Orthostatic hypotension and heart rate variability as indicators of cardiac autonomic neuropathy in diabetes mellitus

Aim: The aim of this study was to emphasize two different points in our work: 1) The well known importance of (subclinical) postural hypotension and reduced heart rate variability as (early) markers of autonomic neuropathy; 2) and the more controversial influence of diabetic control in their worsening. Methods: Two standard cardiovascular response tests (heart rate variability by respiration and orthostatic blood pressure changes) were carried out on 93 diabetic patients with prolonged QT interval in order to determine cardiac dysautonomy. QT segment duration was measured on electrocardiography recordings. Patients with HbA1c levels below 7 were considered as well-controlled diabetics. A cut off of 5 years was selected for the known duration of diabetes. The relations between cardiac autonomic neuropathy and diabetic control and the known duration of diabetes were determined. Results: The mean values for the known duration of diabetes and HbA1c level were 10±7.23 years and 9.5±2.3 mg/dl respectively. Median QTc differences, postural change in the systolic blood pressure, and changes of heart rate by respiration were 0.62 sec, 20 mmHg, and 6 beat/min, respectively. There was no difference in QTc values with respect to diabetes control but QTc values were significantly different with regard to the known duration of diabetes. Blood pressure variations with standing were significantly related to control as well as the known duration of diabetes. Variability of hearth rate with respiration on the other hand was significantly related to the duration but not to the control of diabetes. QTc showed a significant correlation with the known duration of diabetes, postural blood pressure changes, and heart rate variability with respiration. Conclusion: Clinician's should be more alert for the signs of autonomic neuropathy, especially in patients with a history of diabetes for more than five years. Special attention should be given to postural blood pressure changes and heart rate variability with respiration

Hypokalemic Paralysis and Respiratory Failure Due to Excessive Intake of Licorice Syrup

Meyan kökü glycyrrhizic acid içeren Glycyrrhiza glabra'nın köküdür. Aşırı meyan kökü alımı sodyum ve su retansiyonu, hipokalemi, hipertansiyon, metabolik alkaloz, düşük renin aktivitesi ve hipoaldosteronizm ile karekterize hipermineralokortikoidizm benzeri sendroma yol açabilir. Bu yazıda aşırı meyan kökü şerbeti içimi sonrası acil servise solunum sıkıntısı, kol ve bacaklarında güçsüzlük nedeniyle getirilen hipopotasemik paralizili 34 yaşındaki erkek hasta sunuldu. Acil Servise paralizi ve solunum sıkıntısıyla gelen hastalarda aşırı meyan kökü alımı olup olmadığının sorgulanması gerekliliğine dikkat çekilmesi amaçlandı. Kan potasyum düzeyi 1.4 mmol/L olan hastanın potasyum replasmanı sonrası solunum sıkıntısı ve kas kuvvet kaybı tamamen düzeldiLicorice is the root of Glycyrrhiza glabra, which has a herbal ingredient, glycyrrhizic acid. Excessive intake of licorice may cause a hypermineralocorticoidism-like syndrome characterized by sodium and water retention, hypokalemia, hypertension, metabolic alkalosis, low-renin activity, and hypoaldosteronism. In this paper, an 34 years old man who admitted to the emergency department with respiratory failure and marked muscle weakness of all extremities that progressed to paralysis after excessive intake of licorice syrup was presented. It was aimed to draw attention to the necessity of questioning whether there is excessive intake of licorice or not in patients who admitted to emergency department with paralysis and dyspnea. Plasma potassium concentration of the patient was 1.4 mmol/L. The patient's respiratory distress and loss of muscle strength recovered completely after potassium replacemen