Refractory Hypokalemia in Secretory Diarrhea Phenotype of Colonic Pseudo-Obstruction (Ogilvie's Syndrome)

Colonic pseudo-obstruction is an acute non-obstructive colonic dilation associated with constipation or secretory diarrhea. The secretory diarrhea phenotype is associated with refractory hypokalemia that may require different interventions to treat. We present a case of a 51-year-old male who was ad...

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Published inCurēus (Palo Alto, CA) Vol. 14; no. 11; p. e32026
Main Authors Hazzazi, Ahmad A, Aloyouny, Saleh H, Saleem, Akbar
Format Journal Article
LanguageEnglish
Published United States Cureus Inc 29.11.2022
Cureus
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Abstract Colonic pseudo-obstruction is an acute non-obstructive colonic dilation associated with constipation or secretory diarrhea. The secretory diarrhea phenotype is associated with refractory hypokalemia that may require different interventions to treat. We present a case of a 51-year-old male who was admitted with a hemorrhagic stroke whose hospital course was complicated by severe abdominal distension, diarrhea, and hypokalemia. Initial investigations excluded infectious causes. Imaging confirmed colonic pseudo-obstruction. The hypokalemia was severe and refractory, requiring daily potassium replacement along with rectal tube decompression and spironolactone. Despite these interventions, the hypokalemia persists and requires nearly 100 days to resolve completely.
AbstractList Colonic pseudo-obstruction is an acute non-obstructive colonic dilation associated with constipation or secretory diarrhea. The secretory diarrhea phenotype is associated with refractory hypokalemia that may require different interventions to treat. We present a case of a 51-year-old male who was admitted with a hemorrhagic stroke whose hospital course was complicated by severe abdominal distension, diarrhea, and hypokalemia. Initial investigations excluded infectious causes. Imaging confirmed colonic pseudo-obstruction. The hypokalemia was severe and refractory, requiring daily potassium replacement along with rectal tube decompression and spironolactone. Despite these interventions, the hypokalemia persists and requires nearly 100 days to resolve completely.
Author Aloyouny, Saleh H
Saleem, Akbar
Hazzazi, Ahmad A
AuthorAffiliation 1 Internal Medicine, King Abdulaziz Medical City, Riyadh, SAU
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Cites_doi 10.1097/MD.0000000000011187
10.1155/2016/1207240
10.1016/j.amsu.2014.04.002
10.1056/NEJM199907153410301
10.1007/BF02555027
10.1111/nmo.13120
10.1056/NEJM198402163100719
10.1002/path.1750
10.12890/2019_001175
10.1055/s-0035-1549100
10.1152/ajpgi.00132.2009
10.14309/01.ajg.0000780708.45634.23
10.1126/science.1190414
10.5414/CN109002
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Copyright © 2022, Hazzazi et al. 2022 Hazzazi et al.
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Issue 11
Keywords refractory
secretory diarrhea
colonic pseudo-obstruction
hypokalemia
ogilvie's syndrome
Language English
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References Vanek VW (ref1) 1986; 29
Bargiela IS (ref11) 2019; 6
Ponec RJ (ref15) 1999; 341
Chudzinski AP (ref2) 2015; 28
Bazerbachi F (ref3) 2017; 29
Boobés K (ref4) 2017; 87
Mulvihill S (ref13) 1984; 310
Perry MD (ref12) 2009; 297
Mathialahan T (ref6) 2005; 206
Haj M (ref8) 2018; 97
Ben Ameur H (ref9) 2013; 91
Yuan P (ref5) 2010; 329
Valle RG (ref14) 2014; 3
Alleyasin (ref10) 2021; 116
Ram P (ref7) 2016; 2016
References_xml – volume: 97
  year: 2018
  ident: ref8
  article-title: Ogilvie's syndrome: Management and outcomes
  publication-title: Medicine (Baltimore)
  doi: 10.1097/MD.0000000000011187
  contributor:
    fullname: Haj M
– volume: 2016
  year: 2016
  ident: ref7
