Hypoelectrolytemia. Low K, Mg Ca, Na and P.

Did you have to use more than the conservative measures for management?

Yup…

Conservative management failed

Neostigmine trial failed

Colonoscopic decompression-> improved

Colonic dilatation recurred as potassium fell after stopping Spironolactone

Repeated aggressive potassium correction and a Colonoscopic decompression

Slower weaning of Spironolactone helped

That’s amazing!

How were the electrolytes ?

#ECNeph

Sounds like pseudoobstruction... seen in patients with Ogilvie syndrome. Can also cause severe electrolyte dysfunction. But quite rare.. mostly diagnosed by GI before the nephrologists get to see them

Well, these cases are rare.

But dealing with this patient’s case helped to diagnose and treat a similar case pretty fast and effectively.

The second patient required Spironolactone+IV + Oral KCL

Weaned to Spironolactone and Oral KCL over a week

Later only oral KCL

Now, none…

#ECNeph

Several confounders in this case

Investigations will be confusing when the case is evolving

Better to hold on to your horses 🐴 and wait till the patient settles

#ECNeph

Hmmm… Ease of availability, low cost and the fact that short term use doesn’t cause too many adverse effects

#ECNeph

New MRA —> not studied for these though —> But hold that thought ☝🏻

🧠 worth considering — especially if we have renal potassium-wasting, in the set of GI loss #ECNeph

Well, nothing suggestive of a villous adenoma

#ECNeph