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    Home > Active Ingredient News > Immunology News > Patients with severe low potassium and cardiac arrest are the culprits of dry ness syndrome

    Patients with severe low potassium and cardiac arrest are the culprits of dry ness syndrome

    • Last Update: 2020-05-29
    • Source: Internet
    • Author: User
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    As we all know, dryness syndrome is characterized by dry mouth and dry eyes, and in fact its in vitro performance may be initial and fatal, which cannot be ignoredpatients withsyndrome, male, who started with hypokalemiaHe was admitted to hospital for 1 day due to "weakness, with physical mobility disorders"patients 1 day ago sudden vision limbs fatigue, limited mobility, symptoms are aggravated, with breathing difficulties, no sensory abnormalities, unconscious disorder, no limb convulsions, no palpitations, no nausea and vomiting, no diarrhea and other discomfort, denied the history of trauma, self-complaining has no similar medical historyadmitted to hospital:body temperature 37.6 degrees C, pulse 65 times / minute, breathing 22 times / minute, blood pressure 119/63 mmHgdouble lung breathing sound clear, the lower right lung can smell and a little wet soundHeart rhythm, unheard and pathological murmurs in each valve areaAbdominal soft, no pressure pain, anti-jump pain, liver spleen ribs not touched, mobile turbid tone negativeLimb muscle strength 2, pathological negative, double lower limbs without edemaconsultation:emergency treatment, the patient sudden consciousness is not clear, call should not, mouth and lip spit, electrocardiogram prompts the rhythm of the heart, followed by cardiac arrest, immediately to CPR3 minutes later, the patient restored the autonomic heart rhythm, electrocardiogram indicated sinus autonomous heart rhythminto the intensive care unit, the patient has breathing difficulties, mouth and lip, respiratory balloon-assisted breathing oxygen saturation of about 88%, to the trachea intubation auxiliary ventilation quality to pursue the patient's medical history, deny the oral, eye dry, deny the history of head and neck radiation therapy, deny diuretics, glucocorticoids and other drug use history auxiliary inspection: blood gas analysis: pH 7.227, CO2 pressure 27mmHg, standard bicarbonate 13.2mmol/L, standard alkali remaining 15.3mmol/L; emergency electrolytes: sodium 146.4mmol/L, potassium 1.85mmol/L, chlorine 121.8mmol/L; urine routine: urine pH 7.5, urethra 15 to 20/HP, urethra cells 4 to 8/HP; autoantibodies: anti-nuclear antibody positive (1:320 dilution), anti-SSA antibody positive, anti-Ro-52 antibody positive, anti-SSB antibody weak positive, rheumatism factor 35IU/ml; blood routine: red blood cell 132g/L, white blood cell 10.34 x 109/L, platelet 221 x 109/L
    Biochemical: creatinine 74.6 mmol/L, urea nitrogen 4.22mmol/L, glutamate 12U/L, glutamate 14U/L, albumin 38.4g/L, globulin 24.5g/L, blood sugar 9.4mmol/L; thyroid function normally, hepatitis B surface antigen, propane antibody, human immunodeficiency virus (HIV) urological B super: double kidney stones, adrenal gland area did not see abnormal envelope echo; double-sided mumps B super: substantive echo less average; double schirmer test: left 3mm, right 5mm; lip gland biopsy: (lower lip) small glandular tissue with polysaccography, plasma cell dipping (lymphocyl s50 / mm2), see the figure below diagnosis: patients anti-Ro/SSA antibody positive, lip gland biopsy lymphocyte stove s 1 /mm2, double-eye Schirmer test of 5mm/5min according to the 2016 primary dry ness syndrome ACR/EULAR classification criteria, scoring 7 points, excluding anticholinergic drug use history, head and neck radiation therapy history, active hepatitis C, AIDS, nodule disease, amyloid, Ig G4-related diseases, no other connective tissue disease symptoms, in line with the diagnosis of primary dryness syndrome therefore, consider the patient for primary dry ness syndrome, secondary type I renal otolysis, hypokalemia, cardiac arrest treatment: to be ponisson 30mg/d to treat the original disease, pyride acid and potassium pyridoxine, sodium bicarbonate tonic potassium, patients with weak limbs gradually improved, breathing difficulties, arrhythmia did not re-emerge 5 days after the blood gas, electrolytes returned to normal, 10 days after discharge follow-up so far, the pernison law has been reduced, and now pernitson 10mg/d combined hydroxychloroquine maintenance therapy what do we need to pay attention to to avoid missing a diagnosis? dryness syndrome (SS) is a kind of chronic inflammatory autoimmune disease that mainly affects the exoskeleton glands such as tear glands and salivary glands, but also affects multiple organs and systems the causes of SS, which is still unclear, most scholars believe that this is the result of a variety of etiological interactions, such as infection, genetics, endocrine, environment, etc The disease can be divided into primary and secondary, the latter often secondary to rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis and so on The incidence of SS is second only to rheumatoid arthritis, ranking 2nd in rheumatoid diseases, but because the disease is a systemic disease, in addition to mouth, dry eyes, but also can appear in many parts, multi-organ damage, clinical performance is complex and diverse, leakage, misdiagnosis rate is quite high scholars have retrieved the relevant literature of dry syndrome, summed up the three causes of diagnosis of dry syndrome misdiagnosis, we can learn from it, to avoid leakage, misdiagnosis , lack of experience, lack of understanding of the disease
    because rheumatism immunology is a relatively late start in the internal medicine, the development of relatively backward disciplines, almost all county-level hospitals and some hospitals have not set up rheumatism immunology specialists, not even rheumatic immunologists, and most non-specialists on SS awareness is insufficient, if the previous contact cases are few or never contacted, the possibility of misdiagnosis is relatively large for example, SS with cyanosis as the main manifestation of the visit, may be misdiagnosed as allergic cyanosis; therefore, we have to realize that SS can be accumulated throughout the body of multiple organs, resulting in multiple systems, organ damage, and thus a variety of clinical manifestations , consultation and physical examination is not meticulous
    SS is mostly hidden, patients are difficult to say a clear start time, and most patients will not pay attention to the symptoms of mouth, dry eyes, especially SS for middle-aged and elderly women, some patients also combined diabetes If the doctor does not follow a doctor's visit, dry mouth and eyes may be thought to be related to menopause or diabetes in addition, although SS's clinical performance is diverse, but patients are usually due to a single system symptoms to see the appropriate department, most physicians will focus on the patient's visit to the process, disease transformation, etc if you ignore the patient's system of inquiry and physical examination, leakage dry, dry eyes, rampant tooth decay, repeated mumps swelling and so on, limited to some isolated symptomal diagnosis or laboratory diagnosis, will also cause misdiagnosis , or the lack of specific examination equipment in the hospital
    SS patients mouth, dry eye symptoms individual differenceiss are relatively large, coupled with a small number of patients do not consciously mouth, dry eye symptoms, the visit may cause physicians do not choose lip gland biopsy, salivary gland ultrasound and other specific relatively high-specific related examinations, resulting in missed diagnosis of course, and does not rule out the possibility that patients refuse to be examined due to problems such as creativity or cost, especially those without asymptomatic conditions who are more likely to refuse second, China's independent rheumatism immunology department is too few, many hospitals lack specific examination equipment, not routinely carry out diagnostic SS-related examination, resulting in some doctors even if they want to choose a specific examination program for patients can not do anything, then we can recommend patient referral author: Health Care Multi-Team Source: White ball eagle medical court
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