Changes In Sodium Concentration Research Articles

Aquaporin-2 plays an important role in water transportation through the bladder wall in rats.

We investigated the role of the bladder wall in permeating water, focusing on aquaporins. Female Sprague-Dawley rats weighing 300 g were used to investigate the role of the bladder wall in saline permeation. Changes in intravesical fluid volume and sodium concentration were measured in the desmopressin acetate hydrate-loaded and control groups 3 h after administration. Bladders were resected to measure aquaporin-1, 2, and 3 gene expression using qRT-PCR. Additionally, the change of aquaporin-2 expression was measured using Western blotting and immunohistochemistry in intravesical aquaporin-2 siRNA-treated and control groups. Although the intravesical fluid volume and sodium concentration significantly decreased from 0 to 3 h (1.00 ± 0.00 vs 0.83 ± 0.08 mL, 157.80 ± 1.30 vs 146.8 ± 1.92 mEq/mL, P < 0.01, respectively in the control group), administration of desmopressin did not affect the extent of volume change. Aquaporin-2 expression was significantly higher in the 3-h distended bladders than in the empty bladder. Aquaporin-2 siRNA treatment suppressed aquaporin-2 expression and the change of intravesical fluid volume from 0 to 3 h (1.00 ± 0.00 and 0.99 ± 0.02 mL), which was related to the suppression of sodium concentration change in comparison with control siRNA treatment (149.6 ± 2.4 vs 143.6 ± 3.67 mEq/mL, P < 0.05). The rat urinary bladder absorbs water and salts under the full-filled condition. Aquaporin-2 plays an important role in the transport of water, accompanied by sodium concentration change. We demonstrated a part of the bladder absorption mechanism, which may lead to development of a new method for regulating bladder storage function.

Adjusted Plasma Chloride and Bicarbonate Concentrations: An Approach to Identifying Acid–Base Disorders

Chloride disorders (hypochloremia, hyperchloremia) and bicarbonate disorders (hypobicarbonatemia, hyperbicarbonatemia) are common in clinical medicine and indicate metabolic and/or respiratory acid-base disorders. The normally inverse relationship between chloride and bicarbonate concentrations in the blood is altered, however, by changes in fluid balance, i.e., water excess or deficit, with resulting changes in sodium and other electrolyte concentrations and by anion gap metabolic acidosis, which lowers bicarbonate concentrations but not the chloride concentrations. We used formulas derived over a decade ago that utilize dry slide laboratory technology to adjust plasma chloride and bicarbonate concentrations for changes in water balance, as reflected in changes in plasma sodium concentrations and in the plasma anion gap. We then prospectively validated these formulas in 736 consecutive adults, 499 having abnormal basic metabolic panel results and 237 having normal panel results, using modern wet laboratory technology. Plasma chloride and bicarbonate concentrations were inversely correlated (2-tailed P-value <0.0001), but the correlations were only modest (Spearman r: -0.48 for the abnormal group and -0.41 for the normal group). After adjusting the plasma chloride and bicarbonate concentrations using the 2 prior formulas, the inverse correlations were very high, with Spearman r: -0.998 for the abnormal group and -0.999 for the normal group. Adjusting plasma chloride and bicarbonate concentrations for any water imbalance and anion gap alterations leads to very high inverse correlations between these 2 anions, allowing accurate assessment of either subtle or overt acid-base disorders.

Associations between dialysate sodium concentration and plasma sodium concentration of dogs receiving intermittent hemodialysis treatments.

OBJECTIVE To compare dialysate sodium concentration and patient plasma sodium concentration of dogs during intermittent hemodialysis treatments. SAMPLE 211 intermittent hemodialysis treatments performed on 40 client-owned dogs for the management of dialysis-dependent uremia. PROCEDURES Medical records were reviewed to determine the plasma sodium concentration of each dog before and after routine hemodialysis treatments. Associations between detected changes in plasma sodium concentration and dialysate sodium concentration were evaluated by use of Spearman rank correlations and linear regression analysis. RESULTS Significant linear correlations were found between the dialysate sodium concentration and patient sodium concentration. The starting dialysate-to-patient sodium gradient was associated with the strongest correlation to the change in patient sodium concentration at the end of the dialysis session. Modest correlations existed between the dialysate sodium concentration and postdialysis patient sodium concentration as well as between the predialysis dialysate-to-patient sodium gradient and postdialysis dialysate-to-patient sodium gradient. CONCLUSIONS AND CLINICAL RELEVANCE The dialysate sodium concentration was correlated with the patient sodium concentration in dogs, and the dialysate-to-patient sodium gradient could be used to further refine this association to predict the postdialysis patient sodium concentration and potentially manage dysnatremia during hemodialysis. Prospective studies should be performed to determine how these associations can be used to correct aberrations as well as to avoid unwanted alterations in patient sodium concentrations.

