hyperkalemia | Acta Medica Marisiensis

Introduction: Severe hyperkalemia is a life-threatening condition that demands a rapid diagnosis and prompt treatment. The following case report highlights the possible complexity in the clinical presentation of this condition and the importance of a thorough assessment of patients that do not provide the classical clinical findings.
Case presentation: A 40-year-old male called the emergency services for low blood pressure and an overall altered state. Upon arrival, the prehospital team found a patient with shock signs that was complaining of feeling unwell and reported profuse diarrhea starting three days prior. Additionally, the patient also had muscle weakness and occasional spastic movements of the limbs and face. During the assessment, the patient went suddenly into cardiac arrest, life support (including the management of hyperkalemia) was immediately started and return of spontaneous circulation was soon obtained. Point-of-care blood testing established the diagnosis of severe hyperkalemia. Definitive in-hospital care consisted mainly of fluid resuscitation, circulatory support, hemodialysis and antimicrobial therapy and the patient was discharged 16 days later with no neurological impairment.
Conclusions: Although atypical, hyperkalemia can be caused by diarrhea in certain circumstances and its clinical manifestations can be misleading. Thus, keeping a broad clinical perspective and early use of blood tests can ensure proper treatment of life-threatening hyperkalemia.

Cardiovascular disease is a leading cause of death globally. 40 percent of the adult Romanian population is hypertensive, and only three out of seven patients are getting the appropriate treatment. Hyperkalemia is in a close relationship with certain cardiovascular diseases, although the influence of a certain medical treatment on hyperkalemia is not yet established. The aim of our study was to evaluate the pharmacotherapy of a group of patients with cardiovascular disease, representative for the adult population of our are and to analyze the administered drug therapy regarding polypragmasy (the concomitant usage of more than five different classes of substances), over-the-counter drugs and usage of drugs used without medical – physician prescribed – indication, and to evaluate serum potassium levels. The cross-sectional, observational, prospective, pharmaco-epidemiological study targets the observation, recording and analysis of 301 adult patients’ pharmacotherapy and laboratory findings. Based on the demographic data we found that the study group is representative for the adult population of our region. Hypertension was observed in 173 cases, and more than 60 percent of the patients were older than 65 years of age. Other comorbidities, such as ischemic cardiac disease, heart failure, arrhythmias, other cardiovascular diseases as well as chronic kidney failure and diabetes mellitus were positively associated with hypertension. In 50.8 percent of the cases usage of drugs without prescription was present. Likewise, multiple drug combinations were frequent with high rates of polypragmasy. Multiple drug combinations were observed, and self-medication rates were very high, which should be reduced substantially to obtain a more successful pharmacotherapy and a reduced drug interaction-induced side effect.