Changes In Serum Sodium Research Articles

Effects of catheter-based renal denervation on renin-aldosterone system, catecholamines, and electrolytes: A systematic review and meta-analysis.

In recent years, catheter-based renal denervation (RDN) has emerged as a promising instrumental therapy for hypertension. The interruption of sympathetic nervous system was regarded as a possible mechanism for RDN regulating blood pressure. While the results reflected by renin-angiotensin-aldosterone system (RAAS), catecholamines and electrolytes remained inconsistent and was never systematically assessed. Pubmed, Embase, and Web of Science were comprehensively searched from inception to September 5, 2021. Studies that evaluated the effects of RDN on RAAS, catecholamines, and electrolytes were identified. Primary outcomes were changes in RAAS hormones after RDN, and secondary outcomes involved changes in plasma norepinephrine, serum, and urinary sodium and potassium. Out of 6391 retrieved studies, 20 studies (two randomized controlled studies and 18 observational studies) involving 771 persons were eventually included. Plasma renin activity had a statistically significant reduction after RDN (0.24ng/mL/h, 95% CI 0.04 to 0.44, P=.02). While no significant change was found regarding plasma aldosterone (1.53ng/dL, 95% CI -0.61 to 3.67, P=.16), norepinephrine (0.42nmol/L, 95% -0.51 to 1.35, P=0.38), serum sodium and potassium (0.16mmol/L, 95% CI -0.17 to 0.49, P=.34; -0.02mmol/L, 95% CI -0.09 to 0.04, P=.48, respectively), and urinary sodium and potassium (3.95mmol/24h, 95% CI -29.36 to 37.26, P=.82; 10.22mmol/24h, 95% CI -12.11 to 32.54, P=.37, respectively). In conclusion, plasma renin activity significantly decreased after RDN, while no significant change was observed in plasma aldosterone, plasma norepinephrine, and serum and urinary electrolytes.

The effects of feeding and transport length on the welfare of white rhinoceroses (Ceratotherium simum simum) during long-distance translocations: a preliminary study.

Translocation is a valuable conservation tool, but poses significant risks for the transported rhinoceroses. Interventions reducing these risks are required to ensure positive welfare during transportation. The aim of this study was to evaluate the effect of journey duration and feeding during the transport of white rhinoceroses (Ceratotherium simum simum). A total of 32 animals were transported by road during two events, five days apart. Fifteen rhinoceroses in the first transport event (37.0 ± 2.4 hr duration) were not fed, while 17 rhinoceroses in the second event (32.2 ± 1.5 hr duration) were offered lucerne. Blood samples were collected at capture and after transport for the evaluation of changes in serum clinical chemistry analytes. The Wilcoxon rank-sum test was used to compare differences between the groups. In all rhinoceroses, transport resulted in changes in serum electrolyte, metabolite and enzyme concentrations, indicating a loss in total body water, nutritional shifts, stress and fatigue. Fed rhinoceroses, transported over a shorter time, displayed greater changes in osmolality (p < 0.006), serum sodium and chloride concentrations (p = 0.005 and = 0.001, respectively) indicating a greater degree of total body water loss than non-fed rhinoceroses. Feeding and a shorter transport duration reduced, but did not prevent, nutritional challenges. A greater increase in the muscle enzymes CK and AST (p = 0.027 and = 0.001, respectively), indicated greater fatigue in non-fed rhinoceroses transported over a longer time. Further work to distinguish the effects of feeding and journey duration is required to better understand the role feeding may play in mitigating welfare challenges during rhinoceros translocation.

Efficacy and Safety of Transurethral Enucleation with Bipolar Energy for Treatment of Benign Prostatic Hyperplasia: Does Prostate Volume Matter?

We evaluated the association of prostate volume (PV) with the efficacy and safety of transurethral enucleation with bipolar energy (TUEB) for treatment of benign prostatic hyperplasia (BPH). We retrospectively evaluated data from 180 patients with symptomatic BPH who underwent TUEB between 2008 and 2015. Efficacy was assessed by perioperative changes in international prostate symptom score (IPSS), Quality of Life Score (QOLS), maximum flow rate on uroflowmetry (Qmax), and serum prostate-specific antigen level (PSA), which were recorded at 3 months postoperatively. Safety was assessed by perioperative incidence of adverse events (AEs). AEs were recorded up to 2 years after surgery. Patients were divided into two groups based on PV as the standard group (SG; PV < 80 mL) and large group (LG; PV ≥ 80 mL). A total of 132 (73%) patients were grouped as the SG, and 48 (27%) were grouped as the LG. No significant differences between the groups were observed in the preoperative variables age, IPSS, and QOLS. However, the LG had a significantly larger PV and higher serum PSA levels. Analysis of surgical outcomes revealed that postoperative changes in IPSS, QOLS, Qmax, serum PSA, serum sodium, and hemoglobin levels did not differ significantly between groups. However, LG had a significantly longer operative time and heavier specimen weight. The rates of early complications, including hyponatremia and blood transfusion, and late complications after surgery did not differ between the groups. The present findings suggest that TUEB is safe and effective for treatment of BPH, regardless of PV.

