Electrolyte Composition Of Blood Research Articles

Chloride removal and bicarbonate replacement by isotonic sodium bicarbonate-based continuous hemodiafiltration: a novel method to correct severe metabolic acidosis.

Previous reports highlighted the efficacy of hemofiltration utilizing isotonic sodium bicarbonate solution as replacement fluid for severe metabolic acidosis. This approach corrects metabolic acidosis by eliminating chloride and supplementing bicarbonate. Here, we present the results of an in vitro study aimed at determining the effect of Isotonic sodium bicarbonate-based Continuous HemoDiafiltration (IBB-CHDF). Conventional Continuous HemoDiaFiltration (CHDF) and IBB-CHDF utilized aqueous solutions mimicking blood's electrolyte composition. To assess the efficacy and safety, we compared serial changes in pH, HCO3-, Na+, and K+ concentrations. Blood flow rate was 100mL/min, and the dialysis fluid flow rate maintained 1.0 L/h for both CHDF and IBB-CHDF. Replacement flow rates ranged from 0.5 to 1.5 L/h for CHDF and 0.1 to 1.5 L/h for IBB-CHDF. At a replacement flow rate of 0.5 L/h with IBB-CHDF, bicarbonate increased from 14.7 mEq/L to within the physiological range (25.9mEq/L), whereas in conventional CHDF, the post-treatment bicarbonate concentration did not increase (16.5mEq/L). The maximum bicarbonate concentration achieved was 22.0mEq/L at a replacement flow rate of 1.5 L/h in conventional CHDF. Notably, in IBB-CHDF, the sodium concentration remained constant at 150mEq/L, 10mEq/L higher than conventional CHDF, and did not escalate despite increasing the replacement flow rate. IBB-CHDF effectively corrects metabolic acidosis without inducing sodium and water overload by eliminating excess chloride while providing bicarbonate.

Оценка эффективности применения модифицирующей терапии (комплекса VERIS (пектин + инулин) с солевым энтеральным раствором) у пациентов с язвенным колитом

Purpose: to evaluate the effect of the use of modifying therapy (VERIS complex (Pectin + Inulin) in combination with saline enteral solution) on the effectiveness of treatment of patients with moderate ulcerative colitis (UC). Material and methods. A comparative clinical study was conducted with active effects on the observed group. This study included men and women with a moderate attack of ulcerative colitis without severe concomitant pathology and signs of reactivation of an opportunistic infection. Using a continuous sampling method, 45 patients (n = 45) aged 32 ± 7.5 years were selected who were undergoing inpatient treatment in the gastroenterological department of the State Budgetary Healthcare Institution “Research Institute-KKB No. 1” named after Professor S.V. Ochapovsky regarding inflammatory bowel diseases (IBD). Depending on the chosen treatment strategy, all patients were divided into 3 groups: group 1 included patients who, in addition to basic therapy for IBD, received VERIS (pectin + inulin) (n = 15), group 2 included patients receiving only basic therapy (n = 15), the third group included patients who, in addition to the main therapy, received the combination of VERIS (pectin + inulin) + SER (n = 15). In the groups, a comparative assessment of the volume of the lesion, symptoms of the disease, such as pain, fever, tenesmus, stool frequency and the presence of blood in it, as well as the results of laboratory tests, including data from the blood flow rate, ESR, CRP, blood electrolyte composition, nitrogenous wastes, were carried out and liver transaminases, albumin and indicators of electrolyte metabolism (K, Na, Cl). The dynamics of the above-described indicators in each of the groups was also assessed at 3 stages of observation: initially, on the 5th and 10th day of treatment. In addition to the listed parameters, in both groups the duration of hospitalization in bed days, the level of quality of life (IBDQ questionnaire), and the degree of psycho-emotional disorders according to the HADS hospital anxiety and depression scale were assessed. Results. It was found that when the combination VERIS (Pectin + Inulin) was included in the basic therapy in combination with saline enteral solution, a decrease in the activity of the systemic inflammatory process was revealed, which was manifested by positive dynamics of leukocytosis, a decrease in the average erythrocyte sedimentation rate, and an increase in hemoglobin levels. A statistically significant decrease in cytolysis markers (decrease in liver transaminases) and catabolism indicators was also noted, which was reflected in the form of a decrease in the level of nitrogenous wastes. It should be noted that no undesirable side effects or allergic reactions were registered during the study period. The revealed reduction in the length of hospitalization of patients in the group receiving VERIS (pectin + inulin) + SER, an increase in adherence to therapy due to an increase in the quality of life due to the rapid regression of symptoms can be regarded as significant indicators of the effectiveness of the therapy. The above results obtained by us indicate the modifying effect of the complex of enteroprotective drugs on the standard basic therapy of ulcerative colitis. Conclusion. The addition of the enteroprotective combination VERIS (pectin + inulin) in combination with saline enteral solution to the standard therapy of patients with moderate ulcerative colitis increases the effectiveness of treatment results by reducing the inflammatory process, the phenomena of cytolysis, catabolism and, as a consequence, leads to a decrease in hospitalization time, an increase in quality of life. All of the above allows us to consider this combination of drugs with the function of enteroprotection VERIS (pectin + inulin) + SER as a promising way to modify the basic therapy of inflammatory bowel diseases by compensating for intestinal failure during the treatment period.

