Blood Electrolytes Research Articles

Consumption of a Branched-Chain Amino Acids-Containing Sports Beverage During 21 km of Running Reduces Dehydration, Lowers Muscle Damage, and Prevents a Decline in Lower Limb Strength

Objectives: The purpose of this study was to examine the acute effects of branched-chain amino acids (BCAAs)-containing electrolyte beverage (AE) on water–electrolyte balance, muscle damage, time to finish the final 5 km, and muscle strength compared to a standard commercially available carbohydrate–electrolyte sports beverage (CE), pure water (W), and no rehydration (N). Methods: Fourteen trained male participants (20 ± 2 years old) completed four randomized 21 km running trials. The participants were instructed to consume their drink (150 mL W, 150 mL CE, or 150 mL AE) or no rehydration (N) at 5 km, 10 km, and 15 km. Body mass and muscle strength were assessed, and blood samples were collected before and after exercise. Perceptual scales were administered during and after running. Blood electrolyte levels (sodium, potassium, and chloride) and creatine kinase (CK) concentration were analyzed. Results: The change in plasma volume with AE was significantly smaller than that with N (p < 0.05). Consuming AE maintained the best potassium balance (p < 0.05). Twenty-four hours after exercise, serum CK concentrations significantly elevated in N, W, and CE (p < 0.05), but did not reach statistical significance in the AE group (p > 0.05). Compared to N, consuming AE resulted in significantly less soreness 24 h after exercise (p < 0.05). There was no difference in time to finish the final 5 km (p > 0.05). Maximal voluntary isometric force output was significantly lower after exercise with N and W (p < 0.05) but not with CE or AE (p > 0.05). Conclusions: Consuming a BCAAs-containing sports beverage during a 21 km run can help reduce dehydration, maintain potassium balance, lower muscle damage, and prevent the decline in lower limb strength after 21 km running.

Effects of a synergic interaction between magnesium sulphate and ketamine on the perioperative nociception in dogs undergoing tibial plateau leveling osteotomy: a pilot study

IntroductionMagnesium Sulphate (MgSO4) is commonly used in human medicine for the management of perioperative pain in different types of procedures. However, in veterinary medicine, the use of MgSO4 has not been evaluated for its analgesic efficacy in dogs, which has generated conflicts of opinion in this area of veterinary anesthesiology. The aim of this study was to evaluate the perioperative analgesic efficacy of MgSO4 in combination with Ketamine in dogs undergoing Tibial Plateau Leveling Osteotomy (TPLO). Our hypothesis is that MgSO4 plus ketamine have a synergistic action in the management of intra-and postoperative pain.MethodsTwenty adult mixed breed dogs with average age 5.9 ± 2.6 years and weight 27.8 ± 9.2 kg were included in this prospective, clinical, randomized study. Dogs were randomly assigned to two groups. The MK group received ketamine (0.5 mg/kg as starting bolus followed by continuous infusion rate at 1 mg/kg/h). At the end of the ketamine bolus, MgSO4 (50 mg/kg over 15 min) was administered by the same route, followed by a constant rate infusion (CRI) at 15 mg/kg/h, IV. K group received a bolus of ketamine followed by a CRI at the same dosage described in MK group. Main cardiorespiratory parameters were recorded 10 min before the start of surgery (BASE), after the ketamine bolus (T1) and the MgSO4 bolus (T2), during the skin incision (SKIN), the osteotomy (OSTEOTOMY) and skin suturing (SUTURE). In the postoperative period, the short form of Glasgow Composite Pain scale (SF-CMPS) was used to assess pain at 30, 60, 120, and 180 min after extubation (Post30, Post60, Post120, and Post180, respectively). The main blood electrolytes (Mg2+, Ca2+, Na+, K+) were analyzed at BASE, T2, OSTEOTOMY, SUTURE and T3 (one hour after stopping MgSO4 infusion). Number of rescue analgesia and administration times were recorded both in the intra-and postoperative period.ResultsIn K group 7 out of 10 dogs required intraoperatory rescue analgesia compared to MK group (3/10). Furthermore, mean arterial pressure (MAP) and heart rate (HR) were significantly higher at OSTEOTOMY compared to BASE time in both groups. In the postoperative period, at T120, ICMPS-SF score was higher in K group than MK group.ConclusionThe administration of MgSO4 could guarantee better analgesia in the perioperative period in dogs undergoing TPLO, performing a synergistic action with ketamine.

