Bicarbonate Levels Research Articles

31 Impact of the amount of intravenous glucose administration on hospitalization for acute gastroenteritis in a paediatric emergency department

Abstract Background In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established. Objectives The main objective of this study was to evaluate the impact of the amount of intravenous glucose provided to children treated for acute gastroenteritis on hospitalizations. Other objectives were to evaluate practice variation regarding the amount of glucose and liquid provided for IV rehydration in a paediatric emergency department (ED). Design/Methods We conducted a retrospective cohort study from 2019-2022 in a Canadian paediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease or diabetes were excluded. The IV glucose administered during the initial four hours of rehydration was quantified. The primary outcome was hospitalization and return visit in the following seven days was a secondary outcome. 10% of the charts were evaluated in duplicate to assess inter-rater reliability. We examined glucose distribution at one and four hours, and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions. Results Among 6,939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent inter-rater reliability. Notable variations existed in glucose quantities provided, both at one hour (first quartile: 87 mg/Kg; third quartile: 294 mg/Kg) and four hours (first quartile: 681 mg/Kg; third quartile: 1174 mg/kg) of rehydration. Multiple logistic regression showed a greater hospitalization risk with smaller amount of glucose administered during the initial hour (OR for each 100mg/kg increment: 0.60; 95%CI: 0.42-0.84) and four hours (OR: 0.76; 95%CI: 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were at lower risk of return visit (OR for each 100mg/kg increment: 0.52; 95%CI: 0.35-0.78), as well as during the first four hours (OR for each 100 mg/kg increment: 0.83; 95%CI: 0.73-0.94). Conclusion There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.

High altitude impact on serum bicarbonate in healthy Mexican children: concerning the overdiagnosis of renal tubular acidosis

BackgroundAltitude influences bicarbonate levels, it is a variable that is hardly considered in diagnosing Renal Tubular Acidosis (RTA), so it should be a factor to consider when diagnosing this pathology, especially at 2250 mts over the sea level as it is the case of Mexico City. RTA is most often misdiagnosed. Regarding of this, the present study established reference limits for bicarbonate levels in healthy children without pathologies associated with alterations in the acid-base balance in Mexico City and it´s metropolitan area.MethodsA total of 267 healthy pediatric patients were included, within normal estimated glomerular filtration rate (eGFR), and without any associated pathology of any alteration in the acid-base balance.ResultsCompared to older children, children younger than two years of age showed statistically higher levels of calcemia and cystatin C. On the other hand, this same group showed lower values of creatininemia, pCO2, and HCO3-. Percentile 50 of bicarbonate in children under two years of age were 19.9 mEq/L and 21.9 mEq/L in those over that age. A correlation was identified between HCO3- levels and pCO2 (r = 0.68; p < 0.001).ConclusionsIn the study population, an effect of altitude on blood levels of pCO2 and HCO3- was observed.

Community-acquired sepsis in the medical intensive care unit – an experience from a lower-middle-income country

Objective: To determine microbiological pathogens and in-hospital mortality in patients admitted with community-acquired sepsis to the intensive care unit in a tertiary-care setting in a low- and middle-income country. Methods: The retrospective, observational study was conducted at the medical intensive care unit of a large tertiary care hospital in Karachi, and comprised data from January 1 to December 31, 2019, and comprised data of patients with community-acquired sepsis who were assessed using the Sepsis-3 criteria. Data was compared between survivors and non-survivors, and independent factors associated with escalation to a higher level of care were identified. Data was analysed using SPSS 23. Results: Of the 135 patients with mean age 49.8±18.0 years, 91(67.4%) were males and 44(32.6%) were females. The most common primary site of infection was the respiratory tract 63(46.7%). In-hospital mortality was noted in 52(38.5%) cases, while there were 83(61.5%) survivors. Serum levels of lactate and bicarbonate as well as urine output, fungal pathogens, septic shock and sequential organ failure were significantly associated with mortality (p&lt;0.05). Conclusions: Clinical and microbiological spectrum of community-acquired sepsis in a low- and middle-income country was found to be different from other regions of the world. Clinicians should keep these differences in mind while managing these critically ill patients. Key Words: Sepsis, Septic shock, Critical care, Drug resistance, Fungi.

The Effect of Extreme Alkalemia upon Presentation to the Emergency Department on Patient Outcomes

Background/Objectives: The prognostic significance of alkalemia found in an initial emergency department (ED) evaluation has not been described thus far. Methods: We retrospectively reviewed the records of all patients aged 18 years or older evaluated in the ED of one large academic referral center during 2000–2023. Included patients were those with at least one measurement of pH ≥ 7.55 upon initial ED presentation. Alkalemia was deemed primarily metabolic (PM) if PCO2 was ≥35 mmHg and primarily respiratory (PR) if bicarbonate levels were ≤24 mEq/L. The primary outcome was survival 30 days from ED presentation. Results: Of 2440 patients included, 199 (8.1%) had PM and 1494 (61.2%) had PR. Alkalemia severity was not correlated with prognosis. Survival at 30 days was significantly (p &lt; 0.001) lower in the PM group (78.9%) compared with that of either the PR (95.3%) or the combined etiology (92.2%) groups. Multivariate survival analysis after balancing potential observed confounders using propensity score matching revealed the type of alkalemia (PM vs. PR) to be a significant predictor of 30-day mortality (aHR 1.73; 95% C.I. = [1.07 to 2.82]; p = 0.026), irrespective of age, other laboratory values obtained on ED evaluation (including pH), past medical history, or vital signs on presentation. Conclusions: In patients presenting to the ED with significant alkalemia, the mechanism of alkalemia, i.e., primarily metabolic versus primarily respiratory, rather than the absolute degree of alkalemia, is associated with increased mortality.

