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JFMS Open Reports 2023A 6-year-old female Siamese cat presented with an 8-week history of vomiting and progressive hyporexia. On presentation, the cat was found to have a hypochloremic...
CASE SUMMARY
A 6-year-old female Siamese cat presented with an 8-week history of vomiting and progressive hyporexia. On presentation, the cat was found to have a hypochloremic alkalosis. Imaging demonstrated hiatal hernia and megaesophagus. Exploratory laparotomy demonstrated a paraesophageal hiatal hernia. The hernia was reduced, phrenoplasty and esophagopexy were performed, and a gastrotomy tube was placed. Treatment of the hernia led to resolution of the megaesophagus.
RELEVANCE AND NOVEL INFORMATION
Megaesophagus can occur secondarily to paraesophageal hernia in the cat. In this case, correction of the paraesophageal hernia led to complete resolution of the esophageal dilation and all associated clinical signs.
PubMed: 37841898
DOI: 10.1177/20551169231199451 -
Diagnostics (Basel, Switzerland) Oct 2023Asphyxia, a leading cause of illness and death in newborns, can be improved by early detection and management. Arterial blood gas (ABG) analysis is commonly used to...
Asphyxia, a leading cause of illness and death in newborns, can be improved by early detection and management. Arterial blood gas (ABG) analysis is commonly used to diagnose and manage asphyxia, but it is invasive and carries risks. Dermal interstitial fluid (ISF) is an alternative physiological fluid that can provide valuable information about a person's health. ISF is more sensitive to severe hypoxia and metabolic disorders compared to blood, making it an attractive option for minimally invasive asphyxia detection using biosensors. However, obtaining ISF samples from humans is challenging due to ethical concerns and sampling difficulties. To address this, researchers are developing ISF-mimicking solutions as substitutes for early testing and evaluation of biosensors. This paper focuses on the development of these solutions for bench-based testing and validation of continuous asphyxia-monitoring biosensors. With an understanding of the factors influencing system quality and performance, these solutions can aid in the design of biosensors for in vivo monitoring of dermal ISF. Monitoring interstitial fluid pH levels can provide valuable insights into the severity and progression of asphyxia, aiding in accurate diagnosis and informed treatment decisions. In this study, buffer solutions were prepared to mimic the pH of ISF, and their electrical properties were analyzed. The results suggest that certain buffers can effectively mimic metabolic acidosis associated with asphyxia (pH < 7.30), while others can mimic metabolic alkalosis (pH > 7.45). Overall, this research contributes to the development of ISF-mimicking solutions and lays the groundwork for biosensor systems that monitor dermal ISF in real time.
PubMed: 37835868
DOI: 10.3390/diagnostics13193125 -
Nephrology, Dialysis, Transplantation :... Apr 2024Dietary potassium (K+) has emerged as a modifiable factor for cardiovascular and kidney health in the general population, but its role in people with chronic kidney...
BACKGROUND
Dietary potassium (K+) has emerged as a modifiable factor for cardiovascular and kidney health in the general population, but its role in people with chronic kidney disease (CKD) is unclear. Here, we hypothesize that CKD increases the susceptibility to the negative effects of low and high K+ diets.
METHODS
We compared the effects of low, normal and high KChloride (KCl) diets and a high KCitrate diet for 4 weeks in male rats with normal kidney function and in male rats with CKD using the 5/6th nephrectomy model (5/6Nx).
RESULTS
Compared with rats with normal kidney function, 5/6Nx rats on the low KCl diet developed more severe extracellular and intracellular K+ depletion and more severe kidney injury, characterized by nephromegaly, infiltration of T cells and macrophages, decreased estimated glomerular filtration rate and increased albuminuria. The high KCl diet caused hyperkalemia, hyperaldosteronism, hyperchloremic metabolic acidosis and severe hypertension in 5/6Nx but not in sham rats. The high KCitrate diet caused hypochloremic metabolic alkalosis but attenuated hypertension despite higher abundance of the phosphorylated sodium chloride cotransporter (pNCC) and similar levels of plasma aldosterone and epithelial sodium channel abundance. All 5/6Nx groups had more collagen deposition than the sham groups and this effect was most pronounced in the high KCitrate group. Plasma aldosterone correlated strongly with kidney collagen deposition.
CONCLUSIONS
CKD increases the susceptibility to negative effects of low and high K+ diets in male rats, although the injury patterns are different. The low K+ diet caused inflammation, nephromegaly and kidney function decline, whereas the high K+ diet caused hypertension, hyperaldosteronism and kidney fibrosis. High KCitrate attenuated the hypertensive but not the pro-fibrotic effect of high KCl, which may be attributable to K+-induced aldosterone secretion. Our data suggest that especially in people with CKD it is important to identify the optimal threshold of dietary K+ intake.