"TRATAMENTO DA CETOACIDOSE DIABÉTICA NA UNIDADE DE TERAPIA INTENSIVA"

Introduction: Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes caused by a lack of insulin, leading to hyperglycemia and acidosis. Factors such as infections and poor insulin administration can trigger it, and its urgent treatment in the ICU involves fluid replacement, intravenous insulin, and control of complications. Methodology: This article is a literature review on the treatment of diabetic ketoacidosis in the ICU, based on studies from the last 10 years available in English and Portuguese in the PubMed, SciELO, and BVS databases. Complete and free articles were included, excluding those that did not directly address the topic. Results and Discussion: The treatment of diabetic ketoacidosis (DKA) in the ICU follows protocols to quickly correct metabolic and hemodynamic alterations. Initial replacement of isotonic fluids treats severe dehydration and improves tissue perfusion. Low-dose intravenous insulin corrects ketosis and hyperglycemia, but should be adjusted accordingly, with potassium levels also need to be monitored and replaced. Continuous monitoring of blood glucose and electrolytes is crucial to avoid complications such as cerebral edema. Identifying and treating the underlying cause of DKA, such as infections, is essential to prevent recurrences. Conclusion: The treatment of diabetic ketoacidosis in the ICU is mainly based on rapid fluid replacement, controlled insulin administration, and continuous monitoring. Potassium management and identification of the cause are essential to prevent recurrences and improve prognosis, with the ICU being the ideal setting for intensive care and reducing mortality.

Immunological and Biochemistry Comparative Studies of COVID-19, Vaccinated, and Healthy Individuals

Insufficient information on the immune response to the Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2), an essential component in developing effective vaccines and therapies, is a critical issue. Consequently, establishing clinical methods for evaluating immune responses to the SARS-CoV-2 virus and validating the direct participation of the parameters in the development of adaptive immune responses are necessary. Furthermore, a comprehensive guide to the diseases caused by the novel SARS-CoV-2 coronavirus is critical. Employing universal and non-specific early cytokines, specifically, interferon-gamma (IFN-γ) in immune clinics during immune response assessments, presents potential in several respects. IFN-gamma promotes the production of other antiviral molecules and stimulates immune system responses against the virus. Nonetheless, reports indicated that some individuals with severe COVID-19 exhibited impaired IFN-gamma production, which might contribute to the severity of the illness. Enhancing IFN-gamma synthesis or exogenous IFN-gamma therapy has demonstrated potential as a COVID-19 treatment approach. Significant IL-6 levels are associated with cytokine storm progression, which denotes excessive and uncontrolled immune responses that could lead to tissue damage. Targeting IL-6 with specific inhibitors, such as monoclonal antibodies, could reduce COVID-19 severity in certain patients. The results obtained in this study indicated that blood electrolytes and immune variable levels (interleukin 6 and IFN-gamma) were significantly different among the infected, vaccinated, and control groups.

Impact of temperature humidity index (THI) on blood gas and electrolytes of dairy cows in late gestation

The study was carried out to assess the impact of heat stress on dairy cows in late gestation and their newborn calves. Study was conducted in two phases in crossbred cattle during last trimester of pregnancy, maintained in University Livestock Farm and Fodder Research Development Scheme, Mannuthy, KVASU. December to February with minimum THI was taken as season 1 and March to May with maximum THI as season 2 of the study. Microclimatic data in the animal shed was recorded three times at three days intervals. The ambient temperature, relative humidity and THI obtained during season 2 was significantly (p<0.01) higher than season 1 in both macro and microclimatic data. Partial pressure of carbon dioxide (pCO2 ) was low in season 2 but there was no significant difference in potassium (K+), sodium (Na+), bicarbonate (HCO3 - ) and partial pressure of oxygen (pO2 ) between the seasons. Keywords: Heat stress in cattle, THI, blood gases, electrolytes, late gestation

Epidemiology and clinical characteristics of acute viral gastroenteritis in 350 paediatric patients hospitalised between 2019 and 2022 in the Military Institute of Medicine – National Research Institute in Warsaw, Poland: a single-centre retrospective analysis