Study of indications, associated comorbid condi-tions and outcome of patients requiring Bilevel type of Non Inva-sive Positive Pressure Ventilation in a tertiary care hospital

BiLevel non-invasive positive pressure ventilation (BiPAP) is the most utilised supportive treatment in the world of medicine for respiratory failure. COPD is the most common indication for its use. We in-vestigated the indications and effects of comorbidities on BiPAP outcomes because there have been few studies on it. It is a descriptive, observational, cross-sectional study conducted over period of 12 months, wherein 60 patients fulfilling the inclusion criteria for the requirement of BiPAP were includ-ed in the study and evaluated. The indications, associated comorbid conditions and the outcomes of NIV therapy were studied. COPD exacerbation with Type II Respiratory failure was the most common indication (71.4%), followed by asthma [near fatal/severe] (21.4%). Success with BiPAP in COPD was 67.6% . In COPD patients with co-morbidities, success came down to 47.4%. Pneumonia, ILD &amp; Cardiogenic Pulmonary Edema (CPE) had success rates of 0%, 16.7% and 66.7% respectively with BiPAP therapy,with higher mortality rates for pneumonia and ILD. Comorbidities were present in 51.7% of patients and Hypertension (35%) and Diabetes Mellitus (21.7%) were the most common. In patients who had co-morbidities, the mean hospital stay was 12 days, which was higher than the mean hospital stay of 9.3 days in patient with no co-morbidities. The presence of co-morbidities was associated with higher failures with BiPAP (51.6%) comapred to ones with no co-morbidities (13.8%) (p value &lt;0.05). Higher respiratory rate (&gt;28/min), lower ABG pO2, pCO2 and bicarbonate levels and higher blood glucose and total leucocyte counts were associated with higher BiPAP failures and mortality. The conclusion was that the most common indication of BiPAP was a COPD exacerbation with type II respiratory failure and presence of comorbidities led to a poorer outcome with prolonged hospital stay. ABG parameters, blood glucose levels and total leucocyte counts has an effect on NIV outcome and mortality.

8226 A Diagnostic Challenge: Factitious Hypobicarbonatemia in Severe Hypertriglyceridemia

Abstract Disclosure: U. Rafat: None. S. Azmat: None. M. Siddiqui: None. R. Alshantti: None. D. Kircheva: None. V. Trendafilova: None. Background: Serum CO2 levels measured by a chemistry analyzer usually correlate with calculated bicarbonate levels on an ABG. There are some instances however, when this is not the case. Severe hypertriglyceridemia can cause serum bicarbonate levels to appear falsely low on metabolic panel. Clinical Case: A 48-year-old man was referred to Endocrinology Clinic for evaluation of hypogonadism and severe hypertriglyceridemia. Routine labs revealed a plasma CO2 of 11 mmol/L (20-31). Na was 133 mmol/L (136-145), K was 4.4 mmol/L (3.5-4.7), Chloride was 101 mmol/L (98-109) and anion gap was 25 (8-20) measured using a Siemens Vista enzymatic chemistry analyzer. His triglycerides were &amp;gt; 1100 mg/dL (0-150), above upper detection limits of the analyzer. The patient reported fatigue and mild abdominal pain. He was admitted to the hospital for further evaluation. His lipase was 41 U/L (12-73), lactic acid 1.2 mmol/L (0.50-2.20). ABG showed pH of 7.41, HCO3 of 26.6 mmol/L (22-29), and anion gap of 7 (10-20). The patient was well-appearing with normal vital signs and normal physical exam. He was made NPO and started on pravastatin, fenofibrate and fish oil. Once his triglycerides were &amp;lt; 1000 mg/dL, he was started on a very low-fat, low-carbohydrate diet. The CO2 level on BMP normalized on day 3 of hospitalization, when triglycerides measured 1010 mg/dL. No other treatment was given for the low CO2 levels. It does not appear that other lab indices were significantly affected by the hypertriglyceridemia. Review of Literature: A BMP measures serum total carbon dioxide using a chemistry analyzer using either an enzymatic/spectro-photometric method, or an electrode-based method; an ABG sample calculates plasma bicarbonate with the Henderson-Hasselbach equation, using the pH and partial pressure of pCO2 in the sample. Enzymatic analyzers measure CO2 using spectrophotometry and decrease in light absorbance is proportional to the sample’s CO2 levels. It is postulated that severely high triglycerides can interfere with this reaction and cause spuriously low CO2 levels, a phenomenon called pseudohypobicarbonatemia. One proposed mechanism for interference with the enzymatic assay method is turbidity causing a falsely low measured CO2 level. Verghese et al found that the severity of the CO2 measurement error positively correlates with the severity of triglyceride elevation. Conclusion: Awareness of the phenomenon of hypertriglyceridemia-induced pseudohypobicarbonatemia can prevent misdiagnosis or delays in diagnosis, as well as unwarranted testing and treatment. Presentation: 6/3/2024

