Hypophosphataemia: an important cause of collapse

Williams, David M.; Shrikrishnapalasuriyar, Natasha; Price, David E.; Stephens, Jeffrey W.

doi:10.1136/bcr-2018-225821

BMJ Case Reports

2018

DOI: 10.1136/bcr-2018-225821

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Hypophosphataemia: an important cause of collapse

David M. Williams¹,

Natasha Shrikrishnapalasuriyar

David E. Price

et al.

Abstract: We present a case of a 44-year-old man, civil servant, who presented to the emergency department (ED) following an episode of collapse. He was usually fit and well and while at work he had developed a headache with pins and needles over his face and subsequently collapsed. On arrival to ED, he had a Glasgow Coma Scale (GCS) of 4/15. There was no history of note apart from being prescribed citalopram for depression. Laboratory investigations revealed severe hypophosphataemia (phosphate 0.19 mmol/L) and no other… Show more

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2021

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“…Given the rise of short-stay total joint arthroplasty (TJA), this topic is especially pertinent. Electrolyte abnormalities in the general population can be associated with adverse events, including cardiac arrhythmia, acute kidney injury, muscle spasm and weakness, altered mental status, and seizures 11-14 . With contemporary perioperative management protocols, electrolyte-related complications have not been shown to be a major problem in the TJA population.…”

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Routine Postoperative Chemistry Panels Are Not Necessary for Most Total Joint Arthroplasty Patients

Tischler

Restrepo

Ponzio

et al. 2021

Journal of Bone and Joint Surgery

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Background:The routine use of traditional chemistry-7 (chem-7) laboratory tests following total joint arthroplasty (TJA) has been called into question with the advent of short-stay procedures. Our objective was to determine the incidence, risk factors, and clinical interventions associated with inpatient abnormal routine postoperative chem-7 panels.Methods:From 2015 to 2017, 3,162 patients underwent a total of 3,721 TJA procedures, including primary total hip arthroplasty (THA) (n = 1,939; 52.1%) or primary total knee arthroplasty (TKA) (n = 1,782; 47.9%). Patients underwent routine preoperative and postoperative chem-7 testing. Clinical interventions were identified. With use of mixed-effects multivariate logistic regression, potential risk factors for abnormal chemistry panel values (including preoperative chem-7 results, type of surgery, age, sex, race, comorbidities, American Society of Anesthesiologists [ASA] score, and medications) were analyzed.Results:The rates of abnormal preoperative laboratory results were 3.4% for sodium (Na+), 7.4% for potassium (K+), 15.8% for blood urea nitrogen (BUN), and 26.4% for creatinine (Cr). The incidence of abnormal postoperative results was low for K+ (9.7%) and higher for Na+ (25.6%), BUN (55.6%), and Cr (27.9%). Preoperative abnormal laboratory results were a significant predictor of a postoperative abnormality for Na+ (odds ratio [OR] = 2.15; 95% confidence interval [CI] = 1.82 to 2.54), K+ (OR = 4.22; 95% CI = 3.03 to 5.88), and Cr (OR = 3.00; 95% CI = 2.45 to 3.68). Bilateral TJA was associated with increased odds of abnormal postoperative Na+ (OR = 1.56; 95% CI = 1.44 to 1.68). Renal disease was associated with increased odds of abnormal postoperative Cr (OR = 15.21; 95% CI = 5.67 to 40.77). Patients taking loop diuretics had increased odds of abnormal postoperative K+ (OR = 2.10; 95% CI = 1.42 to 3.11) and Cr (OR = 2.28; 95% CI = 1.56 to 3.33). Regarding intervention, 6.7% of hypokalemic patients received potassium chloride (KCl) fluid/tablets. Forty percent of hyponatremic patients received sodium chloride (NaCl) fluid/tablets. The electrolyte-related medicine consultation rate was 0.3% (13 of 3,721).Conclusions:On the basis of our findings, we recommend postoperative chem-7 testing for patients with an abnormal preoperative laboratory result (Na+, K+, BUN, Cr), preexisting renal disease, bilateral TJA, and prescribed angiotensin-converting enzyme inhibitors (ACE), angiotensin II receptor blockers (ARB), and diuretics.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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mentioning

confidence: 99%

Routine Postoperative Chemistry Panels Are Not Necessary for Most Total Joint Arthroplasty Patients

Tischler

Restrepo

Ponzio

et al. 2021

Journal of Bone and Joint Surgery

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Hypophosphataemia: an important cause of collapse

Cited by 1 publication

References 16 publications

Routine Postoperative Chemistry Panels Are Not Necessary for Most Total Joint Arthroplasty Patients

Routine Postoperative Chemistry Panels Are Not Necessary for Most Total Joint Arthroplasty Patients

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