Introduction and objective: Acute gastroenteritis, a common childhood illness worldwide, manifests with symptoms including fever, abdominal pain, vomiting, and diarrhoea. It is highly contagious, with transmission occurring through contaminated water, food, or poor hygiene. Globally, 1.7 billion cases of diarrhoeal diseases are diagnosed annually, causing approximately 525,000 deaths among children under the age of five. Dehydration caused by diarrhoea is a primary cause of hospitalisation, particularly in developing countries. Aim: Analysis of the aetiology, frequency, and seasonal distribution of viral pathogens responsible for acute gastroenteritis in children hospitalised between 2019 and 2022 at the Military Institute of Medicine – National Research Institute in Warsaw, Poland. Materials and methods: Medical records of patients aged 0 to 18 diagnosed with rotavirus, norovirus, and adenovirus-induced acute gastroenteritis were analysed. The pathogens had been identified with reliable immunochromatographic tests. Exclusion criteria encompassed bacterial infections, dietary errors, and inflammatory conditions. Data examined included age, gender, aetiology of gastroenteritis, seasonality, duration of hospitalisation, and clinical symptoms (diarrhoea, vomiting, fever, abdominal pain, and dehydration). Laboratory results such as white blood cell count, C-reactive protein, electrolyte levels, and organ function markers were also evaluated. Results: Data from 350 children hospitalised between 2019 and 2022 were analysed. The highest number of hospitalisations occurred in 2019 and 2022, with fewer cases in 2020–2021, likely reflecting the impact of the COVID-19 pandemic. Most patients were between 6 and 12 months old. Rotavirus infection commonly presented with fever, vomiting, diarrhoea, and dehydration. Adenovirus and mixed infections were associated with slightly higher C-reactive protein levels, while rotavirus infections showed mildly elevated aspartate aminotransferase levels. Haematocrit, blood urea nitrogen, creatinine, and electrolyte levels were similar across all cases. Conclusions: Our analysis showed that rotavirus was the most frequent cause of acute viral diarrhoea in children, followed by norovirus and adenovirus, with mixed infections being the least common. The peak incidence occurred in autumn and winter, except in 2021, reflecting changes in the dynamics of infections related to the coronavirus pandemic. Biochemical findings were not sufficiently characteristic to infer the aetiology of the disease.

Androgen Deficiency, Associations and Survival of Men With Stage 4 and 5 Chronic Kidney Disease: A Cohort Study.

Anaemia is a key cause of morbidity in chronic kidney disease (CKD). Androgen deficiency (AD) in males can contribute to anaemia of all causes, including in CKD. We sought to examine the prevalence of AD in men with CKD, the extent to which it contributed to anaemia and whether it was independently associated with long-term survival. This cross-sectional observational study was conducted among males aged 18 years and over with CKD stages 4 and 5. The study analysed morning blood samples with regard to their full blood count, urea and electrolytes, albumin, lipids, testosterone (T) and sex hormone binding globulin, with calculation of free testosterone by mass action equation. Mortality data were obtained 15 years later for survival analysis. Among 322 patients with a mean age of 63 years, the overall prevalence of AD was 68.9%. There was a statistically significant negative correlation between erythropoiesis stimulating agent (ESA) dose and testosterone concentrations (Pearson correlation -0.193, p = 0.05). There was a positive correlation between haemoglobin (Hb) and free testosterone level among patients not on ESA therapy (Pearson correlation 0.331, p < 0.001). Kaplan-Meier plots showed p < 0.001 on log-rank analysis, indicating that AD was significantly associated with worse survival. However, in Cox regression analysis, free testosterone was not associated with survival (95% CI for free testosterone 0.997-1.000). AD is highly prevalent among this population, and increases further with older age and more severe CKD warranting haemodialysis. Association of lower Hb and higher ESA dose with lower T concentration might be causative, which has important pharmaco-economic as well as clinical implications. Lower survival in men with low T, more likely reflects overall poor health rather than causation. A properly constituted randomised controlled study evaluating the effect of native T replacement is warranted in men with CKD and AD.

