Digestive Diseases and Sciences

, Volume 29, Issue 8, pp 768–772 | Cite as

Intestinal secretion as a cause of hypokalemia and cardiac arrest in a patient with Strongyloidiasis

  • Mary G. Kane
  • James P. Luby
  • Guenter J. Krejs
Case Report
Received:
Revised:
Accepted:

Summary

A 32-year-old white American male contracted strongyloidiasis in Nigeria. Prolonged and severe watery diarrhea was complicated by hypokalemia and cardiac arrest. Steady-state perfusion studies with a plasma-like electrolyte solution revealed net secretion of water, sodium, potasssium, and chloride in a segment of jejunum. Mucosal permeability measured by the ration of [14C]urea and tritiated water diffusion was unchanged. Chloride secretion occurred against both an electrical and chemical gradient, which suggests that chloride secretion was active. Intestinal water and electrolyte secretion may be the mechanism of watery diarrhea in patients with strongyloidiasis.

Keywords

Permeability Urea Cardiac Arrest Nigeria Electrolyte Solution 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Grove DI, Warren KS, Mahmoud AAF: Algorithms in the diagnosis and management of exotic diseases III. Strogyloidiasis. J Infect Dis 131:755–758, 1975Google Scholar
  2. 2.
    Filko EC: Strongyloidiasis. Clin Gastroenterol 7:179–200, 1978Google Scholar
  3. 3.
    Ruebush TK II, Juranek DD, Brodsky RE: Diagnoses of intestinal parasites by state and territorial public health laboratories. J Infect Dis 138:114–118, 1978Google Scholar
  4. 4.
    Hughes JM, Guerrant RL: Systemic syndromes complicaring gastrointestinal infections.In Principles and Practice of Infectious Diseases. GL Mandell, RG Douglas, JE Bennett (eds). New York, John Wiley & Sons; 1979 pp 890–907Google Scholar
  5. 5.
    Milder JE, Walzer PD, Kilgore G, Rutherford I, Klein M: Clinical features ofStrongyloides stercoralis infection in an endemic area of the United States. Gastroenterology 80:1481–1488, 1981Google Scholar
  6. 6.
    Jones CA: Clinical studies in human strongyloidiasis. I. Semeiology. Gastroenterology 16:743–756, 1950Google Scholar
  7. 7.
    Milner PF, Irvine RA, Barton CJ, Bras G, Richards R: Intestinal malasorption inStrongyloides stercoralis infestation. Gut 6:574–581, 1964Google Scholar
  8. 8.
    O'Brien W: Intestinal malabsorption in acute infection withStrongyloides stercoralis. Trans R Soc Trop Med Hyg 69:69–77, 1975Google Scholar
  9. 9.
    Stemmerman GH, Nakasane H:Strongyloides sterocarlis infestation. JAMA 174:1250–1253, 1960Google Scholar
  10. 10.
    Bras G, Irvine RA, Richards RC, Milner PFA, Ragbeer MMS. Infection withStrongyloides stercoralis in Jamaica. Lancet 2:1257–1260, 1964Google Scholar
  11. 11.
    Alcorn MO, Kotcher E: Secondary malabsorption syndrome produced by chronic strongyloidiasis. South Med J 54:193–197, 1961Google Scholar
  12. 12.
    Amir-Ahmadi H, Braum P, Neva F, Gottieb LS, Zamcheck N: Strongyloidiasis at the Boston City Hospital. Am J Dig Dis 13:959–973, 1968Google Scholar
  13. 13.
    Bartholomew C, Butler AK, Bhaskar AG, Jankey N: Pseudoobstruction and a sprue-like syndrome from strongyloidiasis. Postgrad Med J 53:139–142, 1977Google Scholar
  14. 14.
    Garcia FT, Sessions JT, Strum WB, Schweistris E, Tripathy K, Bolanos O, Lotero H, Duque E, Ramelli D, Mayoral LG: Intestinal function and morphology in strongyloidiasis. Am J Trop Med Hyg 26:859–865, 1977Google Scholar
  15. 15.
    Kotchen E, Miranda MG, Esquivel RR, Pena-Chavarria A, Donohough DL, Baldizon CL, Acosta AG, Apuy JLA: Intestinal malabsorption and helminthic and protozoan infections of the small intestine. Gastroenterology 50:366–371, 1966Google Scholar
  16. 16.
    Fordtran JS, Rector FC, Ewton MF, Soter N, Kinney J: Permeability characteristics of the human small intestine. J Clin Invest 44:1935–1944, 1965Google Scholar
  17. 17.
    Cooper H, Levitan R, Fordtran JS, Inglefinger FJ: A method for studying absorption of water and solute from the human small intestine. Gastroenterology 50:1–7, 1966Google Scholar