Study of changes in serum sodium and potassium levels in term and preterm neonates following phototherapy

Background: Neonatal hyperbilirubinemia is a common physical finding in the first week of life. It is a common cause of hospital readmission during neonatal period. Phototherapy is an important treatment modality. However, it has some complications; amongst them serum electrolyte changes are a common complication. Objective of this study is to determine the changes in serum sodium and potassium in neonates before and after phototherapy and compare the occurrence of these changes in relation to gestational age and birth weight.Methods: In a prospective hospital based comparative study both term and preterm neonates admitted in neonatal intensive care unit receiving phototherapy at Cheluvamba hospital Mysore from July 2021 to April 2022 (10 months) were studied. A predesigned proforma aided the enrolment of new-borns into the study. Serum bilirubin and electrolytes and a comparative study was made between before and after phototherapy groups to determine the incidence of electrolyte imbalance.Results: The study group included 100 neonates. Incidence of low-birth-weight babies was 28% and preterm 22%. Mean birth weight and gestational age was 2.91±0.65 kg and 38.43±1.96 week respectively. The incidence of hyponatremia post phototherapy was found to be 9% which was more in low birth weight and preterm neonates (p&lt;0.001) and was statistically significant. The incidence of potassium changes was found to be non-significant.Conclusions: The study shows that neonates under phototherapy are at higher risk of hyponatremia. This risk is greater in premature and low birth weight babies and hence this group of babies should be closely monitored for electrolyte changes and managed accordingly.

The impact of hormonal dynamics and serum sodium fluctuations on symptomatic vasospasm after subarachnoid hemorrhage

BackgroundSymptomatic vasospasm (SVS) is a major cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage (SAH), and serum sodium frequently decreases before SVS. Serum sodium changes might be regulated by sodium metabolism-related hormones. This multi-institutional prospective cohort study therefore investigated the measurement of sodium metabolism-related hormones to elucidate the pathophysiology of serum sodium changes in SAH. MethodsSAH patients were treated with clipping or coiling from September 2017 to August 2020 at five hospitals. The laboratory data of 133 SAH patients were collected over 14 days and correlations between changes in serum sodium, sodium metabolism-related hormones (plasma adrenocorticotropic hormone (ACTH), serum cortisol, plasma arginine vasopressin (AVP)), and SVS were determined. Serum sodium concentrations were measured every day and serum sodium levels >135 mEq/L were maintained until day 14. ResultsOf the 133 patients, 18 developed SVS within 14 days of subarachnoid hemorrhage onset (SVS group) and 115 did not suffer from SVS (non-SVS group). Circulating AVP, ACTH, and cortisol concentrations were significantly higher on day 1 in the SVS group compared with the non-SVS group. Fluctuations in serum sodium in the SVS group were significantly higher than those in the non-SVS group. There were antiparallel fluctuations in serum sodium and potassium from days 2 to 14. ConclusionsElevated levels of ACTH/cortisol and AVP on day 1 may be predictive markers for the occurrence of SVS. Multiple logistic regression analysis showed that serum sodium fluctuations were associated with SVS occurrence. Serum sodium fluctuations were associated with stress-related hormonal dynamics. (249 words)

Tolvaptan versus fluid restriction in acutely hospitalised patients with moderate-profound hyponatraemia (TVFR-HypoNa): design and implementation of an open-label randomised trial

