Normal Potassium Concentration Research Articles

Unexpected Hyperkalemia During Kawasaki Disease

Pseudohyperkalemia is defined as a markedly elevated serum potassium level with a normal plasma potassium concentration. It is mainly caused by leucocytosis and thrombocytosis. Here we report an infant treated with aspirin for Kawasaki disease who developed hyperkalemia during follow-up. He was finally diagnosed with pseudohyperkalemia based on a normal whole blood potassium level measured with a blood gas analyser.

Real-world management of chronic and postprandial hyperkalemia in CKD patients treated with patiromer: a single-center retrospective study.

Hyperkalemia, one of the most important electrolyte abnormalities of chronic kidney disease (CKD), often limits the use of renin-angiotensin-aldosterone system inhibitors and can increase in the postprandial period. In this study we report a real-world experience with the new non-adsorbed potassium binder patiromer in stage 3b-4 CKD patients. Moreover, we performed a cross-sectional analysis to evaluate, for the first time, the efficacy of patiromer in the control of postprandial potassium concentrations. We retrospectively collected data of 40 patients at the time of patiromer initiation (T0), and after 2 (T2), 6 (T6) and 12 (T12) months of treatment. For cross sectional analysis, a blood sample was collected 2h after the main meal for the evaluation of postprandial potassium concentrations. Eighty-two point five percent of patients (33/40) reached normal potassium concentrations at T2. Serum potassium significantly decreased at T2 compared to T0 (5.13 ± 0.48 vs 5.77 ± 0.41mmol/L, respectively; p < 0.001) and the reduction remained significant during the follow-up (5.06 ± 0.36 at T6 and 5.77 ± 0.41 at T12; p < 0.001 vs T0). Renin-angiotensin-aldosterone system inhibitors were continued by 93% of patients (27/29). Adverse events were reported in 27.5% of patients and were all mild-to-moderate. Postprandial potassium concentrations did not significantly change compared to fasting state potassium measured at T12 (4.53 ± 0.33 vs 5.06 ± 0.36mmol/L; p = 0.15). In a real-world setting of advanced CKD patients, patiromer is a useful treatment for hyperkalemia, since it significantly reduces serum potassium levels over the long term and is able to maintain potassium concentrations in the normal range even in the post-prandial period.

Impact of Foliar Spray with Gibberellic Acid GA3 and Nauta Fertilizer on the Some Vital and Mineral Components of Three Cultivars of Grape (Vitis vinifera L.)

The University of Mosul’s Department of Horticulture and Landscape Design / College of Agriculture and Forestry vineyard hosted this study. During the growing season 2022, to study the effects of foliar fertilization with Nauta fertilizer containing amino acids and seaweed extracts in three concentrations (0, 250, and 500 mg l-1) and foliar spraying with gibberellic acid in three concentrations (0, 50, and 100 mg l-1) on three table grape varieties, Halwany Lebanese, Kamali, and Black Khalili, and their interactions and effects on some It is possible to summarize the most important results obtained: According to this study, Halwany surpassed Kamali and Black Khalili in petiole iron concentration and grape variety superiority. Halwany and Kamali were over the Black Khalili variety in the average concentration of potassium in the petioles, just as the grape varieties were over the Halwany variety in the average protein and phosphorus concentrations. The Black Khalili variety also outperformed the Halwany and Kamali varieties in zinc content and carbohydrate percentage. In leaf petioles, nitrogen content increased significantly after foliar application of Nauta organic fertilizer at 250 mg l-1. In addition to the superiority of foliar spraying at 500 mg l-1 of the same fertilizer in main stem carbohydrates, protein, phosphorus, and iron in leaf petioles. Foliar spraying with gibberellic acid, especially at a concentration of 100 mg l-1, led to a significant increase in the average of protein and the concentration of phosphorus, potassium, zinc and iron in the leaf petioles.

