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|Steroid induced hypokalemia||Pia, F. In addition to medications, hypokalemia can also be caused by the ingestion of large quantities of caffeine or licorice. This is the only way to know for sure what your potassium levels are. By Amanda Gardner Updated December 4, The New England Journal of Medicine. Indeed, the patient in case 2 showed decrease of cortisol 2.|
|Steroid induced hypokalemia||Shift of potassium from serum to cells. Attard, A. Revised 04 Aug Taken together, these results indicate that the incidence of high grade hypokalemia related to steroid induced hypokalemia tends to occur among postchemotherapy patients than prechemotherapy patients. Potassium chloride supplements by mouth have the advantage of containing precise quantities of potassium, but the disadvantages of a taste which may be unpleasant, and the potential for side-effects including nausea and abdominal discomfort. Hypokalemia is easily manageable with appropriate monitoring and is less critical than the AEs associated with cytocidal therapies, yet serious hypokalemia often provokes arrhythmia, flaccid paralysis, and respiratory depression, which are life-threatening complications that require urgent treatment.|
Thus, consistent with above-mentioned hypothesis, measuring plasma ACTH and cortisol before abiraterone therapy should be determined especially for patients who are more sensitive to abiraterone as a consequence of adrenocortical insufficiency. The two patients in this report demonstrated that potassium and prednisone supplementation are efficacious in controlling hypokalemia associated with abiraterone.
Meanwhile, treatment with mineralocorticoid receptor antagonist should also be considered as another option. The mineralocorticoid receptor antagonists, spironolactone or eplerenone, are currently approved for the management of heart failure and primary hypertension [ 21 , 22 ]. However, spironolactone interacts with androgen receptor [ 23 , 24 ] and therefore cannot be recommended for CRPC patients. In contrast, eplerenone was used to inhibit mineralocorticoid excess in earlier clinical studies of abiraterone [ 8 , 25 , 26 ].
Although further clinical trials used prednisone or other low dose glucocorticoids, eplerenone remains as a useful option to relieve secondary mineralocorticoid excess by abiraterone in the real-world setting [ 24 , 27 ]. Currently, there is no consensus as to whether a glucocorticoid or mineralocorticoid receptor antagonist is a better choice for controlling mineralocorticoid excess. It may be preferable to add eplerenone when glucocorticoid supplementation is insufficient to manage abiraterone-induced hypokalemia.
The other possible reason for the manifestation of hypokalemia described in this report is due to concurrent administration of furosemide, a drug known to cause hypokalemia. Furosemide acts on the ascending limb of the loop of Henle to inhibit Na-K-Cl symporter resulting in low potassium levels [ 28 ]. The two patients in this report were also taking furosemide. Although it is unclear whether drug-drug interactions between abiraterone and furosemide could augment the risk of hypokalemia, switching from furosemide to other diuretics should be considered before treatment with abiraterone.
In this regard, potassium-sparing diuretic eplerenone may be preferable to prevent hypokalemia. Therefore when a diuretic is needed, switching from furosemide to eplerenone should be considered from the beginning of the abiraterone therapy. In conclusion, these case reports demonstrate that treatment with abiraterone and furosemide instigated serious hypokalemia in patients with CRPC.
Hypokalemia is easily manageable with appropriate monitoring and is less critical than the AEs associated with cytocidal therapies, yet serious hypokalemia often provokes arrhythmia, flaccid paralysis, and respiratory depression, which are life-threatening complications that require urgent treatment. The severity of mineralocorticoid related AEs following abiraterone seems to differ on an individual basis.
To reduce the risk of hypokalemia, evaluation of adrenocortical insufficiency and concomitant drugs is required. This unique hypothesis needs to be elucidated in the future trials. IRB of our hospital omits patient consent with the implementation of following measures. To ensure a patient's privacy, personal data was managed as unlinkable anonymous data; the personal information was deleted from each patient.
To preserve anonymity, each case was assigned a new number. A list that could correlate the number with original patient personal data was not created. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.
Read the winning articles. Journal overview. Academic Editor: Apul Goel. Received 15 May Revised 04 Aug Accepted 30 Aug Published 16 Sep Abstract Introduction. Introduction Prostate cancer PCa is the most common cancer in men in Western industrialized countries [ 1 ]. Case Report 2. Figure 1.
Time - related serum potassium and plasma cortisol changes after prednisone and potassium supplementation. Figure 2. Figure 3. Inhibition of alpha-hydroxylase and C17 and xylase result in a decrease of cortisol and a consequent increase in ACTH. Increased ACTH causes hypokalemia, fluid retention, and hypertension as a consequence of deoxycorticosterone excess.
Addition of dexamethasone 0. Downstream steroid levels remain suppressed. References A. Heidenreich, J. Bellmunt, M. Bolla et al. S3—S12, View at: Google Scholar W. Tran, S. Ouk, N. Clegg et al. Sonpavde, G. Attard, J. Bellmunt et al. Attard, A. Reid, R. Auchus et al. O'Donnell, I. Judson, M. Dowsett et al. Reid, T. Yap, and et al. View at: Google Scholar S. Dinsen, B.
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Scores: Reviews — OCLC Retrieved 13 August Originally published as "Excessive Candor" no. The Universe of Larry Niven. Reprints the review from the July issue of Science Fiction Age. Open Library. OL M. Retrieved 4 August ICD - 10 : E Electrolyte imbalances. High Low. High Low Symptoms and signs Chvostek sign Trousseau sign Milk-alkali syndrome Disorders of calcium metabolism Calcinosis Calciphylaxis , Calcinosis cutis Calcification Metastatic calcification , Dystrophic calcification Familial hypocalciuric hypercalcemia.
Kwashiorkor Marasmus Catabolysis. Delayed milestone Failure to thrive Short stature Idiopathic. Anorexia Weight loss Cachexia Underweight. Authority control. Integrated Authority File Germany. Microsoft Academic 2 3. Categories : Electrolyte disturbances Mineral deficiencies Nephrology Potassium.
Namespaces Article Talk. Views Read Edit View history. Help Learn to edit Community portal Recent changes Upload file. Download as PDF Printable version. Wikimedia Commons. An ECG in a person with a potassium level of 1. Critical care medicine.