• Childhood Kidney Diseases
• /
• v.16 no.1
• /
• pp.54-57
• /
• 2012

A 6-month-old boy with vesicoureteral reflux exhibited features of transient type 1 pseudohypoaldosteronism (PHA) in the course of urinary tract infection. PHA presents hyponatremia, hyperkalemia, and metabolic acidosis, accompanying with high urinary sodium, low potassium excretion, and high plasma aldosterone concentration. Severe electrolyte disturbance can occur in an infant with vesicoureteral reflux because of secondary PHA. Appropriate treatment of dehydration and sodium supplementation induces rapid improvement of electrolyte imbalance and metabolic acidosis resulting from secondary PHA associated with vesicoureteral reflux.

• Childhood Kidney Diseases
• /
• v.18 no.2
• /
• pp.111-115
• /
• 2014

Hyperkalemia is often detected in young infants, particularly in association with acute pyelonephritis or a urinary tract anomaly. Cases of hyperkalemia in this population may also be due to transient pseudohypoaldosteronism, or immaturity of renal tubules in handling potassium excretion. Symptoms of hyperkalemia are non-specific, but are predominantly related to skeletal or cardiac muscle dysfunction, and can be fatal. Therefore, treatment has to be initiated immediately. Administration of fludrocortisone for hyperkalemia is appropriate in cases with hypoaldosteronism, but is challenging in young infants with hyperkalemia due to renal tubular immaturity, without pseudohypoaldosteronism. We report the case of a 25-day-old male presenting with persistent hyperkalemia with normal serum aldosterone, who was admitted with a first episode of pyelonephritis and unilateral high-grade vesicoureteral reflux. The patient was treated successfully with fludrocortisone.

• Clinical and Experimental Pediatrics
• /
• v.49 no.5
• /
• pp.470-474
• /
• 2006

Hypokalemia and hyperkalemia are the most commonly encountered electrolyte abnormalities in hospitalized patients. Because untreated hypokalemia or hyperkalemia is associated with high morbidity and mortality, it is important to recognize and treat them immediately. Hypokalemia and hyperkalemia can result from disruptions in transcellular homeostasis or in the renal regulation of $K^+$ excretion. Although the recognition is simple, appropriate management requires an understanding of normal $K^+$ homeostasis and pathophysiology. In this article, normal $K^+$ homeostasis, pathophysiology, diagnosis and management of hypokalemia and hypokalemia are discussed.

• Clinical and Experimental Pediatrics
• /
• v.52 no.3
• /
• pp.376-379
• /
• 2009

We report a case of a premature newborn baby who presented with hyponatremia, hyperkalemia, and metabolic acidosis accompanied by severe polyhydramnios in utero. The baby was diagnosed with pseudohypoaldosteronism on the basis of normal 17-hydroxyprogesterone levels, elevated aldosterone, and clinical symptoms. His serum electrolyte levels were corrected with sodium chloride supplementation. Sodium supplementation was reduced gradually and discontinued at 5 months of age. At 5 months, the child was able to maintain normal serum electrolyte levels without oral sodium chloride supplementation, and showed normal physical and neurological development. This case illustrates that pseudohypoaldosteronism must be considered if a newborn infant with an antenatal history of severe polyhydramnios shows excessive salt loss with normal levels of 17-hydroxyprogesterone.

• Journal of Veterinary Clinics
• /
• v.27 no.5
• /
• pp.573-578
• /
• 2010

A 4-year-old intact male Shih Tzu dog (weighing 5 kg), was presented with signs of severe dyspnea, exercise intolerance and cyanosis. Diagnostic studies suggested a reverse patent ductus arteriosus (rPDA) with pneumonia. Despite emergency treatments with oxygen, diuretics, antibiotics and medical therapy for hyperkalemia, the dog died of ventricular fibrillation from hyperkalemia and dehydration. Necropsy revealed the rPDA with a marked descending aortic dilation and abnormally arisen left common carotid artery.

• The Journal of the Korean life insurance medical association
• /
• v.27 no.2
• /
• pp.61-65
• /
• 2008

보험 청약자의 심전도에서 볼 수 있는 widened QRS 군은 심실내전도장애, 조기흥분증후군, 좌심비대, 심실성 조율, 고칼륨혈증, 심실성 율동 등으로 인해 나타난다. 임상정보와 기본적인 심전도 판독기술로 감별진단을 할 수 있다. 심실내 전도장애는 전형적인 심전도 소견을 확인한 후 보다 광범위한 전도계 질환과(또는) 심근을 침범하는 질환을 동반하고 있음을 의미하는 심전도 소견이 있는지 자세히 검토하여 위험평가를 하도록 한다.