BackgroundCurrent hyponatraemia guidelines are divided on the use of tolvaptan in hospitalised patients with moderate to severe hyponatraemia, due to an uncertain risk-benefit ratio. We will conduct a randomised trial to test the hypothesis that early use of tolvaptan improves the rate of serum sodium correction and clinical outcomes compared with current standard first-line therapy, restriction of fluid intake, without increasing the risk of serum sodium overcorrection.MethodsWe will enrol hospitalised patients with euvolaemic or hypervolaemic hyponatraemia and serum sodium of 115–130 mmol/L at Austin Health, a tertiary care centre in Melbourne, Australia. Participants will be randomised 1:1 to receive either tolvaptan (initial dose 7.5 mg) or fluid restriction (initial limit 1000 ml per 24 h), with titration of therapy based on serum sodium response according to a pre-determined protocol over a 72-h intervention period.The primary endpoint will be the between-group change in serum sodium over time, from study day 1 to day 4. Secondary endpoints include serum sodium increment in the first 24 and 48 h, proportion of participants with normalised serum sodium, length of hospital stay, requirement for serum sodium re-lowering with intravenous dextrose or desmopressin, cognitive and functional measures (Confusion Assessment Method Short form, Timed Up and Go test, hyponatraemia symptom questionnaire), 30-day readmission rate, treatment satisfaction score and serum sodium 30 days after discharge. The trial will be overseen by an independent Data Safety Monitoring Board. Serum sodium will be monitored every 6–12 h throughout the study period, with pre-specified thresholds for commencing intravenous 5% dextrose if serum sodium rise targets are exceeded.DiscussionWe seek to inform future international guidelines with high-quality data regarding the utility and safety of tolvaptan compared to standard therapy fluid restriction in patients with moderate-severe hyponatraemia in hospital. If tolvaptan use in this patient group is endorsed by our findings, we will have established an evidence-based framework for tolvaptan initiation and monitoring to guide its use.Trial registrationAustralia and New Zealand Clinical Trials Registry ACTRN12619001683123. Registered on December 2 2019

Comparative Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Serum Electrolyte Levels in Patients with Type 2 Diabetes: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials.

Previous studies have reported that sodium-glucose co-transporter 2 (SGLT2) inhibitors (SGLT2is) affect levels of serum electrolytes, especially magnesium. This study aimed to integrate direct and indirect trial evidence to maximize statistical power to clarify their overall and comparative effects in patients with type 2 diabetes (T2D). We systematically searched PubMed, EMBASE, CENTRAL, and ClinicalTrials.gov up to January 2021 to identify eligible randomized controlled trials (RCTs) of SGLT2is that reported mean changes in serum electrolytes, including magnesium, sodium, potassium, phosphate, and calcium. We performed both random-effects pairwise and network meta-analyses to calculate the weighted mean difference (WMD) and 95% confidence intervals (CI). In total, we included 25 RCTs involving 28,269 patients with T2D and 6 SGLT2is. Compared with placebo, SGLT2is were significantly associated with elevations in serum magnesium by 0.07 mmol/L (95% CI, 0.06 to 0.08 mmol/L) and serum phosphate by 0.03 mmol/L (95% CI, 0.02 to 0.04 mmol/L). Our network meta-analysis showed no evidence of significantly superior efficacy of any specific SGLT2 inhibitor over the others, although dapagliflozin was associated with a larger increment in serum magnesium (WMD=0.16 mmol/L) compared with other SGLT2is. Similarly, no statistically detectable differences among the effects of SGLT2is on serum levels of other electrolytes were detected. SGLT2is significantly increased serum magnesium and phosphate levels, consistent with a class effect of SGLT2 inhibition. However, further investigations of long-term efficacy and safety in patients with T2D with different clinical phenotypes are needed.

Biochemical and Haemodynamic Changes during Transurethral Resection of Prostate and Percutaneous LithotripsyAn Observational Pilot Study

Introduction: Fluid absorption and associated electrolyte derangement is an inevitable complication of Transuretheral Resection of Prostate (TURP) and Percutaneous Lithotripsy (PCNL). The present study was conducted to analyse changes in serum electrolytes, Lactate Dehydrogenase (LDH) and acid base status, and to evaluate their role as early predictors of clinical and haemodynamic changes following continuous irrigation during transurethral resection of prostrate and PCNL Aim: To analyse the various biochemical changes during endourological procedures and to determine their role in predicting clinical manifestation and haemodynamic changes in these procedures. Materials and Methods: The present observational study included 20 patients, who underwent TURP and 20 patients who underwent PCNL. A 1.5% glycine and 0.9% normal saline were used for irrigation during TURP and PCNL, respectively. The levels of serum sodium, potassium, free calcium ion, LDH and acid base status were monitored in all patients preoperatively, intraoperatively, at the end of surgery, 6 hours and 24 hours postoperatively. Intraoperative and postoperative haemodynamic parameters were also studied. Results: In TURP group, statistically significant changes were seen in serum sodium, potassium, LDH and free calcium ions. There was no change in acid-base status of patients. In PCNL group, statistically significant changes were seen in serum sodium, LDH, free calcium ion and acid base status. It was observed that some of these changes persisted even 24 hours, postoperatively. However, despite the above changes, the haemodynamic parameters remained within normal limits. Conclusion: Changes in serum sodium, serum potassium and free calcium ion during TURP and PCNL were consistent findings which implies fluid absorption. These changes persist up to 24 hours postoperatively. The monitoring of these parameters in postoperative period should be continued especially in patients suspected to develop or having TURP syndrome.