12616 Pembrolizumab-induced Autoimmune Adrenal Insufficiency: A Case Report And Literature Review

Abstract Disclosure: A. Calderon: None. E. Calderon-Martinez: None. J. Shakil, MD: None. A. Kansara: None. Immunechekpoint inhibitors (ICI)-related Primary Adrenal Insufficiency (PAI) is an uncommon entity. Compared to other endocrine-related adverse effects (irAES), antibody detection is less consistent. TPO and GAD65 antibodies are usually present in about 40-80% of the cases with hypothyroidism, hyperthyroidism, and diabetes. On the contrary, case reports and series for PAI seldom report the presence or absence of 21OH antibodies. We present a case and perform a literature review of PAI, in a patient who received pembrolizumab and developed PAI with 21 hydroxylase antibodies. A 62-year-old man with history HIV on ART (last CD4 count 590 cells/mm3) and locally advanced urothelial cancer on Pembrolizumab, presented with nausea, vomiting, abdominal pain, and decreased urine output. He was noted to be confused, and in hypoactive delirium. On admission, his chemistry panel he was noticed to have normal sodium and potassium levels. The CT scan of the abdomen revealed regional enteritis and was started on IV fluid therapy. His adrenal glands were described as normal on imaging. On the 16th day of hospitalization, the patient became unresponsive and hypotensive. He was transferred to the ICU. His sodium level was 132 mEq/L and potassium level was 6.1 mEq/L, bicarbonate level was 18 mEq/L, calcium of 10.3 mg/dl, and eosinophils of 15%. Random cortisol levels measured before administration of steroids were undetectable twice, 9 hours apart, with an ACTH level of 94. He underwent an ACTH stimulation test with cosyntropin 250 mcg IV with resulting undetectable cortisol levels after 30 and 60 minutes. CT and MRI of the brain showed no signs of hypophysitis. He was started on high-dose hydrocortisone with improvements in his mental status, hypotension, and gastrointestinal symptoms. He was discharged on hydrocortisone. His 21-Hydroxylase antibody was later found out to be positive. After combination immunotherapy regimens, CTLA-4 inhibitors are the most common to cause any irAE, however endocrine irAE particularly are mostly associated with PD-1 inhibitors. Among these, thyroid and pituitary disorders are the most common ones. Reports show that about 10% of patients receiving immunotherapy will develop endocrinopathy. ICI-induced PAI has been reported to occur in 7.6% of patients receiving combination therapy, and 2% of patients receiving Pembrolizumab. It has been reported that only 15% of patients will recover adrenal function. A meta-analysis that gathered 15 cases of ICI-induced PAI, found that only 2 cases had positive 21-hydroxylase antibodies. In our presented case, we have robust biochemical confirmation of PAI, with positive 21 hydroxylase antibody, after being on pembrolizumab for 9 months. Further information is needed to establish the pathophysiology, presentation, and prognosis of ICI-related PAI when anti adrenal antibodies are positive. Presentation: 6/1/2024

8070 Atypical New Onset Diabetes Mellitus in a Young Male: Is this LADA vs Type 1 or Type 2?

Abstract Disclosure: S.K. Devineni: None. S. Shaik: None. J.L. Gilden: None. Background: Recent literature suggests that autoantibody seropositivity is common in new onset autoimmune Diabetes Mellitus (DM), especially in younger patients. Latent autoimmune diabetes of adults (LADA), a form of adult-onset autoimmune DM. is considered a mix of type 1 and type 2 DM, sharing similar immune cell characteristics to both subtypes. Unlike type 1, LADA patients do not require insulin for glycemic control for the first six months after diagnosis. Unlike type 2, LADA patients are positive for single islet autoantibody, glutamic acid decarboxylase (GAD), and anti-gliadin antibodies. Patients with LADA often present with symptoms (polyuria, polydipsia, nocturia, fatigue, and visual changes). We present a case of new onset Diabetes Mellitus in a young male, autoantibody seronegative, at the time of diagnosis. Case report: A 19-year-old Caucasian male was sent to the Emergency Department with a serum blood glucose (BG) level of 579 mg% after routine blood tests. He denied any clinical symptoms and serum levels showed no elevation in ketones, nor bicarbonate levels, ruling out ketoacidosis. His hemoglobin A1c at that time was 14.7%. He denied prior knowledge of personal or family history of DM. or other autoimmune disorders. However, it was discovered that routine labs done 1 ½ months earlier on a Health Screen revealed BG=295 mg% with urine positive for ketones (80 mg/dl) and glucose (&amp;gt;1000 mg/dL). Physical Exam: (HT=178 cm; WT=79 Kg) was unremarkable. Autoantibodies for GAD 65, islet-cell, Zinc transporter 8, and Islet Antigen 2 were all negative. He was hospitalized for 9 days. BG levels were difficult to control and required increasing doses of both long acting and short acting insulin. He was discharged with insulin therapy (30 units of glargine at nighttime and 12 units of premeal aspart). One week later, the patient ate several gummy bears as a nighttime snack and subsequently woke up in the middle of the night feeling shaky and having blurry vision. BG was greater than 300 mg%. In the emergency room, he. received intravenous fluids. No insulin was given as his BG normalized and he was discharged. Later, a continuous glucose monitor revealed multiple hypoglycemic episodes. The patient was living in a situation where he only had limited access to certain foods, and thus his insulin regimen was decreased (28 units glargine and 10 units aspart for meals) Conclusion: We present the case of new onset atypical DM in a young patient whose insulin sensitivity and risk factors seem to resemble a pattern of type 1 DM; despite seronegative autoantibodies We predict that he may eventually seroconvert to type 1 DM. It is also possible that he may have an unusual presentation of LADA or type 2 DM, although he had no hyperglycemic symptoms. Presentation: 6/3/2024