The condition of electrolyte homeostasis in children with hereditary hemolytic anemia

Objective. Determine the content of electrolytes in the blood serum depending on the severity of anemia in children with hereditary hemolytic anemia.Material and methods. Observations were made on 36 children with hereditary hemolytic anemia (NGA) aged between 3 to 14 years. The distribution by gender was as follows: 16 girls (44.5%) and 20 boys (55.5%). The average age of the participants during the study was 9.5±0.45 years. These children were categorized into three groups based on anemia severity. Primary school-aged children formed the majority, followed by preschoolers, with senior school-aged children being the least in number. Upon admission to the clinic, a thorough examination of each child was conducted, encompassing a detailed complete blood count, erythrocyte morphology, biochemical blood tests (measuring total bilirubin and its fractions), blood serum electrolyte levels (K+, Na+, Ca+, Fe+), and an analysis of bone marrow punctate.Results and discussion. Electrolyte analysis yielded these findings: In children with mild HHA (14 patients), compared with the control group, the concentration of blood electrolytes (K+, Na+, Ca+, Fe+) were within the normal range. In children with moderate HHA (12 patients), the concentration of Fe+ was slightly higher compared with the control and the first group, respectively, and there was also a slight increase in the concentrations of K+, Na+, Ca+ compared with healthy children and children with mild HHA. In children with severe HHA (10 patients), as a result of the development of a hemolytic crisis, the concentration of electrolytes in the blood serum is significantly higher than K+, Na+, Ca+, Fe+ compared with children in the control group K+, Na+, Ca+, Fe+ and patients with mild and moderate, respectively.Conclusion. The study revealed significant clinical changes in the internal organs, as well as pronounced metabolic disorders in the body, due to chronic hemic hypoxia and impaired blood electrolyte composition.

Modeling Distal Convoluted Tubule (Patho)Physiology: An Overview of Past Developments and an Outlook Toward the Future.

The kidneys are essential for maintaining electrolyte homeostasis. Blood electrolyte composition is controlled by active reabsorption and secretion processes in dedicated segments of the kidney tubule. Specifically, the distal convoluted tubule (DCT) and connecting tubule are important for regulating the final excretion of sodium, magnesium, and calcium. Studies unravelling the specific function of these segments have greatly improved our understanding of DCT (patho)physiology. Over the years, experimental models used to study the DCT have changed and the field has advanced from early dissection studies with rats and rabbits to the use of various transgenic mouse models. Developments in dissection techniques and cell culture methods have resulted in immortalized mouse DCT cell lines and made it possible to specifically obtain DCT fragments for ex vivo studies. However, we still do not fully understand the complex (patho)physiology of this segment and there is need for advanced human DCT models. Recently, kidney organoids and tubuloids have emerged as new complex cell models that provide excellent opportunities for physiological studies, disease modeling, drug discovery, and even personalized medicine in the future. This review presents an overview of cell models used to study the DCT and provides an outlook on kidney organoids and tubuloids as model for DCT (patho)physiology. Impact statement This study provides a detailed overview of past and future developments on cell models used to study kidney (patho)physiology and specifically the distal convoluted tubule (DCT) segment. Hereby, we highlight the need for an advanced human cell model of this segment and summarize recent advances in the field of kidney organoids and tubuloids with a focus on DCT properties. The findings reported in this review are significant for future developments toward an advanced human model of the DCT that will help to increase our understanding of DCT (patho)physiology.

