multiple linear regression analysis with explanatory variables, including data upon admission and treatment-related indicators. Results The initial serum potassium level of 3.6 ± 0.9 mg/dl decreased to 3.1 ± 0.7 mg/dl at nadir hypophosphatemia, which was observed an average of 2.5 days after admission. A lower serum potassium level at admission and a lower nadir potassium level during refeeding were associated with a lower body mass index, hypoalbuminemia, and binge–purge behavior. Similar results were obtained when the analysis included restrictive or binge–purge types as well as the independent patient group. Conclusions Lower body mass index, hypoalbuminemia, and binge–purge behavior might be used as indicators to guide clinical approaches for controlling serum potassium levels in patients with anorexia nervosa during refeeding. Plain English summary Hypokalemia, low levels of serum potassium, in patients with anorexia nervosa sometimes leads to life-threatening conditions. Thus, it is of great importance to predict the risk of hypokalemia in patients with anorexia nervosa during the refeeding period. Our study found that hypokalemia in patients with anorexia nervosa during refeeding is associated with a lower body mass index and hypoalbuminemia (low levels of serum albumin), in addition to binge–purge behavior.

Hypokalemic Periodic Paralysis Developed in a Patient with Neurogenic Diabetes Insipidus

Hypokalemic periodic paralysis one of the channelopathy disorders with low serum potassium level, clinically presenting as acute onset extremity weakness. In most cases, the cause of the hypokalemia is familial, but rarely hypokalemic periodic paralysis occurs secondary to other diseases including endocrinopathies, renal disorders, gastrointestinal loss. We report a patient with no known underlying diseases, who were diagnosed with sporadic hypokalemic periodic paralysis accompanied by neurogenic diabetes insipidus.

Treatment of Mild Hyperkalemia in Hospitalized Patients: An Unnecessary Practice?

Background: Sodium polystyrene sulfonate (SPS) is one of the most commonly used treatments for mild hyperkalemia. Other treatments include insulin, sodium bicarbonate, and salbutamol, which may be given alone or in combination. The results of research examining treatment effectiveness for mild hyperkalemia (e.g., the ability of SPS to achieve normokalemia) thus far have been inconsistent. Given that the effectiveness of treatment for mild hyperkalemia is debatable, new research is needed. Objective: To determine whether treatment of hospitalized patients with mild hyperkalemia (using SPS or another approach, relative to no treatment) was associated with achievement of normokalemia (serum potassium < 5.1 mmol/L). Methods: For this retrospective, quasi-experimental study, hospitalized patients with index serum potassium level between 5.1 and 6.4 mmol/L were identified. Post-index serum potassium level within 24 hours was dichotomized (< 5.1 or ≥ 5.1 mmol/L). Pre-index serum creatinine and serum potassium levels were recorded as the average of the first 5 values immediately before the index potassium value. For each patient, treatment was categorized as no treatment, SPS treatment, or other treatment strategy. Results: Among the 1944 patients included in the analysis, the average age was 66.8 (standard deviation 13.5) years; 605 (31.1%) of the patients were women and 1339 (68.9%) were men. Logistic regression results indicated that patients who were female and/or had higher pre-index serum potassium were less likely to return to normokalemia within 24 hours after the time of the index serum potassium value. Treatment category was not a statistically significant predictor of the achievement of normokalemia. Most patients with mild hyperkalemia (> 74.5% in each treatment category) achieved normokalemia, whether or not they received treatment. Conclusions: The findings of this study suggest that although follow-up is required for mild hyperkalemia in hospitalized patients, active treatment may be unnecessary. RÉSUMÉ Contexte : Le sulfonate de polystyrène de sodium (SPS) est l’un des traitements les plus communément utilisés pour l’hyperkaliémie légère. D’autres traitements comprennent l’insuline, le bicarbonate de sodium et le salbutamol, qui peuvent être administrés seuls ou ensemble. Les résultats des recherches se penchant sur l’efficacité des traitements de l’hyperkaliémie légère (p. ex., la capacité du SPS à rétablir la normokaliémie) sont contradictoires jusqu’à présent. Étant donné que l’efficacité du traitement de l’hyperkaliémie légère est discutable, de nouvelles recherches sont nécessaires. Objectif : Déterminer si le traitement des patients hospitalisés, présentant une hyperkaliémie légère, (à l’aide de SPS ou d’une autre approche, comparativement à l’absence de traitement) était associé à l’atteinte de la normokaliémie (potassium sérique < 5,1 mmol/L). Méthodes : Des patients hospitalisés, dont l’indice de concentration sérique de potassium se situait entre 5,1 et 6,4 mmol/L, ont été identifiés pour participer à cette étude rétrospective quasi expérimentale. La concentration sérique de potassium mesurée dans les 24 heures après le diagnostic d’hyperkaliémie légère a été dichotomisée (< 5,1 ou ≥ 5,1 mmol/L). Les indices de concentrations sériques de créatinine et de potassium avant le diagnostic d’hyperkaliémie légère ont été obtenus par la moyenne des cinq premières valeurs situées immédiatement avant celle de la concentration de potassium. Le classement du traitement de chaque patient était le suivant : Aucun traitement, Traitement par SPS ou Autre stratégie de traitement. Résultats : L’âge moyen des 1944 patients inclus dans l’analyse était de 66,8 ans (écart type 13,5); 605 (31,1 %) d’entre eux étaient des femmes et 1339 (68,9 %) des hommes. Les résultats de la régression logistique indiquaient que les patientes, donc les femmes, qui avaient un indice sérique de potassium plus élevé au moment du diagnostic, avaient moins de chances de retourner à la normokaliémie dans les 24 heures après l’instant de la mesure de la valeur de l’indice sérique de potassium. La catégorie de traitement n’était pas une variable prédictive statistiquement significative de l’atteinte de la normokaliémie. La plupart des patients présentant une hyperkaliémie légère (> 74,5 % dans chaque catégorie de traitement) atteignaient la normokaliémie, qu’ils aient reçu ou non un traitement. Conclusions : Les résultats de cette étude laissent entendre que, malgré la nécessité d’un suivi des patients hospitalisés en cas d’hyperkaliémie légère, un traitement actif pourrait s’avérer inutile.