DETERMINATION OF MICRONUTRIENTS IN DIABETIC WOMEN: A SERUM ANALYSIS OF SEVEN ELEMENTS

Background: The human body needs minerals and micronutrients. It is important to estimate the micronutrients (Fe+2, Mg+2, Mn+2, Zn+2, Cu+2, K+, Na+) in the serum of female patients with diabetes mellitus (T2DM) as needed for insulin and glucose metabolism, especially zinc, manganese, and magnesium, which activate insulin receptor sites. Aim: Estimate the micronutrient concentrations by (µg/mL) and determine their effects on insulin resistance and diabetes mellitus. Methods: The study was conducted at Maysan Province Endocrinology and Diabetes Center from January to April 2023. It included 120 women aged (20 – 65) years separated into two groups. The control group included 40 healthy women, and the patient group included 80 women with diabetic mellitus (T2DM). The IBM SPSS Statistics and the t-test were used to compare the two groups. Results: The results showed a statistically significant difference at the level (P?0.05) for the average concentration of Magnesium, Manganese, Zinc, Copper, Potassium, and Sodium, while Iron concentration was a non-significant decrease at (P?0.05) in the patients with (T2DM) compared with the control group. The concentration of micronutrients in diabetes mellitus and healthy groups was Na+ &gt; Cu+2 &gt; Zn+2 &gt; Mn+2 &gt; Fe+2 &gt; K+ &gt; Mg+2 and Na+ &gt; Cu+2 &gt; K+ &gt; Mg+2 &gt; Fe+2 &gt; Zn+2 &gt; Mn+2 respectively. In the T2DM group, the trace element with the highest observed concentration was the Sodium ion, while Manganese (Mn+2) had the lowest concentration. Conversely, in the control group, Sodium (Na+) showed the highest concentration and Magnesium (Mg+2) the lowest. Discussion: Sodium had the greatest micronutrient content in both the control and T2DM groups. Micronutrient differences may affect insulin resistance and diabetes. Conclusions: The variation in the micronutrient concentration was statistically significant between the diabetes mellitus and control groups, except for Iron, demonstrating the complex relationship between micronutrient levels and metabolic disorders

Short-term prognosis of changes in plasma potassium following an episode of hyperkalaemia in patients with chronic heart failure

Background/AimThere is an increasing prevalence of chronic heart failure (HF). It is well known that patients with HF and disturbances in the potassium level have an increased mortality risk. The aim of this study was to investigate the prognosis of a second plasma-potassium measurement after an episode with hyperkalaemia on short-term mortality in patients with chronic HF. Methods and resultsFrom Danish national registers, 2,339 patients with chronic HF and hyperkalaemia (>4.6 mmol/L) at first potassium measurement within 14–365 days from concomitant treatment were identified. To be included, a second measurement was required within 6–30 days subsequent to the first measurement and the 60-day mortality was observed. Based on the second measurement, the patients were divided into five groups: <3.5 mmol/L (n = 257), 3.5–4.0 mmol/L (n = 709), 4.1–4.6 mmol/L (n = 1,204, reference), 4.7–5.0 mmol/L (n = 89) and >5.0 mmol/L (n = 80). To assess all-cause and cardiovascular mortality, we used the Cox regression model. The multivariable analysis showed that patients with potassium concentrations <3.5 mmol/L (hazard ratio (HR): 3.03; 95% CI: 2.49–3.70) and 3.5–4.0 mmol/L (HR: 1.81; 95% CI: 1.54–2.14) had a worse prognosis compared to the reference. We observed similar results when calculating the risk of cardiovascular mortality. A restricted cubic spline curve showed a U-shaped relationship between plasma-potassium and all-cause mortality. ConclusionPatients with chronic HF and hyperkalaemia who became hypokalaemic after 6–30 days were associated with a higher 60-day all-cause and cardiovascular mortality compared to the reference. This also applied for patients with low normal potassium concentrations (3.5–4.0 mmol/L).

