Seizures related to severe hypophosphataemia induced by mechanical ventilation

Laaban, J. P.; Marsal, L.; Waked, Mirna; Vuong, T. K.; Rochemaure, J

doi:10.1007/bf02575310

Cited by 13 publications

(5 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hypophosphatemia could be suspected as the cause of the diagnosed seizure; however, disturbance of plasma phosphate levels is not recognized as a cause of acute symptomatic seizures . Cases of seizure associated with hypophosphatemia are rare and only reported associated with other disturbances (such as refeeding syndrome and mechanical hyperventilation in the intensive care unit) . In our series, neurologists and emergency specialists did not consider hypophosphatemia as the cause of the episodes.…”

Section: Discussionmentioning

confidence: 70%

A potential role of hypophosphatemia for diagnosing convulsive seizures: A case‐control study

et al. 2019

View full text Add to dashboard Cite

Objective Transient loss of consciousness (TLOC) is a common presentation in the emergency room, where patient history can usually differentiate syncope from generalized tonic‐clonic (GTC) seizures. Several serum markers, such as creatine kinase and lactate, can be helpful, especially when history is unreliable. Here, we explore a potential supporting role of electrolyte plasma levels in a case‐control study. Methods In our electroencephalographic database, we retrospectively identified consecutive episodes of loss of consciousness in adults seen over 3 years in our hospital emergency department for a case‐control study. We investigated plasma levels of several electrolytes (sodium, potassium, phosphate, calcium, magnesium) at the emergency visit, as well as demographics, diagnosis, blood‐sample delay time, and history of alcohol abuse. Results Of the 126 patients identified, 75 had GTC seizures and 46 had other TLOC causes. Among electrolyte levels, only hypophosphatemia was associated with GTC seizures (median = 0.79 mmol·L–1, range = 0.34‐1.37 in GTC seizures vs 0.93 mmol·L–1, range = 0.52‐1.56, P = 0.001 in TLOC). After adjusting for blood sampling delay, alcohol abuse, and other electrolyte levels, only hypophosphatemia was associated with GTC seizures, occurring in 37 (51%) of GTC seizures and 12 (22%) of other TLOC (odds ratio = 3.5, 95% confidence interval = 1.5‐8.3, P = 0.003). Hypophosphatemia < 0.6 mmol·L–1 was 93% specific and 20% sensitive for GTC seizure occurrence. In follow‐ups, hypophosphatemia was transitory. Significance Transient hypophosphatemia is common after GTC seizures and could represent an additional biological marker to help differentiate GTC seizures from other TLOC, especially when history is unclear. This hypothesis needs to be tested prospectively.

show abstract

Section: Discussionmentioning

confidence: 70%

A potential role of hypophosphatemia for diagnosing convulsive seizures: A case‐control study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Children with chronic hypophosphatemia may develop rickets and impaired growth. Generalized muscle weakness and fatigue are the most common symptoms of hypophosphatemia [52][53][54]; they can mimic low back pain and morning stiffness that are typical for SpA. Patients with chronic hypophosphatemia also develop osteomalacia and resultant bone pain that can be confused with other musculoskeletal disorders such as SpA.…”

Section: Discussionmentioning

confidence: 99%

The Differential Diagnosis of Spondiloarthritis in Adolescence: the Critical Reasoning Originating by A Clinical Case

