经鼻蝶入路垂体腺瘤切除术后患者低钾血症饮食干预效果研究

目的探讨饮食干预对预防经鼻蝶入路垂体腺瘤术后患者并发低钾血症的作用。方法随机将40例经鼻蝶入路垂体腺瘤切除术患者分为实验组和对照组各20例。实验组于手术后第1天起通过饮食补钾,对照组给予传统的静脉补钾。连续监测两组患者术后5d血清钾的变化。结果两组患者术后均出现低钾血症;术后1—4d血清钾浓度两组的差异无统计学意义,术后第5天实验组血清钾浓度高于对照组,差异有统计学意义（P〈0．05）;同时,实验组输液时间比对照组明显缩短,差异有统计学意义（P〈0．01）。结论经鼻蝶入路垂体腺瘤切除术患者术后通过饮食补钾,可以有效预防低钾血症,效果与静脉补钾相同,且可缩短输液时间,有利于患者尽早下床活动。     

低钾性周期性麻痹58例临床分析

目的 探讨低钾性周期性麻痹的临床特点及诊治原则。方法 综合分析58例低钾性周期性麻痹病例的一般临床资料、主要症状及体征,重要辅助检查及治疗转归。结果 病人均有低钾、瘫痪、补钾后迅速恢复等特点,16例心电图有P－R间期、Q－T间期延长、QRS增宽或ST段低、T波变平、U波出现等改变,6例有浅感觉减退,18例肌张力正常,11例腱反射增高,38例腱反射降低,有5例出现尿潴留,有1例出现呼吸肌麻痹。结论 低钾性周期性麻痹临床上有低钾、下运动神经元瘫痪、肌张力减低、腱反射减弱、心电图改变等典型症状,也可有浅感觉减腿、腱反射增高等特殊变化,诊断上须注意与格林－巴林综合征、急性脊髓炎等疾病鉴别。治疗上主要是迅速补钾。     

Severe hypokalemia and rebound hyperkalemia during barbiturate coma in patients with severe traumatic brain injury

ObjectivesTo evaluate the incidence of severe potassium disturbances during barbiturate coma therapy in patients with severe traumatic brain injury (TBI), and the characteristics of these patients.MethodsThe study comprised 37 patients with severe TBI who were treated for barbiturate coma between 2015 and 2017 in level 3 intensive care units of two hospitals.ResultsNo potassium disturbance occurred in 14 patients. Seventeen patients developed mild-moderate hypokalemia (2.6–3.5 mEq/L), and 6 patients developed severe hypokalemia (<2.5 mEq/L) following the induction of barbiturate therapy. The incidence of mild-to-severe barbiturate-induced hypokalemia was 62.2% and the rate of severe hypokalemia was 16.2%. The mean potassium supply per day during thiopentone therapy was statistically significantly different between patients with mild-to-moderate hypokalemic and those with severe hypokalemic (p < 0.001). Four of 6 patients with severe hypokalemia developed rebound hyperkalemia exceeding 6 mEq/L following the cessation of barbiturate infusion. The nadir potassium concentration was 1.5 mEq/L and the highest value was 6.8 mEq/L. The mean time to reach nadir potassium concentrations was 2.8 days. The mortality rate of the 6 patients was 66.7%. Of the 2 survivors of severe hypokalemia, the Glasgow Outcome Scale (GOS) on discharge and the extended GOS one year after the trauma were 5 and 8 respectively.ConclusionsSevere hypokalemia refractory to medical treatment and rebound hyperkalemia is a serious adverse effect of thiopentone coma therapy in patients with severe TBI. Excessive and aggressive potassium replacement during the barbiturate-induced hypokalemia period must be avoided. Weaning barbiturate treatment over time may be advantageous in the management of severe serum potassium disturbances.     

低钾型周期性麻痹28例分析

目的 探讨重症低钾型周期性麻痹的临床特点和治疗方法。方法 28例患者均有心电图异常改变，16例（68％）的患者继发于甲亢，肌腱反射正常15例（53％）、肌腱反射活跃者2例（7％），21例（75％）血清肌酸磷酸激酶有不同程度的增高。结论 低钾型周期性麻痹发病急、进展快、血钾和心电图检查有助于及时诊断本病。抢救成功的关键在于及时有效的补充血钾，使血钾恢复到相对较为安全的水平。     

甲亢并发周期性麻痹30例临床特点分析

目的探讨甲亢并发周期性麻痹的临床特点。方法回顾性分析自2005-2011年收治的30例甲亢并发周期性麻痹病人的临床资料。结果所有病例有较明显诱因,多在夜间睡眠、清晨醒后起病,均为急性起病,以四肢瘫痪为主,近端重于远端,下肢重于上肢。30例患者治疗前血清钾均较正常水平低,其甲状腺功能测定均显示T3、T4升高,TSH降低。结论甲亢并发周期性麻痹有其临床特点,早期诊断及时补钾治疗与预后密切相关。     

Anesthetic considerations in a parturient with renal tubular acidosis and hypothyroidism undergoing cesarean delivery

Renal tubular acidosis, associated with hypothyroidism, is rare. We present the case of a woman with known renal tubular acidosis and treated hypothyroidism who underwent emergency cesarean delivery under uneventful combined spinal-epidural anesthesia. The rationale for choosing the anesthetic technique and the potential risks associated with anesthesia and renal tubular acidosis are discussed.     

A multi-centre study of potassium deficiency in the elderly

Summary

Two-hundred and ten patients from general practice with a mean age of 75 years were assessed for the signs and symptoms of potassium deficiency, before and after receiving a potassium supplement (‘Slow-K’) 8.06 mEq. three times a day. The assessment included potassium and haemoglobin levels, diet, and symptomatic ratings. Following treatment, 86% of patients showed symptomatic improvement, and there was a highly significant increase in mean potassium levels from 3.8 to 4.4 mEq./l. Interestingly there was a slight but significant increase in mean haemoglobin levels from 12.1 to 12.8?g./100ml. It was not possible, because of the trial design, to correlate conclusively the symptomatic improvement with the therapy.     

Hypokalemic Cardiac Arrest: Narrative Review of Case Reports and Current State of Science

PurposeHypokalemic cardiac arrest is an uncommon occurrence in the emergency department. Electrocardiogram findings related to hypokalemic cardiac arrest include prolonged QT, U waves, and preventricular contractions leading to Torsades de Pointes and then arrest. Literature evaluating the prevalence of hypokalemic cardiac arrest is scarce, and its management is lacking. This review provides a summary of current literature, recommendations from current guidelines, and proposed management strategies of hypokalemic cardiac arrest.SummaryIntravenous potassium administration is the treatment for hypokalemic cardiac arrest. Although the treatment for hypokalemic cardiac arrest is known, there is limited evidence on the proper procedure for administering intravenous potassium appropriately and safely. Owing to the time-sensitive nature of treating hypokalemic cardiac arrest, rapid administration of intravenous potassium (10 mEq/100 mL of potassium chloride over 5 minutes) is warranted. Concerns regarding rapid potassium administration are not without merit; however, a risk-benefit analysis and potential mitigation strategies for unwanted side effects need to be considered if hypokalemic cardiac arrest is to remain a reversible cause. It is imperative to identify hypokalemia as the cause for arrest as soon as possible and administer potassium before systemic acidosis, ischemia, and irreversible cell death.ConclusionsMore evidence is necessary to support treatment recommendations for hypokalemic cardiac arrest; however, it is the authors' opinion that, if identified early during cardiac arrest, intravenous potassium should be administered to treat a reversible cause for cardiac arrest.