An evaluation of sodium zirconium cyclosilicate: a new treatment option for hyperkalaemia in China

ABSTRACT Introduction Hyperkalemia is a common complication of chronic kidney disease (CKD), diabetes mellitus (DM), and heart failure (HF) that can lead to severe arrhythmias and sudden death and is associated with a higher risk of mortality. Therefore, the prevention and treatment of hyperkalemia is important. Sodium zirconium cyclosilicate (SZC), a new oral potassium-lowering drug, has offered an additional treatment option for Chinese patients with hyperkalemia since its launch in China in late 2019, and some experience has been accumulated regarding its efficacy and safety. Areas covered In this review, the authors summarize the epidemiological features of hyperkalemia in China and review the clinical data regarding the use of sodium zirconium cyclosilicate in Chinese patients. Expert opinion The prevalence of hyperkalemia is particularly high in Chinese patients with chronic kidney disease and heart failure. In China, recent clinical studies have shown that SZC rapidly reduces serum potassium, maintains normal potassium concentration, and is well tolerated and safe. Two Chinese expert consensus statements have recommended the use of SZC for the acute correction and chronic maintenance of potassium concentration.

A mathematical model of potassium homeostasis: Effect of feedforward and feedback controls.

Maintaining normal potassium (K+) concentrations in the extra- and intracellular fluid is critical for cell function. K+ homeostasis is achieved by ensuring proper distribution between extra- and intracellular fluid compartments and by matching K+ excretion with intake. The Na+-K+-ATPase pump facilitates K+ uptake into the skeletal muscle, where most K+ is stored. Na+-K+-ATPase activity is stimulated by insulin and aldosterone. The kidneys regulate long term K+ homeostasis by controlling the amount of K+ excreted through urine. Renal handling of K+ is mediated by a number of regulatory mechanisms, including an aldosterone-mediated feedback control, in which high extracellular K+ concentration stimulates aldosterone secretion, which enhances urine K+ excretion, and a gastrointestinal feedforward control mechanism, in which dietary K+ intake increases K+ excretion. Recently, a muscle-kidney cross talk signal has been hypothesized, where the K+ concentration in skeletal muscle cells directly affects urine K+ excretion without changes in extracellular K+ concentration. To understand how these mechanisms coordinate under different K+ challenges, we have developed a compartmental model of whole-body K+ regulation. The model represents the intra- and extracellular fluid compartments in a human (male) as well as a detailed kidney compartment. We included (i) the gastrointestinal feedforward control mechanism, (ii) the effect of insulin and (iii) aldosterone on Na+-K+-ATPase K+ uptake, and (iv) aldosterone stimulation of renal K+ secretion. We used this model to investigate the impact of regulatory mechanisms on K+ homeostasis. Model predictions showed how the regulatory mechanisms synthesize to ensure that the extra- and intracelluller fluid K+ concentrations remain in normal range in times of K+ loading and fasting. Additionally, we predict that without the hypothesized muscle-kidney cross talk signal, the model was unable to predict a return to normal extracellular K+ concentration after a period of high K+ loading or depletion.

The effect of different tillage systems and fertilizer combinations on wheat ( Triticum aestivum L.) growth and some of yield components and its weed Competition

A field experiment was conducted during the agricultural season 2020-2021, at the agricultural extension station in Al-Najmi district, 43 km northeast of the , the center of Al-Muthanna Governorate, to determine the effect of tillage depths and different fertilizer combinations on some traits of wheat ( Triticum aestivum L.) and its weed competition. The experiment was applied according to the arrangement of the split block by two factors using the (RCBD) design and with three replicates. The first factor; four treatments of the tillage systems (0, 10, 20 and 30 cm). The second factor; fertilizer combinations with the control treatment (P0 K0 ,P25 K30 ,P50 K60,, P75 K90,P100K120 kg ha-1). The results of the study showed a significant difference for the treatments of tillage systems in most of the studied traits, weed decreased. The treatment of tillage depth of 10 cm was superior in giving the highest average concentration of nitrogen and phosphorous in the plant. The results also showed the superiority of the fertilizer combination F4 in giving the highest average concentration of nitrogen, phosphorous and potassium in the plant.