TO STUDY EFFECT OF PHOTOTHERAPY ON SERUM SODIUM, POTASSIUM AND CHLORIDE LEVELS IN NEONATAL JAUNDICE

INTRODUCTION The most common morbidity in the rst week of life is the jaundice which occurs in 80% of term and 60% of preterm neonates and is the most often causes readmission after the baby is discharged from the hospital. The treatment of neonatal hyperbilirubinemia is phototherapy. Like any other treatment modality, phototherapy also has side effects of which very few studies were done on electrolyte disturbances. Hence present study was designed to determine the serum sodium, potassium and chloride changes in neonates receiving phototherapy for neonatal jaundice. AIMS AND OBJECTIVES To study the effect of phototherapy on serum sodium, Potassium and Chloride levels in neonates with neonatal hyperbilirubinemia. MATERIALS AND METHODS This Hospital Based Longitudinal Observational Study was done in the Department of Paediatrics at MMIMSR, Mullana over a period of one and a half year. Serum bilirubin, sodium, Potassium and Chloride levels were measured before initiation of phototherapy and on termination of phototherapy. RESULTS The study included 100 neonates with hyperbilirubinemia treated with phototherapy with male: female ratio of 58%:42%.The mean gestational age was 37.681.63 weeks and birth weight was 2.790.38kgs. The age of onset of phototherapy and duration of phototherapy were 3.802.50 days and 28.627.02 hours respectively. Before phototherapy, the total serum bilirubin, sodium, potassium and chloride levels were 13.87±1.41,140.72±3.45,4.55±0.44 and 106.08±3.1 respectively which decreased to 9.50±1.60,137.45±3.09,4.20±0.46 and 104.52±3.91 with statistically signicant change in bilirubin(p&lt;0.0001),sodium(p&lt;0.0001), potassium(p&lt;0.0001) and Chloride(p=0.0038).

Changes in Factors Regulating Serum Sodium Homeostasis During Two Ultra-Endurance Mountain Races of Different Distances: 69km vs. 121km.

Overdrinking and non-osmotic arginine vasopressin release are the main risk factors for exercise-associated hyponatremia (EAH) in ultra-marathon events. However, particularly during ultra-marathon running in mountainous regions, eccentric exercise and hypoxia, which have been shown to modulate inflammation, hormones regulating fluid homeostasis (hypoxia), and oxidative stress, could contribute to serum sodium changes in a dose-dependent manner. To the best of our knowledge, the contribution of these factors, the extent of which depends on the duration and geographical location of the race, has not been well studied. Twelve male participants (11 finishers) of the short (69km, 4,260m elevation-gain) and 15 male participants (seven finishers) of the long (121km, 7,554m elevation-gain) single-stage Südtirol Ultra Sky-Race took part in this observational field study. Venous blood was drawn immediately before and after the race. Analyses included serum sodium concentration, copeptin (a stable marker for vasopressin), markers of inflammation, muscle damage and oxidative stress. Heart rate was measured during the race and race time was obtained from the race office. During the short and the long competition two and one finishers, respectively showed serum sodium concentrations >145mmol/L. During the long competition, one athlete showed serum sodium concentrations <135mmol/L. Only during the short competition percent changes in serum sodium concentrations of the finishers were related to percent changes in body mass (r=−0.812, p=0.002), total time (r=−0.608, p=0.047) and training impulse (TRIMP) (r=−0.653, p=0.030). Data show a curvilinear (quadratic) relationship between percent changes in serum sodium concentration and body mass with race time when including all runners (short, long, finishers and non-finishers). The observed prevalence of hypo- and hypernatremia is comparable to literature reports, as is the relationship between serum sodium changes and race time, race intensity and body mass changes of the finishers of the short race. The curvilinear relationship indicates that there might be a turning point of changes in serum sodium and body mass changes after a race time of approximately 20h. Since the turning point is represented mainly by non-finishers, regardless of race duration slight decrease in body mass and a slight increase in serum sodium concentration should be targeted to complete the race. Drinking to the dictate of thirst seems an adequate approach to achieve this goal.

