76 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0116 Cardiology
Severe Hyperkalemia and Lower Extermity Paralysis without Any Ecg Changes: A Case Report
Veysel OZALPER1, Ibrahim CETINDAGLI1, Ergenekon KARAGOZ2, Emrullah SOLMAZGUL1, Cihan TOP1
GATA Haydarpasa Teaching Hospital, Turkey1, GATA Haydarpasa Teaching Hospital, Turkey2 Objective: Hyperkalemia is a common and serious clinical problem that occurs of- ten due to impaired urinary potassium excretion because of acute or chronic kidney disease or drugs that effect renin-angiotensin-aldosterone axis. We report a hyper- kalemic patient with 9.0mEq/L without any ECG changes.
Case Report: A 86-year-old-woman suffering fatigue within two days had admitted emergency service because of sudden bilateral lower extremity paralysis. She had es- ential hypertension, ischemic heart disease and chronic kidney disease and was using Spironolactone, silazopril, asetilsalisilik, isosorbid-5-mononitrat ve karvedilol. Initial neurological examination of extremities was; 2/5 of lower extremity, 4/5 of upper extremity. Initial laboratory fi ndings potassium:9,1mmol/L, sodium:141mmol/L, creati- nine:1,9mg/dl. In his arterial blood gas analyse, pH:7.27, HCO3:16mEq/L, pCO2:30mm- Hg, potassium:9,1mmol/L. Spironolactone and silazopril treatment had stopped. With an intensive electrolyte-follow-up, She was commenced on intravenous fl uid, injection calcium gluconate and glucose/insulin infusion. Within two hours of treatment her potassium level decreased by 1.5 mmol/L. After eight hours of intensive treatment, potassium level reached below 6,5mEq/L. Five Days later, after three days of close follow-up with normal potassium level, the patient had discharged.
Conclusion: ECG differancies like fl attening in U wawe, expansion in QRS, taper in T wawe, arrhytmias, asystoles can be seen in hypercalemia. Especially in the circum- stances that serum potassium level is above 8 mEq/L ECG differancy is expected to be seen. So that, it is suggested that biochemical elevation in hypercalemic cases is verifi ed with ECG. Although it is rarely seen like in our cases, it shouldn’t be forgotten that severe hypercalemia can be seen without ECG differancy.
PS 0117 Cardiology
Diagnosis of Hypertension Using Abpm in a Young, Kayak Athlete: Is it Really Hypertension?
Annamarie BORJA1, Aissa Althea FLAVIER-HUNDAL1, Ashish ANIL-SULE1 Tan Tock Seng Hospital, Singapore1
Introduction: We describe a case of a young athlete who was diagnosed with hyper- tension using ABPM.
Case: A 24-year old male, kayak athlete was referred to Tan Tock Seng Hospital for hypertension in May 2014. He was diagnosed of hypertension in 2010 at Gleneagles Hospital by ambulatory blood pressure monitoring (ABPM) with an average daytime and nighttime BP of >140/90mmHg. He was given anti-hypertensive medication which he took for a few months and defaulted follow up. Examination showed a highly muscular individual with prominence of his upper arm muscles (circumference
~45cms). Using a regular adult-sized cuff sphygmomanometer (12x26cm) his BP was 145/85mmHg. When a larger cuff (12x40cm) was used, as recommended by the Brit- ish Hypertension Society guidelines, his BP was 122/76mmHg.
Important Laboratories and Workup:
Urinalysis: normal (no hematuria, proteinuria, casts) ECG: no left ventricular hyperthropy
Sphygmocor analysis: normal augmentation index (-1 mmHg, heart rate 75) normal pulse wave velocity 5.1+/- 0.4
normal central aortic systolic pressure BPro analysis: Ave 24-hr BP 114/63mmHg
Ave Day BP 121/67mmHg Ave Night BP 102/57mmHg Dipping 15.7%
Discussion/Conclusion: In a hypertensive patient who is non-compliant to medica- tions, end organ damage is expected after 4-5 years. As for this case, the patient had been off anti-hypertensive medications for ~4years but no evidence of end organ damage was noted. We therefore conclude that: (1) In a normotensive patient, over- diagnosing hypertension may mean treating a young patient unnecessarily which can have a big impact on his lifestyle, work and even insurance cover. (2) In a patient with a bigger arm circumference, ABPM with a bigger cuff should be used, or if unavailable, we would recommend BPro for diagnosing hypertension.
PS 0118 Cardiology
Pneumococcal Pneumonia as the Initial Presentation of Multiple Myeloma - A Clinical Case
Igor NUNES1, Tiago SANTOS1 CHLN-HSM, Portugal1
Multiple myeloma is the second most frequent hematologic tumour and represents about 1% of all tumours, with a medium diagnosis age of 70 years. Usually, it presents as anaemia, bone pain, hyperkalemia e kidney failure. Infection susceptibility is most obvious about 2-3 months after the initial diagnosis and after chemotherapy, but it is rarely described as being a form of acute presentation. In this article, we present the clinical case of a patient with initial diagnosis of Streptoccus pneumoniae pneumonia, that then turned into a diagnosis of smoldering myeloma. It is important to consider the possibility of multiple myeloma in middle-aged patients, previously healthy, that present with acute bacterial infection, without an evident predisposing factor.