6849 Insulin Edema in newly diagnosed T1DM Pediatric Patient

Abstract Disclosure: A. Ansar: None. K. McNerney: None. Background: Insulin edema is a rare complication of insulin therapy, especially in the pediatric populations. The pathogenesis is not fully understood but has been linked to Insulin’s role in renal sodium handling and vascular permeability. It has been seen with the initiation of insulin in newly diagnosed patients or the intensification of insulin therapy in those with poor glycemic control.Clinical Case: A previously healthy 12 year old girl presented to the ED with polyuria, polydipsia and fatigue. She was alert and oriented but had kussmaul breathing. She was tachycardic but all other vitals were appropriate. Lab work up showed that she was in DKA with pH 7.07 and bicarbonate 7 mmol/L. Her corrected sodium and electrolytes were normal. Her HbA1C was elevated at 11.7% (4.0-5.6%). Initial fluid resuscitation was performed with 20 mL/kg NS fluids. She was transferred to our Pediatric ICU and was started on the DKA protocol consisting of intravenous insulin infusion at 0.1 unit/kg per hour and 2-bags of dextrose and non-dextrose containing intravenous fluids. She was given a new diagnosis of Type 1 Diabetes. She was transitioned to subcutaneous insulin 22 hours later with multiple daily injections with insulin lispro and glargine, with total dose of insulin at 0.7 unit/kg per day. She was transferred to the general care floor and received diabetes education while in the hospital. On the fifth day after discharge, patient started complaining of leg tightness, puffiness around her eyes and generalized swelling of both feet. She returned to the ED, where she was found to be hemodynamically stable and normotensive with a blood pressure of 113/54 mmHg. Her weight had increased 8.8 kg from the weight at discharge. Her physical exam was notable facial and bilateral periorbital edema, abdominal distension, and 2+ bilateral non-pitting non-tender edema of both legs extending to her medial malleolus. Neurologic exam was performed which was unremarkable. Work up was performed to rule out other causes of edema, including a complete blood count, electrolytes, kidney and liver function tests, all of which were normal. She received 20 mg of furosemide and was instructed to perform fluid restriction to 1 L/m2/day and sodium restriction to &amp;lt;2 grams per day at home. She followed up in clinic 3 days after her ED visit where her weight had decreased by 4.2 kg and her edema had mostly resolved with only 1+ bilateral non-pitting edema. Her total dose of insulin remained at 0.7 unit/kg per day, with acceptable blood glucose levels at home. Her fluid restriction was discontinued and patient was instructed to follow up as usual, and she had no further edema in follow-up. Conclusion: This was a rare case of a newly diagnosed pediatric patient presenting with Insulin edema, which is essential for clinicians to recognize, so they can identify patients presenting with this uncommon side effect to rule out conditions that may present in a similar manner. Presentation: 6/2/2024

A-343 Novel In-Line Hemolysis Detection on a Blood Gas Analyzer for Capillary Samples

Abstract Background Point-of-care (POC) blood gas and electrolyte analyzers utilizing whole blood as the predominant sample type are blinded by the presence of hemolysis until today. Moreover, capillary samples are particularly vulnerable to in-vitro hemolysis due to excessive force applied during sample collection. Here, we introduce the GEM Premier 7000 with iQM3 (GEM 7000) which incorporates automatic, in-line hemolysis detection in capillary blood gas samples without a need for additional sample volume or reagents. Methods The hemolysis detection module which is integrated into the disposable GEM cartridge uses acoustophoretic technology and photometric measurements to detect hemolysis in whole blood. In GEM 7000, hemolysis of ≥ 116 mg/dL was found to have significant interference with potassium results. A hemolysis flag is presented as the degree of hemolysis: none (0 - 50 and 51 - 115), mild (116 - 200 and 201 - 300), moderate (301 - 400), and gross (≥401). Due to volume limitations with native capillary samples and challenges in assessing hemolysis levels with a comparator assay, venous blood spiked volumetrically with hemolysate and transferred to capillary devices was used to verify the hemolysis flag performance. An agreement analysis was performed using the Roche cobas hemolysis value. The device's (GEM 7000) ability to flag hemolyzed capillary samples is demonstrated in a simulated clinical setting using native and contrived fingerstick capillary samples. Results Hemolysis verification with transferred capillary samples demonstrated that 98.2% (274/279) of samples were correctly flagged based on the cobas hemolysis value of spiked hemoglobin. Hemolysis in the native capillary samples (N = 235) was primarily distributed in the 0-50 mg/dL range. Additionally, native capillary samples altered using vigorous flea mixing (&amp;gt; 1 minute) showed hemolysis distribution over a wide hemolysis degree (none to gross), and their potassium results were flagged accordingly. Conclusions By providing integrated hemolysis detection in capillary blood sample measurements, the GEM Premier 7000 with iQM3 system can provide quality and confidence in the clinical interpretation of critical results such as potassium.

