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Hypoelectrolytemia. Low K, Mg Ca, Na and P.
Did you have to use more than the conservative measures for management?
Yup…
Conservative management failed
Neostigmine trial failed
Colonoscopic decompression-> improved
Colonic dilatation recurred as potassium fell after stopping Spironolactone
Repeated aggressive potassium correction and a Colonoscopic decompression
Slower weaning of Spironolactone helped
That’s amazing!
How were the electrolytes ?
#ECNeph
Sounds like pseudoobstruction... seen in patients with Ogilvie syndrome. Can also cause severe electrolyte dysfunction. But quite rare.. mostly diagnosed by GI before the nephrologists get to see them
Well, these cases are rare.
But dealing with this patient’s case helped to diagnose and treat a similar case pretty fast and effectively.
The second patient required Spironolactone+IV + Oral KCL
Weaned to Spironolactone and Oral KCL over a week
Later only oral KCL
Now, none…
#ECNeph
A big thanks to @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social
Thanks to the wonderful #NephSky community for tuning in!
#ECNeph
A glimpse at the causes of an Acquired Bartter Defect too! #ECNeph
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social
How do we manage Ogilvie’s syndrome?
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social
#ECNeph
❓ What is this Acute Pseudo colonic Obstruction (Ogilvie’s syndrome)?
👉 Several theories have been proposed
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social
#ECNeph
👉 In vitro studies suggest that colonic Maxi – K channels are upregulated
👉 These are the same channels upregulated in CKD, enhancing gut excretion of potassium
👉 In ESRD, the colonic excretion of Potassium is 3-fold that of normal individuals
#ECNeph
@myadla.bsky.social @dramiliflores.bsky.social
Here are some of the case reports describing hypokalemia in Ogilvie’s syndrome
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social
#ECNeph
Several confounders in this case
Investigations will be confusing when the case is evolving
Better to hold on to your horses 🐴 and wait till the patient settles
#ECNeph
Can there be any other cause for hypokalemia in this case?
There are several case reports of Ogilvie’s syndrome being associated with severe hypokalemia
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social
#ECNeph
Hmmm… Ease of availability, low cost and the fact that short term use doesn’t cause too many adverse effects
#ECNeph
New MRA —> not studied for these though —> But hold that thought ☝🏻
Here’s an infographic describing the various mechanisms of hypokalemia
Highlighted in brown = Present in this case
Shout out to @dana_m_larsen , my Nephrologist colleague from UCSF for the amazing infographic
#ECNeph
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social
What do you do when there is a fluctuating acid base disorder in hypokalemia?
Keep Calm …
#ECNeph
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social
🧠 worth considering — especially if we have renal potassium-wasting, in the set of GI loss #ECNeph
Here’s a review of the initial clinical course:
Note that there was a fluctuating acid base balance -> look at the case summary
#ECNeph
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social
The story doesn’t end here!
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social
#ECNeph
The patient was treated with 50 mg of Spironolactone and Oral Potassium of 70 mmol per day and maintained normokalemia and normal bowel movements.
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social #ECNeph
Well, nothing suggestive of a villous adenoma
#ECNeph
Now that we know that there is a chloride, Potassium and Calcium loss disorder….
@myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social #ECNeph
28/n what next #ECNeph? Peel another banana?
@dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social
34/ 🧪 What nephron segment could be acting out?
#ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social
36/n
What’s your working diagnosis now? Time to zoom in!
#ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social
33/n 📊 So… if it’s not the aldosterone, who’s stealing the K+?
#ECNeph #MedSky #NephSky @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social
22/n 🧐 How would YOU approach this case?
What’s the unifying diagnosis?
What test or clue are we still missing? #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social
