• Journal of Yeungnam Medical Science
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• 제29권2호
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• pp.113-117
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• 2012

Primary aldosteronism is characterized by hypertension, hypokalemia, and metabolic alkalosis, associated with excessive aldosterone production and suppressed plasma renin activity. Hypokalemia-induced rhabdomyolysis has been rarely reported in primary aldosteronism patients. This paper reports a case of primary aldosteronism presented with rhabdomyolysis due to severe hypokalemia. A 48-year-old male with a three-year history of hypertension presented himself at the authors' hospital with generalized weakness and myalgia in both legs over a period of several days. His laboratory findings showed hypokalemia (1.8 mEq/L) with elevations of his serum creatine phosphokinase and serum myoglobin. His plasma aldosterone level was also elevated, and his plasma renin activity was reduced. An abdominal computed tomography revealed a 2.0 cm hypodense mass in the left adrenal gland, which suggested adrenal adenoma. The accordingly underwent laparoscopic adrenalectomy. Three months later, his plasma potassium level and blood pressure became normal without the use of medications.

• Clinical and Experimental Pediatrics
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• 제54권1호
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• pp.36-39
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• 2011

Bartter syndrome (BS) is a clinically and genetically heterogeneous inherited renal tubular disorder characterized by renal salt wasting, hypokalemic metabolic alkalosis and normotensive hyperreninemic hyperaldosteronism. There have been several case reports of BS complicated by focal segmental glomerulosclerosis (FSGS). Here, we have reported the case of a BS patient who developed FSGS and subsequent end-stage renal disease (ESRD) and provided a brief literature review. The patient presented with classic BS at 3 months of age and developed proteinuria at 7 years. Renal biopsy performed at 11 years of age revealed a FSGS perihilar variant. Hemodialysis was initiated at 11 years of age, and kidney transplantation was performed at 16 years of age. The post-transplantation course has been uneventful for more than 3 years with complete disappearance of BS without the recurrence of FSGS. Genetic study revealed a homozygous p.Trp(TGG)610Stop(TGA) mutation in the CLCNKB gene. In summary, BS may be complicated by secondary FSGS due to the adaptive response to chronic salt-losing nephropathy, and FSGS may progress to ESRD in some patients. Renal transplantation in patients with BS and ESRD results in complete remission of BS.

• Journal of Chest Surgery
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• 제22권2호
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• pp.179-190
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• 1989

The experimental study for extracorporeal preservation of the heart-lung preparation by autoperfusion system was performed in 10 dogs. Under intravenous Pentothal endotracheal anesthesia bilateral thoracotomies were performed. A 24F cannula connected to a plastic reservoir bag located 100 cm above the level of the heart was introduced into the aortic arch. Left subclavian, innominate artery, and descending aorta were ligated and divided. Both vena cavae were ligated and divided after the bag was half filled with blood. A 24F catheter inserted into right atrium and connected to the plastic bag in order to keep constant the preload. The thoracic trachea was intubated and the lungs were ventilated. The heart-lung preparations were removed en bloc and floated in a $34^{\circ}C$ bath of Hartmann solution. The preparations were observed for from 2 hours to 8 hours, with the average of 5.2 hours. Hemodynamic and hematologic variables were measured during preharvest and autoperfusion. The pH revealed severe respiratory alkalosis due to very low $PaCO_2$ during autoperfusion ; $PaO_2$ remained constant for 130-140 mmHg; $A-aDO_2$ increased markedly. The static inspiratory pressure [SIP] at late autoperfusion [6hr] increased significantly as compared with at early autoperfusion [2hr]. There was no difference between white blood cell counts from right atrium and those of left atrium. Heart rates remained constant for 110-120/min; cardiac outputs maintained to approximately 0.6L/min; mean aortic pressures, 75 mmHg; mean pulmonary arterial pressures, 15-18 mmHg; mean right atrial pressures, 9-13 mmHg; mean left atrial pressures, 12 mmHg lower than those of right atrium. Serum Na maintained with normal range during autoperfusion; K increased significantly; Ca decreased progressively. Hemoglobin and hematocrit decreased significantly during autoperfusion. The study demonstrated that stable hemodynamics could be maintained throughout the experiment and the preparation of the lung seemed to be inadequate, especially after 3-4 hours, such as high $A-aDO_2$, increased SIP, and scattered atelectasis and edema in their gross appearances.

• 대한한의학회지
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• 제32권5호
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• pp.134-138
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• 2011

Glycyrrhetinic acid, which is a component of licorice, can cause hypermineralocorticoidism through the inhibition of $11{\beta}$-hydroxysteroid dehydrogenase. So, a high dose intake of licorice can lead to hypermineralocorticoidism with potassium loss and depression of the renin-angiotensin-aldosterone system. We report a 73-year-old man with muscle weakness of proximal lower limbs with hypokalemia (Serum $K^+$: 1.4 mEq/L) due to taking self-prescribed licorice without OMD's diagnosis. He boiled 60~100g licorice / day in water and drank it intermittently for 1 month due to arthralgia and swelling of both his knees. Patient's serum renin activity and aldosterone level were far beyond the normal range. He also had metabolic alkalosis with pH 7.552. After quitting the licorice, hypokalemia and muscle weakness of proximal lower limbs gradually improved within 1week.

• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.436-439
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• 2015

Small cell lung cancer (SCLC), which originated from neuroendocrine tissue, can develop into paraneoplastic endocrine syndromes, such as Cushing syndrome, because of an inappropriate secretion of ectopic adrenocorticotropic hormone (ACTH). This paraneoplastic syndrome is known to be a poor prognostic factor in SCLC. The reason for poor survival may be because of a higher risk of infection associated with hypercortisolemia. Therefore, early detection and appropriate treatment for this syndrome is necessary. But the diagnosis is challenging and the source of ACTH production can be difficult to identify. We report a 69-year-old male patient who had severe hypokalemia, metabolic alkalosis, and hypertension as manifestations of an ACTH-secreting small cell carcinoma of the lung. He was treated with ketoconazole and spironolactone to control the ACTH dependent Cushing syndrome. He survived for 15 months after chemotherapy, which is unusual considering the poor outcome of the ectopic ATH syndrome associated with SCLC.

• Clinical and Experimental Pediatrics
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• 제45권3호
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• pp.413-417
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• 2002

증후군은 원위세뇨관 Na-Cl 공동운반체 유전자 이상으로 발생하는 상염색체 열성 유전질환으로, 저칼륨혈증, 저마그네슘혈증, 대사성 알칼리증, 그리고 저칼슘뇨증 등의 임상적 특징을 보이는 질환이다. 저자들은 Bartter 증후군과의 감별진단과 Gitelman 증후군의 확진을 위해 임상적으로 Gitelman 증후군이 의심되는 두명의 환아에서 신장청소검사를 시행하였다. 각각의 환아는 밤사이 금식을 시킨 후 물 20 mL/kg를 30분에 걸쳐 경구 투여하였고, 곧 이어 half saline을 정맥을 통해 분당 5 mL의 속도로 투여하기 시작하였다. 소변양이 분당 10 mL에 도달했을 때의 검체로 삼투질제거율, 유리수분제거율, 염소제거율, 원위분획염소재흡수율을 계산하였다. 그 후에 첫째 날은 furosemide, 둘째 날은 hydrochlorothiazide를 각각 투여하고 나서 같은 신장청소검사를 시행하였다. 이뇨제를 투여하기 전 원위분획염소재흡수율은 각각 73%, 75%로 정상범위에서 약간 감소되어 있었다. furosemide를 투여한 후 삼투질제거율은 증가하였고 유리수분제거율은 감소하였다. 염소제거율은 10배 이상 증가하였으며, 원위분획염소재흡수율은 현저한 감소를 보였다. Thiazide를 투여한 후에는 위와 같은 청소율의 변화들을 관찰할 수 없었다. 신장청소 검사의 소견은 본 연구의 환아들이 헨레의 고리 상행각의 이상보다는 원위세뇨관 Na-Cl 공동운반체의 이상이 있음을 보여주고 있어 Gitelman 증후군의 병태 생리와 잘 일치한다고 사료된다.

• 한국가금학회지
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• 제17권4호
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• pp.310-317
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• 1990

고온 stress를 받고 있는 산란계의 사료에 소금을 초과 첨가하였을 때 혈액의 산－입기 평형과 음수량 및 난질에 미치는 영향을 조사하기 위하여 실험을 실시하였다. 44주령된 갈색 실용 산란계(Dekalb Warren) 18수를 소금 025% 및 0.75% 처리구에 처리당 9반복, 반복당 1수씩 완전임의 배치하였다. 우선 상은(13~$16^{\circ}C$)에서 3일간의 예비실험을 거친 후 3일간의 본 실험을 수행하였다. 그 후 실온을 고온(33~$35^{\circ}C$)으로 올린 후 3일간의 본 실험 기간을 둠으로써 $2\times2$ 요인실험이 되게 하였다. ANOVA 검정은 5% 수준에서 실시하였으며 처리평균간의 유의성 검정도 역시 5% 수준에서 실시하였다. 얻어진 결과를 요약하면 다음과 같다. 1. 고온 stress에 의하여 사료 섭취량은 유의적으로 감소하였고 음수량과 배설물의 수분 함량은 증가하였으며, 소금의 추가 급여는 사료 섭취량과 음수량에는 영향을 주지 못하였으나 배설물의 수분 함량을 유의적으로 증가시켰다. 2. 고온 stress에 의하여 pH늘 유의적으로 증가하였고 $pCO_2$는 유의적으로 감소하였으며 ${HCO_3}^-$는 유의적인 차이를 나타내지 않았다. 또한 혈액의 산－염기변수는 소금의 추가 급여에 의하여 영향을 받지 않았다. 3. 고온 stress에 의하여 난중 및 난각의 질은 유의하게 감소하였고 Haugh unit는 유의하게 증가하였으며, 소금의 추가 급여는 난중, 난각 및 Haugh unit에 영향을 주지 못하였다. 결론적으로, 본 실험에서는 산란계에서 고온 stress 처리를 하였을 때 예상되는 호흡성 alkalosis와 난질 저하 현상 등을 관찰하였으며, 소금의 추가 급여는 고온 stress를 완화시키지 못하는 것으로 나타났다.

