Errors in potassium measurement can cause pseudohyperkalemia, where serum potassium is falsely elevated. Usually, these are recognized either by the laboratory or the clinician. However, the same factors that cause pseudohyperkalemia can mask hypokalemia by pushing measured values into the reference interval. These cases require a high-index of suspicion by the clinician as they cannot be easily identified in the laboratory. This article discusses the causes and mechanisms of spuriously elevated potassium, and current recommendations to minimize those factors. “Reverse” pseudohyperkalemia and the role of correction factors are also discussed. Relevant articles were identified by a literature search performed on PubMed using the terms “pseudohyperkalemia,” “reverse pseudohyperkalemia,” “factitious hyperkalemia,” “spurious hyperkalemia,” and “masked hypokalemia.”

No abstract

No abstract

Aminoglycoside-induced renal toxicity is well known and may manifest with nonoliguric renal failure or renal tubular dysfunction. Aminoglycoside-induced renal tubular dysfunction could result in diffuse damage or manifest as a Fanconi-like syndrome, Bartter-like syndrome, or distal renal tubular acidosis. We discuss a patient who developed severe renal tubular dysfunction secondary to short-term therapy with Amikacin, resulting in refractory hypokalemia, hypocalcemia, hypomagnesemia, metabolic alkalosis, and polyuria. This constellation of biochemical abnormalities mimic Type 5 Bartter's syndrome, where there is activating mutation of the calcium sensing receptor in the thick ascending loop of Henle and the distal tubule. In this case this activation of the calcium sensing receptor was triggered by amikacin. This phenomenon has been described with gentamicin though never with amikacin. Recovery of the tubular dysfunction took 15 days following cessation of the offending drug, Amikacin.

No abstract

Endosulfan is capable of high lethality and significant morbidity. The commonest manifestations are neurological although other organ dysfunction also occurs. In the absence of effective antidotes, restriction of its availability, along with prompt treatment of toxicity, including preemptive anticonvulsant therapy are suggested.

OBJECTIVE. There are few articles in the literature describing the security and safety aspects of networked medical equipment in radiology departments. Most radiologists are unaware of the security issues. We review the security of the networked medical equipment of a typical radiology department. MATERIALS AND METHODS. All networked medical equipment in a radiology department was scanned for vulnerabilities with a port scanner and a network vulnerability scanner, and the vulnerabilities were classified using the Common Vulnerability Scoring System. A network sniffer was used to capture and analyze traffic on the radiology network for exposure of confidential patient data. We reviewed the use of antivirus software and firewalls on the networked medical equipment. USB ports and CD and DVD drives in the networked medical equipment were tested to see whether they allowed unauthorized access. Implementation of the virtual private network (VPN) that vendors use to access the radiology network was reviewed. RESULTS. Most of the networked medical equipment in our radiology department used vulnerable software with open ports and services. Of the 144 items scanned, 64 (44%) had at least one critical vulnerability, and 119 (83%) had at least one high-risk vulnerability. Most equipment did not encrypt traffic and allowed capture of confidential patient data. Of the 144 items scanned, two (1%) used antivirus software and three (2%) had a firewall enabled. The USB ports were not secure on 49 of the 58 (84%) items with USB ports, and the CD or DVD drive was not secure on 17 of the 31 (55%) items with a CD or DVD drive. One of three vendors had an insecure implementation of VPN access. CONCLUSION. Radiologists and the medical industry need to urgently review and rectify the security issues in existing networked medical equipment. We hope that the results of our study and this article also raise awareness among radiologists about the security issues of networked medical equipment.

Even though intravenous thrombolysis with tissue plasminogen activator (IV tPA) is the standard of care in acute ischemic stroke, its use in pregnancy is not clearly defined. Mechanical thrombectomy devices can be an option; however, literature on the use of such mechanical devices in stroke in pregnancy is lacking. Here we describe two cases that developed acute embolic stroke during pregnancy who were successfully treated by mechanical clot retrieval using the Penumbra system 28 (Penumbra Inc., Alameda, California, USA). To the best of our knowledge, these are the only case reports on the use of the Penumbra device in pregnant patients with acute ischemic stroke.