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North Carolina Medical Journal Owned and Published by The Medical Society of the State of North Carolina Volume 24 March, 1963 Number 3 The Emergency Treatment of Hyperkalemia Ly the Use of Intravenous Molar Sodium Lactate Richard M. Portwood, M.D. and Arthur L. Finn, M.D. Durham Of the effects of hyperkalemia, by far the most serious and life-threatening are the alterations in myocardial conduction. These have been well described by numerous authors1 and include peaking of the T wave, depression of the S-T segment, disappearance of P waves, spreading of the QRS complex, and finally, complete disorganization of the ventricular complex followed by cardiac arrest. Although hyperkalemia may frequently be only one of several terminal factors in otherwise hopeless clinical settings (as in irreversible chronic renal failure), its development and potentially lethal consequences demand prompt recognition and treatment in situations where an ultimately favorable outcome might reasonably be anticipated if hyperkalemic death can be averted. The purpose of this paper is to describe the effects of intravenous molar sodium lactate as an agent for the emergency treatment of potassium intoxication and to illustrate results, particularly in terms of electrocardiographic improvement, that may promptly obtain with its use. Case Reports Case 1 On admission to Duke Hospital, in September, 1959, a 51 year old man was in deep shock, vir- From the" Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, North Carolina. This investigation was supported, in part by a training grant, HTS-5369, and a research grant. H-4807, from the National Heart Institute, Public Health Service, and by a grant from the Life Insurance Medical Research Fund. tually unresponsive, and unable to give a history. Major physical findings included an unobtainable blood pressure, marked bradycardia (pulse rate 20-40/minute) and peripheral signs of vascular collapse. An electrocardiogram was strongly suggestive of hyperkalemia (fig. 1); this probability was substantiated by serum chemistry determinations which yielded the following values: Sodium: 117 Potassium: 8.7 ) Carbon dioxide: 14.1 j. mEq./L. Chloride: 93.3 ) Blood urea nitrogen: 80 mg/100 ml. Initial therapy was with intravenous Aramine in a solution of 5 per cent dextrose in water. When the hyperkalemic aspects of the problem became apparent, the patient was given 50 ml. of molar sodium lactate intravenously with a prompt electrocardiographic response as indicated in figure 1. Ultimately, a diagnosis of primary adrenal insufficiency was established, and with appropriate steroid and electrolyte therapy, the patient was rapidly restored to a state of relatively good health and well-being. A key factor in the successful outcome was the prompt recognition and management of the hyperkalemia; prevention of death from this cause provided time for the diagnosis of a specifically treatable endocrine disorder. Case 2 A 15 year old schoolboy had shown evidence of chronic glomerulonephritis at the age of 13. He was treated initially with the basic rice diet; there was a tendency toward moderate hyperkalemia, necessitating a restricted intake of potassium and occasional use of cation exchange resins. By November, 1961, frank uremic symptoms had developed, and the patient was admitted to the Clinical Research Unit at Duke University Medical Center for a trial of inter-
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1963 |
Identifier | NCHH-17-024 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 24 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-024.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-024 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 93 (title page) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1963 |
Identifier | NCHH-17-024-0107 |
Form General | Periodicals |
Page Type | all; title page; article; article title |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncarolinamed241963medi_0107.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 24 |
Issue Number | 3 |
Page Number | 93 |
Health Discipline | Medicine |
Full Text | North Carolina Medical Journal Owned and Published by The Medical Society of the State of North Carolina Volume 24 March, 1963 Number 3 The Emergency Treatment of Hyperkalemia Ly the Use of Intravenous Molar Sodium Lactate Richard M. Portwood, M.D. and Arthur L. Finn, M.D. Durham Of the effects of hyperkalemia, by far the most serious and life-threatening are the alterations in myocardial conduction. These have been well described by numerous authors1 and include peaking of the T wave, depression of the S-T segment, disappearance of P waves, spreading of the QRS complex, and finally, complete disorganization of the ventricular complex followed by cardiac arrest. Although hyperkalemia may frequently be only one of several terminal factors in otherwise hopeless clinical settings (as in irreversible chronic renal failure), its development and potentially lethal consequences demand prompt recognition and treatment in situations where an ultimately favorable outcome might reasonably be anticipated if hyperkalemic death can be averted. The purpose of this paper is to describe the effects of intravenous molar sodium lactate as an agent for the emergency treatment of potassium intoxication and to illustrate results, particularly in terms of electrocardiographic improvement, that may promptly obtain with its use. Case Reports Case 1 On admission to Duke Hospital, in September, 1959, a 51 year old man was in deep shock, vir- From the" Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, North Carolina. This investigation was supported, in part by a training grant, HTS-5369, and a research grant. H-4807, from the National Heart Institute, Public Health Service, and by a grant from the Life Insurance Medical Research Fund. tually unresponsive, and unable to give a history. Major physical findings included an unobtainable blood pressure, marked bradycardia (pulse rate 20-40/minute) and peripheral signs of vascular collapse. An electrocardiogram was strongly suggestive of hyperkalemia (fig. 1); this probability was substantiated by serum chemistry determinations which yielded the following values: Sodium: 117 Potassium: 8.7 ) Carbon dioxide: 14.1 j. mEq./L. Chloride: 93.3 ) Blood urea nitrogen: 80 mg/100 ml. Initial therapy was with intravenous Aramine in a solution of 5 per cent dextrose in water. When the hyperkalemic aspects of the problem became apparent, the patient was given 50 ml. of molar sodium lactate intravenously with a prompt electrocardiographic response as indicated in figure 1. Ultimately, a diagnosis of primary adrenal insufficiency was established, and with appropriate steroid and electrolyte therapy, the patient was rapidly restored to a state of relatively good health and well-being. A key factor in the successful outcome was the prompt recognition and management of the hyperkalemia; prevention of death from this cause provided time for the diagnosis of a specifically treatable endocrine disorder. Case 2 A 15 year old schoolboy had shown evidence of chronic glomerulonephritis at the age of 13. He was treated initially with the basic rice diet; there was a tendency toward moderate hyperkalemia, necessitating a restricted intake of potassium and occasional use of cation exchange resins. By November, 1961, frank uremic symptoms had developed, and the patient was admitted to the Clinical Research Unit at Duke University Medical Center for a trial of inter- |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-024.pdf |
Document Sort | all; nchh-17 |
Article Title | The Emergency Treatment Of Hyperkalemia By The Use Of Intravenous Molar Sodium Lactate |
Article Author | Richard M . Portwood; Arthur L . Finn |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-024 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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