6463 A Case of Tumour-Induced Osteomalacia Which Remitted After Treatment of Metastatic Prostate Cancer

Abstract Disclosure: J. Chua: None. M. Chuah: None. A case Tumour-induced osteomalacia (TIO) which remitted after treatment of metastatic prostate cancer. Dr Chua Jia Min, Dr Matthew Chuah Bingfeng Abstract Case report: A 69-year-old gentleman with a known history of bladder cancer presented to the emergency department with fatigue, lower back pain and bilateral lower limb weakness worsening over the past one month. MRI and bone scan revealed extensive osteoblastic bone metastases across the skeletal system. This gentleman was referred to the Endocrinology service for the evaluation of high PTH. His corrected calcium was normal at 2.17mmol/L (2.09-2.46mmol/L) and iPTH was raised at 8.74pmol/L (1.60-6.90pmol/L). He was noted to have severe hypophosphatemia 0.34mmol/L (0.94-1.50mmol/L). Bicarbonate levels were normal, there was no glycosuria or proteinuria. There was no history of IV ferrous carboxymaltose use. Further investigations were consistent with urinary phosphate loss - TRP was 0.398 and TMP-GFR was 0.199. ALP was elevated at 282ug/L (39-99ug/L). 25-hydroxyvitamin D was low at 12 ug/L, which accounted for the high PTH levels (secondary hyperparathyroidism). FGF-23 levels returned high at 1293 RU/ml (&amp;lt;180 RU/ml). BMD showed osteoporosis with T-score of -2.6 at the left femoral neck. He was subsequently diagnosed with metastatic prostate adenocarcinoma, based on histology from a bone biopsy of an affected vertebrae. PSA was markedly raised at 606ug/L. A diagnosis of TIO secondary to metastatic prostate cancer was made. The patient was started on PO sodium-phosphate solution 4ml TDS (approximately 3mmol/kg/day of elemental phosphorus), calcitriol 0.25mcg BD and vitamin D was replaced. After phosphate was replete, the patient's weakness and fatigue improved. He was subsequently started on androgen deprivation therapy with leuprorelin acetate injection once every 3 months and apalutamide daily. SC denosumab 60mg Q6monthly was also commenced in view of extensive bone metastases. Repeat imaging showed response to treatment with decrease in the size of the prostate and bone lesions. His PSA levels are now undetectable and TMP-GFR has normalised. His oral phosphate and calcitriol doses were gradually reduced and subsequently stopped. His calcium and phosphate levels remain within normal limits on no supplementation, suggesting remission of his TIO. PTH levels normalised after vitamin D repletion. Learning points TIO is a rare paraneoplastic syndrome usually associated with mesenchymal tumours, and treatment involves resection of the causative tumour. Cases of TIO secondary to prostate cancer (an epithelial cancer) are exceedingly rare. Despite metastatic disease, this patient responded exceedingly well to his cancer therapy. Suppression of the tumour cells with androgen deprivation therapy resulted in the lack of phosphotonin production and remission of his TIO. Presentation: 6/1/2024

