A Case Of Postileostomy Hypovolemia Presenting As Pseudohypoaldosteronism With Complete Resolution After Ostomy Reversal

Niyazov, Daniil; Shawa, Hassan

doi:10.4158/ep151011.cr

Cited by 4 publications

(2 citation statements)

References 10 publications

(13 reference statements)

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“…In some severe cases, PHA may develop (15)(16)(17). Only a few case reports indicated patients with secondary PHA due to excessive gastrointestinal losses through ileostomy, and the condition resolved when the ileostomy was closed (17)(18)(19)(20). In our case series, we examined serum aldosterone level in patients with high output stoma while patient had body weight loss or electrolyte imbalance.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Case Report: Newborns With Pseudohypoaldosteronism Secondary to Excessive Gastrointestinal Losses Through High Output Stoma

Chen

Lin

et al. 2021

Front. Pediatr.

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Life-threatening electrolyte imbalance is not uncommon in preemies. Differential diagnosis is important for immediate treatment. The syndrome of pseudohypoaldosteronism (PHA) is characterized by increased aldosterone secretion associated with clinical signs of hypoaldosteronism reflecting mineralocorticoid resistance. There are type I, type II, and secondary type of PHA. Most secondary PHA reported in the pediatric population result from urinary infection and obstructive uropathy and extremely rarely from gastrointestinal fluid loss. Seven preemies accepted jejunostomy or ileostomy, and they suffered from high output stoma. Electrolyte imbalance with bodyweight loss or cardiac event was noted. We found a high level of aldosterone and renin and diagnosed them with secondary PHA due to excessive gastrointestinal losses. After stomal reversal, aldosterone and renin level became normalized, and electrolyte was corrected. This study reports the finding of secondary pseudohyperaldosteronism (hyponatremia, hyperkalemia, and metabolic acidosis) in a series of cases with intestinal resection and ostomy of different causes. Early stomal reversal was recommended.

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Section: Discussion/conclusionmentioning

confidence: 99%

Case Report: Newborns With Pseudohypoaldosteronism Secondary to Excessive Gastrointestinal Losses Through High Output Stoma

Chen

Lin

et al. 2021

Front. Pediatr.

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“…3 Conversely, Niyazov et al speculated that a chronic increase in the aldosterone levels may induce the downregulation of the mineralocorticoid receptor, thus contributing to the development of secondary PHA. 4 Furthermore, preterm infants have been reported to be susceptible to hyponatremia despite their increased renineangiotensinealdosterone system, possibly because of tubular immaturity. 5 Therefore, we consider that preterm infants with ileostomy potentially have renal tubular resistance to aldosterone and are at a risk of developing secondary PHA triggered by profound volume depletion.…”

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confidence: 99%

Three cases of pseudohypoaldosteronism following ileostomy in preterm infants

Nakasone

Fujioka

Nishida

et al. 2021

Pediatrics & Neonatology

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Pseudohypoaldosteronism (PHA) is a disorder caused by renal tubular resistance to aldosterone and is characterized by hyperkalemia, hyponatremia, metabolic acidosis, and high plasma renin and aldosterone levels. 1 In general, PHA is classified as "primary" when it is caused by genetic mutations and "secondary" when it is associated with urinary tract malformations and/or urinary infections. Secondary PHA usually occurs in infants. 2 A few adult cases of secondary PHA caused by ileum resection have been reported in the literature, 3,4 but none of the newborns have reported ileum resectioneinduced PHA. Herein, we describe three preterm infant cases of secondary PHA following ileostomy without renal complications. The gestational age and birthweight of the patients ranged from 24 to 29 weeks and 568e706 g, respectively. Ileostomy was performed on days 6, 9, and 3 for cases 1, 2, and 3, respectively. PHA occurred following possible trigger events associated with the decrease of Na supply or volume depletion on the days 21, 144, and 74 in cases 1, 2, and 3, respectively. The onset of PHA with initial symptom for each case was on day 22 with oliguria, day 145 with cardiac arrest, and day 96 with no symptoms, respectively. Blood testing at the onset revealed hyponatremia, hyperkalemia, and high plasma renin and aldosterone concentrations in all the cases. Abdominal ultrasonography and urinalysis revealed no renal abnormalities or urinary tract infections in all the cases. Additionally, congenital adrenal hyperplasia was excluded because of the negative results of the mass screening tests. Hyponatremia/hyperkalemia was normalized immediately after the bolus infusion of normal saline with/without glucose-insulin therapy, which was replaced by the oral supplementation of sodium chloride (NaCl). In cases 1 and 3, NaCl supplementation could be completed Letter to the Editor

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Sodium depletion and secondary hyperaldosteronism in outpatients with an ileostomy: a cross-sectional study

Rud

Brantlov

Quist

et al. 2023

Scandinavian Journal of Gastroenterology

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A Case Of Postileostomy Hypovolemia Presenting As Pseudohypoaldosteronism With Complete Resolution After Ostomy Reversal

Cited by 4 publications

References 10 publications

Case Report: Newborns With Pseudohypoaldosteronism Secondary to Excessive Gastrointestinal Losses Through High Output Stoma

Case Report: Newborns With Pseudohypoaldosteronism Secondary to Excessive Gastrointestinal Losses Through High Output Stoma

Three cases of pseudohypoaldosteronism following ileostomy in preterm infants

Sodium depletion and secondary hyperaldosteronism in outpatients with an ileostomy: a cross-sectional study

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