2022

J Orthop Res Ther

View full text Add to dashboard Cite

Background: Spondyloarthritis (SpA) are chronic inflammatory diseases characterized by axial and peripheral arthritis, enthesitis, dactylitis, uveitis, psoriasis, inflammatory bowel disease and association with HLA-B27. Teenagers present more frequently with peripheral or root arthritis than adults and differential diagnosis can be challenging. The category juvenile SpA is not universally accepted by pediatric rheumatologists and patients younger than 16 years with features of SpA are classified, according to International League of Associations for Rheumatology (ILAR) into three of the six categories of JIA: enthesitisrelated arthritis, psoriatic arthritis and undifferentiated arthritis.Case report: Here we describe the case of a 16 years old boy with right coxalgia and pubalgia who was wrongly diagnosed as affected by SpA. Lack of improvement under treatment with anti-TNF leads us to revalue the diagnosis. Hip MR and CT, as well as a skeletal scintigraphy showed findings consistent with a Osteoid Osteoma (OO) of the right hip. The lesion was successfully treated with radiofrequency ablation (RFA).Conclusions: SpA may mimic an OO since in both conditions pain gets worse during the night, is relived by Nonsteroidal Anti-Inflammatory Drugs (NSAID), patients may have limp and imaging may show a synovitis. Other diseases that should be considered in the differential diagnosis of SpA in a teenagers are rheumatoid arthritis, subsets of JIA other than enthesitis-related arthritis and psoriatic arthritis, septic arthritis, spondylodiscitis, proximal femoral epiphysiolysis, Legg-Calvé-Perthes Disease, brucellosis, osteosarcoma, Ewing sarcoma, leukemia, primary non-Hodgkin lymphoma of the bone, hypoparathyroidism, hypophosphatemia, osteomalacia, Paget's disease and Klippel Feil syndrome.

show abstract

“…One third of present patients had high plasma phosphate on admission, a rate which decreased over time in CRF patients but not in ARDS patients. It has been described that acute reduction of phosphoremia, as it occurs after rapid reduction in PaCO 2 and rapid increase in plasma pH after onset of mechanical ventilation, may lead to severe cardiac arrhythmias and seizures in CRF patients in ARF [25,26].…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Acid-Base Disorders in Patients with Acute on Chronic Respiratory Failure and Acute Respiratory Distress Syndrome. A Prospective, One Center Study

Guérin¹,

Bayle²,

Poggi³

et al. 2008

TOCCHEMJ

View full text Add to dashboard Cite

Abstract:Background: With Stewart approach, pH depends on strong ion difference (SIDe), PaCO 2 and non volatile weak acids (Atot). This approach might detect complex acid-base disorders undetected by conventional approach. We designed this study to describe acid-base disorders with both Stewart and conventional approaches and to compare the diagnostic performance in patients with chronic respiratory failure (CRF) in acute respiratory failure (ARF) or with acute respiratory distress syndrome (ARDS) because they are expected to have complex acid-base disorders. Conventional approach was based on standardized base excess (SBE), bicarbonate (HCO 3 -) and anion gap (AG). Working hypotheses were that in CRF, metabolic alkalosis was associated with respiratory acidosis and in ARDS, Stewart approach was able to identify metabolic acidosis not detected with the conventional approach.Methods: Observational study in a medical ICU of a University hospital on 36 patients with obstructive CRF (CRFo), 36 with non obstructive CRF (CRFno) and 28 with ARDS prospectively included over 8 months. Measurements were performed on ICU admission, day 1 and day 2 after admission.Results: Metabolic alkalosis occurred in less than 5% of samples in CRF patients and in 0 ARDS patient. As compared to CRF patients, ARDS patients exhibited lower SBE, higher AG, lower SIDe and lower Atot. In ARDS, low SIDe was primarily due to elevated unidentified anions. Hypoalbuminemia was present in more than 75% of patients without difference between groups. Normal values of SBE, HCO 3 -and AG were very common. Stewart approach detected low SIDe in 13% of samples with normal SBE, in 13.8% of samples with normal HCO 3 -, and in 11% of samples with normal AG corrected for abnormal albumin concentration, without difference between CRF and ARDS.Conclusions: In these selected critically ill patients, Stewart approach exceeded the diagnostic performance of the conventional approach even when AG corrected was taken into account. Further studies in CRF patients with chronic hypercapnia and elevated bicarbonatemia are required to assess the incidence of associated metabolic alkalosis.

show abstract

Seizures related to severe hypophosphataemia induced by mechanical ventilation

Cited by 13 publications

References 3 publications

A potential role of hypophosphatemia for diagnosing convulsive seizures: A case‐control study

A potential role of hypophosphatemia for diagnosing convulsive seizures: A case‐control study

The Differential Diagnosis of Spondiloarthritis in Adolescence: the Critical Reasoning Originating by A Clinical Case

Quantitative Analysis of Acid-Base Disorders in Patients with Acute on Chronic Respiratory Failure and Acute Respiratory Distress Syndrome. A Prospective, One Center Study

Contact Info

Product

Resources

About