8104 Rare Case Of Ectopic Cushing’s Syndrome Secondary To Metastatic Parotid Pleomorphic Adenocarcinoma

Abstract Disclosure: B.S. Neutel: None. P. Manroa: None. Background: Pleomorphic adenocarcinoma of the parotid gland is a rare malignancy and ectopic ACTH secretion from these tumors is very rarely described. We report a case of ectopic Cushing’s syndrome (CS) in such a patient and describe the clinical course. Clinical Case: A 69-year-old female with left parotid pleomorphic adenocarcinoma status post surgery and adjuvant radiotherapy presented to her local hospital approximately 7 months after initial treatment with proximal muscle weakness and near-syncope. Workup revealed profound hypokalemia at 1.6 mmol/L (n 3.5-5.3 mmol/L) along with new-onset hypertension (BP 175/110 mm Hg) and hyperglycemia with a HbA1c 6.5 % (n &amp;lt;5.7%), as well as metabolic alkalosis with a bicarbonate level of &amp;gt;40 mmol/L (n 22-32 mmol/L). A CT scan showed multiple liver metastases and a biopsy confirmed metastatic parotid pleomorphic adenocarcinoma. She was then transferred to our comprehensive cancer center for further management. She reported muscle weakness, easy bruising, and facial edema. She denied acne, hirsutism, or abdominal striae. Endocrine workup revealed a random cortisol of 56 mcg/dL (n 3-18 mcg/dL) and ACTH of 378 pg/mL (n 7.2-63.3 pg/mL). Her AM cortisol level remained unsuppressed at 79.2 and 59.4 mcg/dL (n&amp;lt; 1.8 mcg/dL) after 1 mg and 8 mg overnight dexamethasone suppression tests respectively. Late-night salivary cortisol was 7.9 mcg/dL (n &amp;lt;0.112 mcg/dL). An MRI of the sella was negative for any pituitary lesions. After stabilizing her clinical condition and correcting electrolyte abnormalities, she was started on chemotherapy with paclitaxel and carboplatin by the oncologist. Based on clinical suspicion of ectopic CS, ketoconazole was started and titrated upwards with rapid improvement of blood pressure, hypokalemia, and hyperglycemia. She was discharged home and antihypertensives were tapered off. ACTH staining on the liver biopsy was unable to be performed due to paucity of the specimen. A Ga-68-DOTATATE PET CT revealed increased radiotracer uptake in the liver lesion suggestive of SSTR 2 receptor positivity. Despite initial clinical improvement, her disease progressed with widespread liver, lymph node, and osseous metastases within 3 months necessitating escalating doses of ketoconazole, spironolactone, and potassium supplementation. The patient elected to pursue hospice care due to intolerance to chemotherapy and passed away shortly afterward. Conclusion: Although ectopic CS caused by parotid pleomorphic adenocarcinoma is rare, prompt recognition and treatment is necessary because ectopic ACTH production is associated with poor prognosis in these patients. Presentation: 6/3/2024

Impact of mini-dose dexmedetomidine supplemented analgesia on sleep structure in patients at high risk of obstructive sleep apnea: a pilot trial.

Obstructive sleep apnea (OSA) is common in surgical patients and associated with worse perioperative outcomes. To investigate the effect of mini-dose dexmedetomidine supplemented analgesia on postoperative sleep quality pattern in patients at high risk of OSA. A pilot randomized, double-blind, placebo-controlled trial. A tertiary university hospital in Beijing, China. One hundred and fifty-two adult patients who had a STOP-Bang score ≥3 and a serum bicarbonate level ≥28 mmol/L and were scheduled for major noncardiac surgery between 29 January 2021 and 20 September 2022. After surgery, patients were provided with high-flow nasal cannula and randomized in a 1:1 ratio to receive self-controlled opioid analgesia supplemented with either mini-dose dexmedetomidine (median 0.02 μg/kg/h) or placebo. We monitored polysomnogram from 9:00 pm to 6:00 am during the first night. Our primary outcome was the percentage of stage 2 non-rapid eye movement (N2) sleep. Secondary and exploratory outcomes included other postoperative sleep structure parameters, sleep-respiratory parameters, and subjective sleep quality (Richards-Campbell Sleep Questionnaire; 0-100 score range, higher score better). All 152 patients were included in intention-to-treat analysis; 123 patients were included in sleep structure analysis. Mini-dose dexmedetomidine supplemented analgesia increased the percentage of stage N2 sleep (median difference, 10%; 95% CI, 1 to 21%; p = 0.029); it also decreased the percentage of stage N1 sleep (median difference, -10%; 95% CI, -20% to -1%; p = 0.042). Other sleep structure and sleep-respiratory parameters did not differ significantly between the two groups. Subjective sleep quality was slightly improved with dexmedetomidine on the night of surgery, but not statistically significant (median difference, 6; 95% CI, 0 to 13; p = 0.060). Adverse events were similar between groups. Among patients at high risk of OSA who underwent noncardiac surgery, mini-dose dexmedetomidine supplemented analgesia may improve sleep quality without increasing adverse events. Clinicaltrials.gov, identifier NCT04608331.

Kidney toxicology of a novel compound Lithium Bis(trifluoromethanesulfonyl)imide (LiTFSI, ie. HQ-115) used in energy applications: An epigenetic perspective

Exposure to emerging energy-based environmental contaminants such as lithium bis(trifluoromethanesulfonyl)imide (LiTFSI, trade name HQ-115), poses a significant threat to human health, yet its impact on kidney function and epigenetic regulation remains poorly understood. Here, we investigated the effects of LiTFSI exposure on kidney-related biochemical indicators, renal injuries, and epigenetic alterations in male CD-1 mice under both 14-day and 30-day exposure durations. Our study revealed that LiTFSI exposure led to changes in kidney-related markers, notably affecting serum bicarbonate levels, while relative kidney weight remained unaffected. Histological analysis revealed tubule dilation, inflammation, and loss of kidney structure in LiTFSI-exposed mice, alongside dysregulated expression of genes associated with inflammation, renal function, and uric acid metabolism. Epigenetic analysis further identified widespread DNA methylation changes in the two exposure regimes. Functional analysis revealed that differentially methylated regions are implicated in cell apoptosis and cancer-related pathways and are enriched with development-related transcription factor binding motifs, suggesting a potential mechanism of action underlying exposure induced kidney damage. These findings underscore the intricate interplay between environmental exposures, epigenetic modulation, and kidney health, emphasizing the need for additional research to unravel precise mechanisms and develop targeted interventions to mitigate the adverse effects of LiTFSI and exposure of similar clean energy compounds on human health.