The Prognostic Importance of Serum Sodium for Mortality among Critically Ill Patients Requiring Continuous Renal Replacement Therapy

Background: Serum sodium derangement is common in critically ill patients requiring continuous renal replacement therapy (CRRT). We aimed to assess the association between serum sodium before and during CRRT with mortality. Methods: This is a historical cohort study of 1,520 critically ill patients receiving CRRT from December 2006 through November 2015 in a tertiary hospital in the United States. Using logistic regression analysis, we used serum sodium before CRRT, mean serum sodium, and serum sodium changes during CRRT to predict 90-day mortality after CRRT initiation. Results: Compared with the normal serum sodium levels, the odds ratio (OR) of 90-day mortality in patients with serum sodium before CRRT of 143–147 and ≥148 mmol/L were 1.45 (95% CI 1.03–2.05) and 2.24 (95% CI 1.33–3.87), respectively. There was no significant increase in 90-day mortality in serum sodium of ≤137 mmol/L. During CRRT, the mean serum sodium levels of ≤137 (OR 1.41; 95% CI 1.01–1.98) and ≥143 mmol/L (OR 1.52; 95% CI 1.14–2.03) were associated with higher 90-day mortality. The greater serum sodium changes during CRRT were associated with higher 90-mortality (OR 1.35; 95% CI 1.21–1.51 per 5-mmol/L increase). Conclusion: Before CRRT initiation, hypernatremia and during CRRT, hypo- and hypernatremia were associated with increased mortality.

CHANGES IN BASIC BLOOD SERUM ELECTROLYTES IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION, COMPLICATED BY ACUTE KIDNEY INJURY

Abstract. Relevance. Acute kidney injury during myocardial infarction worsens the prognosis. At the same time, changes in electrolyte metabolism have been studied only in cases of severe lesions. And most of the data were obtained for patients over 60 years old. Aim. To evaluate the features of changes in serum potassium, sodium, calcium, and chlorides in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 168 patients. A comparative analysis of serum sodium, potassium, calcium and chloride concentration in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics, analysis of their impact on the risk of acute kidney injury (ANOVA) were performed. Results. The study group differed from the control in high levels of sodium (143.3 ± 3.4 and 140.3 ± 4.5 (mmol/l); respectively; p = 0.004) and chlorides (104.6 ± 2.7 and 102.8 ± 3.5 (mmol/l); p = 0.047) at the end of the third week of the disease. The concentrations of the studied electrolytes increased at the second observation point in both groups of patients. The main markers of the acute kidney injury risk development in the first hours of myocardial infarction were: potassium levels &lt; 4.75 mmol/l (absolute risk: 17.2%; p = 0.003), sodium ≥ 140 mmol/l (absolute risk: 18.2%; relative - 3.64; p = 0.01), chlorides ≥ 104 mmol/l (absolute risk: 22.6%; relative - 3.67; p = 0.02). Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by low levels of potassium (&lt;4.75 mmol/l) as well as higher levels of sodium (≥140 mmol/l) and chloride (≥104 mmol/l) serum in the first hours of IM. The listed above values should be used in the formation of the high-risk groups for the acute kidney injury development, as well as for prognostic modeling.

Effects of Dried Aloe Vera Gel and Diclofenac on Sodium and Potassium Homeostasis: An Experimental Study on Hypertensive Rats

Background: Anti-inflammatory role of Aloe vera gel is well established. Diclofenac is extensively used for acute and chronic inflammation. The present study was conducted to compare dried Aloe vera gel and diclofenac effects on sodium and potassium balance in hypertensive rats.&#x0D; Material and Methods: This experimental study was conducted at Sargodha Medical College from May to November 2016. Twenty-four healthy male Sprague Dawley rats 7-8 weeks of age were included in study. Any unhealthy-looking rat was excluded from the study. Rats were equally and randomly divided into four groups Normal control (group A), Model control (group B), Aloe vera (group C) &amp; Diclofenac (group D). Hypertension was induced by a 20 % sucrose diet in all groups except group A in 8 weeks’ time. Group B, C &amp; D received distilled water and Aloe vera dried gel 400 mg/kg &amp; diclofenac powder 12 mg/kg body weight respectively orally between 8 to 10 weeks. Serum and urine analysis was performed for hematocrit, sodium, and potassium concentrations at zero, eight and ten weeks. Twenty-four-hour urinary sodium excretion was calculated. Data was analyzed using Graph Pad Prism version 6.&#x0D; Result: After 2-week administration of aloe vera and diclofenac powder, serum potassium significantly decreased in Group C (p &lt;0.001) while increased in Group B and D (p &lt;0.001) as compared to group A. Urinary sodium concentration and excretion increased significantly in Group C (p &lt;0.01) as compared to Group A whereas result of Group D was insignificant. No significant change in serum sodium and hematocrit of any group was observed.&#x0D; Conclusion: Aloe vera causes less sodium retention than diclofenac but decreases serum potassium contrary to the effect of diclofenac in hypertensive rats.

Safety and Efficacy of Urea for Hyponatremia.

