Browsing by Author "Chothia, Mogamat-Yazied"

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    Bolus administration of intravenous glucose in the treatment of hyperkalemia : a randomized controlled trial
    (Karger, 2014-02) Chothia, Mogamat-Yazied; Halperin, Mitchell L.; Rensburg, Megan A.; Hassan, Mogamat Shafick; Davids, Mogamat Razeen
    Background: Hyperkalemia is a common medical emergency that may result in serious cardiac arrhythmias. Standard therapy with insulin plus glucose reliably lowers the serum potassium concentration ([K + ]) but carries the risk of hypoglycemia. This study examined whether an intravenous glucose- only bolus lowers serum [K + ] in stable, nondiabetic, hyperkalemic patients and compared this intervention with insulin-plus-glucose therapy. Methods: A randomized, crossover study was conducted in 10 chronic hemodialysis patients who were prone to hyperkalemia. Administration of 10 units of insulin with 100 ml of 50% glucose (50 g) was compared with the administration of 100 ml of 50% glucose only. Serum [K + ] was measured up to 60 min. Patients were monitored for hypoglycemia and EKG changes. Results: Baseline serum [K + ] was 6.01 ± 0.87 and 6.23 ± 1.20 mmol/l in the insulin and glucose-only groups, respectively (p = 0.45). At 60 min, the glucose-only group had a fall in [K + ] of 0.50 ± 0.31 mmol/l (p < 0.001). In the insulin group, there was a fall of 0.83 ± 0.53 mmol/l at 60 min (p < 0.001) and a lower serum [K + ] at that time compared to the glucose-only group (5.18 ± 0.76 vs. 5.73 ± 1.12 mmol/l, respectively; p = 0.01). In the glucose-only group, the glucose area under the curve (AUC) was greater and the insulin AUC was smaller. Two patients in the insulin group developed hypoglycemia. Conclusion: Infusion of a glucose-only bolus caused a clinically significant decrease in serum [K + ] without any episodes of hypoglycemia.
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    A descriptive study of patients with inflammatory myopathies at Tygerberg Academic Hospital and a review of current classifications
    (2009-06-03) Chothia, Mogamat-Yazied; Manie, Mourood
    Introduction: Idiopathic inflammatory myopathy (IIM) is a rare chronic disease of skeletal muscle. Determining its exact prevalence is complicated by the lack of uniformity of the definition and hence the classification of this condition. Therapeutic choices vary considerably because of the paucity of randomized controlled trials for this condition. Aims: To determine the prevalence of inflammatory myopathy in our drainage area, categorise our cases and to describe their extra-muscular and extra-cutaneous manifestations; to examine the utility of current classifications of IIM in our setting and propose an alternative classification; and to review the details and the effectiveness of the therapies given. Methods: A retrospective, cross-sectional, descriptive study was conducted. Information was obtained from the records of patients attending the clinic between January to June 2008. Demographic, clinical and laboratory data were extracted using a standardised data sheet. Results: Out of 1495 patients, 31 subjects with IIM were found. Estimated prevalence was 15.5 per million population. There were 28 females (90%) and 3 males (10%). The mean age of the patients was 45.2 years. Six (19.4%) had dermatomyositis (DM), 2 (6.5%) had polymyositis (PM) and 23 (74.2%) had connective tissue disease-associated myopathy (CAM). Muscle power in most patients was 4/5 (72.2%). Interstitial lung disease was the most common extra-muscular-/extra-cutaneous feature (25.8%). Antinuclear antibodies (ANA) were positive in 24 (77.4%) patients. There was a statistically significant difference of creatinine phosphokinase (CPK) levels between DM/PM versus CAM at presentation (p=0.024). Conclusion: IIM in our study population is more common compared to previous reports in the literature. CAM is the commonest cause by far, a finding not previously noted. Malignancy-associated inflammatory myopathy is rare. Studies evaluating the muscle biopsy findings in patients with CAM are required. There is a need for a new classification - we propose the umbrella term “auto-immune inflammatory myopathy”. We confirmed that IIM is a chronic debilitating condition requiring long term immunosuppressive therapy.