Evaluation of the Quality of Yard-Long Bean (Vigna unguiculata sub sp. sesquipedalis L.) Cultivars to Meet the Nutritional Security of Increasing Population

It is well-known that eating highly nutritious foods has health benefits which may include the prevention of diabetes, heart disease, cancers and other diseases. We examined five yard-long bean cultivars commonly grown in Bangladesh to determine their quality and nutritional composition in terms of carbohydrates, protein, moisture content, fat, ash, sugar crude fiber, as well as their average concentrations of the important nutrients vitamins A (folate) B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxamine), and C (ascorbic acid), the electrolytes sodium and potassium, and the minerals iron, calcium, magnesium and zinc. The experiment was conducted at the Horticulture Research Centre (latitude 23.9920° N and longitude 90.4125° E, having an elevation of 8.2 m asl) of the Bangladesh Agricultural Research Institute (BARI), Joydebpur, Bangladesh during 2019–2020 to find out the best yard-long bean cultivar to meet the nutritional security of the increasing population of Bangladesh. We observed average energy concentrations of the five yard-long bean cultivars between 37.62 to 45.94 Kcal/100 g. Similarly, average carbohydrate concentrations ranged between 6.28 to 8.41 g/100 g, average protein between 2.80 and 3.30 g/100 g, average fat between 0.10 and 0.19 g/100 g, average sugar between 1.47 to 2.34 g/100 g, and average crude fiber between 1.23 to 1.85 g/100 g. All five yard-long bean cultivars had high average concentrations of folate and key vitamins critical for human health: vitamin A (846.23–869.36 IU), vitamin B1 (0.096–0.115 mg), vitamin B2 (0.109–0.118 mg), vitamin B3 (0.40–0.42 mg), vitamin B6 (0.020–0.025 mg), and vitamin C (18.20–20.22 mg). Average sodium concentrations in the yard-long bean pods ranged from 3.97 to 4.18 mg, while average potassium concentrations varied between 230.03 and 246.57 mg. We observed high average concentrations of the minerals iron (0.85–1.28 mg), calcium (42.11–58.83 mg), magnesium (40.44–46.50 mg), and zinc (0.36–0.40 mg). Following this thorough investigation, we recommend the five yard-long bean cultivars be promoted for production and consumption within Bangladesh to improve human health and nutrition and to contribute to the prevention of key health complications including diabetes, obesity and some cancers.

Assessment of radiological health risk and radiogenic heat production changeability of different sedimentary rocks at Gabal Um Hamd, Southwestern Sinai, Egypt

Soil is a source of natural radionuclides and a source of natural radiation risk to humans. This study aims to measure the radioactivity concentrations, contributions, radiological hazards and to quantify the radiogenic heat productions in thirty two rock samples having different lithology from the middle member of Um Bogma Formation in Gabal Um Hamd, southwestern Sinai, Egypt. The concentration of natural radionuclides was determined using a p-type Hyper Pure Germanium (HPGe) detector. The average activity concentrations of uranium thorium and potassium in the interested area were found to be 4909.58 ± 54.34 5003.12 ± 17.56 79.04 ± 8.82 and 137.35 ± 8.64 respectively. Other hazard indices average values were measured, such as: annual effective dose equivalent, radium equivalent activity, external and internal indices, annual gonad equivalent dose, and excess lifetime cancer risk. The radiologic hazards results, obtained in this study shows that the radiation levels are higher than the internationally approved values and the recommended safety limits. Furthermore, the results show that the radiogenic heat value ranged from 3.58 to 402.45 μW m −3 with an average value of 60.11 ± 0.79μW m −3 in the studied area which is higher than previously reported averages.