  18. 18.
    Krejs GJ, Walsh JH, Morawski SG, Fordtran JS: Intractable diarrhea. Intestinal perfusion studies and plasma VIP concentrations in patients with pancreatic cholera syndrome and surreptitious ingestion of laxatives and diuretics. Am J Dig Dis 22:280–292, 1977Google Scholar
  19. 19.
    Krejs GJ, Fordtran JS, Bloom SR, Fahrenkrug J, Schaffalitzky de Muckadell OB, Fischer JE, Humphrey CS, O'Dorisio TM, Said SI, Walsh JH, Shulkes AA. Effect of VIP infusion on water and ion transport in the human jejunum. Gastroenterology 78:722–727, 1980Google Scholar
  20. 20.
    Fordtran JS, Rector FC, Locklear TW, Ewton MF: Water and solute movement in the small intestine of patients with sprue. J Clin Invest 46:287–297, 1967Google Scholar
  21. 21.
    Read NW, Cooper K, Fordtran JS: Effect of modified sham feeding on jejunal transport and pancreatic and biliary secretions in man. Am J Physiol 234:E417-E420, 1978Google Scholar
  22. 22.
    Fordtran JS, Levitan R, Bikerman V, Burrows BA, Ingelfinger FJ: The kinetics of water absorption in the human small intestine. Trans Assoc Am Physiscians Phila 74:195–205, 1961Google Scholar
  23. 23.
    DaCosta LR: Small-intestinal cell turnover in patients with parasitic infections. Br Med J 3 281–283, 1971Google Scholar
  24. 24.
    Marcial-Rojas RA: Strongyloidiasis.In Pathology of protozoal and helminithic diseases. Marcial-Rojas (ed). Baltimore Williams and Wilkins, 1971, pp 711–733Google Scholar
  25. 25.
    DaSilva OA, Amarel CFS, DaSilveira JCB, Lopez M, Pittella JEH: Hypokalemic respiratory muscle paralsis followingStrongyloides stercoralis hyperinfecion: A cases report. Am J Trop Med Hyg 30:69–73, 1981Google Scholar
  26. 26.
    Paola D de, Dias LB, Rodriguez da Silva J: Enteritis due toStrongyloides stercoradis: A report of 5 fatal cases. Am J Dig Dis 7:1086–1097, 1962Google Scholar
  27. 27.
    Poltera AA: Fatal strongyloidiasis in Uganda. Ann Trop Med Parisiiol 68:81–90, 1974Google Scholar
  28. 28.
    Brandborg LL: Structure and function of the small intestine in some parasitic diseases. Am J Clin Nutr 24:124–131, 1971Google Scholar
  29. 29.
    Guerrant RL: Infectious gastrointesinal syndromes.In Principles and Practice of Infectious Diseases GL Mandell, RG Douglas, JE Bennett (eds). New York, John Wiley & Sons, 1979, pp 847–862Google Scholar
  30. 30.
    Sharp GW: Action of choleratoxin on fluid and electrolyte movement in the small inntesine. Annu Rev Med 24:19–28, 1973Google Scholar
  31. 31.
    Krejs GJ, Barkley RM, Read NW, Fordtran JS: Intestinal secretion induced by vasoactive intestine polypeptide: A comparison with cholera toxin in the canine jejunumin vivo. J Clin Invnvest 61:1337–1345, 1978Google Scholar
  32. 32.
    Holmgren J: Actions of cholera toxin and the prevention and treatment of cholera. Nature 292:413–417, 1981Google Scholar
  33. 33.
    Carpenter CCJ: The pathophysiology of secretory diarrheas. Med Clin North Am 66:597–610, 1982Google Scholar
  34. 34.
    Mimori T, Nawa Y, Korenaga M, Tada I:Strongyloides ratti: Mast cell and goblet cell responses in the small intestine of infected rats. Exp Parasitol 54:366–370, 1982Google Scholar
  35. 35.
    Olson CE, Schiller EL:Strongyloides ratti infection in rats. I. Immunopathology. Am J Trop Med Hyg 27:521–526, 1978Google Scholar
  36. 36.
    Bienenstock J, Befus AD: Mucosal immunology. Immunology 41:249–270, 1978Google Scholar
  37. 37.
    Welsh MJ, Smith PL, Fromm M, Frizzell RA: Crypts are the site of intestinal fluid and electrolyte secretion. Seicence 218:1219–1221, 1982Google Scholar

Copyright information

© Plenum Publishing Corporation 1984

Authors and Affiliations

  • Mary G. Kane
    • 1
  • James P. Luby
    • 1
  • Guenter J. Krejs
    • 1
  1. 1.the Divison of Gastroenterology and Infectious DiseasesUniversity of Texas Health Science Center at Dallas, Southwestern Medical SchoolDallas

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