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    Hypodipsic-hypernatremia syndrome in an adult with polycythemia : a case report
    (BMC (part of Springer Nature), 2018-12-27) Chothia, Mogamat-Yazied; George, Kiran; Sheik, Muhammed; Davids, Mogamat Razeen
    Background: Hypernatremia is a very common electrolyte disorder and is frequently encountered in out-patient as well as in-hospital settings. We describe an adult who was found to have unexplained relative polycythemia and episodic hypernatremia. A diagnosis of idiopathic hypodipsic-hypernatremia syndrome was made and the patient was managed with a water-drinking schedule. Case presentation: A 24-year-old South African-Indian man was found to have polycythemia in association with episodes of hypernatremia. Investigations indicated that he had relative polycythemia. He experienced no thirst at a time when his serum sodium concentration was found to be 151 mmol/L. Further testing indicated that his renal response to arginine vasopressin was intact and magnetic resonance imaging of his brain revealed no hypothalamic lesions. A diagnosis of idiopathic hypodipsic-hypernatremia syndrome was made and he was managed with a water-drinking schedule that corrected his hypernatremia. Conclusion: Hypodipsia should always be considered when a patient without physical or cognitive disability presents with unexplained episodic hypernatremia or with relative polycythemia.
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    Improving the emergency management of hyperkalaemia
    (Stellenbosch : Stellenbosch University, 2022-08) Chothia, Mogamat-Yazied; Davids, Mogamat Razeen; Chikte, Usuf; Faculty of Medicine and Health Sciences. Dept. of Medicine. Division of Nephrology.
    ENGLISH ABSTRACT: Hyperkalaemia is a common electrolyte disorder in hospitalised adult patients and is associated with life-threatening muscle weakness and cardiac arrhythmias if left untreated. The central theme of this project was to improve the emergency management of hyperkalaemia by contributing data to fill important knowledge gaps and shed light on areas of the management where there is still controversy. We investigated the epidemiology, diagnostic aspects, treatment-related adverse effects, the knowledge of medical specialists regarding managing hyperkalaemia and we tested a novel treatment option. Our retrospective cohort study is the largest African study to report on the frequency, risk factors and outcome of hospitalised adult patients with hyperkalaemia. In-hospital death was high (29%) and acute kidney injury was the strongest predictor of mortality. Fourteen percent of our patients with hyperkalaemia were HIV positive. There was no difference in mortality based on HIV status. Future research should investigate whether the earlier identification and treatment of patients with hyperkalaemia in association with AKI will improve outcomes. Our scoping review on the adverse effects of insulin therapy for hyperkalaemia is the first comprehensive review of the topic. The prevalence of hypoglycaemia was 17%. Lower insulin doses were associated with a reduced prevalence of severe hypoglycaemia, and continuous infusion of dextrose was associated with a lower overall prevalence. There were no differences in the prevalence of hypoglycaemia by insulin dose, type, rate of administration or timing relative to dextrose. There was also no difference related to dextrose dose. The most important predictor of hypoglycaemia was lower pre-treatment serum glucose concentrations. In our survey, which tested the knowledge of medical specialists on the emergency management of hyperkalaemia, we found wide variations in their knowledge and practice. Knowledge gaps were identified in all facets of management, particularly around the optimal and safe use of insulin-based therapies. Our findings should be useful in informing the development of consensus-based guidelines and educational materials. To improve the diagnosis of hyperkalaemia in the emergency department, we performed a method comparison study between point-of-care blood gas analyser (POC-BGA) and laboratory auto-analyser potassium concentrations ([K+]). We found a systematic negative bias of -0.4 mmol/L, with the difference remaining relatively constant across the hyperkalaemic range. We recommend that POC-BGA measurements of [K+] can therefore be used, with adjustment for this bias, allowing for rapid diagnosis and the prompt initiation of treatment. To address the risk of hypoglycaemia after insulin therapy, we investigated a novel treatment for the management of hyperkalaemia. In a randomised, cross-over trial, stable patients on chronic haemodialysis received treatment with either an intravenous dextrose-only bolus or standard insulin-plus-dextrose therapy. In the dextrose-only group, a clinically significant decrease of 0.5 mmol/L in the [K+] was found, without any episodes of hypoglycaemia. Although the decrease in the [K+] was greater in the insulin-plus-dextrose group, 20% of the participants developed hypoglycaemia. A dextrose-only bolus is therefore an attractive treatment option especially in busy, resource-limited emergency departments where careful and frequent monitoring of the blood glucose concentration may not be possible. These studies have highlighted the importance of hyperkalaemia in hospitalised patients and contributed to improvements in the diagnosis and emergency management of this condition. We anticipate that our findings will inform treatment guidelines and inform the training of healthcare workers and students.