  article-title: Use of aldosterone antagonist to treat diarrhea and hypokalemia of Ogilvie's syndrome
  publication-title: Case Rep Gastrointest Med
  doi: 10.1155/2016/1207240
  contributor:
    fullname: Ram P
– volume: 3
  year: 2014
  ident: ref14
  article-title: Neostigmine for acute colonic pseudo-obstruction: A meta-analysis
  publication-title: Ann Med Surg (Lond)
  doi: 10.1016/j.amsu.2014.04.002
  contributor:
    fullname: Valle RG
– volume: 91
  year: 2013
  ident: ref9
  article-title: [Treatment of acute colonic pseudo-obstruction (Ogilvie's Syndrome). Systematic review]
  publication-title: Tunis Med
  contributor:
    fullname: Ben Ameur H
– volume: 341
  year: 1999
  ident: ref15
  article-title: Neostigmine for the treatment of acute colonic pseudo-obstruction
  publication-title: N Engl J Med
  doi: 10.1056/NEJM199907153410301
  contributor:
    fullname: Ponec RJ
– volume: 29
  year: 1986
  ident: ref1
  article-title: Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases
  publication-title: Dis Colon Rectum
  doi: 10.1007/BF02555027
  contributor:
    fullname: Vanek VW
– volume: 29
  year: 2017
  ident: ref3
  article-title: Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature
  publication-title: Neurogastroenterol Motil
  doi: 10.1111/nmo.13120
  contributor:
    fullname: Bazerbachi F
– volume: 310
  year: 1984
  ident: ref13
  article-title: Severe diarrhea after colonic pseudo-obstruction: Treatment with somatostatin
  publication-title: N Engl J Med
  doi: 10.1056/NEJM198402163100719
  contributor:
    fullname: Mulvihill S
– volume: 206
  year: 2005
  ident: ref6
  article-title: Enhanced large intestinal potassium permeability in end-stage renal disease
  publication-title: J Pathol
  doi: 10.1002/path.1750
  contributor:
    fullname: Mathialahan T
– volume: 6
  year: 2019
  ident: ref11
  article-title: A rare presentation of Ogilvie's syndrome
  publication-title: Eur J Case Rep Intern Med
  doi: 10.12890/2019_001175
  contributor:
    fullname: Bargiela IS
– volume: 28
  year: 2015
  ident: ref2
  article-title: Acute colonic pseudoobstruction
  publication-title: Clin Colon Rectal Surg
  doi: 10.1055/s-0035-1549100
  contributor:
    fullname: Chudzinski AP
– volume: 297
  year: 2009
  ident: ref12
  article-title: Regulation of colonic apical potassium (BK) channels by cAMP and somatostatin
  publication-title: Am J Physiol Gastrointest Liver Physiol
  doi: 10.1152/ajpgi.00132.2009
  contributor:
    fullname: Perry MD
– volume: 116
  year: 2021
  ident: ref10
  article-title: Refractory hypokalemia in the setting of ogilvie syndrome
  publication-title: Am J Gastroenterol
  doi: 10.14309/01.ajg.0000780708.45634.23
  contributor:
    fullname: Alleyasin
– volume: 329
  year: 2010
  ident: ref5
  article-title: Structure of the human BK channel Ca2+-activation apparatus at 3.0 A resolution
  publication-title: Science
  doi: 10.1126/science.1190414
  contributor:
    fullname: Yuan P
– volume: 87
  year: 2017
  ident: ref4
  article-title: Hypokalemia associated with acute colonic pseudo-obstruction in an ESRD patient
  publication-title: Clin Nephrol
  doi: 10.5414/CN109002
  contributor:
    fullname: Boobés K
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Snippet Colonic pseudo-obstruction is an acute non-obstructive colonic dilation associated with constipation or secretory diarrhea. The secretory diarrhea phenotype is...
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StartPage e32026
SubjectTerms Abdomen
Bone surgery
Case reports
Colon
Diarrhea
Electrolytes
Gastroenterology
Hypokalemia
Internal Medicine
Mortality
Other
Pathophysiology
Patients
Potassium
Urine
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Title Refractory Hypokalemia in Secretory Diarrhea Phenotype of Colonic Pseudo-Obstruction (Ogilvie's Syndrome)
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