MED3 Digitalis toxicity, hyperkalemia, and acute renal failure. (Medicine).MED3 DIGITALIS TOXICITY, HYPERKALEMIA Hyperkalemia Definition The normal concentration of potassium in the serum is in the range of 3.5 to 5.0 mM. Hyperkalemia refers to serum or plasma levels of potassium ions above 5.0 mM. , AND ACUTE RENAL FAILURE acute renal failure Acute kidney failure Nephrology An abrupt decline in renal function, triggered by various processes–eg, sepsis, shock, trauma, kidney stones, drug toxicity-aspirin, lithium, substances of abuse, toxins, iodinated radiocontrast. . S. Hinan Ahmed, MD, James Smith, MD, and Richard Paul, MD. Medical University of South Carolina “MUSC” redirects here. For Abel Santa María airport in Santa Clara, Cuba (ICAO code MUSC), see Abel Santa María Airport. The Medical University of South Carolina , Charleston. We present a case of digitalis toxicity with associated hyperkalemia and acute renal failure. A 76-year-old white woman with PMH PMH abbr. past medical history significant for A-fib (1997), CHF CHF In currencies, this is the abbreviation for the Swiss Franc. Notes: The currency market, also known as the Foreign Exchange market, is the largest financial market in the world, with a daily average volume of over US $1 trillion. , HTN, DM who was brought to the ER by family with C/O intermittent chest pain, worsening SOB, markedly decreased appetite, weakness, and confusion about 2 or 3 days. Also C/O visual hallucinations, nausea, and decreased urine output. Her medications included digoxin digoxin: see digitalis. 0.375 mg QD, coumadin 5 mg QD, synthroid 0.1 mg QD, glipizide 10 mg QD, tiazac 120 mg QD, darvocet N-100/PRN, lasix 20 mg/PRN. On physical examination VS: T-98, P 53, RR 18, BP 101/64 mm Hg. Patient was in NAD, A & O X 3; Lungs: bibasilar crackles; CVS: irregularly irregular, bradycardia bradycardia: see arrhythmia. , grade II/VI SBM; ABD: Soft, NT, ND, + BS; BXTRE: 3+ LB edema R>L. Labs on admission included WBC: 8.5, Hgb: 9.7, Hct: 28.2; Na: 135, K: 6.5; Cl: 101; HCO3: 20; BUN: 67; Cr: 5.5; Glu: 91; Ca: 8.8, Mg: 2.8, PO4: 5.7 PT: 30.9, INR: 4.27, PTT: 56.8; TSH: 1.63. An ECG in the revealed bradycardia (HR-40) with junctional rhythm. UA: bacteria-many, WBC-46, RBC-23, leuk-small, protein-30; Digoxin level: 7.7. Patient has a baseline Sr. Cr. of 0.9. Patient received 5 vials of digibind in the ER, with digoxin level decreasing to <0.3 within 2 hours. Repeat ECG: Sinus rhythm with first degree AV block, ST segment slanting especially in lateral leads, shortened Q-T interval. Received IVF, kayexalate, and lasix. INR, K + and Sr. Cr. continued to decrease. Patient's acute renal failure may have been the cause of digitalis toxicity or vice versa. Although digitalis toxicity has been shown to cause hyperkalemia, it is not usually known to cause acute renal failure. The acute renal failure was prerenal as a calculated FeNa was 0.13, but with patient's history of lasix use it is not as reliable. |
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