• The Journal of Korean Medicine
• /
• v.44 no.4
• /
• pp.163-169
• /
• 2023

Methods: This study presents a comprehensive case study of an elderly male diagnosed with acute kidney injury (AKI) resulting from severe dehydration, supported by an extended follow-up with laboratory findings. Results: An 83-year-old male patient experienced severe diarrhea overnight, leading to hospitalization due to symptoms of dehydration and hypotension. His laboratory results displayed a typical AKI pattern, including a significant increase in creatinine levels (5.19 mg/dL) and the presence of hyperkalemia and hyponatremia. Following general treatments, including the administration of an herbal drug (Bulhwangeumjeonggi-san), the estimated glomerular filtration rate (eGFR) improved from 10 ml/min (Stage 5) to 34 ml/min (Stage 3) within five days when he was discharged. Although subsequent eGFR tests, conducted one and two months later as an outpatient, revealed an improvement of 42 ml/min, the patient still experienced mild chronic dysfunction as a consequence. Conclusion: This study presents a noteworthy case of acute kidney injury attributed to severe dehydration, emphasizing the importance of medical awareness regarding diarrhea-induced kidney function impairment, especially in the elderly population.

• Journal of Nutrition and Health
• /
• v.47 no.1
• /
• pp.33-44
• /
• 2014

Purpose: Elevated serum phosphorus and potassium levels are a major problem for hemodialysis (HD) patients. Hyperphosphatemia and hyperkalemia are closely related to intake of dietary phosphorus and potassium. Methods: This study was conducted in order to investigate the effects of food consumed on serum phosphorus and potassium levels in 48 HD patients (20 males and 28 females). We collected anthropometric data, biochemical parameters, and dietary data of the subjects. Dietary data for usual intake were obtained by use of a food-frequency questionnaire (FFQ) consisting of 21 food items. Results: The mean body mass index (BMI) was $22.2{\pm}3.0kg/m^2$, mean serum phosphorus level was $4.50{\pm}1.52mg/dl$, and mean serum potassium level was $4.74{\pm}0.73mEq/l$. Hyperphosphatemia (> 4.5 mg/dl) was found in 45.8% of subjects, and hyperkalemia (> 5.0 mEq/l) in 35.4%. Subjects who took medication only were 56% of total, and those who took medication with dietary therapy were 27%. Patients with medication and dietary therapy showed significantly lower serum phosphorus levels compared to patients with medication only (p < 0.05). Mean duration of HD was $7.9{\pm}7.3$ years and it showed positive correlation with serum potassium levels (p < 0.05). Serum phosphorus levels showed positive correlation with intake of mixed grains and soybean milk (p < 0.05). Serum potassium levels showed positive correlation with intake of mixed grains (p < 0.01), potatoes, fish, and high-potassium vegetables (p < 0.05). On the other hand, intake of white rice showed negative correlation with serum potassium levels (p < 0.05). Conclusion: The results of our study suggest that intake of white rice rather than mixed grains is an important factor in sustaining normal serum phosphorus and potassium levels. In addition, limiting intake of soybean milk, potatoes, and fish to under three serving per week is recommended. Finally, conduct of a strict dietary therapy along with medical treatment is desirable because inappropriate food intake increases serum phosphorus and potassium levels to a higher than normal range.

• 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.

• 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.

• Journal of Veterinary Clinics
• /
• v.28 no.4
• /
• pp.352-356
• /
• 2011

Abstract: This study was aimed to diagnose acid-base disorders of dogs with canine parvoviral enteritis (CPE) and data to establish a rational fluid therapy regimen for patients with CPE. A total of 43 dogs which had clinical signs of CPE and had detected canine parvovirus by polymerase chain reaction, were bled anaerobically from jugular vein at the time of admission. Blood chemical test, determination of electrolytes and blood gas analysis were conducted, and calculated values were obtained from each measured items. The values of blood chemical and electrolytes of dogs with CPE were various depending on the degree of clinical signs, and these tests were not specific to diagnose for CPE. Hypochloremia (20.9%), hyperchloremia (11.6%), hypokalemia (7.0%), hyperkalemia (11.6%), hyponatremia (9.3%) and hypernatremia (18.6%) were diagnosed as abnormalities of electrolytes from 43 dogs with CPE. The 29 out of 43 dogs (67.4%) were metabolic acidosis and 3 dogs (7.0%) were metabolic alkalosis. The acid-base status of 11 dogs out of 43 dogs (25.6%) was normal.

• Childhood Kidney Diseases
• /
• v.19 no.1
• /
• pp.48-52
• /
• 2015

Streptococcus pneumoniae associated hemolytic uremic syndrome (SpHUS) is one of the causes of atypical hemolytic uremic syndrome, and increasingly reported. They are more severe and leave more long-term sequelae than more prevalent, typical hemolytic uremic syndrome. But it is not so easy to diagnose SpHUS for several reasons (below), and there was no diagnostic criteria of consensus. A 18 month-old-girl with sudden onset of oliguria and generalized edema was admitted through the emergency room. She had pneumonia with pleural effusion and laboratory findings of HUS, DIC, and positive direct Coombs' test. As DIC or SpHUS was suspected, we started to treat her with broad spectrum antibiotics, transfusion of washed RBC and replacement of antithrombin III. On the $3^{rd}$ day, due to severe hyperkalemia and metabolic acidosis, continuous renal replacement therapy (CRRT) was started. She showed gradual improvement in 4 days on CRRT and discharged in 16 days of hospital care. At the follow up to one year, she has maintained normal renal function without proteinuria and hypertension. We report this case with review of articles including recently suggested diagnostic criteria of SpHUS.

