Dataset Information

Severe metabolic alkalosis-a diagnostic dilemma.

ABSTRACT:

Background

Cushing's syndrome due to ectopic ACTH secretion has been associated with many cancers; most commonly small cell carcinoma of the lung and bronchial carcinoid tumors. Usually, patients who confer this diagnosis have poor prognosis.

Case presentation

A 66-year-old female presented with worsening shortness of breath and weakness over three days. Initial laboratory derangements included severe hypokalemia and metabolic alkalosis. Treatment included high amounts of potassium chloride and acetazolamide. Imaging studies revealed anterior medial right upper lobe lung mass as well as suspicion for many liver metastases. Liver biopsy was sought and was positive for small cell carcinoma.

Conclusion

We describe a case of severe metabolic alkalosis and hypokalemia in a patient with Cushing's syndrome due to ectopic ACTH secretion from small cell lung cancer. To our knowledge, this is the first case identified which exhibited such significant metabolic derangements in the form of serum and arterial blood bicarbonate. As prognosis is quite poor, we recommend swift diagnosis and management.

SUBMITTER: Foray N

PROVIDER: S-EPMC6122389 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Severe metabolic alkalosis-a diagnostic dilemma.

Foray Nathalie N Stone Taylor T Johnson Alexander A Ali Mirza M Kulkarni Shreedhar S Gao John J Sreedhar Rajagopal R

Respiratory medicine case reports 20180824

<h4>Background</h4>Cushing's syndrome due to ectopic ACTH secretion has been associated with many cancers; most commonly small cell carcinoma of the lung and bronchial carcinoid tumors. Usually, patients who confer this diagnosis have poor prognosis.<h4>Case presentation</h4>A 66-year-old female presented with worsening shortness of breath and weakness over three days. Initial laboratory derangements included severe hypokalemia and metabolic alkalosis. Treatment included high amounts of potassiu ...[more]

PMID: 30186758

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Project description:AimTo report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex (SNR), in order to present common investigation strategies and diagnostic pitfalls.MethodsRetrospective case series of twenty-two patients, mainly children, with SNR or accommodation spasm (AS). AS was diagnosed on the basis of blurred vision and a difference of ≥2 dioptres between manifest and cycloplegic retinoscopy. If esotropia and miosis were present, the patients were diagnosed with SNR. All patients underwent visual acuity testing, orthoptic evaluation, assessment of refraction before and after cycloplegia, and dilated fundoscopy. Additional diagnostic investigations, such as neuroimaging, lumbar puncture (LP), electrophysiology and blood tests, were also recorded. Screen use among children was assessed in hours per day.ResultsThere were 19 female and 3 male patients (age range 7-33y, median=10y). Seventeen patients had AS and 5 patients had SNR, with episodic blurry vision and headaches being the most common symptoms. Brain neuroimaging was performed in six patients (27%), although only one had a history of brain trauma. Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy. The majority of patients (90%) reported prolonged daily screen time (>2h/d), and in 55% of cases there were concurrent social problems or psychological triggers. Treatment consisted of careful explanation of the condition, atropine 1% eye drops and full cycloplegic correction by means of bifocal glasses.ConclusionThe diagnosis of SNR and AS may be challenging, because symptoms are usually intermittent and nonspecific, and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment, that may exaggerate the underlying psychological disorder. Hence, detailed clinical testing and assessment of psychosocial profile is necessary, in order to avoid unnecessary investigations. Neuroimaging should be performed only in selected cases. Finally, due to prolonged screen use SNR and AS may become more frequent in the future.

Dataset Information

Severe metabolic alkalosis-a diagnostic dilemma.

Background

Case presentation

Conclusion

Publications

Severe metabolic alkalosis-a diagnostic dilemma.

Similar Datasets

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