• YAKHAK HOEJI
• /
• v.37 no.5
• /
• pp.463-475
• /
• 1993

Pharmacological effects of lemakalim on cardiovascular system were investigated using isolated rat hearts and conscious SHRs subjected to hyperkalemic and hypokalemic condition. In the isolated hearts perfused with normal physiological salt solution(4.7 mM KCI), lemakalim increased cardiac function and coronary flow, and these effects were significantly potentiated under hypokalemic(1.2, 2.5 mM KCI), but attenuated under hyperkalemic(IO mM KCI) condition. In conscious SHRS, lemakalim(0.1, 0.2, 0.3mg/kg, p.o.) produced a dose-related decrease in systolic blood pressure, the maximal hypotensive effect being reached around 0.5 hr after dosing. The intensity and the duration of hypotensive effect of lemakalim were significantly increased when administered in combination with dihydrochlorothiazide (2 mg/kg, p.o.), but decreased with triamterene(32 mg/kg, p.o.). It appears that the differential effects of two types of diuretics on the hypotensive action of lemakalim are due to their hypokalemic and hyperkalemic action, respectively. It is conclued that the concomitant use of $K^{+}$ channel openers and hypokalemic diuretics may be an appropriate model of combination therapy in the treatment of hypertension.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.16 no.12
• /
• pp.8176-8186
• /
• 2015

This research was conducted for the purpose of developing a high-fidelity simulation education program, applying it to clinical field and analyzing this program's effect on nursing college students in order to solve problems being caused from the gap between the adult nursing theoretical class and practical education. As the analysis method, this study developed a scenario including an algorithm for caring hyperkalemia patients, the evaluation check list, and debriefing according to the adult nursing theoretical class's learning goal and measured the high-fidelity simulation program's effect in using the non-equivalent control group pre-test and post-test design. As the results from the analysis, there secured the simulation education program's general properties and dependent variable's homogeneity in the experimental group and the control group. The nursing simulation practice program for hyperkalemia patients showed slight effect on the experimental group compared to the control group in fields such as nursing practice ability, problem solving ability, critical thinking skills, self-confidence of nursing, and knowledge. (t=-83.313, p<.001, t=-3.169, p=.003, t=-2.473, p=.017, t=-4.036, p<.001, t=-5.044, p<.001). High-Fidelity simulation programs in conjunction with an adult nursing theory classes of nursing students nursing practice ability, problem solving ability, critical thinking skills, self-confidence of nursing, and knowledge. This simulation program may be an effective educational method for nursing practice and also support improved quality of nursing education.

• The Journal of the Korea Contents Association
• /
• v.13 no.9
• /
• pp.312-321
• /
• 2013

The purpose of this study was to develop a scenario suited for our clinical situations and evaluate the application possibility by evaluating students' problem solving ability and learning satisfaction in simulation learning. This study consisted of contents which could be applied for varied situations such as complications and symptoms related to liver cirrhosis, looking into hyperkalemia symptoms of patients with liver cirrhosis in emergency unit. The stage of developing scenario was organized in the order of setting simulation learning objectives and situations of scenario, making algorithm, writing checklists of clinical performance appraisal, and debriefing. The scenario was constructed with monitor setting(actions), patient/mannequin(actions), expected interventions(events), and cues in chronological order, according to the scenario progression outline of Jeffries (2007). The scenario was used in 2011, consisting of 4-5 people per group of 53 senior nursing students who registered for 'clinical performance appraisal' course. The problem solving ability improved from a score of 4.05 before simulation learning to a score of 4.30 after simulation learning (t=-3.97, p<.001). The score for learning satisfaction after the simulation learning was high (4.09/5). Considering that simulation learning encouraged students to be the main body of class, this learning method can be the effective way of nursing education.

• Childhood Kidney Diseases
• /
• v.14 no.2
• /
• pp.132-142
• /
• 2010

Hypokalemia usually reflects total body potassium deficiency, but less commonly results from transcellular potassium redistribution with normal body potassium stores. The differential diagnosis of hypokalemia includes pseudohypokalemia, cellular potassium redistribution, inadequate potassium intake, excessive cutaneous or gastrointestinal potassium loss, and renal potassium wasting. To discriminate excessive renal from extrarenal potassium losses as a cause for hypokalemia, urine potassium concentration or TTKG should be measured. Decreased values are indicative of extrarenal losses or inadequate intake. In contrast, excessive renal potassium losses are expected with increased values. Renal potassium wasting with normal or low blood pressure suggests hypokalemia associated with acidosis, vomiting, tubular disorders or increased renal potassium secretion. In hypokalemia associated with hypertension, plasam renin and aldosterone should be measured to differentiated among hyperreninemic hyperaldosteronism, primary hyperaldosteronism, and mineralocorticoid excess other than aldosterone or target organ activation. Hypokalemia may manifest as weakness, seizure, myalgia, rhabdomyolysis, constipation, ileus, arrhythmia, paresthesias, etc. Therapy for hypokalemia consists of treatment of underlying disease and potassium supplementation. The evaluation of hyperkalemia is also a multistep process. The differential diagnosis of hyperkalemia includes pseudohypokalemia, redistribution, and true hyperkalemia. True hyperkalemia associated with decreased glomerular filtration rate is associated with renal failure or increased body potassium contents. When glomerular filtration rate is above 15 mL/min/$1.73m^2$, plasma renin and aldosterone must be measured to differentiate hyporeninemic hypoaldosteronism, primary aldosteronism, disturbance of aldosterone action or target organ dysfunction. Hyperkalemia can cause arrhythmia, paresthesias, fatigue, etc. Therapy for hyperkalemia consists of administration of calcium gluconate, insulin, beta2 agonist, bicarbonate, furosemide, resin and dialysis. Potassium intake must be restricted and associated drugs should be withdrawn.