Spatial Heterogeneity of Selected Soil Nutrients Related to Torreya grandis cv. Merrillii Plantation in Southeastern China

Chinese Torreya grandis (Torreya grandis cv. Merrillii) is a unique economic tree species in China. Intensive management related to application of chemical fertilizer and herbicides caused serious soil quality degradation of Chinese Torreya grandis plantations. Totally, 120 soil samples were collected from the main disbtributed areas of Chinese Torreya grandis in Southeastern China. In this area, soil pH values varied from 3.68 to 6.78, with a median value of 4.91, implying a trend of acidification. The average concentrations of organic matter, available nitrogen, available phosphorus and available potassium were 27.52 g kg−1, 135.77 mg kg−1, 15.12 mg kg−1, and 153.43 mg kg−1, respectively. The results of spatial analysis revealed that target variables had clear spatial patterns. The soil fertility was relevantly high in most of the study area, with soil nutrient imbalances existing. The stand age had a large effect on soil properties, which were also mainly influenced by human activities. Therefore, it is necessary to change the fertilization method for a sustainable management of Torreya grandis plantation.

Spatial correlation of nutrients in a typical soil-hickory system of southeastern China and its implication for site-specific fertilizer application

Chinese hickory (Carya cathayensis Sarg.) is the most popularly edible nut in China. Currently, there is an increasing concern on the quality of Chinese hickory, due to soil degradation of hickory plantations. In this study, a total of 153 pairs of soil and Chinese-hickory-nut samples were collected from Lin’an city, a typical Chinese hickory producing area. The results showed that the average concentrations of soil available nitrogen (ANsoil), available phosphorus (APsoil), available potassium (AKsoil), and total nitrogen, phosphorus and potassium in nuts were 155.17, 14.04, 83.71 mg kg-1, and 106.64, 73.15, 374.16 mg kg-1, respectively. The APsoil concentrations in Chinese hickory plantation soils had a strong variability coefficient of 126.06%. More than 60% of the soil samples had low soil AP concentration with low pH values. The average concentrations of available boron (ABsoil), available Zinc (AZnsoil) and total manganese (TMnsoil) in soils were 0.26 mg kg-1, 1.14 mg kg-1 and 613.36 mg kg-1, respectively. The above mentioned micro-nutrients in soils of hickory plantation were low, especially the deficiency of B was obvious. The spatial patterns of the nutrients of hickory nuts were similar with that of soils to some extent, especially in their high- and low-values regions. Overall, the spatial cross-corregrams indicated that the quality of hickory nuts was greatly affected by APsoil, ABsoil, AZnsoil and TMnsoil. The results imply that the quality of hickory nuts is closely related to soil nutrients, such information can be further used to guide precision fertilization application in plantation management.

Whole body potassium as a biomarker for potassium uptake using a mouse model

Potassium is known for its effect on modifiable chronic diseases like hypertension, cardiac disease, diabetes (type-2), and bone health. In this study, a new method, neutron generator based neutron activation analysis (NAA), was utilized to measure potassium (K) in mouse carcasses. A DD110 neutron generator based NAA assembly was used for irradiation.Thirty-two postmortem mice (n= 16 males and 16 females, average weight 22.02pm 1.3 and 17.9pm 1.1 g) were employed for this study. Soft-tissue equivalent mouse phantoms were prepared for the calibration. All mice were irradiated for 10 minutes, and the gamma spectrum with 42K was collected using a high efficiency, high purity germanium (HPGe) detector. A lead shielding assembly was designed and developed around the HPGe detector to obtain an improved detection limit. Each mouse sample was irradiated and measured twice to reduce uncertainty. The average potassium concentration was found to be significantly higher in males (2846 pm 525 upmu g/g) compared to females (2116.2 pm 432 upmu g/g). We also observed a significant correlation between potassium concentration and the weight of the mice. The detection limit for potassium quantification with the NAA system was 46 ppm. The radiation dose to the mouse was approximately 56 { pm 1.6 } mSv for 10-min irradiation. In conclusion, this method is suitable for estimating individual potassium concentration in small animals. The direct evaluation of total body potassium in small animals provides a new way to estimate potassium uptake in animal models. This method can be adapted later to quantify potassium in the human hand and small animals in vivo. When used in vivo, it is also expected to be a valuable tool for longitudinal assessment, kinetics, and health outcomes.

