Search

Mrs D., 82 years old, is addressed to the emergency department for back pain and dyspnea associated with heart failure. This patient had a venous potassium to 7.4 mmol/L (without hemolysis) without clinical repercussions or electrocardiographic signs. A significant gap is found with arterial kaliema (4.3 mmol/L) determined using gazometric apparatus. This gap is explained by the high leukocytosis of this patient (561 G/L) within a context of chronic lymphocytic leukemia as well as by the fragility of these cells revealed by specific rules for samples transport between the clinical departments and the central laboratory. An efficient talk between biologist and clinician identified this phenomenon for this patient and avoid mistakenly initiation of treatment. This event allows us to recall the different causes leading to overestimate the true value of kaliema when samples are managed at the central laboratory, and to describe the care of patients with true hyperkalemia.

Introduction: The prognosis of anorexia nervosa (AN) is severe (death in 2 to 5% of cases). AN is closely linked to episodes of bulimia., Observation: A 25 year-old woman suffering from anorexia nervosa was hospitalised for an occlusive syndrome with vomiting, presence of abdominal cramps, absence of hydroaeric sounds and suspension of stools and gas. The biological examinations were normal. The abdominal scan revealed voluminous gastric dilatation. The diagnosis of functional occlusive syndrome was retained. With medical treatment and follow-up in intensive care the gastric dilatation progressively regressed., Discussion: The periods of restricted nourishment during NA are interspaced by episodes of bulimia and at the origin of sometimes severe digestive complications. The abnormalities in gastric motility can lead to major dilatation of the stomach with the risk of perforation. The onset of abdominal pain in the context of AN during an episode of bulimia must evoke the diagnosis of acute gastric dilatation with major risk of perforation.