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

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.

Changes in Blood Potassium after Reperfusion during Living-Donor Liver Transplantation: An Exploratory Study

The incidence of hyperkalemia (> 5.5 mEq/L) or high blood potassium (5–5.5 mEq/L) during living-donor liver transplantation (LDLT) is reported to be more than 10%. It occurs more frequently in the early post-reperfusion period and is a major cause of post-reperfusion arrhythmia and cardiac arrest. Unlike deceased-donor liver transplantation, the pattern of blood potassium changes immediately after reperfusion has not been described in LDLT. From January 2021 to March 2021, fifteen consecutive patients were enrolled. Baseline blood potassium was measured from blood samples obtained 10-min (T-10) and immediately before (T0) reperfusion. During the first 5 min after reperfusion, blood potassium measurements were conducted every one minute (T1–T5). The blood potassium levels at T-10 and T0 were 3.8 ± 0.4 and 3.9 ± 0.4 mEq/L, respectively. After reperfusion, mean increases (95% CI) in blood potassium from T-10 and T0 were 0.5 (0.4–0.6) and 0.4 (0.3–0.5) mEq/L, respectively. Blood potassium peaked at T1, returned to baseline at T3, and fell below the baseline at T5. Peak blood potassium after reperfusion showed strong correlations with blood potassium measured at T-10 (p < 0.001) and T0 (p < 0.0001). These findings can support the establishment of future research plans and perioperative management of blood potassium in LDLT.

Effect of Continuous Nursing Model on Nursing Effect of Continuous Peritoneal Dialysis

Objective: To analyze and study the effect of continuous nursing mode for continuous peritoneal dialysis nursing. Methods: 40 patients with continuous peritoneal dialysis received in our hospital were randomly selected as the research object. The research time was from June 2018 to June 2020. The patients were divided into two groups by random number table method. The patients with routine nursing mode were named as the control group and the patients with continuous nursing mode were named as the observation group (20 cases in each group). The clinical nursing effects of different nursing modes are compared. Results: After nursing, the nursing compliance of the observation group was 95%, which was higher than 70% of the control group. There was significant difference between the two groups (P < 0.05). Comparing the blood routine related indexes of the two groups, the blood potassium, hemoglobin, serum creatinine and carbon dioxide binding force of the observation group were better than those of the control group (P < 0.05). The incidence of peritonitis and rehospitalization rate in half a year in the observation group were lower than those in the control group (P < 0.05). Conclusion: The continuous nursing model for patients undergoing continuous peritoneal dialysis can improve the treatment effect of patients, significantly improve the compliance of patients, significantly improve the serological indexes, promote the health of patients, reduce the incidence of peritonitis, and significantly reduce the rehospitalization rate in half a year. It has a broad prospect of clinical promotion.

The effect of imatinib and nilotinib on blood calcium and blood potassium levels in chronic myeloid leukemia patient: a literature review

Imatinib and nilotinib are first-line treatments for chronic myeloid leukemia (CML) patients, which act specifically against target cells. However, these drugs may cause side effects, such as electrolyte disturbances. This literature review aimed to provide a comparison of the effects of imatinib and nilotinib on blood potassium and calcium levels. It also summarized their hypothetical mechanism. A comprehensive electronic search of the different databases was conducted using "chronic myeloid leukemia”, “tyrosine kinase inhibitors”, “imatinib”, “nilotinib”, “potassium”, “calcium”, “electrolytes” as keywords. This review used Pubmed-MEDLINE, Cochrane Library, and Google Scholar as electronic databases. Related 16 articles published from 2006 to 2020 were reviewed. Changes in blood potassium levels range from increased to decreased levels, while changes in blood calcium levels tend to below the normal value. Tyrosine Kinase Inhibitors (TKIs), including imatinib and nilotinib, have a non-specific target, namely platelet-derived growth factor receptor (PDGFR), which indirectly affects blood potassium and calcium levels in CML patients. The clinical manifestations of these changes vary from being visible only in laboratory tests to displaying a variety of signs and symptoms.

Hypoglycaemia combined with mild hypokalaemia reduces the heart rate and causes abnormal pacemaker activity in a computational model of a human sinoatrial cell

Low blood glucose, hypoglycaemia, has been implicated as a possible contributing factor to sudden cardiac death (SCD) in people with diabetes but it is challenging to investigate in clinical studies. We hypothesized the effects of hypoglycaemia on the sinoatrial node (SAN) in the heart to be a candidate mechanism and adapted a computational model of the human SAN action potential developed by Fabbri et al. , to investigate the effects of hypoglycaemia on the pacemaker rate. Using Latin hypercube sampling, we combined the effects of low glucose (LG) on the human ether-a-go-go-related gene channel with reduced blood potassium, hypokalaemia, and added sympathetic and parasympathetic stimulus. We showed that hypoglycaemia on its own causes a small decrease in heart rate but there was also a marked decrease in heart rate when combined with hypokalaemia. The effect of the sympathetic stimulus was diminished, causing a smaller increase in heart rate, with LG and hypokalaemia compared to normoglycaemia. By contrast, the effect of the parasympathetic stimulus was enhanced, causing a greater decrease in heart rate. We therefore demonstrate a potential mechanistic explanation for hypoglycaemia-induced bradycardia and show that sinus arrest is a plausible mechanism for SCD in people with diabetes.