Безопіатна аналгоседація під час стентування коронарних артерій

The widespread usage of opioids / opiates in anesthetic practice has highlighted a number of related problems. Therefore, in recent years, the concept of opiate-free anesthesia has been gaining popularity among anesthesiologists around the world. In this context, we are interested in lidocaine as a component of this anesthesia. The attention of anesthesiologists to lidocaine during analgesia is due to its analgesic, anti-inflammatory and antihyperalgesic properties. The basis of the analgesic effect of the drug is that it blocks sodium channels and depolarizes nociceptive peripheral neurons, simultaneously inhibits NMDA receptors, reduces the number of cytokine complexes circulating in the plasma, and dissociates the Gq protein. In general, these properties lead to a decrease in opiate consumption, an acceleration of rehabilitation, a decrease in episodes of nausea and vomiting, a reduction in hospital stay, and even has certain neuroprotective properties. The purpose of our work was to establish the main aspects of non-opiate anesthesia usage that was based on lidocaine during coronary stenting. Material and methods. We studied 60 patients with coronary artery disease who underwent stenting of the coronary arteries in a planned manner. The main diagnosis was exertional angina FC II-III. In terms of the duration of the surgery, it was 38.54±19.3 minutes, and the number of stents was 1.3±0.7. The patients were evenly divided into two study groups, depending on the prescribed drug regimen. The first group included patients who were sedated by slow intravenous administration of diazepam and fentanyl. In the group of non-opiate anesthesia, a lidocaine solution was the main component of analgesia. At the stages before the start of the surgery, during the main stage, namely, the stent placement, and after the end of the surgery, the parameters of hemodynamics, saturation, gas and electrolyte composition of blood, the level of glycemia and cortisol were assessed. Results and discussion. The main complaint of patients in the control group was drowsiness, which was noted by 36.7% of patients. We attribute this feature to the use of diazepam. However, drowsiness was also noted in 33.3% of the experimental group after surgery. This fact can be explained by the use of significant doses of propofol, which were needed to maintain hemodynamics at the appropriate level. Episodes of nausea and vomiting may occur during surgery, especially when using opiates with a high probability. The phenomena of nausea were observed in 13.4% of the 1st group, and in the 2nd group it occurred in 3.3% of cases. According to the recommendations, we administered 4 mg of ondasetron solution after which the nausea disappeared. In the second group, complaints related to the local anesthetic effects of lidocaine came to the fore. 63.3% complained of "crawling ants" or numbness in the hand, the same sensations in the cheek and numbness of the tongue – 33.3%. After the operation, the feeling of numbness in the hand persisted in 16.7%. It should be noted that these sensations did not cause significant discomfort and did not interfere with anesthesia. Conclusion. In the course of the work, we came to the conclusion that the usage of lidocaine at a dose of 1 mg / kg of the patient's body weight is safe for coronary artery stenting operations and, at the same time, there are no negative effects inherent in opiate based anesthesia. At the same time, the local anesthetic effects after using lidocaine do not worsen the course of the postoperative period

Optimization of infusion-transfusion therapy in patients with traumatic brain injury

Objective. Intensive therapy of severe traumatic brain injury belongs to the most difficult section of resuscitation. Therefore, the main purpose of intensive care during the implementation is to eliminate disorders of Rheosorbilact homeostasis.
 Materials and methods. We analyzed 30 patients with traumatic brain injury in the intensive care unit of the Republican Clinical Hospital between 2018 and 2019. All patients were divided into two groups: 1st – control group (16 patients) – received complex intensive therapy without Rheosorbilact, while 2nd group (14 patients), received Rheosorbilact in a comprehensive intensive therapy. The main pharmacologically active substances of the drug are sorbitol, basic cations (Na, K, Ca, Mg), and sodium lactate. Thanks to these components, the drug has a hyperosmolar effect, causing fluid from the intercellular space to enter the vascular channel and thus improves microcirculation and perfusion of brain tissue. In order to monitor the effectiveness of the therapy in the dynamics evaluated indicators of hemodynamics (level of consciousness and diuresis), laboratory data (hemotocrit, electrolyte composition of blood, acid-alkaline blood condition, coagulogram), and MRI data. Rheosorbilact was used as part of a complex therapy in an infusion-transfusion program in the amount of 200-400 ml daily intravenous drip.
 Results. In patients, whom after the beginning of complex intensive therapy was included Rheosorbilact, was observed earlier (the first 6 h) compared to the control group, which did not use Rheosorbilact, stabilization of hemodynamics.
 Conclusions. Infusion therapy with Rheosorbilact in patients with traumatic brain injury contributed primarily to stabilization of hemodynamics and faster normalization of vital functions of the body.

