Cargando…

Rare Case of Refractory Hypokalemia in a Patient with Acute Monocytic Leukemia

Patient: Female, 82-year-old Final Diagnosis: Acute myeloid leukemia (AML) • hypokalemia Symptoms: General fatigue • poor appetite Clinical Procedure: — Specialty: Hematology • General and Internal Medicine • Nephrology OBJECTIVE: Unknown etiology BACKGROUND: Refractory hypokalemia has been rarely d...

Descripción completa

Detalles Bibliográficos
Autores principales: Naseer, Minha, Kania, Brooke, Ghrewati, Moutaz, Mahmoud, Anas, Faheem, Beenish, Singhal, Monisha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10259269/
https://www.ncbi.nlm.nih.gov/pubmed/37285330
http://dx.doi.org/10.12659/AJCR.938775
_version_ 1785057626087751680
author Naseer, Minha
Kania, Brooke
Ghrewati, Moutaz
Mahmoud, Anas
Faheem, Beenish
Singhal, Monisha
author_facet Naseer, Minha
Kania, Brooke
Ghrewati, Moutaz
Mahmoud, Anas
Faheem, Beenish
Singhal, Monisha
author_sort Naseer, Minha
collection PubMed
description Patient: Female, 82-year-old Final Diagnosis: Acute myeloid leukemia (AML) • hypokalemia Symptoms: General fatigue • poor appetite Clinical Procedure: — Specialty: Hematology • General and Internal Medicine • Nephrology OBJECTIVE: Unknown etiology BACKGROUND: Refractory hypokalemia has been rarely demonstrated in patients with acute monocytic leukemia (AMoL). Hypokalemia develops in these patients owing to renal tubular dysfunction, secondary to lysozyme enzymes that are released by monocytes in AMoL. Additionally, renin-like substances are produced from monocytes and can lead to hypokalemia and metabolic alkalosis. There is also an entity called spurious hypokalemia, in which high numbers of metabolically active cells in blood samples increase sodium-potassium ATPase activity, resulting in influx of potassium. Additional research is warranted regarding this specific demographic to create standardized treatment approaches to electrolyte repletion. CASE REPORT: In this case report, we demonstrate a rare case of an 82-year-old woman with AMoL, complicated by refractory hypokalemia, who presented with concerns of fatigue. The patient’s initial laboratory results were significant for leukocytosis with monocytosis and severe hypokalemia. Refractory hypokalemia was noted, despite administration of aggressive repletions. During her hospitalization, AMoL was diagnosed and an extensive work-up was performed to evaluate the underlying cause of hypokalemia. Ultimately, the patient died on day 4 of hospitalization. We describe the correlation between severe refractory hypokalemia and leukocytosis and provide a literature review of multiple etiologies of refractory hypokalemia in patients with AMoL. CONCLUSIONS: We evaluated the numerous pathophysiologic mechanisms responsible for refractory hypokalemia in patients with AMoL. Our therapeutic outcomes were limited owing to the patient’s early death. It is of high importance to evaluate the underlying cause of hypokalemia in these patients and to treat accordingly with caution.
format Online
Article
Text
id pubmed-10259269
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher International Scientific Literature, Inc.
record_format MEDLINE/PubMed
spelling pubmed-102592692023-06-13 Rare Case of Refractory Hypokalemia in a Patient with Acute Monocytic Leukemia Naseer, Minha Kania, Brooke Ghrewati, Moutaz Mahmoud, Anas Faheem, Beenish Singhal, Monisha Am J Case Rep Articles Patient: Female, 82-year-old Final Diagnosis: Acute myeloid leukemia (AML) • hypokalemia Symptoms: General fatigue • poor appetite Clinical Procedure: — Specialty: Hematology • General and Internal Medicine • Nephrology OBJECTIVE: Unknown etiology BACKGROUND: Refractory hypokalemia has been rarely demonstrated in patients with acute monocytic leukemia (AMoL). Hypokalemia develops in these patients owing to renal tubular dysfunction, secondary to lysozyme enzymes that are released by monocytes in AMoL. Additionally, renin-like substances are produced from monocytes and can lead to hypokalemia and metabolic alkalosis. There is also an entity called spurious hypokalemia, in which high numbers of metabolically active cells in blood samples increase sodium-potassium ATPase activity, resulting in influx of potassium. Additional research is warranted regarding this specific demographic to create standardized treatment approaches to electrolyte repletion. CASE REPORT: In this case report, we demonstrate a rare case of an 82-year-old woman with AMoL, complicated by refractory hypokalemia, who presented with concerns of fatigue. The patient’s initial laboratory results were significant for leukocytosis with monocytosis and severe hypokalemia. Refractory hypokalemia was noted, despite administration of aggressive repletions. During her hospitalization, AMoL was diagnosed and an extensive work-up was performed to evaluate the underlying cause of hypokalemia. Ultimately, the patient died on day 4 of hospitalization. We describe the correlation between severe refractory hypokalemia and leukocytosis and provide a literature review of multiple etiologies of refractory hypokalemia in patients with AMoL. CONCLUSIONS: We evaluated the numerous pathophysiologic mechanisms responsible for refractory hypokalemia in patients with AMoL. Our therapeutic outcomes were limited owing to the patient’s early death. It is of high importance to evaluate the underlying cause of hypokalemia in these patients and to treat accordingly with caution. International Scientific Literature, Inc. 2023-06-07 /pmc/articles/PMC10259269/ /pubmed/37285330 http://dx.doi.org/10.12659/AJCR.938775 Text en © Am J Case Rep, 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Naseer, Minha
Kania, Brooke
Ghrewati, Moutaz
Mahmoud, Anas
Faheem, Beenish
Singhal, Monisha
Rare Case of Refractory Hypokalemia in a Patient with Acute Monocytic Leukemia
title Rare Case of Refractory Hypokalemia in a Patient with Acute Monocytic Leukemia
title_full Rare Case of Refractory Hypokalemia in a Patient with Acute Monocytic Leukemia
title_fullStr Rare Case of Refractory Hypokalemia in a Patient with Acute Monocytic Leukemia
title_full_unstemmed Rare Case of Refractory Hypokalemia in a Patient with Acute Monocytic Leukemia
title_short Rare Case of Refractory Hypokalemia in a Patient with Acute Monocytic Leukemia
title_sort rare case of refractory hypokalemia in a patient with acute monocytic leukemia
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10259269/
https://www.ncbi.nlm.nih.gov/pubmed/37285330
http://dx.doi.org/10.12659/AJCR.938775
work_keys_str_mv AT naseerminha rarecaseofrefractoryhypokalemiainapatientwithacutemonocyticleukemia
AT kaniabrooke rarecaseofrefractoryhypokalemiainapatientwithacutemonocyticleukemia
AT ghrewatimoutaz rarecaseofrefractoryhypokalemiainapatientwithacutemonocyticleukemia
AT mahmoudanas rarecaseofrefractoryhypokalemiainapatientwithacutemonocyticleukemia
AT faheembeenish rarecaseofrefractoryhypokalemiainapatientwithacutemonocyticleukemia
AT singhalmonisha rarecaseofrefractoryhypokalemiainapatientwithacutemonocyticleukemia