Topics: Animals; Male; Rats; Potassium, Dietary; Rats, Sprague-Dawley; Renal Insufficiency, Chronic; Glomerular Filtration Rate
PubMed: 37813819
DOI: 10.1093/ndt/gfad220 -
Cureus Sep 2023In a patient with persistent hypokalemia, it is important to consider Gitelman syndrome, a rare, salt-wasting tubulopathy inherited in an autosomal recessive pattern....
In a patient with persistent hypokalemia, it is important to consider Gitelman syndrome, a rare, salt-wasting tubulopathy inherited in an autosomal recessive pattern. Gitelman syndrome leads to electrolyte abnormalities like hypokalemia, hypomagnesemia, and metabolic alkalosis. Typical clinical features include muscle cramps, fatigue, polydipsia, and salt cravings. Our case involves a female patient in her early 40s who visited the endocrinology clinic with symptoms of polyuria, constipation, muscle weakness, and fatigue. Electrolyte abnormalities included hypokalemia, hypomagnesemia, hypochloremia, and hyperreninemia. Initial tests, such as renal function tests, renal ultrasound, and CT scan, yielded normal results. Differential diagnosis of Gitelman syndrome and Bartter syndrome was considered due to the mutual electrolyte abnormalities of hypokalemia and metabolic alkalosis. Bartter syndrome was ruled out in our patient due to the presence of hypomagnesemia, which indicates a different defective receptor. Ultimately, genetic testing would be necessary to confirm the diagnosis of Gitelman syndrome considering the characteristic electrolyte disturbances and classic clinical presentation of fatigue, weakness, and salt craving.
PubMed: 37795074
DOI: 10.7759/cureus.44590 -
Cureus Aug 2023Gitelman syndrome (GS) is a rare autosomal recessive salt-losing renal tubular disorder associated with a mutation of SLC12A3 or CLCNKB genes which encodes the...
Gitelman syndrome (GS) is a rare autosomal recessive salt-losing renal tubular disorder associated with a mutation of SLC12A3 or CLCNKB genes which encodes the thiazide-sensitive sodium-chloride co-transporter (NCCT) in the distal renal tubule. It is inherited as an autosomal recessive disorder. Hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria, and renin-angiotensin-aldosterone system (RAAS) activation are characteristics of GS. GS is often misdiagnosed or underdiagnosed owing to its low incidence and lack of awareness. Its prevalence is estimated to be around 1-10 per 40,000 people. We report a case of cardiac arrest secondary to torsade de pointes (TdP) because of GS-induced hypomagnesemia. Our case highlights the importance of clinicians being aware of the potential electrolyte abnormalities and complications associated with GS, as it can lead to catastrophic consequences if not identified and corrected earlier.
PubMed: 37791211
DOI: 10.7759/cureus.44464 -
Alternative Therapies in Health and... Jan 2024Rett syndrome (RTT) is now widely recognized as a profound neurological disorder that predominantly affects females and is closely associated with mutations in the...
BACKGROUND
Rett syndrome (RTT) is now widely recognized as a profound neurological disorder that predominantly affects females and is closely associated with mutations in the methylated CpG binding protein 2 (MECP2) gene located on the X chromosome. The Characteristic symptoms of RTT include the loss of acquired language and motor skills, repetitive hand movements, irregular breathing, and seizures. Additionally, RTT patients may experience sporadic episodes of gastrointestinal problems, hypoplasia, early-onset osteoporosis, bruxism, and screaming episodes. It is worth noting that males exhibit a unique and variable phenotype, though rare in RTT cases, often accompanied by severe manifestations.
CASE PRESENTATION
In this report, we present the case of a young male child with a de novo c.806delG hemizygous mutation, leading to an atypical presentation of RTT that remarkably mirrors the clinical features of Bartter syndrome, a genetic metabolic disorder. The clinical manifestations in this case included the loss of previously acquired language and motor skills, repetitive hand movements, breathing irregularities, seizures, sporadic episodes of gastrointestinal distress, hypoplasia, early-onset osteoporosis, bruxism, and episodes of screaming. This distinctive presentation underscores the complex diagnostic landscape of RTT, particularly in males, and highlights the need for vigilant clinical evaluation.
CONCLUSIONS
This case report sheds light on an unusual and atypical presentation of RTT in a young male child with a de novo c.806delG hemizygous mutation. The resemblance of clinical features to Bartter syndrome underscores the diagnostic challenges posed by RTT and highlights the importance of comprehensive clinical assessment and genetic testing, especially in cases deviating from the typical RTT phenotype. Our findings contribute valuable insights into the early diagnosis and management of atypical RTT presentations.