Background and Objective: Urea is an alternative for treatment of hyponatremia however, its use has not been widely studied. The purpose of this study was to evaluate the safety and efficacy of urea for the treatment of hyponatremia. Methods: A retrospective cohort of patients with hyponatremia (serum sodium <135 mEq/L) of any cause who received at least 1 dose of urea during hospitalization and no prior use of urea. Serum sodium levels were collected at baseline and for 4 days or until urea was discontinued, whichever occurred first. The primary outcome was the serum sodium change between baseline and discharge or urea discontinuation. Results: Median serum sodium increased 2 [IQR, 0-4] mEq/L per day after urea administration at a median dose of 30 g/day. A significant difference in serum sodium was observed between baseline and discharge or discontinuation (124.2 ± 4 vs 130.1 ± 5.1; P < .001) and serum blood urea nitrogen (BUN) levels (18.4 ± 13.1 vs 41.1 ± 26.6; P ≤ .001). Serum sodium overcorrection (increase >8 mEq/L in 24 hours) occurred in 6 patients (8%). Urea was discontinued in 39 patients (53%); 20 discontinuations were due to patient intolerance. Conclusion: Urea appears to be an effective treatment for hyponatremia; however, patient tolerance, the rate of serum sodium overcorrection, and outpatient affordability may limit its use.

A comparative study of serum electrolytes, calcium and phosphorus levels in end stage renal disease patients undergoing hemodialysis

End stage Renal Disease (ESRD) represents the terminal stage of Chronic Kidney Disease (CKD) stage 5 where in there is accumulation of toxins, fluid and electrolytes which are normally excreted by the kidneys resulting in the uremic syndrome which leads to death unless the toxins are removed by renal replacement therapy, using dialysis or kidney transplantation. To estimate and compare the serum levels of electrolytes, calcium and phosphorus in ESRD patients before and after hemodialysis sessions.Cross sectional study conducted on 70 ESRD diagnosed patients, aged 30-75years of either gender on maintenance Hemodialysis. Blood samples were collected before and after Hemodialysis, analysed for Serum Electrolytes by semi autoanalyser from Roche. Serum Calcium and Phosphorus using Cobas Integra 400 plus from Roche for which Internal and External Quality Assurance Programmes are maintained. The data obtained was analysed using statistical package SPSS 20 version. The parameters are compared using paired‘t’ test, the test of probability less than 0.05 (P &amp;#60; 0.05) considered as statistically significant. There is significant decrease in mean serum Potassium, Chloride and Phosphorus, significant increase in serum Calcium and no change in serum Sodium after hemodialysis.Thus from our study we conclude that monitoring serum electrolytes, calcium and phosphorus have prognostic significance in ESRD patients undergoing hemodialysis.

Risk of Hyponatremia and Associated Clinical Characteristics in Patients with Acute Lymphoblastic Leukemia after CD19 Targeted Chimeric Antigen Receptor (CAR) T-Cells

Introduction: CD19-specific chimeric antigen receptor (CAR) T-cells have demonstrated high response rates in patients with acute lymphoblastic leukemia (ALL) in multiple clinical trials. The most prevalent toxicities of CD19 CAR T-cells are cytokine release syndrome (CRS), associated with elevation of proinflammatory cytokines such as IL-6, and neurotoxicity. There is increasing evidence that suggests IL-6 is involved in regulation of vasopressin secretion. The combination of IL-6 elevation, vasopressin secretion, and increased water intake may result in hyponatremia, creating a challenge in fluid management, particularly in the setting of neurotoxicity. However, the prevalence and severity of hyponatremia in patients receiving CD19 CAR T-cells remain unknown.Methods: We performed a retrospective analysis of adult patients with relapsed ALL who received CD19 CAR T-cells at Memorial Sloan Kettering Cancer Center. Hyponatremia was graded using the CTCAE v.4.0 definitions. Association of characteristics with post-infusion hyponatremia was assessed using Fisher's exact test or Wilcoxon rank sum test. Variables reviewed were grade and duration of hyponatremia, fever, CRS, neurotoxicity, C-reactive protein (CRP), IL-6, T-cell dose, and conditioning chemotherapy (fludarabine vs. cyclophosphamide).Results: Fifty-one patients were included in our analysis, with a median age of 44 years (range, 23-74). Following treatment, ≥ grade 1 hyponatremia occurred in 21 (41%) of patients with median sodium of 133 (range, 124-140): 13 patients (25%) had grade 1 and 8 patients (16%) had grade 3. When assessed by a change in serum sodium from baseline, 29 patients (57%) experienced >7 mEq change in sodium post-infusion. No patients developed grade 4 or grade 5 hyponatremia. Hyponatremia occurred at a median of 5 days after treatment (range, 1-32) with a median duration of 3 days (range, 0-25). Hyponatremia significantly correlated with development of grade 2-4 fever (p=0.006), severe CRS (p=0.011), any grade neurotoxicity (p=0.005), peak CRP (p<0.0001), but not with peak IL-6 (0.173), conditioning chemotherapy (p=0.75), and T-cell dose (p=0.374).Conclusion: In our cohort of adult patients with ALL treated with CD19 CAR T-cells, hyponatremia was common, mostly grades 0-1, and occurred early within the first week of treatment, correlating with the development of CAR-associated toxicities including fever, CRS, and neurotoxicity. Notably, while CRP, considered to be a reliable surrogate marker of IL-6, significantly correlated with hyponatremia, absolute magnitude of IL-6 elevation did not. Further analysis to determine the etiology and mechanism of hyponatremia will be presented, which will provide more insights to a cause-and-effect relationship between hyponatremia and CAR-associated toxicities. Because hyponatremia occurs commonly during the times of CRS, it is important to carefully monitor electrolytes, volume status, and use of IV fluids to prevent development of worsening or severe hyponatremia which can further complicate neurotoxicity in patients receiving CD19 CAR T-cells. DisclosuresHorvat:Amgen: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees. Brentjens:Juno Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Patents & Royalties, Research Funding. Park:Amgen: Consultancy.