A-358 Extended linearity studies for pO2, pCO2, K+ Cl- on GEM 5000 blood gas analyzers using a combination of verification materials

Abstract Background Blood gas analyzers (BGA) measure blood gases pO2,pCO2,O2Hb,COHb,MetHb, and several analytes in the workup and management of acid-base disorders. GEM 5000 BGA (Instrumentation Laboratory, a Werfen Company) have very broad reportable ranges for the measured analytes. However, manufacturer’s current linearity materials do not cover the entire reportable ranges claims. This poses challenge to clinical laboratories, especially for pO2 and pCO2 to comply with College of American Pathologists (CAP) requirements to verify instruments performance every six months through the entire reportable range. We evaluated secondary materials in combination with manufacturer’s primary linearity materials for pO2, pCO2, K+ and Cl- for an extended linearity verification. Methods Routine linearity studies was performed with PVP (5-levels), a primary material provided by the GEM 5000 analyzer manufacturer. Hypoxic (pO2: 5-25mmHg) and hyperbaric (pO2: 600-670mmHg) materials obtained from Eurotrol Inc. and VK-R5 linearity material (Radiometer America Inc.) for pCO2, K+ and Cl- were processed on GEM 5000. All materials at all levels were assayed in duplicate. Results from PVP, Eurotrol and VK-R5 were combined from low to high levels to assess linearity verification. Results Linearity range of 15-630mmHg with r2=0.99 was verified for pO2. Using a combination of VK-R5 with PVP, a linearity range of 14-127 mmHg (r2=0.99) for pCO2, 1.1-14.1 mmol/L (r2=1.00) for K+, and 51-153 mmol/L (r2=1.00) for Cl-were verified. See table for details. Conclusions A combination of BGA manufacturer’s primary linearity material with secondary vendors material was useful in addressing linearity verification for blood gases pO2, pCO2, and electrolytes K+Cl- over an extended range close to the manufacturer’s claims. We recommend other laboratories that experience similar BGA linearity verification challenges to consider this approach for verification of the manufacturer’s claims. It would have been very helpful if manufacturer can provide materials that cover both the lower and upper limits of their claims.

Characterization of a novel variant in KCNJ16, encoding Kir5.1 channel.

The essential role of the inwardly rectifying potassium channel Kir5.1 (KCNJ16) in controlling electrolyte homeostasis and blood pressure has been demonstrated in human and animal studies. Previous studies have identified several bi-allelic mutations of KCNJ16 in humans, causing severe hypokalemia, renal salt wasting, and disturbed acid-base homeostasis. Here, we identified a novel homozygous variant of KCNJ16, I26T, in an Amish patient affected with polydipsia, developmental delay, and chronic metabolic acidosis with low serum bicarbonate concentration. Subsequently, we generated the rat model with I26T mutation using Dahl salt-sensitive rat (I26T rat) to characterize this variant. The male mutant rats displayed similar blood pressure and electrolyte homeostasis under baseline and with a high salt (4% NaCl) challenge. Blood pH, HCO3 - and renal damage also remained similar between WT and I26T rats after high salt challenge. Additionally, single-channel patch clamp analysis revealed similar channel activity in CHO cells overexpressed with WT and I26T mutant Kir4.1/5.1 channels. In summary, this study reported a novel variant in KCNJ16, namely I26T, which is likely a benign variant and not associated with pathologic phenotype in either human or Dahl salt-sensitive rats, indicating that the type/location of variant should be considered when diagnosing and treating patients with KCNJ16 mutations.

A single-center, double-blind, randomized, placebo-controlled, two-arm study to evaluate the safety and efficacy of once-weekly sirolimus (rapamycin) on muscle strength and endurance in older adults following a 13-week exercise program

BackgroundAging leads to a decline in muscle mass and strength, contributing to frailty and decreased quality of life. Sirolimus (rapamycin) , an mTOR inhibitor, has shown potential in preclinical studies to extend lifespan and improve health span. This study evaluates the safety and efficacy of once-weekly sirolimus (rapamycin) administration on muscle strength and endurance in older adults engaged in a 13-week exercise program.MethodsThis randomized, double-blind, placebo-controlled trial will enroll 40 participants aged 65–85. Participants will be randomly assigned to receive either sirolimus (rapamycin) 6 mg/week or placebo for 13 weeks, in conjunction with an at-home exercise program. The primary outcome measure is the change in muscle strength and endurance, assessed by the 30-Second Chair-Stand Test. Secondary outcome measures include adverse events, changes in muscle strength and endurance as measured by the 6-min walk test, handgrip strength, and participant-reported outcomes using the SF-36 survey. Assessments will be conducted at baseline, mid-intervention (week 6), and post-intervention (week 13). Blood samples will be collected for hematology and biochemistry analyses, including full blood count, urea and electrolytes, liver function tests, HbA1c, lipids, serum IGF-1, and hs-CRP. DNA methylation will be analyzed using TruDiagnostic™ to explore changes in biological age.DiscussionThis study aims to provide insights into the potential benefits of intermittent sirolimus (rapamycin) administration on muscle performance in older adults. By alternating periods of mTOR inhibition through rapamycin and activation via exercise, this study will explore a novel approach to enhancing muscle strength and endurance in the aging population. The results could have significant implications for developing interventions to improve physical function and overall health outcomes in older adults. Safety and tolerability will also be closely monitored to ensure the feasibility of this regimen for wider application.Trial registrationAustralia New Zealand Clinical Trials Registry, ACTRN12624000790549. Registered on 26 June 2024 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12624000790549.

