Pheochromocytoma rarely presents with unexplained hypokalaemia, although there are some case reports in the literature. The mechanism behind this could be the increased cellular potassium uptake promoted by beta-2-adrenoreceptor hyperactivation and insulin resistance. We present the case of a 68-year-old hypertensive female patient with a unilateral adrenal mass discovered on angio-CT and typical signs of adrenergic hyperstimulation (hypertensive crisis, headache, and sweating) associated with multiple arrhythmic episodes but with normal plasma and urinary catecholamine levels. During the work-up for hormonal hypersecretion and the cessation of anti-aldosterone medication, the patient presented resistant hypokalaemia. Due to uncorrectable hypokalaemia, we were unable to perform hormonal investigations for primary hyperaldosteronism and referred the patient for laparoscopic adrenalectomy. The histological diagnosis revealed left pheochromocytoma. Postoperatively, the patient experienced rebound hyperkalaemia. In a patient with a unilateral adrenal mass and hypokalaemia, besides primary hyperaldosteronism and adrenocorticotropic hormone-independent hypercortisolism, a possible pheochromocytoma should be ruled out as well by the clinician before surgery.

Patients with newly diagnosed hematological malignancies often present with a considerable cellular burden, leading to complications including hyperkalemia. However, pseudohyperkalemia, arising from in vitro cell lysis, can pose challenges in clinical practice. Although pseudohyperkalemia is frequently reported in adult hematological malignancies, its occurrence in pediatric patients is underreported, and its incidence in this demographic remains unclear. We retrospectively reviewed the medical records of pediatric patients who received a new diagnosis of hematological malignancies from 2011 to 2022 at Taichung Veterans General Hospital. Hyperkalemia was defined by a serum or plasma potassium level exceeding 5.5 mEq/L. Pseudohyperkalemia was defined by 1) a potassium decrease of over 1 mEq/L in within 4 h without intervention or 2) the absence of electrocardiography changes indicative of hyperkalemia. Cases with apparent red blood cell hemolysis were excluded. A total of 157 pediatric patients with a new diagnosis of hematological malignancies were included, 14 of whom exhibited hyperkalemia. Among these 14 cases, 7 cases (4.5%) were of pseudohyperkalemia. This rate increased to 21.2% in patients with initial hyperleukocytosis. Pseudohyperkalemia was associated with a higher initial white blood cell count and lower serum sodium level. All episodes of pseudohyperkalemia occurred in the pediatric emergency department, where samples were obtained as plasma, whereas all true hyperkalemia cases were observed in the ordinary ward or intensive care unit, where samples were obtained as serum. Timely recognition of pseudohyperkalemia is crucial to avoiding unnecessary potassium-lowering interventions in pediatric patients with newly diagnosed hematological malignancies.

Rhabdomyolysis, a medical condition caused by the destruction of striated muscle fibers, can have many etiologies, with the most common one being traumatic etiologies, that is, crushing injuries, heavy exertion, and being trapped under rubbles, and so forth. Rhabdomyolysis causes many complications, including acute kidney injury and different electrolyte imbalances, which later can cause cardiac dysrhythmia and even death as a result. This systematic review and meta-analysis investigate the incidence of imbalances of four important electrolytes among patients diagnosed with traumatic rhabdomyolysis. PubMed, Scopus, Web of Science, and Embase databases were searched for any article related to traumatic rhabdomyolysis using keywords related to the topic of our study, excluding case studies and case series. Relevant data were extracted from the included articles, and finally, a meta-analysis was performed on them to calculate the pooled incidence of each electrolyte imbalance. Collectively, 32 articles were included in our study (through the database and citation checking). The following were the pooled incidence of each electrolyte imbalance: hyperkalemia, 31% (95%CI 22%-41%); hypokalemia, 10% (95%CI 4%-17%); hypernatremia, 3% (95%CI 0%-8%); hyponatremia, 23% (95%CI 7%-44%); hypercalcemia, 0% (95%CI 0%-1%); hypocalcemia, 57% (95%CI: 22%-88%); hyperphosphatemia, 33% (95%CI 11%-59%); hypophosphatemia, 4% (95%CI 0%-16%). According to the meta-analyses, the rate of hyperkalemia, hyponatremia, hypocalcemia, and hyperphosphatemia is higher than their counterpart in patients diagnosed with traumatic rhabdomyolysis.