• Advances in pediatric surgery
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• 제12권2호
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• pp.192-201
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• 2006

1989년 3월부터 2005년 5월까지 울산대학교 의과대학 서울아산병원 소아외과에서 치료받은 신생아 Bochdalek 탈장 67예를 대상으로 하였다. 1989년 3월부터 1999년 말까지 조기수술, 과호흡, 수술시 흉관의 삽입을 시행한 I기(33예)와, 2000년 1월부터 2005년 5월까지 지연 수술, 최소한의 호흡 요법과 고빈도 환기 요법, 일산화질소 흡입 요법을 병행하고, 수술시 흉관의 삽입을 제한한 II기(34예)로 나누어 생존율을 비교하였다. I기의 경우 33예 중 20예가 생존하여 60.6 %, II기의 경우 34예 중 25예가 생존하여 73.5 %의 신생아기 생존율을 보였으나 통계학적 유의성은 없었다. 하지만 II기에서 생존율이 향상된 경향을 보임으로, II기에 불필요한 수술은 피할 수 있었던 것으로 생각되며, 나쁜 예후 인자를 갖는 예에서 치료 원칙의 변화가 의미 있는 역할을 했을 것으로 생각된다. 지연수술, 호흡요법, 일산화질소 흡입요법 각각의 영향에 대한 조사를 할 수 없었던 것은 이번 연구의 한계이다. 그러나 수술 전에 충분하게 제반 상태가 안정된 후에 시행하는 지연 수술이 바람직하다고 생각되며, 수술시 흉관 삽입은 피하는 것이 좋겠다. 수술 전후의 고빈도 환기 요법과 에 대해서는 좀 더 연구가 필요할 것으로 보인다.

• Tuberculosis and Respiratory Diseases
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• 제42권6호
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• pp.934-940
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• 1995

기침, 호흡곤란 및 성한 전신 쇄약감을 주소로 내원하여 기관지 내시경 및 경부 림프절 생검을 통한 조직검사로 소세포 폐암을 확진하고, 병력상 심한 전신무력감 및 체중감소를 호소해며, 검사상 성한 저칼륨혈증 및 대사성 알칼리증의 소견이 있으며, 최근 발생된 고혈당, 고혈압 등의 증상이 있어 시행한 내분비학적 생화학 검사상 혈중 cortisol이 상승하고, cortisol의 일간 변동(diurnal variation)이 소실되었으며, 24시간 뇨 free cortisol의 현저한 상승으로 Cushing 증후군이 paraneoplastic syndrome으로 소세포 폐암에서 동반되었음을 확인한 1예를 경험하였기에 보고하는 바이다.

• The Korean Journal of Physiology
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• 제16권1호
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• pp.13-23
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• 1982

Effects of external pH and potassium concentrations on the electrical and mechanical properties were investigated on rabbit papillary muscle. Papillary muscles were perfused in horizontal chamber with Tris Tyrode solutions and action potential along with isometric tension was recorded simultaneously. Potassium concentrations were varied between 1 and 12 mM at low(6.9), normal(7.4) and high (7.9) external pH. The following results were obtained: 1) On rasing the potassium concentration from 1 to 12 mM resting membrane potentials decreased from $-88.8{\pm}2.8$ to $-66.4{\pm}1.2\;mV$ at normal pH and the amplitude of action potential decreased from $115.1{\pm}0.7$ to $97.5{\pm}2.8\;mV$. On lowering the potassium concentration, membrane hyperpolarized and at 1 mM potassium concentration resting potentials were $-107{\pm}2.2\;mV$. Duration of action potential especially $APD_{60}{\sim}APD_{90}$ increased($APD_{90}$: $214{\pm}15.8\;ms$ at 1 mM $K^+$ to $287{\pm}18.1\;ms$ at 12 mM $K^+$). 2) During acidosis membranes hyperpolarized by more than 20 mV within 1 min. and then slow recovery was observed during the following 10 min. During alkalosis membranes depolarized about 10 mV, which were maintained until washing with normal Tyrode solutions. 3) On lowering the external pH(7.9-6.5), duration of action potential increased progressively and it was most prominent at pH 6.5 and $K^+$ 1mM. 4) Magnitude of developed tension was $0.6{\pm}0.14\;g/mm^2$ at normal pH and potassium concentration (stimulus frequency : 60/min). Relative isometric tension to normal value increased along the increment of stimulus frequency($44.2{\pm}4.2%$ at 6/min to $271{\pm}86.7%$ at 180/min). Force-frequency relations were altered quantitatively during the perfusion with different external pH solutions. 5) Developed tension did not show marked variation within the range of $2{\sim}8\;mM$ potassium concentrations. Positive inotropism was observed at less than 2 mM $K^+$ and negative inotropism beyond 12 mM $K^+$ concentrations. From the above results we concluded that the effects of potassium ion concentration on electrical and mechanical properties of rabbit papillary muscle are related to the changes in surface negative charge due to acid base disturbances.