THE IRONY! SELF-INDUCED HYPERKALEMIC EMERGENCY IN PRIMARY HYPERALDOSTERONISM. Asad Mussarat, Luke Yesbeck, Angus Harper, Ashley Van, Rebecca Maitski, Seth Vignes; Louisiana State University, New Orleans, LA.
Introduction: Hyperkalemia is a common medical emergency that, if uncontrolled, can lead to life-threatening complications such as muscle weakness, paralysis, and arrhythmias. Etiologies include both natural and iatrogenic dysregulation of potassium homeostasis, affecting both intracellular and extracellular potassium levels. These disturbances may arise from increased potassium intake, extracellular shifting, or decreased renal excretion. While the degree of hyperkalemia is significant, the rapidity of the change in potassium levels is often more crucial. Case: A 52-year-old female with primary hyperaldosteronism and post-traumatic stress disorder presented with three days of vomiting and diarrhea. Due to her chronic hypokalemia and gastrointestinal losses, she tripled her doses of lisinopril (25 mg), spironolactone (25 mg), and potassium chloride (20 mg) to restore her electrolyte losses. She experienced generalized muscle weakness, fatigue, and anxiety, but denied chest pain or palpitations. Her blood pressure was 159/98 mmHg, and the physical exam showed bilateral muscle weakness. Admission labs revealed a potassium level of 9.5 mEq/L, bicarbonate of 19 mEq/L, and creatinine of 4.07 mg/dL. She was diagnosed with
drug-induced hyperkalemia, complicated by Type 4 renal tubular acidosis. An electrocardiogram showed peaked T waves and a prolonged PR interval. She was treated with calcium gluconate, aggressive intravenous fluids, and potassium shifters, including furosemide, sodium bicarbonate, and albuterol. Her potassium and creatinine levels gradually improved without requiring hemodialysis. Her potassium supplements and antihypertensive medications were discontinued until follow-up with nephrology. She was counseled on medication adherence and discharged in stable condition. Discussion: This case highlights the need for caution when using medications that affect electrolyte balance. Hospitalized hyperkalemic patients have a significantly higher mortality rate. Despite her critically elevated potassium, this patient showed no signs of cardiac instability, underscoring the importance of early recognition in hyperkalemic emergencies. Hemodialysis was considered but fortunately not required. Patient education is essential, especially regarding the risks of self-dosing medications. Early recognition and prompt treatment of hyperkalemic emergencies are essential to ensure favorable outcomes.
PRECIPITATION OF ACUTE MYOPERICARDITIS BY DIABETIC KETOACIDOSIS. Heath Scott, Ahmed Fazal-Ur-Rehman, Ryan Falcone, Timothy Keys; Louisiana State University, Lafayette, LA.
Introduction: Diabetic Ketoacidosis (DKA) is a serious complication of diabetes mellitus and can present with numerous end-organ insults. Myopericarditis is a rare complication of DKA, one that is potentially overlooked by clinicians. Case: The patient is a 19-year-old female with a type 1 diabetes mellitus who was transferred to our facility for neurology services following a questionable seizure in the setting of DKA. She endorsed heavy drinking the night prior and subsequent fatigue, nausea, vomiting, and malaise. At the outside facility, she was found to be hyperglycemic with a profound anion gap acidosis (pH<6.9). There, she experienced
two episodes of seizure-like activity, prompting transfer. On the physical exam, she was tachycardic and tachypneic, but otherwise hemodynamically stable; diffuse abdominal tenderness; vaginal erythema and white discharge was noted during catheterization. Initial labs revealed a bicarbonate of <5 mmol/L, anion gap ≥21, beta-hydroxybutyrate 8.4 mmol/L, pH 7.14, pCO2 and pO2 within normal limits; BUN/Creatinine 6.7 mmol/L /1.4 μmol/L; Phosphorus 1.8 mmol/L. A urinalysis revealed 4+ ketonuria, glucosuria, and 2+ pyuria with many bacteria. By the next evening, her gap had closed, and electrolytes were stable. A electroencephalogram was negative. By mid-evening, she began to experience atypical 18
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