CHEMICAL ELEMENTS IN EGG SHELL OF A COMMERCIAL STRAIN OF DOMESTIC FOWL MANAGED IN A TROPICAL ENVIRONMENT

A study was conducted to determine the chemical elements of the egg shell of exotic commercial pullets (Lohmann) in their first laying year. A total of 160 eggs from eight pullet were randomly selected at three-monthly intervals during the production year for the determination of chemical elements of the eggshell. The average concentrations of calcium, magnesium, phosphorus, nitrogen, potassium, sodium, zinc and iron were 90.36%, 0.87%, 0.90%, 3.85%, 0.51%, 0.10%, 0.002%, and 0.005% respectively. Most of the paired variates of the mineral elements showed significant (P &lt; 0.01) inter-relationship as depicted by measures of correlation coefficients. There were no significant relationships between Ca and most mineral elements and on the other hand mg was significantly correlated with phosphorus N, K, and Zn. Correlation coefficients between P and Fe, N and Na, Zn or Fe and between Na and Zn were not significant.

Cation Flux and Electrolyte Composition of Frozen-Deglycerolized Blood

Cation flux and the extracellular and erythrocyte concentrations of sodium, potassium, calcium, magnesium, chloride, and acid soluble phosphorus were measured in fresh blood collected in various anticoagulant solutions, ACD blood stored at 4 C, and in frozen-deglycerolized blood stored at -80 to -120 C. Considerable variations in concentrations of extracellular and erythrocyte electrolytes were encountered due to certain characteristics of the anticoagulants employed and to the effects of storage, temperature, pH, and extracellular electrolyte concentration on erythrocyte electrolyte concentration. In contrast to ACD blood stored at 4 C, frozen-deglycerolized blood 1 day to 32 months old had slightly elevated erythrocyte concentrations of sodium and chloride and normal erythrocyte concentrations of potassium and phosphorus. Both ACD and frozen-deglycerolized blood had normal sodium and potassium fluxes. These data show that prolonged freezing and glycerolization of erythrocytes do not significantly impair the active transport processes responsible for maintenance of cellular electrolyte concentration.

Rising Trend of Hypokalemia Prevalence in the US Population and Possible Food Causes

Background: Potassium intake deficiency is a chronic issue in the US and many other countries. Possible causes of the deficiency are understudied.Objective: This study examined potassium deficiency in the US population and possible causes for the new trend.Methods: Serum potassium data of 28,379 men and 29,617 women between ages 12 and 80 years old who participated in the US National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016 were examined. Blood samples were collected by NHANES and blood biochemistry data were measured in designed laboratories. The data were released bi-annually. Possible causes of low potassium intakes were explored.Results: There was an apparent decline of serum potassium in the US population between ages 12 and 80 years from 1999 to 2016. Annual average serum potassium concentrations changed from 4.14 ± 0.01 to 3.97 ± 0.01 mmol/l during this period. Hypokalemia prevalence in the US rose from 3.78%±0.68% to 11.06%±1.08% during this period with a higher hypokalemia prevalence in non-Hispanic black than in non-Hispanic white persons. It is possible that declining potassium concentration in food sources in the US contributed to lower potassium intake and increasing potassium deficiency.Conclusion: The rising trend of hypokalemia prevalence in the US population between 1999 and 2016 is alarming. Renewed efforts to reduce potassium intake deficiency in the US at population level are needed. The impact of possible decreasing crop available potassium levels and increasing consumption of processed food on the potassium deficit trend in the US are possible explanations for the rise in hypokalemia prevalence and require further study.

SUN-LB92 The Importance of Early Diagnosis and Treatment of Primary Aldosteronism on the Progression of Chronic Kidney Disease, Compared With Essential Hypertension: A Retrospective Cohort Study

