原发性醛固酮增多症和低钾血症

原发性醛固酮增多症 (原醛 )是由于肾上腺皮质发生肿瘤或者增生 ,使醛固酮分泌过多 ,临床表现高血压和低钾血症。1　流行病学原醛是一种继发性高血压。近来由于ＣＴ和ＭＲＩ在临床上广泛应用 ,肾上腺意外瘤的发现增高 ,使原醛的发现也越来越多。原醛的病因分为肾上腺皮质球状带的腺瘤和增生为两种主要原因。原醛发病年龄从儿童到老人都可发生。好发年龄为 30～ 5 0岁 ,增生者发病率在男女性别中没有差别 ,腺瘤多见于女性 ,约占 70 %。由于原醛是一种可以治愈的高血压 ,及时发现及时治疗 ,可以治愈高血压和低钾血症 ,保护心血管免受损害 ,对…     

类癌与低钾血症

类癌是一种生长缓慢的上皮细胞肿瘤 ,具有恶化的倾向。原发肿瘤常发生在胃肠道。恶性类癌可转移至肝脏 ,使血流中血清素等物质增多。所以 ,也有人认为是一种内分泌肿瘤。临床表现除局部症状外 ,还有皮肤潮红 ,腹泻 ,腹痛 ,哮喘 ,心脏瓣膜病变 ,以及水电解质失衡如低钾血症。此时称为类癌综合征。类癌发病年龄较广 ,文献报告 16～81岁的年龄均可发生。男女均可罹患。1　病理及发病机理类癌最多发生在阑尾 ,其次为回肠、空肠 ;直肠、胃、十二指肠、盲肠、结肠等处较为少见 ;偶可发生于支气管、胆囊、胰腺和卵巢。典型病变是在消化道粘膜下层 ,…     

肾素瘤与低钾血症

肾素瘤又称原发性肾素增多症、肾素分泌瘤 ,绝大多数为起源于肾小球旁复合器中的毛细血管外膜细胞的肾球旁细胞瘤 ,少数可为肾癌或肾外恶性肿瘤。肾球旁细胞瘤是一种罕见的产生肾素的肾小球球旁装置肿瘤 ,于 196 7年Ｒｏｂｅｒｔｓｏｎ等报道第 1例 ,196 8年Ｋｉｈａｒａ等报道第 2例 ,故命名为Ｒｏｂｅｒｔｓｏｎ -Ｋｉｈａｒａ综合征。肿瘤分泌大量肾素 ,在临床上表现为严重的高血压、高肾素、高醛固酮及低血钾的综合征群。1　病理生理[1]肾素主要由肾小球颗粒细胞合成、贮存和分泌。肾小球入球微动脉行至近肾小体血管极处 ,其血管壁中膜…     

Genetic hypokalemia

INTRODUCTION: Hypokalemia is the most frequent electrolytic disturbance in hospitalized patients. It is sometimes familial. Careful clinical and biological evaluation may guide further genetic analysis. CURRENT KNOWLEDGE AND KEY POINTS: Genetic hypokalemia is linked to disorders of mineralocorticoid hormone synthesis or action (glucocorticoid-remediable hyperaldosteronism, congenital adrenal hyperplasia, apparent excess of mineralocorticoids), to renal tubular disorders (Liddle's syndrome, Bartter's and Gitelmann's syndrome, tubular acidosis) or to disorders of cellular transfer of potassium (hypokalemic periodic paralysis). FUTURE PROSPECTS AND PROJECTS: Molecular mechanisms of adult Bartter's syndrome are probably different from pediatric syndromes. A better clinical and biological evaluation with longitudinal follow-up could allow significant progress in the knowledge of the natural history and prognosis of these syndromes.     

Licorice-induced hypokalemia

Excessive intake of licorice can cause hypokalemia and hypertension and generally, the onset and severity of symptoms depend on the dose and duration of licorice intake, as well as individual susceptibility. We describe a patient with hypokalemia caused by long term consumption of natural licorice root after quitting smoking. The case emphasizes the importance of considering a detailed patients' history, which often may lead the treating physician to the correct clinical diagnosis.     