• Journal of Trauma and Injury
• /
• v.32 no.4
• /
• pp.238-242
• /
• 2019

Extreme acidosis is a life-threatening physiological state that causes disturbances in the cardiovascular, pulmonary, immune, and hematological systems. Trauma patients commonly present to the operating room (OR) in hypovolemic shock, leading to tissue hypoperfusion and the development of acute metabolic acidosis with or without a respiratory component. It is often believed that trauma patients presenting to the OR in severe metabolic acidosis (pH <7.0) will have a nearly universal mortality rate despite aggressive resuscitation and damage control. The current literature does not include reports of successful resuscitations from a lower pH, which may lead providers to assume that a good outcome is not possible. However, here we describe a case of successful resuscitation from an initial pH of 6.5 with survival to discharge home 95 days after admission with almost full recovery. We describe the effects of acute acidosis on the respiratory and cardiovascular systems and hemostasis. Finally, we discuss the pillars of management in patients with extreme acute acidosis due to hemorrhage: transfusion, treatment of hyperkalemia, and consideration of buffering acidosis with bicarbonate and hyperventilation.

• Clinical and Experimental Pediatrics
• /
• v.54 no.11
• /
• pp.470-472
• /
• 2011

Familial hyperkalemic periodic paralysis (HYPP) is an autosomal-dominant channelopathy characterized by transient and recurrent episodes of paralysis with concomitant hyperkalemia. Mutations in the skeletal muscle voltage-gated sodium channel gene $SCN4A$ have been reported to be responsible for this disease. Here, we report the case of a 16-year-old girl with HYPP whose mutational analysis revealed a heterozygous c.2111C>T substitution in the $SCN4A$ gene leading to a Thr704Met mutation in the protein sequence. The parents were clinically unaffected and did not have a mutation in the $SCN4A$ gene. A $de$ $novo$ $SCN4A$ mutation for familial HYPP has not previously been reported. The patient did not respond to acetazolamide, but showed a marked improvement in paralytic symptoms upon treatment with hydrochlorothiazide. The findings in this case indicate that a $de$ $novo$ mutation needs to be considered when an isolated family member is found to have a HYPP phenotype.

• Journal of Yeungnam Medical Science
• /
• v.3 no.1
• /
• pp.375-382
• /
• 1986

We studied the effects of the acute intermittent peritoneal dialysis in severe acute renal failure of 1 newborn infant and 2 young infants during 18 months period from February 1985 to April 1986. The predisposing illnesses were severe acute gastroenteritis with dehydration. Reye's syndrome, and bilateral nephrolithiasis with hyperuricemia. The concomittent illnesses were severe hypernatremia, hyponatremia, hyperkalemia, hypocalcemia, hypoglycemia, DIC(disseminated intravascular coagulopathy), paralytic ileus, metabolic acidosis and gastrointestinal bleeding. As a dialvsate, Imperinol $solution^R$, 1.5% was used in all cases. The cycles of dialysis were 8, 16, and 41 times in each cases. Observed complications during dialysis were leakage, and abdominal wall and scrotol swelling in 2 cases, hyperglycemia in 1 case, and peritonitis in 1 case. Acinetobacter calcoaceticus was cultured in peritoneal fluid of peritonitis. These complications were treated by stopping dialysis in leakage and abdiminal wall swelling, insulin therapy in hyperglycemia, and intraperitoneal and systemic antibiotics therapy in peritonitis. We experienced improvements of severe acute renal failure with variable concomittant illnesses by acute intermittent peritoneal dialysis despite of the treatable complications of dialysis in all cases.

• Journal of Genetic Medicine
• /
• v.10 no.2
• /
• pp.81-87
• /
• 2013

Pseudohypoaldosteronism (PHA), a rare syndrome of systemic or renal mineralocorticoid resistance, is clinically characterized by hyperkalemia, metabolic acidosis, and elevated plasma aldosterone levels with either renal salt wasting or hypertension. PHA is a heterogeneous disorder both clinically and genetically and can be divided into three subgroups; PHA type 1 (PHA1), type 2 (PHA2) and type 3 (PHA3). PHA1 and PHA2 are genetic disorders, and PHA3 is a secondary disease of transient mineralocorticoid resistance mostly associated with urinary tract infections and obstructive uropathies. PHA1 includes two different forms with different severity of the disease and phenotype: a systemic type of disease with autosomal recessive inheritance (caused by mutations of the amiloride-sensitive epithelial sodium channel, ENaC) and a renal form with autosomal dominant inheritance (caused by mutations of the mineralocorticoid receptor, MR). In the kidneys, the distal nephron takes charge of the fine regulation of water absorption and ion handling under the control of aldosterone. Two major intracellular actors necessary for the action of aldosterone are the MR and the ENaC. Impairment of the intracellular aldosterone signal transduction pathway results in resistance to the action of mineralocorticoids, which leads to PHA. Herein, ion handling the distal nephron and the clinico-genetic findings of PHA are reviewed with special emphasis on PHA type 1.