<META NAME=“author” CONTENT=“Windows 사용자”>Introduction: Primary aldosteronism(PA) has few clinical phenotypes and features, compared with other endocrine hypertension(HTN). Even though hypokalemia is a typical sign of PA, most of PA reveals normal potassium concentration. For that reason, PA is likely to undetected and underestimated and it may account for larger proportion of total HTN than we expected. However, it has known that PA has higher risk of renal complications than essential hypertension(EH) and has been controversy which treatment between medication and operation is better for renal protection of PA. Methods: We retrospectively reviewed the medial records of patients with PA and EH of a single medical center from January, 2009 to December, 2019. PA patients were divided into medical and surgical treatment groups. EH patients were distinguished from one that satisfied with case detection test, called non-confirmed PA. We excluded cases with other secondary HTN and baseline eGFR < 60 mL/min/1.73m2. Results: Patients with PA(N=66) and patients with EH(N=514) were selected for analysis. Each baseline mean eGFR of patients with PA and EH indicated 91.2 ± 74.5 and 87.1 ± 19.7 mL/min/1.73m2 and statistically insignificant differences(P = 0.1688) as well as baseline SBP(P = 0.5403) and DBP(P = 0.8691). However, in spite of treatment of PA and controlled BP, mean eGFR of PA patients was lower than one of EH patients and its difference was statistically significant showing 66.5 ± 14.2 and 94.6 ± 195.9 mL/min/1.73m2 (P < .0001) at 2~ 5 years, 52.4 ± 17.9 and 77.6 ± 20.6 mL/min/1.73m2 (P < 0.0004) at 6~10 years. Baseline mean eGFR of PA with normokalemia and hypokalemia respectively were 77.7 ± 11.6 and 98.9 ± 92.5 mL/min/1.73m2 (P = 0.0269). Baseline mean eGFR of non-confirmed PA and EH were 82.5 ± 13.2 and 88.4 ± 21.1 mL/min/1.73m2 (P = 0.0240). Although baseline mean eGFR of PA with surgical treatment was better than one with medical treatment, it was reversal after 2~5 years indicating mean eGFR of PA patients treated with operation, 62.9 ± 16.1 mL/min/1.73m2 and one treated with spironolactone, 70.5 ± 12.6 mL/min/1.73m2 (P = 0.0010). Conclusions: This study support PA has worse effects on renal function than EH. PA is frequently unsuspected and undiagnosed because it hardly shows symptoms and signs. Many cases do not reveal main characteristics such as uncontrolled HTN and hypokalemia, so that patients with PA maybe have longstanding exposure to risk of CKD. Therefore it is necessary to do case detection test and rule out PA in initial hypertensive patients. In addition, more longitudinal study and research should be performed to decide personalized and adequate treatments for PA patients.

Risk of Developing Hypokalemia in Patients With Hypertension Treated With Combination Antihypertensive Therapy.

Little is known about the occurrence of hypokalemia due to combination therapy for hypertension. Using data from Danish administrative registries, we investigated the association between different combinations of antihypertensive therapy and risk of developing hypokalemia. Using incidence density matching, 2 patients without hypokalemia were matched to a patient with hypokalemia (K, <3.5 mmol/L) on age, sex, renal function, and time between index date and date of potassium measurement. Combination therapies were subdivided into 10 groups including β-blockers (BB)+thiazides (BB+thiazides), calcium channel blockers (CCB)+renin angiotensin system inhibitors (RASi)+thiazides (CCB+RASi+Thiazides), calcium channel blockers+thiazides (CCB+thiazides), and β-blockers+renin angiotensin system inhibitors+thiazides (BB+RASi+thiazides). We used conditional logistic regression to estimate the odds of developing hypokalemia for different combinations of antihypertensive drugs within 90 days of combination therapy initiation. We matched 463 patients with hypokalemia to 926 patients with normal potassium concentrations. The multivariable analysis showed 5.82× increased odds of developing hypokalemia if administered CCB+thiazides (95% CI, 3.06-11.08) compared with CCB+RASi. Other combinations significantly associated with increased hypokalemia odds were BB+thiazides (odds ratio, 3.34 [95% CI, 1.67-6.66]), CCB+RASi+thiazides (odds ratio, 3.07 [95% CI, 1.72-5.46]), and BB+RASi+thiazides (odds ratio, 2.78 [95% CI, 1.41-5.47]). Combinations of thiazides with CCB, RASi, or BB were strongly associated with increased hypokalemia risk within 90 days of treatment initiation.