Potassium and Cardiac Surgery

Potassium homeostasis affects cardiac rhythm and contractility, along with vascular reactivity and vascular smooth muscle proliferation. This chapter will focus on potassium dynamics during and after cardiac surgery involving cardioplegic arrest and cardiopulmonary bypass (CPB). Hyperkalemic, hypothermic solutions are frequently used to induce cardioplegic arrest and protect the heart during cardiac surgery involving CPB. Common consequences of hyperkalemic cardioplegic arrest and reperfusion include microvascular dysfunction involving several organ systems and myocardial dysfunction. Immediately after CPB, blood potassium levels often drop precipitously due to a variety of factors, including CPB -induced electrolyte depletion and frequent, long-term administration of insulin during and after surgery. Meanwhile, some patients with pre-existing kidney dysfunction may experience postoperative hyperkalemia following cardioplegia. Any degree of postoperative hyper/hypokalemia significantly elevates the risk of cardiac arrythmias and subsequent myocardial failure. Therefore, proper management of blood potassium levels during and after cardioplegia/CPB is crucial for optimizing patient outcomes following cardiac surgery.

Alteration of Gut Microbiota Relates to Metabolic Disorders in Primary Aldosteronism Patients

PurposeThis study aimed to determine the relationships among gut microbiota, primary aldosteronism (PA), and related metabolic disorders.MethodsThe study enrolled 13 PA patients, 26 sex-matched primary hypertension patients, and 26 sex-matched healthy controls. Demographic and clinical characteristics such as age, body mass index (BMI), blood aldosterone–renin ratio, blood potassium, blood glucose, blood lipid parameters, and history of diabetes mellitus (DM) were compared between the three groups. The gut microbiota of each participant was examined by 16S rRNA gene sequencing. Spearman correlation analysis was performed to demonstrate the relationship between gut microbiota and clinical characteristics.ResultsBMI and the percentage of DM in PA patients were higher than those in healthy controls (p &lt; 0.05), but not higher than those in primary hypertension patients (p &gt; 0.05). The gut microbiota of healthy controls and primary hypertension patients had a higher alpha diversity level than that of PA patients. PA patients had fewer short-chain fatty acid (SCFA)-producing genera (Prevotella, Blautia, Coprococcus, Anaerostipes, and Ruminococcus) and more inflammation-associated genera (Megamonas, Sutterella, and Streptococcus) than healthy controls (p &lt; 0.05). The gut microbiota of PA patients was more inclined to encode microbial pathways involved in sugar metabolism, such as starch and sucrose metabolism and fructose and mannose metabolism. Blood potassium was negatively correlated with the relative abundance of Romboutsia (R = −0.364, q = 0.023). Diastolic blood pressure (DBP) was positively correlated with Romboutsia (R = 0.386, q = 0.015). Systolic blood pressure (SBP) was negatively correlated with Blautia (R = −0.349, q = 0.030).ConclusionsThe alteration of gut microbiota in PA patients, especially bacteria and pathways involved in inflammation, SCFAs, and sugar metabolism, may be associated with chronic metabolic disorders.

Insulin Stimulation Reduces Aortic Waveform in Adults with Metabolic Syndrome

Adults with metabolic syndrome (MetS) have increased fasting arterial stiffness and altered central hemodynamics that contribute, partly, to increased cardiovascular disease (CVD) risk. Although insulin affects aortic wave reflections in healthy adults, the effects in individuals with MetS are unclear. We hypothesized that insulin stimulation would reduce measures of pressure waveforms and hemodynamics in people with MetS. Thirty-five adults with obesity (27F; 54.2 ± 6.0 yr; 37.1 ± 4.8 kg/m2) were selected for MetS (ATP III criteria) following an overnight fast. Pulse wave analysis was assessed using applanation tonometry before and after a 2hr euglycemic-hyperinsulinemic clamp (90 mg/dl, 40 mU/m2/min). Deconvolution analysis was used to decompose the aortic waveform (augmentation index corrected to heart rate of 75 bpm (AIx@75); augmentation pressure (AP)) into backward and forward pressure components. Aerobic fitness (VO2max), body composition (DXA), and blood biochemistries were also assessed. Insulin significantly reduced augmentation index (AIx@75, 28.0 ± 9.6 vs. 23.0 ± 9.9 %, P<0.01), augmentation pressure (14.8 ± 6.4 vs. 12.0 ± 5.7 mmHg, P<0.01), pulse pressure amplification (1.26 ± 0.01 vs. 0.03 ± 0.01, P=0.01), and inflammation (hsCRP: P=0.02; MMP-7: P=0.03) compared to fasting. In subgroup analyses to understand HTN influence, there were no insulin stimulation differences on any outcome. VO2max, visceral fat, and blood potassium correlated with fasting AIx@75 (r=-0.39, P=0.02; r=0.41, P=0.03; r=-0.53, P=0.002). Potassium levels were also associated with insulin-mediated reductions in AP (r=0.52, P=0.002). Our results suggest insulin stimulation improves indices of aortic reflection in adults with MetS.