Investigation of clinical and paraclinical consequences of tramadol poisoning and related factors

Tramadol, is frequently misused and leading to an increase in cases of overdose and poisoning worldwide. This study aimed to investigate the clinical and paraclinical consequences of tramadol poisoning and related factors. This was a retrospective study performed on patients with acute tramadol poisoning who were referred to the Amir Al-Momenin Hospital Emergency Department, Zabol, during 2019-2020. Patients’ socio-demographic information and clinical and paraclinical manifestations were collected in a predesigned checklist. Overall, 71 subjects were included in this study. The mean dose of tramadol was 640.14 ± 521 mg. Seizures occurred in 17 subjects that were not dose-dependent. In patients who died or were in a coma, pH, bicarbonate (HCO3 ), and oxygen saturation (O2 sat) levels decreased, while PCO2 levels increased significantly (P &lt; 0.05). The dose of tramadol used in the poisoning of this substance played no role in the course of the disease and the prognosis of patients, but low pH, HCO3 , O2 sat, and high CO2 pressure could be related to the outcome of these patients.

Association between baseline serum bicarbonate and the risk of postoperative delirium in patients undergoing cardiac surgery in the ICU: a retrospective study from the MIMIC-IV database

BackgroundAlthough serum bicarbonate is a reliable predictor of various disease complications, its relationship with postoperative delirium (POD) remains unclear. Our research aimed to assess the effect of baseline serum bicarbonate levels on the incidence of POD in cardiac surgery patients.MethodsA retrospective analysis was conducted on cardiac surgery patients who met specific inclusion and exclusion criteria, using data from the Marketplace for Information in Critical Care Medicine (MIMIC-IV) database. Univariate and multivariate logistic regression models are employed to explore the correlation between serum bicarbonate levels and the risk of POD, and their predictive efficacy is assessed by means of restricted cubic spline regression models (RCS) and receiver operating characteristic curves (ROC). In addition, subgroup and sensitivity analyses are conducted to test the robustness of the results.ResultsIn this study, 5,422 patients were included, where the incidence of POD was 13.0%. For each 1 mmol/L increase in bicarbonate, a 13% reduction in the risk of POD was observed in the fully adjusted model (OR = 0.87, 95% CI: 0.83–0.91, P < 0.001). The RCS model demonstrated a linear negative correlation between the level of bicarbonate and the risk of POD (P for nonlinearity = 0.987). The ROC curve analysis demonstrated that the bicarbonate level had moderate predictive efficacy (AUC = 0.629). Both subgroup and sensitivity analyses reaffirmed the robustness of these results.ConclusionsLower baseline serum bicarbonate levels in cardiac surgery patients are linked to a higher risk of POD. Monitoring and adjusting serum bicarbonate levels may help identify high-risk patients and potentially improve outcomes.

Dyselectrolytaemia in Acute Stroke Patients, A Study of Hundred Cases in Holy Family Red Crescent Medical College Hospital

Introduction: Stroke is a growing public health concern in low- and middle-income countries. There are many studies on stroke, its associated conditions, and its effect on stroke patients’ outcomes, but few studies on dyselectrolytaemia in stroke patients have been done in our country. This study aimed to highlight the pattern and correlation of dyselectrolytaemia in acute stroke patients of a tertiary care hospital. Methods: This cross-sectional study was conducted in the Department of Medicine, Holy Family Red Crescent Medical College Hospital, from January, 2016 to June, 2016. A total of 100 patients with stroke were selected as study subjects as per inclusion and exclusion criteria. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 20.0 for Windows. The mean values were calculated for continuous variables. The quantitative observations were indicated by frequencies and percentages. The chi-square test with Yates correction was used to analyze the categorical variables. Student t-test was used for continuous variables. P values &lt;0.05 were considered statistically significant. Result: In this study, 31 (31.0%) patients had dyselectrolytaemia. This study shows serum electrolytes of the study patients, it was observed that 17(17.0%) patients had hyponatremia: serum sodium level (&lt;135 mmol/I), 13(13.0%) patients had hypokalaemia serum potassium (&lt;3.5 mmol/l), 16(16.0%) patients had hypochloraemia serum Chloride level (&lt;96 mmol/l) and 11(11.0%) patients had low bicarbonate level (&lt; 24 mmol/I). Conclusion: This study highlights the prevalence of dyselectrolytaemia in acute stroke patients. Among the 100 patients studied, 17% experienced hyponatremia, 13% had hypokalaemia, 16% exhibited hypochloraemia, and 11% had low bicarbonate levels. These findings highlight the importance of routine electrolyte monitoring and prompt management in acute stroke care to prevent complications and improve patient outcomes.

