- ED 08-4 DIAGNOSIS AND TREATMENT OF HYPERTENSIVE EMERGENCY IN CHILDREN. [Journal Article]
- JHJ Hypertens 2016; 34 Suppl 1 - ISH 2016 Abstract Book:e373-e374
- According to the seventh report of Joint National Committee (JNC 7), hypertensive emergency (HE), a kind of hypertensive crisis, is defined as a sudden and abrupt elevation in blood pressure so as to...
According to the seventh report of Joint National Committee (JNC 7), hypertensive emergency (HE), a kind of hypertensive crisis, is defined as a sudden and abrupt elevation in blood pressure so as to cause acute target organ dysfunctions, including central nervous system, cardiovascular system or kidneys. Patients with HE require immediate reduction in markedly elevated blood pressure. Currently, there are no international guidelines for children HE, so the JNC definition is commonly used. Hypertensive emergency in children is rare but a life-threatening emergency. Generally, secondary hypertension is the most common reason of hypertensive emergency. We analyzed clinical features of 16 patients with HE who were diagnosed as HE from Jan 2007 to Dec 2015 in our hospital. Results showed that all patients were diagnosed as secondary hypertension, including 10 cases associated with renal diseases, 3 cases with Takayasu arteritis,1case with hypercortisolism, 1 case with migraine, and 1 case with unknown reason. The pathophysiologic mechanisms of HE involve sympathetic hyperactivity and increasing of vasoconstricting substances, activation of renin-angiotensin system (RAS), decreasing in auto-regulation of target organs, and chronic endothelial damage and remodeling. There is strong evidence that the renin-angiotensin system plays an important role in the genesis of hypertensive crisis. Target organ dysfunctions may be manifested as hypertensive encephalopathy, acute left ventricular failure, acute renal failure and papilledema, etc. Hypertensive encephalopathy is the most common one with the symptoms of persistent headache, nausea, vomiting, altered mental status, convulsion and coma. Some patients may be revealed as reversible posterior leukoencephalopathy. Among 16 patients involved in our study, 13 patients had encephalopathy with 4 cases of reversible posterior leukoencephalopathy, 4 patients had acute heart failure with 1 case of fundus exudation, and 2 case of acute renal failure. 2 patients died with 3 target organ dysfunctions, including encephalopathy, acute heart failure, and acute renal failure, which showed that multiple organ dysfunction may increase the mortality of HE, so earlier identification of target organ dysfunction to take steps is important. As to the key points of diagnosis of HE, one is the level of blood pressure and its elevation speed, the other is to identify target organ dysfunction earlier. Detailed medical history and complete physical examination are important. Additionally, serum electrolytes, complete blood counts, blood urea nitrogen, creatine, urinalysis, chest radiography, electrocardiogram, enchocardiography, brain MRI and fundoscopy may be needed in some situation. It is worth mentioning that 8 patients had hypokalemia, and hypokalemia is associated with the activation of RAS. It indicates the possibility that hypokalemia may be a predictive factor of HE. The treatment of HE is based on the differentiation of acute, chronic or acute attack on chronic hypertension. Once HE is confirmed, intravenous drugs should be emergently applied. It is suggested that the targeted drop of mean arterial pressure in the first 6∼8 hours should reach 25% of the difference between the original value and the target value, and should be followed by a gradual reduction to the target value within 24∼48 hours. Safe and efficacious drugs with rapid onset of action are favorable. According to our experience, sodium nitroprusside and phentolamine are the most useful and effective in our hospital. It's notable that lowering intracranial pressure is more important than decreasing blood pressure for those patients with a high intracranial pressure who are diagnosed as encephalopathy. However, rapidly decreasing blood pressure levels may result in decreasing blood flow of brain, causing ischemia and infarction. To patients with acute left heart failure, management including sedation, oxygen supplement, cardiotonics, diuresis, and vascular dilation should be necessary. Long-acting oral anti-hypertensive medications should be introduced in conscious child after the blood pressure has been reasonably controlled within 24-48 hours. According to our experience, these patients with HE should need more than 2 kinds of anti-hypertensive drugs. In summary, the key points of diagnosis and treatment of HE are earlier identification and effective therapy to control the development of acute target organ dysfunctions.