MO150SERUM SODIUM DECLINE OCCURS DURING THE ACUTE PHASE OF COVID-19

Background and AimsHyponatremia is associated with aggravation of inflammation in COVID-19 patients. However, to the best of our knowledge, no study has used longitudinal data and investigated the association between hyponatremia and COVID-19. Therefore, we analyzed COVID-19 patients’ changes in serum sodium (Na) levels from admission to discharge.MethodWe conducted a retrospective, single-center, observational cohort study, involving adult COVID-19 patients who were admitted to Japan Self-Defense Forces Central Hospital between April 1 and May 31, 2020. Serum Na level of < 135 mEq/L was defined as hyponatremia, 135–145 mEq/L as normonatremia, and > 145 mEq/L as hypernatremia. Inflammation was assessed by serum C-reactive protein (CRP) levels. Univariate logistic regression analyses were used to assess associations between hyponatremia at admission and need for oxygen or death during hospitalization. A comparison of serum Na levels at admission and discharge was tested using a paired t-test. Cross-sectional associations between serum Na and CRP levels at admission or days from onset to admission were analyzed using multivariate linear regression analyses. A restricted cubic spline (RCS) curve incorporated in one of these multivariate linear regression analyses was used to identify when serum Na levels were the lowest. In addition, we employed a mixed-effect model to examine the longitudinal association between changes in serum Na and CRP levels during hospitalization.ResultsNinety-eight patients were enrolled, of whom 53 (54%) were male and 39 (40%) had a smoking history. Mean (SD) or median (IQR) of age, eGFR, body mass index (BMI), serum Na, and CRP at admission were 50 (17) years, 82 (20) mL/min/1.73m2, 23.3 (5.5), 138 (3.7) mEq/L, and 1.8 (0.2–6.0) mg/dL, respectively. It took an mean of 8.9 (3.7) days from onset to admission due to social disruption. According to government policies, during observation period, patients diagnosed with COVID-19 have to be hospitalized, even if they have minor or improving clinical symptoms.At admission, hyponatremia was observed in 11 (11.2%) patients; the rest of the patients had normonatremia. Twenty-seven (27.6%) patients received oxygen, and 4 (4.1%) died during hospitalization. Hyponatremia at admission was significantly associated with the need for oxygen (odds ratio: 41.2; 95% CI: 4.9–344; P=0.001) and death (odds ratio: 32.3; 95% CI: 3.0-347; P=0.004). Irrespective of hyponatremia at admission, the serum Na levels at discharge were significantly higher than those at admission (Fig. 1).In both cross-sectional and longitudinal analyses, serum Na levels were negatively associated with serum CRP levels after adjustment for age, sex, eGFR, BMI, and smoking history (P<0.001), which suggests that serum Na levels may reflect the activity of COVID-19. Furthermore, the serum Na levels at admission were positively associated with days from onset to admission after adjustment for age, sex, eGFR, BMI, smoking history, and serum CRP levels (P=0.035), and the RCS curve showed that the serum Na levels tended to be the lowest around the 7th day after onset (Fig. 2).ConclusionHyponatremia in COVID-19 may occur secondarily, and a condition called “COVID-19-induced hyponatremia” might exist.