BLOOD AND URINE ELECTROLYTES DYNAMIC PATTERN OBSERVED AT DIFFERENT MONITORING STAGES IN PATIENTS SUFFERING FROM TOXIC SHOCK SYNDROME AND UNDERGOING VARIOUS TYPES OF INFUSION THERAPY

The need to study how the infusion therapy affects the electrolyte composition of blood is a topical issue nowadays. Such a study will provide the necessary answers and help us to introduce the most effective infusion therapy strategies for patients suffering from severe hemodynamic disorders accompanying toxic shock syndrome (TSS). The study analyzes and summarizes the examination and treatment results of 111 patients suffering from various forms of severe infectious disease complicated by TSS. As a result of the study, it was determined that infusion therapy using a combination of hypertensive and colloidal solutions significantly contributes to the rapid restoration of electrolyte composition and compensates for acidosis. Given these data, a combination of 10% sodium chloride solution with 6% colloidal solution can be considered a preferable solution for initial infusion therapy in patients suffering from TSS.

Diuretic therapy of chronic heart failure of patients with hypertension in combination with diabetes mellitus type 2

The aim of the study was to investigate the xipamide influence on clinical manifestations of chronic heart failure, blood pressure, carbohydrate and lipid metabolism, blood electrolytes, renal function of patients with essential hypertension combined with diabetes mellitus type 2.Materials and methods. 35 patients (19 women and 16 men) with chronic heart failure II–III functional class according to the classification of NYHA in the middle ages (60,6±1,2) years were examined. Heart failure was due to hypertension (average duration was (10,7±6,3) years, hypertension of 2–3 degrees) in combination with diabetes mellitus type 2 (average duration – (9,5±3,2) year). Xipamide was appointed on the background of both diseases basic treatment in the initial dose of 10-20 mg once a day after eating in the morning. The dose was doubled if necessary. For further therapy xipamide was prescribed in maintenance dose 10–20 mg/day. After 3 months clinical profile of carbohydrate and lipid metabolism, renal function were evaluated.Results. The study revealed that xipamide is an effective and safe means of active treatment of patients with chronic heart failure on the background of hypertension combined with diabetes mellitus type 2. It is also effective for patients in the stage of decompensation, as well as maintenance therapy in heart failure stabilization.Conclusions. Xipamide addition to the basic therapy of chronic heart failure can significantly improve clinical and hemodynamic status of patients almost without affecting on the electrolyte composition of blood, lipid and carbohydrate metabolism and renal function.

Methods of Molecular Transfusion in the Intensive Therapy of Critical States

Development of extracorporeal blood purification acquires greater significance in the intensive care of multiple organ failures (MOF) with all the pathophysiological aspects of its constituent parts. MOF are the main cause of mortality among critically ill patients and treatment of these patients require significant investment. The purpose of the implementation of extracorporeal blood correction techniques today is multiple organ support therapy (MOST). Early extracorporeal therapy is used only in the treatment of renal failure. Today extracorporeal techniques are increasingly being used to replace the functions of various organs and systems. MOST includes diffusion, convection, filtration, sorption, apheresis methodic. They affect the molecular and electrolyte composition of blood, allow to correct, repair, replace, and maintain homeostasis in severe multiorgan dysfunction. Extracorporeal new molecular technologies have been successfully applied in the intensive care of severe heart and respiratory failure, acute kidney injury and acute hepatic dysfunction, in the treatment of severe sepsis, metabolic disorders, the correction of immune imbalance.

ПОРІВНЯЛЬНА ХАРАКТЕРИСТИКА ФАКТОРІВ РИЗИКУ

<p>To optimize the therapeutic tactics and improve the treatment of peritonitis on the basis of retrospective analysis there are determined the significant risk factors: female gender, age 60 – 90 years, time to hospitalization for more than 48 hours, a history of myocardial infarction, stroke, cardiac arrhythmia, biliary, fecal and fibrinous purulent exudate, the terminal phase flow, operations with resection of the intestine and postoperative complications such as pulmonary embolism, myocardial infarction, pleurisy, early intestinal obstruction. Changes in the electrolyte composition of blood and lower albumin <35 % of high risk prognostic course of peritonitis that requires immediate correction in the pre-and postoperative periods. The combination of three or more risk factors for various systems, creating a negative outlook for further treatment and the patient's life.</p>

A new method for the determination of arylesterase activity in human serum using simulated body fluid

Arylesterase activity (EC 3.1.1.2), one of the three functions of the paraoxonase enzyme (PON1), is thought to protect low-density lipoproteins (LDL) and high-density lipoprotein (HDL) from oxidation and to facilitate reverse cholesterol transport. The Eckerson et al. method, which employs Tris/HCl buffer, has been extensively used and could be considered as the reference method, although it shows relatively low precision and reproducibility. Using simulated body fluid (SBF), which simulates blood electrolyte composition, a significant improvement in arylesterase activity determination was achieved. Modifications of SBF bicarbonate and chloride concentrations did not result in further improvements. To validate this method arylesterase activity was measured using SBF and Tris/HCl in 23 subjects with increased cardiovascular disease risk. Precision was significantly higher using SBF than with Tris/HCl. Data from both methods do not significantly differ in samples with arylesterase activity ≥30.6 U/L using SBF, but do differ significantly when very low activity samples (<30.6 U/L) were included. Differences suggest that the Tris/HCl buffer gives misleading activity results, especially in very low activity samples. For the first time, results suggest that SBF can successfully be used instead of Tris/HCl in arylesterase activity determination.

