Nonazotemic hyperkalemia with renal and extrarenal defects in potassium transport: association with high levels of digoxin-like immunoreactive factor.
We report a hypertensive patient with nonazotemic hyperkalemia caused by a combined disturbance in both the internal and external balance of potassium. During a follow-up of 30 months, exacerbations of hyperkalemia were observed, interposed with a return to the previous baseline. Two brief normokalemic periods were recorded. Blood pressure tended to be higher during hyperkalemic peaks. The following findings were detected: (1) hyperchloremic hyperkalemic acidosis with normal glomerular filtration rate, adequately elevated plasma aldosterone levels, and normovolemia; (2) a tubular defect in potassium excretion, refractory to intravenous sodium sulfate (nonreabsorbable anion) and mineralocorticoids; (3) impaired tissue uptake of potassium under insulin administration; (4) exaggerated hyperkalemia following beta-adrenergic blockade and blunted hypokalemic response to a beta-agonist; and (5) a defect in Na/K transport in erythrocytes detected in vitro, coexistent with an elevated level of free digoxin-like immunoreactive factor in serum. These results suggest that our patient had a generalized abnormality in potassium transport.
Renal Unit, Poriah Hospital, Tiberias, Israel.
P
P
Szylman
B
B
Wolach
J
J
Winaver
R
R
Panett
P
P
Cohen
L
L
Shenkman
O S
OS
Better
D000136:Acid-Base Equilibrium; D000328:Adult; D001692:Biological Transport; D001798:Blood Proteins / Q000378:metabolism*; D002298:Cardenolides; D004077:Digoxin; D004573:Electrolytes / Q000378:metabolism; D005665:Furosemide / Q000494:pharmacology; D005947:Glucose / Q000494:pharmacology; D006728:Hormones / Q000097:blood; D006801:Humans; D006852:Hydrochlorothiazide / Q000494:pharmacology; D006947:Hyperkalemia / Q000378:metabolism* / Q000503:physiopathology; D007328:Insulin / Q000494:pharmacology; D007668:Kidney / Q000378:metabolism*; D008297:Male; D011188:Potassium / Q000037:antagonists & inhibitors / Q000378:metabolism* / Q000502:physiology; D012503:Saponins; D012964:Sodium / Q000097:blood; D013268:Stimulation, Chemical; D013566:Sympathomimetics / Q000494:pharmacology
D001798:Blood Proteins; D002298:Cardenolides; D004573:Electrolytes; D006728:Hormones; D007328:Insulin; D012503:Saponins; D013566:Sympathomimetics; C034504:digoxin-like factors; D006852:Hydrochlorothiazide; D004077:Digoxin; D005665:Furosemide; D012964:Sodium; D005947:Glucose; D011188:Potassium