Using Gamma Spectroscopy to Calculate Radioactive Contaminants in Foreign and Local Tobacco Samples

The normal radioactivity levels of Uranium-238, Thorium-232, and Potassium-40 were calculated for ten types of foreign and local cigarettes available on the Iraqi market using a gamma-ray spectroscopy technique employing the germanium detector system. The results of this study showed that the average specific activity for each of Uranium-238, Thorium-232 and Potassium-40 were 21.689± 4.596, 18.906 ± 4.148, and 430.094 ± 19.449 (Bq/Kg) respectively. The annual effective dose, radium equivalent activity and excess lifetime cancer risk for the studied samples were also calculated, and their rates were 11.582 μsv/y, 81.841 Bq/Kg, and 40.538 people per million per year respectively. The outcomes indicate that the rate of concentration of uranium and thorium is lower than the permissible values, whereas the average concentration of potassium was slightly higher than the permissible values. This research is important because it warns against several types of cigarettes that contain high concentrations of radionuclides, which can lead to infection cancer and then lead to the death of the person who has used it profusely. Therefore, the aim of the current research is to evaluate the radiological risks of radionuclides in tobacco cigarette smoke by evaluating their natural radionuclide concentrations.

Changes in selected electrolytes in adult intensive care patients at the University Teaching Hospital, Lusaka, Zambia

Background: The importance of regulating electrolyte levels is well recognized in most Intensive Care Units (ICU). Various institutions across the globe have found varying figures on the extent and causes of electrolytes derangements in ICUs. The extent of electrolyte and fluid imbalance in patients being admitted and already admitted to the Main ICU (MICU) at the University Teaching Hospital (UTH) Lusaka Zambia is unknown. This study aimed to explore the 24hour changes in sodium and potassium in adult MICU patients at the UTH, Lusaka, Zambia. Methods: This was a prospective cohort study of the patients admitted to the MICU at UTH, Lusaka, Zambia. Data was collected over a four-month period (August to November) in 2017. Only consenting patients 18 years and above admitted for at least 24 hours in the unit were enrolled. On admission, routine baseline investigations were obtained from every patient which included a full blood count and renal function tests. The second set of investigations was collected 24 hours post MICU admission. The blood samples were obtained from a peripheral vein in heparinized bottles for renal function tests. Serum electrolyte analysis was done was at UTH. Normal serum concentrations of sodium and potassium were considered as 135-145mmol/l and 3.5 - 4.5mmol/L, respectively. Comparisons between means were done with the Wilcoxon signed-rank test. Logistic regression analysis was used to investigate the relationship between dependent and independent variables. A p-value &lt; 0.05 was considered statistically significant. Statistical analysis was performed with STATA 13 SE. Results: A total number of 100 patients were included in this study with a mean age of 36.8 years (SD = 12.1). The mean value of sodium level was 136.7 (SD = 8.9) mmol/L and 139.0 (SD = 11.6) mmol/L, on admission and 24 hours post-admission respectively. This difference in serum sodium level was shown to be statistically significant with a P-value = 0.0051. Hypernatremia was shown to be associated with an increased risk of death (p = 0.021) in the Unit with an odds ratio of 4.0 at 95% confidence interval of 1.3 to 13.8. Hyponatremia was the most prevalent electrolyte imbalance but was neither shown to be associated with mortality (P-value = 0.18) nor prolonged ICU stay (0.56) at 24 hours post-admission. The mean value of potassium level was 4.2 (SD = 1.1) mmol/L and 4.3 (SD = 1.1), on admission and 24 hours post-admission respectively. This difference was not statistically significant (P-value = 0.57). Conclusion: There was a statistically significant change in serum sodium levels after 24 hours post-admission but there was no statistically significant change in potassium. Hyponatremia was the most prevalent abnormality whilst hypernatremia had a statistically significant association with mortality. Therefore, electrolyte imbalances can occur as early as the first day of admission in ICU with fatal complications. Correcting electrolyte imbalances in MICU patients is an urgent necessity and should not be delayed.