Effects of Heat Stress on Growth Performance, Physiological Responses, and Carcass Traits in Broilers

High environmental temperatures lead to metabolic changes, body weight reduction, and high mortality in chickens, affecting poultry production worldwide. This study aimed to evaluate the effects of heat stress, assessed by the temperature–humidity index (THI), on the growth performance, physiological response, carcasses, and hematological traits of broilers. A total of 200 broilers (between 17 and 31 days old) were kept in thermoneutral conditions (21 °C; 60% relative humidity, RH) for 3 days during the adaptation period, followed by 14 days of exposure to the experimental treatments. The broilers were randomly assigned to 4 groups of equal size and raised in a temperature–humidity controlled chamber with THI ranging from 67 (21 °C; RH 60%) to 84 (33 °C; RH 60%). In boilers subjected to severe heat stress (THI 84), feed intake (-30%) and body weight gain (-51%) were decreased (P<0.05) in comparison with the performance parameters of broilers under thermoneutral conditions (THI 67). Moreover, under heat stress, the respiration rate and rectal temperature significantly increased (P<0.05), whereas blood parameters showed reduced levels of red blood cells, hemoglobin, white blood cells, lymphocytes, and electrolytes (K+, Na+). Regarding carcass traits, differences were observed in broilers exposed to severe heat stress, particularly in the reduction of the bursa of Fabricius as an immune organ growth index (P<0.05). This study shows that severe heat stress, as revealed by the high THI levels, alters the physiological reactions and metabolic processes of broiler chickens, leading to negative effects on their growth.

The potential of heavily doped n-type silicon in plasmonic sensors

In this paper, we introduce a CMOS-compatible H-shaped plasmonic sensor with a silicon-insulator-silicon (SIS) configuration, utilizing highly doped n-type silicon as an alternative to traditional plasmonic materials like silver and gold. By employing precise carrier concentrations, we tune both the real and imaginary parts of permittivity, enabling the negative real permittivity required for efficient surface plasmon polariton (SPP) propagation. Our findings reveal a significant correlation between silicon doping concentration and sensitivity, highlighting the optimization potential of n-type silicon for advanced plasmonic applications. Through Finite Element Method (FEM) optimization, the sensor achieved a peak sensitivity of 5841.43 nm/RIU and a FOM of 23.8426. The sensor’s capabilities extend to temperature sensing with PDMS and ethanol, blood electrolyte detection for sodium and potassium, chemical detection, and magnetic field sensing. By utilizing minute changes in resonant wavelength through SPPs and SIS structures, our approach underscores n-type silicon’s potential in advancing plasmonic sensor technology.

Sodium bicarbonate - known medication, new prospects?

Critical conditions frequently involve disturbances in blood gas analysis and electrolyte imbalances. Sodium bicarbonate has seen expanded medical use in recent years. The European Resuscitation Council (ERC) Guidelines endorse sodium bicarbonate for hyperkalemia, malignant hyperthermia, and specific drug intoxications. Its potential roles in treating intracranial hypertension and symptomatic hyponatremia are also being explored. However, its application in emergency departments (ED) remains inconsistent, particularly in profound metabolic acidosis cases. We conducted a review of sodium bicarbonate’s therapeutic uses. The evolving understanding of sodium bicarbonate's role in emergency medicine and intensive care highlights both its potential applications and associated risks. While not universally beneficial, especially in lactic acidosis, it may aid specific patient subgroups, such as those with acute kidney injury. Its use in hyperkalemia, intracranial hypertension and diabetic ketoacidosis (DKA) also presents mixed results, with potential benefits in particular contexts. Further large-scale, randomized controlled trials are needed to develop precise guidelines, ensuring its safe and effective use tailored to individual patient needs.