New approaches to genetic manipulation of mice: tissue-specific expression of ACE.

The renin-angiotensin system (RAS) plays a central role in body physiology, controlling blood pressure and blood electrolyte composition. ACE.1 (null) mice are null for all expression of angiotensin-converting enzyme (ACE). These mice have low blood pressure, the inability to concentrate urine, and a maldevelopment of the kidney. In contrast, ACE.2 (tissue null) mice produce one-third normal plasma ACE but no tissue ACE. They also have low blood pressure and cannot concentrate urine, but they have normal indices of renal function. These mice, while very informative, show that the null approach to creating knockout mice has intrinsic limitations given the many different physiological systems that no longer operate in an animal without a functioning RAS. To investigate the fine control of body physiology by the RAS, we developed a novel promoter swapping approach to generate a more selective tissue knockout of ACE expression. We used this to create ACE.3 (liver ACE) mice that selectively express ACE in the liver but lack all ACE within the vasculature. Evaluation of these mice shows that endothelial expression of ACE is not required for blood pressure control or normal renal function. Targeted homologous recombination has the power to create new strains of mice expressing the RAS in selected subsets of tissues. Not only will these new genetic models be useful for studying blood pressure regulation but also they show great promise for the investigation of the function of the RAS in complicated disease models.

Red blood system in 10–12-year-old children of the Far North

Healthy children between the ages of 10 and 12 years (n=699) of the Far North (Taimyr peninsular) and Siberia (Krasnoyarsk city) were examined. The red blood system was investigated relative to the duration of residence in the polar region and the season of the year. The red blood cell (RBC) count and the hemoglobin level in children from the newly arrived population corresponded to the normal age values, and those of the aborigines were at the lower border of the normal value range. The qualitative composition of their red blood was changed—the level of the alkaline-resistant hemoglobin was elevated. In all the children who lived in the polar regions, the mean RBC volume was augmented, along with seasonal dynamics of blood electrolyte composition, changes in phospholipid spectrum of erythrocyte membranes, and certain activation of lipid peroxidation reactions. The oxygen-binding capacity of blood was changed in children from the polar regions, which led to alterations of hemoglobin affinity to O2 in pO2 in the direction of its increase in the lungs and decrease in tissues under conditions of existing pO2. These deviations were the most common (from 5/6 to 2/3) in children during the first five years of their residence in polar regions; afterwards their frequency as compared to the control curve did not exceed 1/2, as in the aborigines.

Automatic, Noninvasive Intradialytic Clearance Measurement

The feasibility of non invasive, automatic intradialytic measurement of effective clearance is demonstrated by a mathematical derivation. In a practical setting the conductivity difference between dialysate inlet and outlet of the dialyzer is measured for two different dialysate inlet concentrations. This allows for the calculation of the electrolyte dialysance, which is equal to the effective urea clearance, provided dialysate flow, blood flow and blood electrolyte composition remain unchanged during the measuring interval.

The effects of hypermagnesaemia on calcitonin secretion in vivo.

SUMMARY The influence of magnesium on calcitonin (CT) secretion rate has been studied in pigs by perfusion of porcine thyroid glands, isolated in situ, under controlled conditions of flow rate and blood electrolyte composition. At concentrations of 4·4–12·7 mequiv./l, magnesium stimulated CT secretion in the presence of a normal calcium concentration in the perfusate. The maximum effect was reached at a concentration of about 7 mequiv. Mg/l. At higher magnesium concentrations, the secretion rate of CT tended to revert towards that found with concentrations of calcium and magnesium within the normal range. When hypermagnesaemia was superimposed on hypercalcaemia there was a fall in the secretion rate of CT as the Mg: Ca ratio in the perfusing blood plasma approached 1. The stimulatory effect of hypermagnesaemia was usually less than that caused by an equimolar increase in plasma calcium concentration. The results suggest that changes in plasma magnesium concentration probably do not influence CT secretion under normal conditions.

About the electrolyte balance in heart failure

Many works have been devoted to the study of the electrolyte composition of blood in circulatory insufficiency, but the data obtained are contradictory.