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5 results

  • 3.11.3 - Potassium

  • from Section 3.11 - Metabolic Disorders
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 366-369

  • Summary

    Key Learning Points

    1. 1. Potassium is the principal intracellular cation and its concentration gradient greatly influences the resting potential of excitable membranes.

    2. 2. Potassium disorders are common in patients with low glomerular filtration rate and renal tubular disorders, and critically ill patients are at particular risk of alterations in serum potassium level.

    3. 3. Disorders of potassium balance predispose a patient to serious complications, in particular cardiac arrhythmias and muscle weakness.

    4. 4. Intravenous maintenance fluid alone should provide 1 mmol/(kg day) of potassium.

    5. 5. Concentrated potassium solutions given peripherally may cause pain, inflammation and venous thrombosis.

  • Low-dose steroid-induced bradyarrhythmias and treatment refractory hypokalaemia: a case report

  • Arindam Ghosh, Saba Annigeri, Anupama Nair
  • Journal:
    Cardiology in the Young / Volume 31 / Issue 4 / April 2021
    Published online by Cambridge University Press:
    03 December 2020, pp. 651-653

  • Corticosteroid therapy has become an important modality of treatment for diseases in which rapid control of immunoinflammatory processes is required. However, one of the serious, but less known adverse effect of this therapy is cardiac arrhythmias. This includes both tachyarrhythmias and bradyarrhythmias. Corticosteroid use may also be associated with electrolyte imbalances like hypokalaemia by its mineralocorticoid activity. Those side effects are mainly seen with high-dose intravenous methyl-prednisolone or oral pulse dose prednisolone therapy. Here we report our experience in a child with warm idiopathic autoimmune haemolytic anaemia who developed sinus bradyarrhythmias and treatment refractory hypokalaemia during low-dose steroid therapy with reduction in heart rate by 60% of baseline.

  • Chapter 17 - Electrolyte and Metabolic Emergencies

  • from Part 3 - Emergency Prescribing
  • Edited by Hugh Montgomery, Robert Shulman, Mayur Murali
  • Book:
    Surviving Prescribing
    Published online:
    08 June 2020
    Print publication:
    25 June 2020, pp 67-74

  • Summary

    A slow and steady increase in some electrolyte or others may go overlooked (or even consciously ignored), and can remain asymptomatic. However, they can cause trouble insidiously, or catastrophically, and thus require early correction. Readers are advised of the causes of electrolyte disturbance (‘Us and Them’), provided with the ‘Rule of What’s’ to manage trouble and given prescribing advice to manage electrolyte and metabolic disturbance.

  • Chapter 29 - Failure of oxygenation

  • from Section III: - Organ dysfunction and management
  • Edited by Fang Gao Smith, University of Warwick
  • Edited in association with Joyce Yeung
  • Book:
    Core Topics in Critical Care Medicine
    Published online:
    06 July 2010
    Print publication:
    22 April 2010, pp 232-240

  • Summary

    Fluid and electrolyte balance is an important everyday practice on the intensive care unit. The different types of fluids are crystalloids that include Hartmann's solution, normal (isotonic) saline, dextrose, and colloids that include albumin, starch and gelatins. The disorders of sodium concentration are nearly always caused by excess free water (hyponatraemia) or free water loss (hypernatraemia). The potassium balance is affected by hypokalaemia and hyperkalaemia. The abnormalities in magnesium are caused by hypomagnesaemia and hypermagnesaemia. The abnormalities in phosphorous are caused by hypophosphataemia and hyperphosphataemia. The abnormalities in calcium are caused by hypocalcaemia and hypercalcaemia. Hypercalcaemia is not a common problem in intensive care. In 90% of cases, the underlying cause is hyper-parathyroidism or malignancy. Treatment is indicated when the hypercalcaemia is associated with adverse effects, or when the serum calcium is greater than 14 mg/dl (ionized calcium above 3.5 mmol/l).

  • Changes in Level of Consciousness and Association with Hyperglycemia as Tool for Predicting and Preventing Re-bleeding after Spontaneous Subarachnoid Hemorrhage

  • Yoichi Kitsuta, Noriyuki Suzuki, Mitsugi Sugiyama, Isao Yamamoto
  • Journal:
    Prehospital and Disaster Medicine / Volume 21 / Issue 3 / June 2006
    Published online by Cambridge University Press:
    28 June 2012, pp. 190-195
    Print publication:
    June 2006
  • Introduction:

    It is crucial to predict and prevent re-bleeding from ruptured intracranial aneurysms in patients with subarachnoid hemorrhage (SAH). During the prehospital period and on arrival to the hospital, blood glucose and serum potassium levels, as well as changes in levels of consciousness were assessed in patients in the acute stage of spontaneous subarachnoid hemorrhage. These assessments were analyzed as possible risk factors for re-bleeding and as potential contributors to the prevention of re-bleeding, both in prehospital care and after hospital admission.

    Methods:

    Upon the arrival of 202 patients with spontaneous subarachnoid hemorrhage, the following indications were examined retrospectively: (1) presence/absence of re-bleeding; (2) time interval between the onset of SAH and re-bleeding; (3) level of consciousness using the Glasgow Coma Scale (GCS) score before and on arrival; (4) amount and distribution of subarachnoid blood using Fisher's Computerized Tomography Classification; (5) blood pressure; (6) blood glucose concentration; and (7) serum potassium concentration. The patients were hospitalized in the Yokohama City University Critical Care and Emergency Center (Yokohama, Japan) between January 1991 and December 2000. The re-bleeding rate was analyzed using the chi-square ([X]2 test, and the averages and standard deviations of hematological data were compared using the Mann-Whitney U-test. The level of statistical significance was set at p <0.05.

    Results:

    The overall re-bleeding rate was 20.8%. Among 119 patients with a GCS score of 3–7 before arrival, 42 (35.3%) had re-bleeding, but none of the 83 patients with a GCS score of 8–15 before arrival had re-bleeding. Of 105 patients with a GCS score of 13–15 on arrival, 14 (51.8%) of 27 patients whose consciousness level was a GCS score of 3–7 before arrival experienced re-bleeding. The re-bleeding rate of this group was high. Moreover, this rebleeding group had a significantly higher blood glucose concentration than did the patients whose GCS score was 13–15 both before and on arrival. Between the patients with or without re-bleeding, there was no significant difference in the blood pressure on arrival or in distribution according to Fisher's Computerized Tomography Classification

    Conclusion:

    Since the re-bleeding rate is high in patients who have hyperglycemia and a history of a level of consciousness as low as a GCS score of 3–7, a detailed assessment of level of consciousness and blood glucose tests performed on arrival provide important information that will contribute to predicting and preventing re-bleeding. This may be extended to the prehospital phase, because blood glucose tests are simple and safe when performed by paramedics.