A Rare Case of Hypokalemia and Hypomagnesemia

Abstract

An 18-year-old adolescent male presented to our emergency department complaining of chest pain that started about 2 days earlier and remained unchanged. Chest x-rays revealed a right apical pneumothorax. The patient did not use any medication. Two months earlier he had presented to the emergency department with a similar episode that resolved spontaneously. Blood testing performed at the time of presentation showed severe hypokalemia with a potassium concentration of 2.5 mmol/L. He was admitted to our respiratory unit.He was 180 cm (70.9 in) tall and weighed 64 kg (141 lb, body max index 19.8 kg/m 2 ). He was in good general health, and the physical examination was unremarkable. A renal ultrasound was normal. He noted an unintentional weight loss of 7 kg (15.4 lb) over the last 36 months. Furthermore, he reported fatigue and muscle weakness. His personal history and family history were unremarkable. He was delivered naturally at term and developed normally during childhood and puberty.Further blood tests revealed moderate hypomagnesemia of 1.2 mg/dL [0.5 mmol/L; reference interval 1.7-2.2 mg/dL (0.7-0.9 mmol/L)]. Arterial blood gas analysis showed metabolic alkalosis (pH 7.46, bicarbonate 28.9 mmol/L). Sodium, chloride, and calcium were within reference intervals. Renal function, fasting blood glucose, and a complete blood count were normal. Table 1 provides a selection of relevant laboratory results at presentation and during follow-up.As recommended by the British Thoracic Society, the patient was scheduled for video-assisted thoracoscopic surgery (1 ). Before surgery, an endocrine specialist was consulted to further investigate the cause of the patient's hypokalemia and hypomagnesemia. The spontaneous pneumothorax was unrelated to the abnormal electrolyte results and is not further discussed here. The patient's pronounced hypokalemia and hypomagnesemia were initially treated with potassium canrenoate, potassium chloride, and magnesium (Fig. 1). With this therapy, serum potassium improved and stabilized at 2.8 -2.9 mmol/L. Subsequently, amiloride was added to the patient's therapy, which led to a further improvement of serum potassium. However, he reported increasing fatigue, which led to the discontinuation of potassium canrenoate, without which correction of potassium was insufficient. Therefore, it was decided to replace amiloride by potassium canrenoate and spironolactone. Three months after the initial presentation, his potassium had risen to 3.4 mmol/L.Within 10 weeks after the initiation of spironolactone therapy, he developed gynecomastia, a well-known side effect of this drug. Consequently, spironolactone was again replaced by amiloride, although at a higher dose. As serum potassium remained low, at approximately 2.8 mmol/L, he was switched from amiloride to eplerenone, a mineralocorticoid receptor antagonist that does not cause gynecomastia. Potassium and magnesium supplementation were continued as before. With this therapy, serum potassium and magnesium concentrations stabilized near the lower limi...

Políticas públicas del adulto mayor. Eficiencia en la atención sanitaria estatal del Ecuador

“…El ciclo de vida del ser humano está conformada por varias etapas, una de ellas, la vejez; que por su edad es llamado adulto mayor; este grupo etario merecen la atención, acogida y amparo de los derechos humanos, que desde 1945 viene gestionándose internacionalmente por la Organización de las Naciones Unidas (ONU), sin exclusión de raza, color, sexo, idioma, religión, edad, u otra condición humana; el envejecimiento de las personas conlleva transformaciones sociales como laborales, financieras, y promoción de bienes y servicios (Naciones Unidas, 2021), y requieren atención y protección especial, priorizada, personalizada, en materia de inclusión social, económica, de forma prioritaria, especializada y llevando una vida de paz, sin violencia (Ministerio de Inclusión Económica y Social , 2018); de estas personas cuya edad sea a partir de 60 años (Convención Interamericana sobre la Protección de los Derechos Humanos de las Personas Mayores, 2019), por lo que debe ser una declaración política Edwyn Williams Marín-Tapia 110 capacidades del grupo de personas mayores, orientación de atención integral y de servicios enfocados en adultos mayores y accesibilidad a los servicios a largo plazo (Organización Panamericana de la Salud OPS, 2021). The Stakeholder Group on Ageing (SGA) es una entidad preocupada en los adultos mayores cuyos objetivos pretenden integrar los problemas del envejecimiento en la Agenda 2030 para el desarrollo sostenible a nivel nacional, regional y mundial (Dongilli et al 2016).…”