RESUMEN
A 35-year-old Malaysian man presented with rapid onset of flaccid quadriparesis associated with nausea and vomiting. General blood tests revealed severe hypokalaemia (serum potassium 1.5 mmol/L) and hypophosphataemia (serum phosphate 0.29 mmol/L) as a potential cause of the flaccid paralysis. Arterial blood gases showed mixed acid base disturbance of respiratory alkalosis and metabolic acidosis with hyperlactataemia. Thyrotoxic periodic paralysis (TPP) was suspected as the underlying cause of this presentation and thyroid function tests showed severe hyperthyroid results (free T4 > 77.2 pmol/L, free T3 19.3 pmol/L, thyroid-stimulating hormone [TSH] < 0.05 mIU/L). Treatment with intravenous potassium and phosphate infusion and oral propranolol resulted in rapid resolution of his symptoms. A discussion of the clinical and pathophysiological features and treatment of TPP (a very rare encounter in UK clinical practice) is presented, and to our knowledge associated hyperlactataemia has not been previously described.
Asunto(s)
Parálisis Periódica Hipopotasémica/diagnóstico , Tirotoxicosis/diagnóstico , Administración Oral , Adulto , Pueblo Asiatico , Diagnóstico Diferencial , Humanos , Parálisis Periódica Hipopotasémica/complicaciones , Parálisis Periódica Hipopotasémica/etnología , Malasia , Masculino , Fosfatos/uso terapéutico , Potasio/uso terapéutico , Propranolol/administración & dosificación , Tirotoxicosis/complicaciones , Tirotoxicosis/etnologíaRESUMEN
A 73 year old white man presented with life threatening hypokalaemic paralysis requiring admission to an intensive care unit. Biochemical investigations showed severe hypokalaemia with hyperchloraemic metabolic acidosis, a spot urine pH of 6.5, and a positive urinary anion gap, establishing the diagnosis of distal renal tubular acidosis. Autoimmune tests revealed Sjögren syndrome as the underlying cause of the distal renal tubular acidosis. Full recovery followed potassium and alkali replacement. This dramatic presentation of Sjögren syndrome has not previously been reported in an elderly man.
Asunto(s)
Hipopotasemia/etiología , Parálisis/etiología , Síndrome de Sjögren/complicaciones , Acidosis Tubular Renal/etiología , Anciano , Humanos , MasculinoAsunto(s)
Enfermedades de las Glándulas Suprarrenales/fisiopatología , Coma/complicaciones , Hipoglucemia/complicaciones , Ácido 3-Hidroxibutírico/orina , Enfermedades de las Glándulas Suprarrenales/sangre , Enfermedades de las Glándulas Suprarrenales/complicaciones , Hormona Adrenocorticotrópica/deficiencia , Péptido C/sangre , Coma/sangre , Femenino , Humanos , Hipoglucemia/sangre , Insulina/sangre , Cetonas/orina , Hormonas Tiroideas/sangreAsunto(s)
Personal de Laboratorio Clínico , Patología Clínica , Rol del Médico , Medicina Clínica , HumanosRESUMEN
A young woman presented with progressive yellowing of her skin over a period of six months. Liver function tests were requested by her general practitioner and the results prompted the Chemical Pathology Department to instigate further tests to reach the final diagnosis. Hypercarotenaemia had caused her yellow skin, and various other biochemical abnormalities pointed towards primary hypothyroidism as an underlying cause. Thyroxine replacement treatment successfully corrected all the biochemical abnormalities including hypercarotenaemia. As far as is known, yellow skin as a sole presenting feature of hypothyroidism is extremely rare.
Asunto(s)
Hipotiroidismo/complicaciones , Trastornos de la Pigmentación/etiología , Adulto , Carotenoides/sangre , Femenino , Humanos , Hipotiroidismo/sangre , Pruebas de Función Hepática , Pruebas de Función de la Tiroides , Factores de TiempoRESUMEN
The aim of this study was to compare the effectiveness of subcutaneous and intravenous fluid therapy in hydrating, elderly acute stroke patients. Thirty-four such patients, needing parenteral fluids because of impaired consciousness or dysphagia, were randomly allocated to receive either subcutaneous or intravenous fluids (2 litres of dextrose-saline/24 hours). Serum osmolality was measured before starting fluid therapy (Day 1) and on Days 2 and 3. An analysis of covariance of the osmolalities showed no statistical difference between the two groups (P = 0.12). The total cost of cannulae used over the 3 days for the subcutaneous route was approximately a third of that for the intravenous route. Complication rates were similar for the two groups. The results suggest that subcutaneous fluid therapy is an effective alternative to the intravenous route.