Incidence and Factors Associated with Delirium in Children in a Single Pediatric Intensive Care Unit in Brazil

PurposeTo identify the incidence of delirium in a Pediatric Intensive Care Unit (PICU); to determine the factors associated with the occurrence of delirium and the agreement between two scales used for detection of pediatric delirium in critically ill children. Designs and methodDescriptive longitudinal study carried out in a PICU. The sample consisted of 65 critically ill children admitted to the PICU, with more than 24 h of hospitalization, excluding children with neurological or cognitive impairment, hearing and visual impairment, chronic encephalopathy and declining consent to participate in the study. Two scales were applied, the Cornell Assessment of Pediatric Delirium (CAPD) and the Sophia Observation Withdrawal Symptoms – Pediatric Delirium Scale (SOS_PD). Descriptive and inferential statistical analysis, with a 5% significance level was performed. ResultsDelirium was identified in 7.7% of children, with duration of the disorder of about 2 days. A very good agreement (Kappa = 1; p-value <0.001) between the two scales was identified. CAPD presented positive predictive value of 80.0%. There was a statistical association between the occurrence of delirium and age less than 2 years (p = 0.060); female gender (p = 0.057); use of mechanical pulmonary ventilation (p = 0.034); antiemetics (p = 0.002); anticholinergics (p = 0.044), and changes in serum sodium and potassium (p = 0.053). ConclusionDemographic, clinical, and pharmacological conditions were associated with the occurrence of delirium. Practice implicationsRoutine monitoring is the first step to any delirium prevention strategies, so delirium screening by the bedside nurse must be valued through a commitment to education and training.

A protocol for the management of hyponatremia peri-liver transplant reduces post-transplant neurological complications.

Rapid changes in serum sodium (ΔSNa) peri-liver transplant (LT) predispose to post-LT neurological complications (NC). We aimed to assess whether implementation of a protocol directed at limiting peri-LT ΔSNa reduced post-LT NC. A retrospective single-center review of adult LT recipients from 1/2016 to 10/2017 was performed. Patients with hyponatremia (SNa<135mEq/L) within 7days of LT were analyzed in two eras: pre-protocol (1/2016-9/2016) and post-protocol (10/2016-10/2017). The primary outcome was the development of NC within 1month of LT. Perioperative ΔSNa (ΔSNaPost-LT) was assessed as a secondary outcome. Among 85 and 107 patients who underwent LT pre- and post-protocol, 39 (46%) and 42 (39%) were hyponatremic within 7days of LT, respectively. Significantly fewer patients in the post-protocol era developed NC vs. pre-protocol (7.1% vs. 25.6%, p=.02). Additionally, fewer LT recipients in the post-protocol era developed ΔSNaPost-LT≥10mEq/L (9.5% vs. 30.7%, p=.02). Intraoperatively, more patients post-protocol received hypotonic saline (33.3% vs. 2.6%, p<.01). Multivariable logistic regression revealed that transplantation in the post-protocol era was associated with significantly reduced odds (odds ratio 0.11, 95% confidence interval 0.01-0.50) of developing NC. In conclusion, the implementation of a multidisciplinary protocol aimed at reducing ΔSNa peri-LT was independently associated with a reduction in post-LT NC.

Biochemical Changes in Neonates with and without Seizure: A Comparative Study

Background: Seizure is a common neurological disorder in the pediatric age group.&#x0D; Objective: Neonates with seizure have decreased in serum calcium, magnesium, sodium, potassium, and glucose if compared to neonates without seizure.&#x0D; Methodology: This comparative cross-sectional study was carried out in the Department of Biochemistry at Mymensingh Medical Collage, Mymensingh, Bangladesh in cooperation with the Department of Pediatric of Mymensingh Medical Collage &amp; Hospital, Mymensingh, Bangladesh from July 2005 to June 2006. Neonates were included in the study. Subjects were divided into two groups designated as group I as control group and group II cases. From each subject at least 2 ml of blood were collected from femoral vein and was collected serum for biochemical analysis.&#x0D; Result: A total of 60 neonates were included in the study. Subjects were divided into two groups-group-I control- (n=20) and group II cases-(n=40). The concentration of serum calcium, magnesium, sodium, potassium, and glucose yielded 7.33 ±0.79, 5.79 ±1.10; 2.18 ± 0.23,1.61 ± 0.25; 134.82 ±3.03, 133.68±8.57; 4.80 ±0.56,5.89 ±2.02; 66.33 ± 8.23, 62.25± 7.96 in group I and group II respectively.&#x0D; Conclusion: Significant decreases of serum calcium, magnesium and significant increase of serum potassium in neonates with seizure are found in this study. The change in serum sodium and glucose are not significant. &#x0D; Journal of Current and Advance Medical Research, January 2021;8(1):25-29