Acid–base and electrolyte changes in dogs after packed red blood cell transfusion

AbstractBackgroundPacked RBC (pRBC) transfusions are often necessary to enhance organ perfusion and tissue oxygenation in cases of severe anemia.ObjectivesWe aimed to describe changes in acid–base and biochemical parameters in dogs after transfusion of pRBC and potential effects on the outcome.MethodsThe prospective observational study included anemic dogs requiring pRBC transfusions. Venous blood gas and electrolytes were measured pre‐transfusion and repeated within 1 h post‐transfusion. Signalment, pre‐existing conditions and underlying disease(s), number of days spent of hospitalization, the quantity of transfused pRBC units, and the outcome were also recorded. Associations between analytical values and all other parameters before and after transfusion were assessed using the Wilcoxon test. A generalized linear model was generated for each of the blood gas parameters post‐transfusion, including the pre‐transfusion values and the characteristics of the animal as fixed effects. The effect of the blood gas parameters on the mortality and hospitalization length was assessed using logistic regression and generalized linear models, respectively.ResultsTwenty‐six dogs with different causes of anemia were included in the study, with dogs remaining hospitalized for a median of 3 days (range: 0–11). Pre‐transfusion heart rate, respiratory rate, Angap, base excess, and lactate were higher than post‐transfusion values. Post‐transfusion results showed an increase in hematocrit, hemoglobin, HCO3‐, PCO2, tCO2, and chloride. Pre‐transfusion hypophosphatemia and receiving an increased volume of transfused pRBC were associated with a longer hospital stay, while higher pre‐transfusion lactate values were associated with higher mortality.ConclusionspRBC transfusion in anemic dogs was associated with an improvement in perfusion and acid–base parameters. Pre‐transfusion lactate may be an indicator of mortality in dogs.

Perioperative Complications in Percutaneous Nephrolithotomy: Predictive Risk Factors and Hemodynamic Alterations.

Background Percutaneous nephrolithotomy (PCNL) is one of the most frequently used methods of treating large and/or complex kidney stones. Despite the growing interest in this area, there are relatively few papers that report studies of the changes in hemodynamics in the perioperative period and the potential factors that might influence the patient's condition. This aspect, however, has not been well described in the current literature, although fluctuations in blood pressure, temperature, and electrolyte balance during surgery may also lead to development of complications. Objectives In this study, variations in vital signs during surgery and between surgeries of 134 patients who underwent PCNLwere analyzed in relation to other predisposing factors such as hypothermia and the need for blood transfusion. Methods Biochemical data such as systolic blood pressure (SBP) and diastolic blood pressure (DBP), temperature, hemoglobin (Hb), hematocrit (Hct), and serum sodium and potassium were assessed at admission, during PCNL, and at 24 hours after surgery in 134 patients. In this study logistic regression was used to assess the influence of factors such as age, BMI (body mass index), surgery duration, volume of irrigation fluid, number of tracts, estimated blood loss, hypothermia, and requirement of red blood cell transfusions. Results The mean arterial pressure declined during surgery as compared to the preoperative value, reaching a value of 97.34 during the operation. The monitored mean temperature of the patient during the perioperative period was therefore reduced, with a small increase towards the end of the surgery. In the plasma concentrations, there was a decrease compared to pre- and postoperative values, and there was also a decline in 48-hour Hb, Hct, and sodium values. The analysis identified the volume of irrigation fluid as a predictor of mild hypothermia risk. A longer surgery time along with more tracts and worse condition of the patient meant that the patient needed more blood transfusion. It was also noted that none of them influenced the amount of Hb that was lost. Conclusion Variability in the recorded ABCs (airway, breathing, and circulation) before and after PCNL procedures was normative. Despite hypothermia being associated with the volume of irrigation fluids used in surgeries, most of the transfusions were administered in patient-complicated operations and critical states. This suggested that there was potential in defining the modifiable factors that worsen clinically reported outcomes to assist in enhancing protocol.

Inhibition of WNK Kinases in NK Cells Disrupts Cellular Osmoregulation and Control of Tumor Metastasis

Introduction: The serine/threonine with-no-lysine (WNK) kinase family function in blood pressure control, electrolyte homeostasis, and cellular osmoregulation. These kinases and their downstream effectors are considered promising therapeutic targets in hypertension and stroke. However, the role of WNK kinases in immune cells remains poorly understood. Methods: Using the small-molecule WNK kinase inhibitors WNK463 and WNK-IN-11, we investigated how WNK kinase inhibition affects natural killer (NK) cell physiology. Results: WNK kinase inhibition with WNK463 or WNK-IN-11 significantly decreased IL-2-activated NK cell volume, motility, and cytolytic activity. Treatment of NK cells with these inhibitors induced autophagy by activating AMPK and inhibiting mTOR signaling. Moreover, WNK kinase inhibition increased phosphorylation of Akt and c-Myc by misaligning activity of activating kinases and inhibitory phosphatases. Treatment of tumor-bearing mice with WNK463 impaired tumor metastasis control by adoptively transferred NK cells. Conclusion: The catalytic activity of WNK kinases has a critical role of multiple aspects of NK cell physiology and their pharmacologic inhibition negatively impacts NK cell function.