Background Stroke is a major cause of death and long-term disability worldwide, with varying incidence and risk factors across different populations. This study aims to analyze demographic, clinical, and laboratory risk factors for stroke among the Saudi Arabian population to enhance the understanding of its behavior and associated mortality. Methods In this retrospective cohort study, we analyzed data from 3586 patients diagnosed with hemorrhagic or non-hemorrhagic stroke at King Fahad Medical City from January 1, 2020, to November 11, 2022. We collected data on demographic variables, past medical history, social history, nationality, and laboratory components. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 27.0. (Armonk, NY: IBM Corp.), with significance set at p<0.05. Results The study population was predominantly male (57.86%) and within the age group of 51 to 80 years (58.8%). A significant portion of patients were Saudi nationals (99.6%), with hypertension (50.2%) and diabetes (40.4%) being the most common comorbidities. Laboratory abnormalities related to sodium and potassium levels were strongly linked to mortality rates. Notably, ischemic stroke was the most common type across all age groups, except for patients under age 16, where hemorrhagic stroke was more prevalent. Conclusions Our findings reveal significant associations between stroke risk factors and mortality within the Saudi Arabian population, highlighting the impact of hypertension, diabetes, and electrolyte imbalances. The study underscores the need for targeted stroke prevention and management strategies in Saudi Arabia, aligning with global trends to mitigate the burden of this disease.

Background In this study, researchers investigated non-invasive methods for analyzing creatinine levels by using saliva to address the need for frequent phlebotomy in chronic kidney disease (CKD) patients, which can damage their veins due to repeated blood withdrawals for creatinine level assessments. Methods This is a cross-sectional study in a tertiary healthcare setting conducted on 50 patients diagnosed with CKD. After collecting serum and salivary creatinine, we used Pearson correlation to assess the correlation between the two factors. Results The mean age of the patients was 50 years with a standard deviation of ± 15.32 years. 33 (66%) patients were males and 17 (34%) were females. Most patients were in the age group of 51 - 70 years, comprising 26 (52%) of the sample. The serum creatinine and salivary creatinine values ranged between 7.26-12.00 and 0.45-0.98, respectively. The median values were 9.72 and 0.75, respectively. There was a very weak positive linear relationship between serum and salivary creatinine levels; however, there was no significant association between them (p = 0.52). Nonetheless, a statistically significant, moderately negative linear correlation exists between serum urea and serum albumin (r = -0.36; p = 0.01). Additionally, there is a statistically significant weak negative linear correlation between serum chloride and serum urea (r = -0.3; p = 0.03). Comparing serum chloride and serum sodium reveals a statistically significant, moderately positive linear relationship (r = 0.4; p = 0.004). Serum phosphorus and serum creatinine display a statistically significant moderate positive linear relationship (r = 0.44; p = 0.001). Moreover, estimated glomerular filtration rate (eGFR) and serum creatinine exhibit a statistically significant strong negative linear correlation (r = -0.79; p < 0.001), while eGFR and serum phosphorus demonstrate a statistically significant weak negative linear correlation (r = -0.30; p = 0.03). Conclusion The study found no significant association between salivary and serum creatinine levels. Further multicentric studies on a larger population must be conducted to find the potential correlation between serum and salivary markers.

Proton pump inhibitors (PPIs) are frequently used medications to treat a wide variety of gastrointestinal conditions. By irreversibly inhibiting the hydrogen-potassium ATPase pump, they remarkably reduce gastric acid secretion. However, chronic PPI intake can result in serious complications, including severe hypomagnesemia. The following case report presents a severe case of refractory PPI-induced hypomagnesemia (PPIH), resistant to continuous oral and intravenous magnesium replacement, in a 70-year-old male patient, with a long history of PPI use due to persistent epigastric pain. Upon each of the 10 admissions to the hospital, he presented with severe signs and symptoms of hypomagnesemia, such as nausea, muscle fasciculation, diffuse cramps, weakness, neuromuscular irritability, and ECG disturbances, including non-specific T-wave abnormalities. In fact, PPIH has been reported for the first time in 2006. It is believed that the excessive, chronic intake of PPIs can disturb the normal functioning of the transient receptor potential melastatin 6/7 (TRPM 6/7), which is the main pathway of active intestinal magnesium absorption, leading to hypomagnesemia. PPIH is typically characterized by stubborn resistance to oral and intravenous magnesium replenishment but usually resolves after PPI withdrawal. Hence, despite being among the safest and most commonly prescribed drugs, PPI intake should be closely monitored when prolonged usage is planned. Additionally, continuous follow-up and regular assessment of serum magnesium levels are crucial to avoid the occurrence of PPIH and to prevent its potentially deleterious complications, including life-threatening arrhythmias.

