piperidines and Hypokalemia

Both severe hypokalemia and persistent hypertension are clinical symptoms of hyperaldosteronism. Hyperaldosteronism may occur as a primary or secondary syndrome. Excess ACTH produced ectopically by tumors may induce hyperaldosteronism through the mineralocorticoid activity of glucocorticoids that are upregulated by ACTH. Licorice, with the active ingredient glycyrrhiza, is also a well-known inducer of hyperaldosteronism under specific conditions. In this report, we describe a case of severe hypokalemia caused by ectopic ACTH syndrome (EAS) elicited by an intrathoracic carcinoid tumor, which had transformed to produce ACTH during the 6-year clinical course, and was modulated by licorice ingestion. Hypokalemia was not clearly recognized preoperatively but became obvious within 3 h of general anesthesia with epidural blockade. At the end of anesthesia, arterial blood gas analysis indicated severe hypokalemia ([K(+)] = 1.7 mEq/l) and metabolic alkalosis (pH 7.56, PaCO(2) = 54.9 mmHg, HCO(3)(-) = 44.5 mmol/l, BE = 21.8 mmol/l), without any typical symptoms such as muscle weakness or ECG abnormalities. The hypokalemia was resistant to potassium supplementation and persisted for 4 days. Perioperative imbalance between the administration and elimination of potassium and surgical stress might contribute to the rapid exacerbation and induce the clinical manifestation of EAS.

Topics: ACTH Syndrome, Ectopic; Adjuvants, Anesthesia; Anesthesia; Anesthetics, Intravenous; Blood Gas Analysis; Blood Pressure; Carcinoid Tumor; Fentanyl; Heart Rate; Hormones; Humans; Hypertension; Hypokalemia; Male; Middle Aged; Nicardipine; Perioperative Period; Piperidines; Pneumonia, Pneumocystis; Psychotic Disorders; Remifentanil; Thoracic Neoplasms; Tomography, X-Ray Computed

An 82-year-old female underwent emergency surgery for right femoral incarcerated hernia under general anesthesia. Anesthesia was induced and maintained with remifentanil and propofol. Her laboratory data showed severe hypokalemia (1.83 mEq x l(-1)) and metabolic alkalosis (HCO3 36.9 mmol x l(-1)). We suspected that the causes of such abnormalities were due to an endocrinological abnormality, but we could not ascertain the actual cause. Drip infusion of sodium chloride and saline solution infusion, to avoid supplying lactate or acetate, the source of bicarbonate ions, were chosen for palliative treatment. No adverse event occurred during surgery. After surgery, endocrinological functions were examined. Primary aldosteronism was ruled out because serum aldosterone and rennin activity were within normal ranges. The patient had been taking a Kampo preparation, Shakuyaku-kanzo-to, for two years. Glycyrrhizin, the main component of Shakuyaku-kanzo-to, has been reported to be a cause of pseudoaldosteronism by inhibiting the enzyme converting cortisol to cortisone. With these findings we confirmed that severe hypokalemia was induced by pseudoaldosteronism by long-term administration of Shakuyaku-kanzo-to.

Topics: Aged, 80 and over; Anesthesia, General; Drug Combinations; Drugs, Chinese Herbal; Emergencies; Female; Glycyrrhiza; Hernia, Femoral; Humans; Hypokalemia; Intraoperative Complications; Liddle Syndrome; Paeonia; Piperidines; Propofol; Remifentanil; Severity of Illness Index

A 35-year-old woman with known familial hypokalaemic periodic paralysis received general anaesthesia for reduction of bilateral breast hyperplasia. Uncomplicated general anaesthesia was performed using a propofol target-controlled infusion, remifentanil infusion and bolus doses of mivacurium with neuromuscular function monitoring. Plasma potassium concentrations were controlled intermittently in the peri-operative period and supplemented to achieve normokalaemia. Despite continuous substitution, an episode of low plasma potassium concentration occurred during the recovery period; this was without any clinical signs of muscle paralysis or respiratory distress.

Topics: Adult; Analgesics, Opioid; Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Intravenous; Female; Humans; Hypokalemia; Isoquinolines; Mivacurium; Neuromuscular Nondepolarizing Agents; Paralyses, Familial Periodic; Piperidines; Propofol; Remifentanil

Topics: Cisapride; Gastrointestinal Agents; Humans; Hypokalemia; Long QT Syndrome; Piperidines

Topics: Amides; Clopamide; Diet, Sodium-Restricted; Diuretics; Humans; Hyperaldosteronism; Hypokalemia; Piperidines; Potassium

Topics: Amides; Clopamide; Diuretics; Female; Humans; Hypokalemia; Middle Aged; Piperidines; Water-Electrolyte Balance

Topics: Adolescent; Adult; Aged; Amides; Blood Glucose; Blood Urea Nitrogen; Carbohydrate Metabolism; Diuretics; Female; Glucose Tolerance Test; Humans; Hypokalemia; Male; Middle Aged; Piperidines

Topics: Amides; Clopamide; Diuretics; Ergot Alkaloids; Hypertension; Hypertension, Renal; Hypokalemia; Piperidines; Reserpine