Efficacy and safety of long-term treatment with elobixibat in hemodialysis patients with chronic constipation: an observational study

BackgroundConstipation is a common complication in hemodialysis patients and can impact their quality of life. Elobixibat selectively inhibits ileal bile acid transporter to suppress bile acid reabsorption, increase the amount of bile acid entering the colonic lumen, and promote water secretion and colonic motility in the large intestine. While the efficacy and safety of elobixibat in hemodialysis patients up to 12 weeks after administration have been reported, the long-term efficacy and safety of elobixibat in hemodialysis patients with chronic constipation are yet to be elucidated. This study evaluates the efficacy and safety of long-term treatment with elobixibat in hemodialysis patients with chronic constipation.MethodsThis was a single-center observational study. A total of 54 patients who had received elobixibat for at least 24 weeks were enrolled. Data on the frequency of spontaneous bowel movements (SBM), Bristol stool form scale (BSFS), patient satisfaction, constipation scoring system (CSS), interdialytic weight gain, laboratory values including blood electrolyte levels, controlling nutritional status (CONUT) score, and adverse events were collected and retrospectively compared between baseline and the last observation.ResultsLong-term elobixibat treatment in the 54 hemodialysis patients with chronic constipation significantly increased (p < 0.05) the frequency of SBM and mean stool form score assessed as per the BSFS at the last observation (duration of treatment, 24.4 to 240.0 weeks). Patient satisfaction and CSS also improved (p < 0.05). Mean serum phosphorus levels decreased (p < 0.05). The treatment was well tolerated.ConclusionsLong-term treatment with elobixibat maintained good bowel movement status and patient satisfaction in hemodialysis patients with chronic constipation. Improved dialysis-related laboratory levels were also demonstrated.Trial registration: UMIN Clinical Trials Registry, UMIN000049865, 22 December 2022, retrospectively registered.

Abstract P118: Effect of renal denervation on the blood pressure and progression of diabetic kidney disease in T2DN rats

Background: As a common complication of diabetes, diabetic kidney disease (DKD) is a chronic progressive disorder that can lead to kidney failure, and it is currently the leading cause of kidney replacement therapy in the USA and worldwide. Although renal denervation (RDNx) has recently been approved by the FDA to treat hypertension, contradictory findings have been reported on the effect of RDNx on the blood pressure and progression of DKD in type 2 diabetic mellitus. Here, we used type 2 diabetic nephropathy (T2DN) rats, a well-established non-obese model that displays similar renal abnormalities and hyperglycemic levels as seen in humans, to evaluate the effect of RNDx on the blood pressure and progression of DKD. Methods: Bilateral RDNx or sham surgeries were performed on male T2DN rats with mild and severe stages of DN (~20 or &gt;35 weeks old). The blood pressure was monitored chronically using radio telemetry throughout the entire experiment. 24-hr urine collection, glucose tolerance test, and GFR measurement were performed at baseline and at the end of the experiments. Blood and urine electrolytes were measured using a blood gas analyzer. The amount of norepinephrine in the kidney was evaluated by ELISA. Results: Bilateral RNDx were successfully performed on T2DN rats with a significant reduction of norepinephrine in the kidneys of the RDNx group (244±13 vs. 8±1 pg/mg for &gt;35 weeks old rats). The mean arterial pressure (MAP) and heart rate remain the same between the Sham and RDNx groups. The glucose tolerance test also indicates no difference between the two groups. While there is a significant decrease in the GFR in Sham group from baseline to week 3, the GFRs between Sham and RDNx groups are not different. Similarly, total body weight, kidney to total body weight ratio, heart to total body weight ratio, and blood and urine electrolytes are also not different between Sham and RDNx groups. Analysis of the younger group (~20 weeks old) is in progress. Conclusion: In summary, our data suggests that RDNx does not affect the blood pressure and progression of DKD in male T2ND rats, at least at the stage of severe kidney injury (&gt;35 weeks old). Funding sources: National Institute of Health R01 DK135644 and R01 DK129227, Department of Veterans Affairs I01 BX004024 (to AS), and APS Postdoctoral fellowship (to BX).