Evaluation of Serum Electrolytes among Geriatric and Non-Geriatric Men in Osisoma, ABA, Nigeria

Background: Ageing is a progressive development associated with a decline in the physiological functions, which increases susceptibility to organ dysfunction (especially the kidney) in geriatrics. This facilitates the risk of electrolyte imbalance, as the kidneys play a crucial role in maintaining these electrolyte concentration. Aim: This was a cross-sectional study designed to evaluate serum sodium ( ), potassium ( ), chloride ( ), and bicarbonate ( ) levels, and understand their prevalence among apparently healthy geriatric and non-geriatric men residing in Osisoma, Aba. Methodology: A total of 100 apparently healthy participants were enrolled for this study, comprising of 50 geriatric men aged 65 years and above, and 50 non-geriatric men aged 20-30 years. From both groups, serum samples were used for the analyses of sodium ( ), potassium ( ), chloride ( ), and bicarbonate ( ) using Spectrophotometer. The data obtained was analyzed statistically using Statistical Package for Social Science (SPSS version 25), student’s t-test, one way analysis of variance (ANOVA), pearson correlation coefficient and P values less than 0.05 were considered statistically significant. Results: The mean values of sodium (136.6+3.9mmol/L), potassium (3.9+0.5mmol/L), chloride (100.2+3.9mmol/L) and bicarbonate (24.4+4.3 mmol/L) levels in geriatric subjects showed no statistical significant difference (P &gt; 0.05) when compared to the mean values of sodium (136.9+2.3 mmol/L), potassium (3.9+0.4 mmol/L), chloride (100.8+2.8 mmol/L) and bicarbonate (24.9+3.9 mmol/L) in non-geriatric subjects. The study also revealed a significant difference (P = 0.001) in the mean value of bicarbonate (24.8+4.3 mmol/L; 25.8+1.9mmol/L, and 18.1 +3.3 mmol/L) among geriatric subjects, when compared based on age range using ANOVA. There was a significant negative correlation between the ages and bicarbonate levels (r = -0.4, P = 0.008), a non-significant positive correlation between ages and sodium levels (r = 0.1, P = 0.498), and chloride levels (r = 0.2, P = 0.125), and a non-significant negative correlation between the ages and potassium levels (r = -0.1, P = 0.691) in geriatric subjects. Conclusion: The result from this study showed no significant alteration of serum electrolytes between geriatric and non-geriatric subjects, and a significant alteration of bicarbonate levels among the geriatric subjects. This present study has shown that ageing without any comorbidities has lesser effect on serum electrolytes.

Assessment of the Potential Mechanisms of Anti-diarrhoeal Activities of Ethanol Extract of Monoon longifolium Leave in Wistar Rat

Background: Numerous diseases related to diarrhea are the primary cause of morbidity and mortality in underdeveloped countries, accounting for hundreds of thousands of deaths annually. Polyalthia longifolia, the false ashoka, commonly referred to as Monoon longifolium is a tree species from Asia. It is commonly found in southern india, Sri Lanka and Nigeria. Polyalthia longifolia has been utilized for decades to treat an extensive variety of illnesses, including diarrhea. Method: The plant was extracted with ethanol using cold maceration. Preliminary qualitative and quantitative phytochemical screening of ethanol extract of Polyalthia longifolia leaf was conducted using the techniquees of Harbone (1998); Trease and Evans (1978). The Lorke (1983) approach was used to calculate the Median Lethal Dose (LD50). Diarrhea caused by castor oil was produced using the Awouter et al., 1973 method. The testing for gastrointestinal transit was conducted using the Mascolo et al. (1996) technique. The Tietz (1994) method was used to conduct the electrolyte levels assay. The assay for kidney function indicators was conducted using Bartels and Bohmer's (1972) methodology. Results: The results of phytochemical screening showed that alkaloids and tannins occurred in high concentration, flavonoids and steroids occurred in moderate concentration, whereas terpenoids, glycosides and phenolic acid occurred in lowest concentration. The acute toxicity study revealed that the plant extract was not toxic even at the dose of 5000 mg/kg. Groups treated with 200,400, and 600 mg/kg b.w of extract showed significant (P &lt; 0.05) inhibition in the frequency of defecation of wet feces and total fecal output compared with positive control. Similarly, Groups treated with 200, 400, and 600 mg/kg body weight of extract demonstrated significant (P &lt; 0.05) antimotility activity when compared with the positive control. However, groups treated with 200,400 and 600mg/kg body weight showed a significant (P &lt; 0.05) increase in chlorine and sodium with corresponding decrease in bicarbonate and potassium level when compared with the positive control. The results from kidney function markers showed that groups treated with 200, 400 and 600 mg/kg b.w in a dose dependent manner showed a significant (p &lt; 0.05) reduction in creatine and urea when compared with positive control. Conclusion: The ethanol leaf extract of Polyalthia longifolia has considerable antidiarrheal activity on castor oil-induced diarrhea and gastrointestinal motility models, confirming the reason for its wide use in traditional treatment of diarrheal conditions.

Respiratory Syncytial Virus Infections in Pediatric Intensive Care: Association of Sociodemographic Data and Clinical Outcomes with Viral and Bacterial Co-infections.

