Complicaciones metabólicas y óseas de las derivaciones urinarias

Megías, Marta Cano; Delgado, Eva Golmayo Muñoz

doi:10.1016/j.endonu.2014.10.007

Cited by 3 publications

(2 citation statements)

References 43 publications

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“…Although the precise mechanism remains unknown, ICIs cause hyperkalemia on rare occasions, regardless of endocrinopathies [ 37 ]. In the present case, cortisol deficiency together with ileal conduit-related HMA (loss of HCO 3 and gain of chloride from the conduit) [ 32 ], CKD, T2D, and the use of a RAAS inhibitor probably led to the severe hyperkalemia. Prompt administration of corticosteroids and treatment with normal saline, sodium bicarbonate, glucose/insulin, and cation exchange resin, as well as discontinuation of the RAAS inhibitor, helped the patient recover from severe hyperkalemia ( Figure 2 ).…”

Section: Discussionmentioning

confidence: 89%

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Isolated Adrenocorticotropic Hormone Deficiency Associated with Severe Hyperkalemia During Pembrolizumab Therapy in a Patient with Ureteral Cancer and an Ileal Conduit: A Case Report and Literature Review

Hinata¹,

Ohara²,

Sakurai³

et al. 2021

Am J Case Rep

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Patient: Female, 78-year-old Final Diagnosis: Isolated adrenocorticotropic hormone deficiency Symptoms: Anorexia • general weakness • muscle pain Medication: Hydrocortisone Clinical Procedure: Endocrine test Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Immune checkpoint inhibitors (ICIs) are anticancer medications that enhance the antitumor immune response. The clinical benefit afforded by ICIs, however, can be accompanied by immune-related adverse events (IRAEs). One of the common endocrine IRAEs is hypophysitis, which often causes hypopituitarism with secondary adrenal insufficiency (AI). Secondary AI, including isolated adrenocorticotropic hormone (ACTH) deficiency (IAD), is often associated with hyponatremia. Here, we report an unusual case of ICI-related IAD associated with severe hyperkalemia. Case Report: A 78-year-old woman who had an ileal conduit, chronic kidney disease, type 2 diabetes mellitus, and hyper-tension and was taking an angiotensin II receptor blocker began treatment for advanced ureteral cancer with the anti-programmed cell death protein 1 inhibitor pembrolizumab. The therapy effectively controlled the cancer, but 4 1/2 months after starting it, the patient developed anorexia, general weakness, and muscle pain and was diagnosed with IAD associated with severe hyperkalemia and hyperchloremic metabolic acidosis. She recovered after prompt administration of corticosteroids and treatment with sodium bicarbonate, glucose/insulin, and cation exchange resins. Conclusions: Hyperkalemia is a common symptom of primary AI but is less common in patients with central AI because a lack of ACTH does not cause aldosterone deficiency and mineralocorticoid action is preserved. The present case demonstrates the need for physicians to be aware of severe hyperkalemia as a life-threatening complication of secondary AI induced by ICIs, particularly in patients with predisposing factors, such as kidney dysfunction, diabetes mellitus, an ileal conduit, and renin-angiotensin-aldosterone system inhibitor use.

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Section: Discussionmentioning

confidence: 89%

“…She also developed mild hyperkalemia and started treatment with dietary potassium restriction and oral calcium polystyrene sulfonate (30 g/d). In addition, she was presumed to have hyperchloremic metabolic acidosis (HMA) associated with her ileal conduit [ 32 ].…”

Section: Case Reportmentioning

confidence: 99%

Isolated Adrenocorticotropic Hormone Deficiency Associated with Severe Hyperkalemia During Pembrolizumab Therapy in a Patient with Ureteral Cancer and an Ileal Conduit: A Case Report and Literature Review

Hinata¹,

Ohara²,

Sakurai³

et al. 2021

Am J Case Rep

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Long-Term Safety of Tedizolid in a Patient With Spondilodiscitis After Switch From Linezolid Due to Toxicity

Álvarez

Pardo

García

et al. 2018

Infect Dis Clin Pract

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The patient is a 57-year-old man with liver cirrhosis, Bricker anastomosis after a radical cystoprostatectomy and, a history of bacteremias caused by extended-spectrum β-lactamase-positive Escherichia coli, Enterococcus faecium, and Candida albicans. He presented with persistent low back pain and was diagnosed with vertebral osteomyelitis, for which he received ertapenem-linezolid treatment. However, after 20 days, linezolid had to be discontinued because of myelotoxicity and metabolic acidosis. The patient was switched to tedizolid, which, in combination with ertapenem, was successfully given for 114 days until biopsy showed no growth of gram-positive cocci. We conclude that tedizolid can be an alternative to linezolid in case of toxicity, especially in long-term treatments.

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Osteomalacia as a Result of Urinary Diversion

et al. 2017

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A 54 years old man, who had undergone a cystectomy and urinary diversion surgery 31 years previously, complained of progressive generalized bone pain, muscle weakness and walking abnormality for six months. Laboratory investigations revealed elevated alkaline phosphatase, high serum chloride level and metabolic acidosis. Osteomalacia was suspected due to clinical and laboratory findings. Osteomalacia due to hyperchloremic metabolic acidosis is a complication of urinary diversion. Regular monitoring of pH, chloride, bicarbonate, and calcium-phosphorus metabolism is therefore essential for early diagnosis and treatment.

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Complicaciones metabólicas y óseas de las derivaciones urinarias

Cited by 3 publications

References 43 publications

Isolated Adrenocorticotropic Hormone Deficiency Associated with Severe Hyperkalemia During Pembrolizumab Therapy in a Patient with Ureteral Cancer and an Ileal Conduit: A Case Report and Literature Review

Isolated Adrenocorticotropic Hormone Deficiency Associated with Severe Hyperkalemia During Pembrolizumab Therapy in a Patient with Ureteral Cancer and an Ileal Conduit: A Case Report and Literature Review

Long-Term Safety of Tedizolid in a Patient With Spondilodiscitis After Switch From Linezolid Due to Toxicity

Osteomalacia as a Result of Urinary Diversion

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