Topics: Child; Female; Humans; Male; Rett Syndrome; Methyl-CpG-Binding Protein 2; Bruxism; Bartter Syndrome; Hypoxia; Seizures; Alkalosis; Osteoporosis
PubMed: 37773669
DOI: No ID Found -
Frontiers in Endocrinology 2023Ectopic adrenocorticotropic hormone syndrome (EAS) is a condition of hypercortisolism caused by non-pituitary tumors that secrete adrenocorticotropic hormone (ACTH). A...
Ectopic adrenocorticotropic hormone syndrome (EAS) is a condition of hypercortisolism caused by non-pituitary tumors that secrete adrenocorticotropic hormone (ACTH). A rare occurrence of this syndrome is due to an ACTH-producing neuroendocrine tumor that originates from the gallbladder. One patient with severe hypokalemia and alkalosis was admitted to our hospital. Clinical presentations and radiographic findings confirmed the diagnosis of an aggressive ACTH-producing gallbladder malignancy with multiple liver metastases. The diagnosis was verified by pathological and immunohistochemical measurements from a biopsy of the hepatic metastasis. A literature review identified only four similar cases had been reported. Despite being rare and having a poor prognosis, hormone-producing neuroendocrine tumors that derive from the gallbladder should be considered in the differential diagnosis of ectopic ACTH syndrome.
PubMed: 37772081
DOI: 10.3389/fendo.2023.1224381 -
Oxford Medical Case Reports Sep 2023Licorice can cause pseudoaldosteronism and QT prolongation as its side effect. Trigeminal nerve stimulation, including surgical intervention involving the face, can...
Licorice can cause pseudoaldosteronism and QT prolongation as its side effect. Trigeminal nerve stimulation, including surgical intervention involving the face, can cause transient bradycardia, known as the trigeminocardiac reflex. Although rare, a combination of these two etiologies can cause ventricular tachycardia. A 50-year-old female patient with a history of hypertension and intake of an herbal drug containing licorice underwent impacted wisdom tooth extraction under general anesthesia. Immediately after placing a month-long prop for visualization in the oral cavity, sinus bradycardia occurred, followed by ventricular tachycardia and torsade de pointes. Mouth prop was removed and cardiopulmonary resuscitation was initiated, and the arrhythmia was resolved. Hypokalemia, metabolic alkalosis and normal aldosterone levels were observed. An inverted T wave and a prominent U-wave were observed on the electrocardiogram. Potassium excretion in urine was normal, although hypokalemia was present. The patient was treated with potassium correction.
PubMed: 37771690
DOI: 10.1093/omcr/omad098 -
Radiology Case Reports Dec 2023We report a case of unilateral left metastatic pulmonary calcification (MPC) in a 30-year-old woman with systemic lupus erythematosus, acute nephritis, and left main...
We report a case of unilateral left metastatic pulmonary calcification (MPC) in a 30-year-old woman with systemic lupus erythematosus, acute nephritis, and left main pulmonary artery pulmonary embolism. Unilateral MPC is rare and is mostly seen in the context of ipsilateral pulmonary embolism. The proposed mechanism is the promotion of calcium salts precipitation by focal alkalosis resulting from reduced blood flow to the lung affected by the pulmonary arterial obstruction.
PubMed: 37766834
DOI: 10.1016/j.radcr.2023.08.102 -
Viruses Sep 2023High-flow nasal cannula (HFNC) and ventilator-delivered non-invasive mechanical ventilation (NIV) were used to treat acute respiratory distress syndrome (ARDS) due to...
High-flow nasal cannula (HFNC) and ventilator-delivered non-invasive mechanical ventilation (NIV) were used to treat acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia, especially in low- and middle-income countries (LMICs), due to lack of ventilators and manpower resources despite the paucity of data regarding their efficacy. This prospective study aimed to analyse the efficacy of HFNC versus NIV in the management of COVID-19 ARDS. A total of 88 RT-PCR-confirmed COVID-19 patients with moderate ARDS were recruited. Linear regression and generalized estimating equations (GEEs) were used for trends in vital parameters over time. A total of 37 patients were on HFNC, and 51 were on NIV. Patients in the HFNC group stayed slightly but not significantly longer in the ICU as compared to their NIV counterparts (HFNC vs. NIV: 8.00 (4.0-12.0) days vs. 7.00 (2.0-12.0) days; = 0.055). Intubation rates, complications, and mortality were similar in both groups. The switch to HFNC from NIV was 5.8%, while 37.8% required a switch to NIV from HFNC. The resolution of respiratory alkalosis was better with NIV. We conclude that in patients with COVID-19 pneumonia with moderate ARDS, the duration of treatment in the ICU, intubation rate, and mortality did not differ significantly with the use of HFNC or NIV for respiratory support.
Topics: Humans; Cannula; Respiration, Artificial; Prospective Studies; Respiratory Insufficiency; Noninvasive Ventilation; COVID-19; Respiratory Distress Syndrome
PubMed: 37766286
DOI: 10.3390/v15091879