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    Intradialytic hypertension during chronic haemodialysis and subclinical fluid overload assessed by bioimpedance spectroscopy
    (Oxford University Press European Renal Association, 2016-06-19) Sebastian, Sajith; Filmalter, Christelle; Harvey, Justin; Chothia, Mogamat-Yazied
    Background: Intradialytic hypertension (IDH) increases morbidity and mortality. The prevalence in South Africa is unknown. The pathogenesis is unclear, but it has been suggested that IDH may be due to subclinical fluid overload. The objective of this study was to determine the prevalence of IDH and to evaluate its association with fluid overload using bioimpedance spectroscopy (BIS). Methods: A cross-sectional study involving 190 chronic haemodialysis patients in the Western Cape province of South Africa was conducted between January 2013 and May 2014. IDH was defined as a >10 mmHg increase in systolic blood pressure in at least four of six prior consecutive haemodialysis sessions. Results: The prevalence of IDH was 28.4% (n = 54). Therewas a trend towards pre-dialysis overhydration in the IDH group when compared with controls {2.6 L [95% confidence interval (CI) 1.7–3.4] versus 1.8 L [95% CI 1.4–2.1], respectively; P = 0.06} as measured by BIS, but no difference in mean ultrafiltration (UF) volume (2.4 versus 2.6 L; P = 0.30). A trend towards greater use of antihypertensive drugs was noted in the IDH group [2.5 drugs (95% CI 2.15–2.87) versus 2.1 (95% CI 1.82–2.30); P = 0.05]. More participants in the IDH group received calcium channel blockers (54 versus 36; P = 0.03). Conclusions: The prevalence of IDH in our treatment centres is much higher than previously reported. Subclinical fluid overload may be a major contributing factor to the mechanism of this condition. The use of BIS identifies patients who may benefit from additional UF.
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    Pseudohypokalaemia and pseudohypoxaemia in a patient with acute myeloid leukaemia
    (African Association of Nephrology, 2020) Chothia, Mogamat-Yazied; Davids, Mogamat Razeen
    ENGLISH ABSTRACT: Spurious laboratory results are frequently encountered in patients with haematological disorders and lead to unnecessary additional laboratory investigations and inappropriate treatment. An 80-year-old woman, known with acute myeloid leukaemia, was admitted with suspected sepsis. Laboratory tests revealed a leukocyte count of 358 x 109/L, serum potassium concentration of 2.6 mmol/L and partial pressure of arterial oxygen of 5.3 kPa. The patient did not display any clinical or electrocardiographic features of hypokalaemia and there were no signs of respiratory distress. A diagnosis of pseudohypokalaemia and pseudohypoxaemia was made and inappropriate therapeutic interventions were avoided. Pseudohypokalaemia and pseudohypoxaemia should always be a consideration in patients with hyperleukocytosis due to haematological malignancies, especially when there are no clinical features to support these findings. The inappropriate administration of potassium in such cases may cause serious cardiac arrythmias.
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    Residual renal function in chronic dialysis is not associated with reduced erythropoietin-stimulating agent dose requirements : a cross-sectional study
    (BioMed Central, 2017-11-25) Louw, Elizabeth Helene; Chothia, Mogamat-Yazied
    Background: Anaemia is a very common problem in patients with end-stage kidney disease (ESKD) and the use of erythropoietin-stimulating agents (ESA) has revolutionised its treatment. Residual renal function (RRF) is associated with a reduction in ESA resistance and mortality in chronic dialysis. The primary aim was to establish whether RRF has an association with ESA dose requirements in ESKD patients receiving chronic dialysis. Methods: A single center, cross-sectional study involving 100 chronic dialysis patients was conducted from December 2015 to May 2016. Participants were divided into two groups depending on presence of RRF, which was defined as a 24-h urine sample volume of ≥ 100 ml. Erythropoietin resistance index [ERI = total weekly ESA dose (IU)/weight (kg)/haemoglobin concentration (g/dL] was used as a measure of ESA dose requirements. Results: There was no difference in ERI between those with RRF as compared to those without (9.5 versus 11.0, respectively; P = 0.45). Also, ERI did not differ between those receiving haemodialysis as compared with peritoneal dialysis (10.8 versus 10.2, respectively; P = 0.84) or in those using renin-angiotensin system (RAS) blockers as compared with no RAS blocker use (11.6 versus 9.2, respectively; P = 0.10). Lower ERI was evident for those with cystic kidney disease as compared to those with other causes of ESKD (6.9 versus 16.5, respectively; P = 0.32) although this did not reach statistical significance. Higher ERI was found in those with evidence of systemic inflammation as compared to those without (16.5 versus 9.5, respectively; P = 0.003). Conclusions: There was no association between RRF and ESA dose requirements, irrespective of dialysis modality, RAS blocker use, primary renal disease or hyperparathyroidism.