- Serum level of scorpion toxins, electrolytes and electrocardiogram alterations in Mexican children envenomed by scorpion sting. [Journal Article]
- TToxicon 2016 Sep 29; 122:103-108
- The scorpion Centruroides limpidus limpidus (C.l.l.) is endemic in México, producing hundreds of accidents in humans; children being one of the most susceptible targets. Few studies reported that sev...
The scorpion Centruroides limpidus limpidus (C.l.l.) is endemic in México, producing hundreds of accidents in humans; children being one of the most susceptible targets. Few studies reported that severe envenoming by scorpion venom induces cardiac damage and electrolytes abnormalities in children, but the relationship of envenoming severity and toxic blood levels is unknown. The aim of this study was to determine the relationship among clinical status of envenoming, serum electrolyte, electrocardiographic abnormalities, and serum toxin levels in 44 children stung by scorpion over a period of 6 months in the State of Morelos, Mexico. The patients were said to be asymptomatic, when they presented just local symptoms, and were said to be symptomatic when showing local symptoms and at least one systemic symptom. The clinical status was evaluated at the admission at the emergency room of the Hospital, and 30 min after the administration of polyspecific F(ab')2 anti-scorpion therapy to symptomatic children. Forty-one percent of the children were asymptomatic and 59% symptomatic. Potassium and sodium imbalance and an elongation of the QT interval were detected; the rate of hypokalemia was higher in symptomatic than on asymptomatic children (50% and 6%, respectively). Hypokalemia persisted in 19% in symptomatic patients, whereas sodium reached normal levels 30 min after anti-venom therapy. The hypokalemia statistically correlated with elongation of the QT interval. The concentration of the toxic components of C.l.l in serum was significantly higher in symptomatic than asymptomatic children, and the serum levels of the toxic component significantly decreased to undetectable levels after the application of anti-venom therapy. Despite the small size of the sample, this study establishes that severity of envenoming was statistically related to potassium imbalance in serum, QT interval and the concentration of toxic components in serum, which decreased at undetectable levels after specific treatment with the anti-scorpion venom, correlating with clinical disappearance or greatly reduction of symptoms of envenomation.
- Frequency of hyponatraemia and hypokalaemia in malnourished children with acute diarrhoea. [Journal Article]
- JPJ Pak Med Assoc 2016; 66(9):1077-1080
- CONCLUSIONS: Electrolyte disturbances among malnourished children may not be clinically evident, but diarrhoeal illness aggravated these imbalances.
- Atorvastatin for Prevention of Amikacin-induced Electrolytes Imbalances; a Randomized Clinical Trial. [Journal Article]
- IJIran J Pharm Res 2016; 15(2):627-34
- Aminoglycosides are still widely used for treatment of gram-negative sepsis in critically ill patients. The most reported electrolyte abnormalities related to these drugs are hypokalemia, hypomagnese...
Aminoglycosides are still widely used for treatment of gram-negative sepsis in critically ill patients. The most reported electrolyte abnormalities related to these drugs are hypokalemia, hypomagnesemia, and hypocalcemia.In this study potential benefit of atorvastatin in prevention of amikacin-induced electrolytes imbalances has been evaluated. In this trial 44 patients were assigned to the atorvastatin or placebo group based on the simple randomization method. Atorvastatin group received amikacinwith dose of 15 mg/kg/day in two equal divided doses every 12 h as intravenous infusion during 30 min and atorvastatin 40 mg tablet as daily oral dose for 7 days. Patients in the placebo group received same dose of amikacinand placebo tablet (Placebo group) for at least 7 days. Serum electrolytes (sodium, potassium, calcium, phosphor and magnesium) concentrations, blood urea nitrogen and serum creatinine levels were measured at day 0 and end of the study. Baseline mean ± SDof serum potassium concentration in the atorvastatin and placebo group was 4.07± 0.37 and 4.15 ± 0.53 meq/l respectively (p=0.88). Serum potassium concentration remained unchanged at the end of the study in the atorvastatin group (P=0.61) but significantly decreased from 4.15 ± 0.53 to 3.80 ± 0.55meq/l in the placebo group at day 7(P = 0.02).In this pilot study, atorvastatin as 40 mg daily oral dose prevented renal potassium loss during course of amikacin therapy in the critically ill patients. In the future well designed randomized clinical trials with adequate sample size,renoprotective effects of statins should be examined.
- Relationship between serum total magnesium and serum potassium in emergency surgical patients in a tertiary hospital in Ghana. [Journal Article]
- GMGhana Med J 2016; 50(2):78-83
- CONCLUSIONS: A mathematical relationship was found between serum total magnesium and serum potassium among adult patients who require emergency intra-abdominal surgery. However, it had limited clinical utility.
- Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy. [Journal Article]
- MMedicine (Baltimore) 2016; 95(36):e4542
- Electrolyte and mineral disturbances remain a major concern in patients undergoing continuous renal replacement therapy (CRRT); however, it is not clear whether those imbalances are associated with a...
Electrolyte and mineral disturbances remain a major concern in patients undergoing continuous renal replacement therapy (CRRT); however, it is not clear whether those imbalances are associated with adverse outcomes in patients with septic acute kidney injury (AKI) undergoing CRRT. We conducted a post-hoc analysis of data from a prospective randomized controlled trial. A total of 210 patients with a mean age of 62.2 years (136 [64.8%] males) in 2 hospitals were enrolled. Levels of sodium, potassium, calcium, and phosphate measured before (0 hour) and 24 hours after CRRT initiation. Before starting CRRT, at least 1 deficiency and excess in electrolytes or minerals were observed in 126 (60.0%) and 188 (67.6%) patients, respectively. The excess in these parameters was greatly improved, whereas hypokalemia and hypophosphatemia became more prevalent at 24 hours after CRRT. However, 1 and 2 or more deficiencies in those parameters at the 2 time points were not associated with mortality. However, during 28 days, 89 (71.2%) deaths occurred in patients with phosphate levels at 0 hour of ≥4.5 mg/dL as compared with 49 (57.6%) in patients with phosphate levels <4.5 mg/dL. The 90-day mortality was also significantly higher in patients with hyperphosphatemia. Similarly, in 184 patients who survived at 24 hours after CRRT, hyperphosphatemia conferred a 2.2-fold and 2.6-fold increased risk of 28- and 90-day mortality, respectively. The results remained unaltered when the serum phosphate level was analyzed as a continuous variable. Electrolyte and mineral disturbances are common, and hyperphosphatemia may predict poor prognosis in septic AKI patients undergoing CRRT.
- Genotype/Phenotype Analysis in 67 Chinese Patients with Gitelman's Syndrome. [Journal Article]
- AJAm J Nephrol 2016; 44(2):159-68
- CONCLUSIONS: We identified 41 mutations related to GS, containing 11 novel variants and 5 high-frequency ones, which should facilitate earlier and more accurate diagnosis of GS. FE of electrolytes in urine may be more sensitive in the phenotype evaluation and differential diagnosis than corresponding serum electrolytes. Hypokalemia and hypomagnesemia in GS were difficult to correct; however, spironolactone might be helpful for hypokalemia to some degree. Compared with normal people, patients with GS were at higher risk of developing type 2 diabetes.
- Severe hyperkalemia following adrenalectomy for aldosteronoma: prediction, pathogenesis and approach to clinical management- a case series. [Journal Article]
- BEBMC Endocr Disord 2016 Jul 27; 16(1):43
- CONCLUSIONS: Post APA resection severe hyperkalemia may be a common entity and screening should be actively considered in high risk patients. Older age, longer duration of hypertension, impaired pre-op and post-op GFR and higher levels of pre-op aldosterone and are all risk factors which predict the likelihood of developing post-operative hyperkalemia. Fludrocortisone, sodium bicarbonate, loop diuretics and potassium binders can be used for treatment. Treatment choice should be tailored to patient characteristics including fluid status, blood pressure and serum creatinine. Potassium binders should be avoided in patients with history of recent abdominal surgery, opioid use and constipation. Serum electrolytes and creatinine should be monitored every 1-2 weeks after starting treatment to ensure an adequate response. Prolonged management may be necessary in some cases and at-risk patients should be counselled as to the meaning and importance of post-operative changes in measured renal function and potassium.
- Plasma Potassium Concentration on Admission Correlates with Neurologic Outcome in Traumatic Brain Injury Patients Treated with Targeted Temperature Management: A Post Hoc Analysis of a Multicenter Randomized Controlled Trial. [Journal Article]
- WNWorld Neurosurg 2016; 94:437-441
- CONCLUSIONS: The initial potassium level may be an indicator in determining appropriate targeted temperature management for patients with TBI. Fever control may be considered instead of MTH for normokalemia patients with TBI on admission.
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- Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders. [Journal Article]
- JNJ Nutr Metab 2016; 2016:5168978
- CONCLUSIONS: A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.