[ Diabetes Solutions ]

Fluid & Electrolyte Disturbances

We describe herein a case of hypokalemia due to proximal renal tubular acidosis (RTA) and Fanconi’s syndrome (FS) and nephrogenic diabetes insipidus with DIC – a rare complication of Sjögren’s syndrome (SS) and brucellosis. Measurements of BP and urinary potassium excretion, and assessment of acid-base balance are often helpful when the cause is not apparent. The main nephron site where K secretion is regulated is the cortical collecting duct, mainly via the effects of aldosterone. Nat Clin Pract Nephrol. fluids (n = 12); and group 3, K-deficient diet and fluid intake matched to group 1 (n = 14). A 27-year-old woman presented to her primary care physician with severe hypertension (220/150 mmHg, normal values 750 when aldosterone is measured as pM and renin as renin activity), many of whom have plasma aldosterone levels within the ‘normal’ range. The degree of reduction of K + does not keep a close relationship with the [K +] in plasma.

An increased number of autophagosomes was also confirmed by immunofluorescence, demonstrating co-localization of LC3 and Lamp1 with AQP2 and several other down-regulated proteins in IMCD cells. A 46-year-old man, alleged fall from height, presented with transient loss of consciousness with Glasgow coma scale (GCS) of 14/15. At the admission the patient was febrile and asthenic; blood tests showed severe hyponatremia (Na 120 mEq/l) and hypokalemia (K 2.6 mEq/l), neutrophil leucocytosis, normal liver and renal functions. Sjögren syndrome was firstly identified by Mikulicz in 1982, in a patient who had swelling of bilateral parotid glands and lacrimal gland infiltration. Your heart is a smooth muscle and when your potassium drops too low, this can cause palpitations and irregular heart beats. There was no past history of diarrhea or upper respiratory infection in the recent past or any past history of neurological or renal disorders. There is a past history of repeated fractures with trivial trauma.

Orthostatic hypotension, with or without reflex tachycardia, may occur resulting in syncope. This voltage sensor comprises the S4 alpha helix of each of the four transmembrane domains (I-IV) of the protein, and contains basic residues that only allow entry of the positive sodium ions at appropriate membrane voltages by blocking or opening the channel pore. ^ Lafferty AR, Torpy DJ, Stowasser M, et al. Proximal renal tubulopathy generally resolved or improved after tenofovir DF was stopped; however, decreased CrCl did not completely resolve in some patients after stopping the drug. GFR decreases in proportion to decreased renal blood flow and serum concentrations of urea and creatinine increase correspondingly. The most recent articles on Bartter syndrome can be found through PubMed, a searchable database of biomedical journal articles. Increased cosecretion of H+ and K+ from increased sodium reabsorption causes alkalosis and hypokalemia.

Subsequent potassium measurement remained at 1.6 mmol/l with thiopentone infusion rate at 3 mg/kg/h. Infusion of insulin, hypotonic saline, and potassium salts led to correction of all of his biochemical abnormalities. The consequent increase in Na+ reabsorption and associated increase in secretion of H+ and K+ causes alkalosis and hypokalemia. Back to your original beaker…. Of note, the patient was also receiving monthly zoledronic acid for treatment of bone disease for 26 months. Urea is reabsorbed along with water and the serum urea concentration is increased. The definitive therapy is surgical resection of the tumor.

Decreased aldosterone elaboration results in diminished Na+ reabsorption and consequently diminished H+ and K+ secretion causing acidosis and hyperkalemia. The abdomen was soft and non-tender, with no masses or organomegaly. Hyponatremia and hypoosmolality are thereby prevented but at the expense of the development of hypovolemia. Decreased renal perfusion pressure results in increased renin release and increased formation of angiotensin-II and consequent decreased renal blood flow. Repeat electrodiagnostic studies were performed within 48 hours of the initial paralysis. This occurs due to volume expansion once weight gain exceeds 3 kg. A step-by-step and schematic evaluation of all clinical and laboratory signs is necessary to adequately recognize and treat hydro-electrolyte disorders, helping to solve also the most complex clinical problems [20].

Autonomous elaboration of ADH results in continuous water reabsorption and the propensity to hypervolemia. Increased renal perfusion pressure inhibits renin release so that aldosterone stimulated Na+ reabsorption is diminished, resulting in hyponatremia and hyperkalemia and acidosis from the corresponding decrease in K+ and H+ secretion. Negative fluid balance 24 h before onset of HAH was observed in 84 patients (56 in the non-hypernatremia group and 28 in the hypernatremia group). The management of Sjögren’s syndrome. Complete ADH deficiency results in the potential loss of about 15 liters of water per day. Thus, it is currently believed that valproic acid-induced Fanconi syndrome may be caused by a direct nephrotoxic effect or hypersensitivity as major mechanisms.716 In the case reported here, drug-induced hypersensitivity was not likely, as there were neither signs of interstitial nephritis nor any extra-renal manifestations of hypersensitivity. Consequent renin release by the kidneys causes decreased renal blood flow and increased aldosterone stimulated Na+ reabsorption accompanied by alkalosis and hypokalemia.

(Urine is acidic despite alkalemia.) With decreased renal blood flow, serum creatinine and urea concentrations increase in proportion to decreased GFR, but urea is somewhat lower than expected because of diminished water reabsorption, so that the serum urea/creatinine ratio is decreased. In the ususal case, with ready access to fluids, normal fluid volume is maintained by hyperosmolality stimulated thirst and serum creatinine and urea are not elevated.

Tags: , ,