Hypokalemia – unfavorable prognostic factor in hepatic cirrhosis

Andrada Florinela Dumitru (a)(i), Anca Pantea Stoian (b), Laura Mazilu (c)(i)(j), Adrian Suceveanu (d)(i)(j), Irinel Raluca Parepa (e)(i)(j), Felix Voinea (f)(i)(j), Claudia Voinea (g)(i)(j), Andra-Iulia Suceveanu (h)(i)(j)

a): MD, gastroenterology
b): MD, PhD, diabetes, nutrition and metabolic disease, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
c): MD, PhD, internal medicine, senior lecturer
d): MD, PhD, internal medicine, senior lecturer
e): MD, PhD, internal medicine, MD, PhD,
f): MD, PhD, urology, senior lecturer
g): MD, PhD, endocrinology, senior lecturer
h): MD, PhD, gastroenterology, senior lecturer
i): Departament of Internal Medicine The Emergency Hospital “Sf.Apostol Andrei”, Constanţa, Romania
j): Faculty of Medicine, University “Ovidius’’, Constanţa, Romania

Abstract

Potassium, the main constituent of the intracellular buffer system, is an electrolyte that requires careful monitoring due to its indispensable role in the body’s homeostasis, as well as due to its involvement in muscle contraction and nerve conduction. Decreased plasma concentrations cause symptoms that can progress from fatigue, pain and muscle cramps, respiratory failure and arrhythmias with revealing electrocardiographic changes. Thus, any known patient with pathology that can induce or associate hypokalemia (e.g., anorexia nervosa, Zollinger-Ellison syndrome, malabsorption syndrome, osmotic diuresis, chronic diuretic therapy, secondary hyperaldosteronism, diabetes, metabolic alcalosis etc) should be closely monitorized and requires serum potassium level to be known at any new sign / symptom appeared as an indicator of hypokalemia.

Restoring the normal level can be achieved by diet (eating foods rich in potassium) or by administration of potassium chloride, potassium bicarbonate or potassium phosphate.

To support the importance of monitoring serum potassium level, we present the case of a known patient with mixed hepatic cirrhosis (B + ethanol), without etiological treatment, which is hospitalized for haematemesis, melenic stools, sclero-tegumentary jaundice and altered general condition. Biological tests detected severe anemia, hypokalemia, metabolic alcalosis, cytolysis and cholestasis syndrome, and upper digestive endoscopy identifies the bleeding sources of the upper digestive haemorrhage. Under pathogenic and symptomatic treatment, the patient presented an unfavorable evolution with the maintenance of severe hypokalemia and the occurrence of electrocardiographic and cardiac rhythm changes.

Key words: hypopotasemia, liver cirrhosis, upper digestive bleeding

(Full text in Romanian language)

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