Preventing hypokalemia

Dietary modification is an inefficient and calorically unwise means of preventing hypokalemia; potassium supplements present compliance problems and are of little or no use in the patient with a concomitant magnesium deficiency. Prescribing potassium-sparing diuretics is the best prevention-oriented choice, but diabetics and older patients must be monitored for signs of hyperkalemia, and it is generally better not to use these agents in patients who are also taking ACE inhibitors.     

弥漫性甲状腺肿伴甲亢与低钾血症

甲亢按病因不同可分为许多类型 ,最常见的是弥漫性甲状腺肿伴甲亢 ,又称突眼性甲状腺肿 (Ｇｒａｖｅｓ’ｓ病、Ｂａｓｅ ｄｏｗ病 )。此型占全部甲亢病人的 90 %以上。近年来 ,研究该型发病主要与自身免疫反应有关。约 3%～ 6 8%的弥漫性甲状腺肿伴甲亢患者出现低钾血症而发生周期性麻痹 ,临床上称之为甲亢性周期性麻痹 ,或甲亢性低钾麻痹。1　发生率甲亢性周期性麻痹多见于东方国家 ,尤其在我国和日本发生率最高。本症西方国家较少见 ,北美国家的发生率不足我国的 1/ 10。本病好发于男性青壮年 ,患者可先有甲亢 ,后合并周期性麻痹 ,也可以…     

Diuretic-induced hypokalemia and cardiac arrhythmias

Premature ventricular contractions have long been recognized as a complication of severe diuretic-induced hypokalemia. Likewise, diuretic-induced mild hypokalemia is known to have an arrhythmogenic potential in patients who are concurrently being treated with digitalis compounds. Recent studies using exercise and ambulatory monitoring of the electrocardiogram suggest that diuretic-induced premature ventricular contractions may be a more common phenomenon than was previously recognized. The risk of this form of ventricular ectopic activity is controversial. However, the available data are substantial enough to warrant some precautions on the part of the clinician.     

Latamoxef versus Carbenicillin plus Gentamicin or Carbenicillin plus Mecillinam in Leukopenic,Febrile Patients with Solid Tumors

ABSTRACT Sixty-six febrile episodes associated with leukopenia were observed in 56 patients with solid tumors, WBC >1.5x10⁹/l and temperature ≥38.5°C. Stratification to antibiotic treatment regimen was made with regard to prior cis-dichlorodiamineplatinum (cis-platinum) treatment or not. Patients who had received no cis-platinum were randomized between carbenicillin 10 g every 8 h plus gentamicin 80 mg every 8 h or latamoxef 2 g every 8 h (group I). Patients having received cis-platinum were treated with carbenicillin 10 g every 8 h plus mecillinam 800 mg every 8 h or latamoxef 2 g every 8 h (group II). The first dose of latamoxef was preceded by 10 mg of vitamin K i.v. In group I, clinical response was observed in 10 of 19 febrile episodes (52.6%) treated with carbenicillin plus gentamicin and in 10 of 14 (71.4%) treated with latamoxef (p>0.05). In group II, 6 of 14 febrile episodes treated with carbenicillin plus mecillinam responded (42.9%) while 11 of 19 (57.9%) responded to latamoxef (p>0.05). No bleeding due to antibiotic treatment was observed. No statistical difference between standard antibiotic therapy and latamoxef was seen in this subset of patients.     

Sixty-eight-year-old patient with hypokalemia

A 68-year-old patient with severe hypokalemia and metabolic alkalosis is described. Six years before admission he had been treated for a small cell bronchial carcinoma. We discuss the diagnostic approach of hypokalemia and the way in which we reached the diagnosis. The patient suffered from metastatic small cell carcinoma with a very high plasma adrenocorticotropic hormone concentration, possibly due to production of corticotropin-releasing hormone by the malignancy.