UNASSIGNED: A stoma is an artificial anastomosis of the gastrointestinal tract to the abdominal skin wall to reroute the stream of feces. Fecal diversion, bowel decompression, and anastomosis protection are common indications for stomas. Relative to other surgical operations, stomas have a high morbidity rate, with rates averaging 40% and ranging 14-79%. The most common early complication was peristomal skin irritation. In contrast, parastomal hernias were the most common late complication.
UNASSIGNED: This research was performed at King Hamad University Hospital (KHUH) in the Kingdom of Bahrain. Our study included patients who had undergone ileostomies and colostomies. The inclusion criteria included adult patients who are 15 years and older, both emergency and elective cases, and with ASA score of 1-4. The excluded patients were those who had had their stomas performed outside of KHUH and those who were not following up in the hyperbaric department of our hospital. This study was performed using a retrospective study design. The sample size was 98 which included patients with stomas that were following up with the hyperbaric team between January 2018 and February 2021.
UNASSIGNED: We have broken down the indications for stoma formation. The breakdown of all our documented complications are illustrated in the given figure.
UNASSIGNED: Within our institutional study, 63.3% of stoma complications consisted of skin problems. This formed the majority of complications. Establishing a stoma care unit would offer continuous support and care to patients and help them in returning to an optimal quality of life. Additionally, this goal can be met through preoperative and postoperative education regarding surgery and stoma formation. This includes preoperative stoma marking and siting, as well as improved recovery through instruction from knowledgeable stoma care specialists regarding hands-on stoma care.Finally, patients can be assisted through specialized stoma clinics.
UNASSIGNED: Qassim T, Saeed MF, Qassim A, et al. Intestinal Stomas-Current Practice and Challenges: An Institutional Review. Euroasian J Hepato-Gastroenterol 2023;13(2):115-119.

Biallelic pathogenic variants in CLDN10 cause the very rare and distinct multiplex epithelium dysfunction manifested by hypohidrosis and electrolyte imbalance (HELIX) syndrome. HELIX patients often present with heat intolerance and reduced tear secretion. Here, we report on eight new patients (four families) who presented soon after birth with fine scales in the palms and soles and hypohidrosis that was associated with high body temperature. Exome sequencing identified a novel homozygous pathogenic variant in CLDN10 in one family (NM_006984:exon1:c.138G>A:p.W46*) and a previously reported pathogenic founder variant in the other three (NM_006984:exon5:c.653del:P218Lfs*21). The detailed clinical reports of these patients and a review of previously reported patients further delineate the phenotype of this extremely rare disorder.

This case series describes 2 women on prolonged therapy with class III antiarrhythmics who developed torsades de pointes polymorphic ventricular tachycardia in the setting of catheter ablation for atrial fibrillation as a result of QTc prolonging factors. Clinicians must exercise increased vigilance in the perioperative period in patients on QTc-prolonging medications. (Level of Difficulty: Intermediate.).

Electrolyte abnormalities are common in acute stroke patients and have a substantial impact on the course and prognosis of the disease. Electrolyte imbalances such as hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, and phosphate abnormalities are frequently seen in this patient population. The incidence, root causes, and medical ramifications of electrolyte abnormalities in acute stroke patients are investigated in this comprehensive study. According to our research, hyponatremia is the most prevalent electrolyte imbalance. The most common reason for hyponatremia in stroke patients is the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Higher mortality rates, longer hospital admissions, and less favorable functional outcomes are all linked to hyponatremia. Acute stroke patients also typically experience hypokalemia, which affects the severity of the stroke and the recovery of functional abilities. The review furthermore emphasizes the incidence and clinical consequences of hypercalcemia, hypomagnesemia, hypophosphatemia, and hypocalcemia in patients with acute stroke. The results highlight the significance of early electrolyte imbalance detection and treatment in acute stroke patients. To better comprehend therapeutic approaches, evaluate their influence on stroke outcomes, and analyze prognostic implications, more research is required.