The aim of the study was to evaluate respiratory syncytial virus (RSV) infections in cases followed in the pediatric intensive care unit (PICU). The study was designed as a prospective cohort in 6 PICUs. There were 3 groups: only RSV (+), RSV (v+) who were positive for another viral agent(s) in addition to RSV, and RSV (b+) who were positive for a bacterial agent(s) in addition to RSV. A total of 119 cases were included in the study, 67 (56.3%) of whom were male. The RSV (+) group had a lower pH compared to the other groups and a higher rate of acute bronc hiolitis/bronchitis diagnoses compared to the RSV (v+) group. The RSV (v+) group had higher bicarbonate levels, higher creatinine levels, longer hospital stays, and higher Pediatric Risk of Mortality-3 scores (PRISM-3) compared to the RSV (+) group. Cases with RSV (b+) were younger and also had lower body weight compared to the other groups. Furthermore, the RSV (b+) group had higher C-reactive protein and Procalcitonin (PCT) levels and higher rates of High Flow Nasal Cannula-Oxygen Therapy (HFNC-OT) use. Multiple linear regression analysis revealed that PRISM-3 score, PCT levels, Pediatric Acute Respiratory Distress Syndrome diagnoses, inhaled steroid use, chronic illness status, and heart rate on admission were associated with the length of stay in the PICU. High flow nasal cannula-oxygen therapy continues to be the most frequently preferred respiratory support method in RSV infections. Viral infections accompanying RSV can increase the severity of the disease.

A retrospective analysis of the relationship between dermatomyositis‐associated interstitial lung disease and disease duration, age, arterial blood gas pH, and serum Cl− levels

AbstractBackgroundDermatomyositis‐associated interstitial lung disease (DM‐ILD) represents a severe and insidious complication of dermatomyositis (DM). The study aimed to investigate the association between DM‐ILD and arterial blood gas indices, serum ion levels, and the timing of interstitial lung disease onset, with the goal of identifying potential predictors for DM‐ILD.MethodsThe investigation involved the collection of basic data from 89 patients with DM hospitalized at the Chinese PLA General Hospital between January 2019 and April 2022, and 43 normal control patients hospitalized for physical examinations during the same period. Analyses were conducted to explore the relationship between DM‐ILD, arterial blood gas indices, disease duration, and serum ions. A regression model to predict DM‐ILD was developed using these indices, and a receiver operating characteristic curve was generated.ResultsSignificant differences were observed in pH and PaO2 between the control group and the disease group (p &lt; 0.05). The DM group exhibited higher levels of pH, actual bicarbonate, and base excess (BE) compared with the control group. In contrast, pH and BE levels were lower in the DM‐ILD group than in the DM group, with these differences being statistically significant (p &lt; 0.05). Interstitial lung disease was correlated with the duration of the disease and pH levels (p &lt; 0.05). The cutoff values for age, disease duration, pH, and Cl− were 55.5 years, 5.5 years, 7.432, and 101.5 mmol/L, respectively. The model demonstrated a prediction sensitivity and specificity for DM‐ILD of 0.809 and 0.722, respectively, with an area under the curve of 0.809.ConclusionArterial blood gas analysis and serum Cl− levels may assist in predicting DM‐ILD. A combined monitoring approach involving arterial blood gas pH, disease duration, age, and serum Cl− levels could enhance the accuracy of DM‐ILD predictions and hold significant clinical evaluation potential.

Effects of intravenous sodium thiosulfate on vascular calcification in dialysis patients with end-stage renal disease: a systematic review and meta-analysis.

In dialysis patients, vascular calcification is a common complication and is closely related to the morbidity and mortality of cardiovascular disease. We performed a systematic review to determine the efficacy and safety of sodium thiosulfate (STS) in the progression of vascular calcification in dialysis patients with end-stage renal disease. The PubMed, Web of Science, Embase, Cochrane Library, Wanfang, CNKI, China Biology Medicine disc and Weipu databases were searched up to 9 March 2022 for clinical trials to synthesise findings on the efficacy and safety of STS in the progression of vascular calcification in dialysis patients. The primary outcome was coronary artery calcification scores (CACS) or abdominal aortic calcification scores (AACS) or Kauppila index. The secondary outcome was pulse-wave velocity (PWV). Laboratory data were shown in safety data. A random-effect model was used to provide the summary measures of effect [standardised mean difference (SMD) and 95% confidence interval (CI)]. Seven randomised, controlled trials and one nonrandomised, controlled trial involving 370 patients were included. Six studies reported that the progression of CACS or AACS was slower in the intravenous STS group compared with the control group (SMD -3.24, 95% CI: -5.29, -1.18, p = 0.002). Two studies showed the increase in PWV was less in the STS group compared with the control group (SMD -0.52, 95% CI: -0.92, -0.13, p = 0.009). During the trial period, a lower high-sensitivity C-reactive protein level (SMD 1.61, 95% CI: 0.19, 3.04, p = 0.03), a decrease in serum bicarbonate level (SMD 0.67, 95% CI: 0.22, 1.11, p = 0.003) and an increase in serum phosphate level (SMD -0.32, 95% CI: -0.62, -0.03, p = 0.03) were noted in the intravenous STS group compared with the control group. However, serum calcium and parathyroid hormone levels showed no difference between the two groups after the trials. The most common adverse events were temporary nausea and vomiting, which occurred in 12.5 to 75% of patients. Intravenous STS may slow down the progression of vascular calcification and ameliorate arterial stiffness in dialysis patients. Reliably defining the efficacy and safety of intravenous STS in attenuating the progression of vascular calcification requires a high-quality trial with a large sample size.