Thiazides and hypokalaemia in diabetic ketoacidosis

In a series of forty-one episodes of diabetic coma or pre-coma, three patients had plasma potassium values of less than 3.0 mEq/l. All three had been taking thiazide diuretics with only one receiving oral potassium supplements. None was previously known to be diabetic, representing 18% of the new diabetics in the series. The mean plasma potassium for the other new diabetics was 4·7 ± 0·2 mEq/l. These findings emphasize that adequate potassium supplements should be given with thiazide diuretics to diabetic subjects and to those with an increased risk of developing the disease.     

Myocardial damage due to hypokalaemia and hypophosphataemia

A case of severe hypokalaemia with stupor, skeletal muscle and heart muscle damage is reported. An initial infusion of glucose-insulin and potassium (GIK) produced a temporary clinical improvement with reduction of creatine kinase (CKMB) and elevation of serum K+. On the 4th day of treatment, neuromuscular and cardiovascular deterioration occurred accompanied by a further rise of CKMB. This deterioration was coincident with a serum phosphate of 0.26 mmol/l. The impaired left ventricular (LV) function was measured using echocardiography and detecting the ejection fraction (EF). GIK was stopped and a potassium phosphate infusion commenced. As the phosphate and potassium deficiencies were corrected, the neuromuscular and cardiac abnormalities resolved, CKMB fell to normal and LVEF rose from 40% to 72%. We suggest that additional cardiac damage due to hypophosphataemia may have occurred in this patient, who already had cardiac impairment as a result of profound hypokalaemia. Possible mechanisms are discussed.     

Severe hypokalaemia from kaolin and morphine abuse

A 34 year old man, registered disabled as a result of muscle weakness, was admitted to hospital because of increasing weakness. He had profound hypokalaemia and admitted to taking up to 1400 ml of kaolin and morphine mixture daily. After considerable potassium replacement muscle power recovered completely. The hypokalaemia is likely to have been caused by the combination of liquorice extract and sodium bicarbonate in kaolin and morphine.     

Watery diarrhoea and hypokalaemia associated with a phaeochromocytoma

The syndrome of water diarrhoea, hypokalaemia and achlorhydria (WDHA) is well described in association with a non-beta islet cell tumour of the pancreas. The following case report is of a 28-year-old woman with a WDHA syndrome that was cured by the removal of a phaeochromocytoma.     

Persistent hypokalaemia in a Jamaican hypertensive patient

We report the case of a 48-year old man with uncontrolled hypertension and persistent hypokalaemia from an aldosterone producing adrenal adenoma treated by laparoscopic adrenalectomy. Clinicians' identification of primary hyperaldosteronism is critical as the correct treatment results in improved blood pressure control and reduced risk of complications.     

Life-threatening hypokalaemia associated with ibuprofen-induced renal tubular acidosis

Renal tubular acidosis is an underreported complication of ibuprofen misuse, and can result in life-threatening hypokalaemia. We describe four patients who presented with profound hypokalaemia and muscle weakness associated with excessive ibuprofen ingestion. Ibuprofen cessation and supportive management resulted in complete biochemical resolution within a few days. These cases remind practitioners about potential complications of unmonitored use of over-the-counter analgesics, including those with potential for misuse due to their codeine content.     

溶菌酶脂质体的制备工艺

研究了溶菌酶脂质体的制备工艺,确定了具有较高包封率的工艺条件。采用逆相蒸发法,考察了溶剂密度、膜材浓度、制备温度和超声时间等因素对溶菌酶脂质体包封率、稳定性及形态学的影响。研究结果表明:0.6 g卵磷脂和0.3 g胆固醇加入到12 mL密度为1 g/mL的混合有机溶剂中,37°C下用逆相蒸发法制备溶菌酶脂质体,并对其进行1.5 m in超声后所得产品包封率可达84%以上,所得脂质体形态圆整,粒径为150~400 nm,在4°C下保存40 d外观无明显变化。