Pharmacological Properties of Loop Diuretics and Their Clinical Effects

Edematous states caused by an excessesive extracellular fluid retention are major components of cardiovascular and renal disorders including chronic kidney disease, nephrotic syndrome, and heart failure. The use of diuretic drugs from various groups including loop duiretics are important means of pharmacological correction of these clinical conditions. Moreover, diuretics used to lower bood pressure as a part of antihypertensive treatment, reduce cardiovascular events. The response of patients to the dose of a diuretic is reflected by a sigmoid dose-response curve which can be affected by changes of sodium content in the body. Loop diuretics may fail to control salt and water retention despite the use of appropriate doses. The main reasons for loop diuretic resistance may be determined by further reduction of glomerular filtration rate and reduced peak concentration of loop diuretics in primary urine. Chronic treatment with loop diuretics can cause compensatory hyperthrophy of epithelial cells along the ascending limb of the loop of Henle and thus decrease of its diuretic effect. The principles of avoiding this phenomenon are the restriction of sodium intake, correction of doses, timing and frequency of drug administration, and use of combination diuretic therapy. Loop diuretic - related adverse events that involve uricaemia and ototoxicity also should be taken into consideration.

Extracellular volume depletion and resultant hypotonic hyponatremia: A novel translational approach

Although several methods currently exist to determine that a person is hypovolemic, it often remains very challenging to accurately estimate the effective circulating volume or amount of intravascular volume depletion in a non-controlled setting. This depletion of intravascular volume can have many causes and is frequently accompanied by hypotonic hyponatremia as a result of hypovolemia-induced release of arginine vasopressin (AVP) from the posterior pituitary gland. Here, we derive a novel, comprehensible equation that provides a theoretical insight into the complex interrelationship between the degree of isotonic volume depletion and the resultant change in plasma sodium concentration. We believe that the presented model can prove to be a valuable tool for the analysis of fluid and electrolyte imbalances.

Neuronal circuits involved in osmotic challenges.

The maintenance of plasma sodium concentration within a narrow limit is crucial to life. When it differs from normal physiological patterns, several mechanisms are activated in order to restore body fluid homeostasis. Such mechanisms may be vegetative and/or behavioral, and several regions of the central nervous system (CNS) are involved in their triggering. Some of these are responsible for sensory pathways that perceive a disturbance of the body fluid homeostasis and transmit information to other regions. These regions, in turn, initiate adequate adjustments in order to restore homeostasis. The main cardiovascular and autonomic responses to a change in plasma sodium concentration are: i) changes in arterial blood pressure and heart rate; ii) changes in sympathetic activity to the renal system in order to ensure adequate renal sodium excretion/absorption, and iii) the secretion of compounds involved in sodium ion homeostasis (ANP, Ang-II, and ADH, for example). Due to their cardiovascular effects, hypertonic saline solutions have been used to promote resuscitation in hemorrhagic patients, thereby increasing survival rates following trauma. In the present review, we expose and discuss the role of several CNS regions involved in body fluid homeostasis and the effects of acute and chronic hyperosmotic challenges.

Effect of electrolyte supplementation on electrolyte profile in Marwari horses during 20 km moderate intensity riding exercise

The effect of electrolyte supplementation on plasma electrolyte profile in horses in hot environmental conditions was studied using sweat loss and sweat electrolyte concentration. Eleven adult Marwari mares were selected for the study. To develop an electrolyte supplement, 7 mares were given a preliminary 20 km moderate intensity exercise and the electrolyte supplement was designed on basis of their body weight loss and sweat electrolyte concentration during exercise. In the subsequent trials, 4 mares were kept in an exercise control group that did not receive the supplement (ECG), while 3 mares were kept in the exercise supplementation group (ESG) that received the supplement. Four other mares were used as resting controls (RG). ESG mares were daily fed 50 g electrolyte supplement and 150 g supplement orally 1 h before the 20 km trial. Mares of ESG and ECG groups were conferred 3 km trot + canter riding every day in the morning and a 20 km trot + canter ride on every 10th day of the total trial period of 40 days. Blood analysis revealed a significant (P&lt;0.05) decline in plasma calcium and chloride concentrations immediately after exercise in both groups. There was significant less post-exercise decrease of plasma calcium and chloride concentration in ESG mares. Post-exercise plasma sodium concentration was higher (P&lt;0.05) and plasma potassium concentration was lower only in ESG mares (P&lt;0.05) compared to pre-exercise concentrations. The supplement did not affect the physiological responses (heart rate and rectal temperature). However, the changes in plasma sodium, potassium, calcium and chloride concentration were in favour of better performance in supplemented (ESG) mares and advocate sweat-developed electrolyte supplementation in riding mares.

Relationship between Sodium Intake and Water Intake: The False and the True

Background: Generally, eating salty food items increases thirst. Thirst is also stimulated by the experimental infusion of hypertonic saline. But, in steady state, does the kidney need a higher amount of water to excrete sodium on a high than on a low sodium intake? This issue is still controversial. The purpose of this review is to provide examples of how the kidney handles water in relation to salt intake/output. It is based on re-analysis of previously published studies in which salt intake was adjusted to several different levels in the same subjects, and in databases of epidemiologic studies in populations on an ad libitum diet. Summary and Key Messages: These re-analyses allow us to draw the following conclusions: (1) In a steady state situation, the urine volume (and thus the fluid intake) remains unchanged over a large range of sodium intakes. The adaptation to a higher sodium excretion rests only on changes in urinary sodium concentration. However, above a certain limit, this concentration cannot increase further and the urine volume may then increase. (2) In population studies, it is not legitimate to assume that sodium is responsible for changes in urine volume, since people who eat more sodium also eat more of other nutrients leading to an increase in the excretion of potassium, urea and other solutes, besides sodium. (3) After an abrupt increase in sodium intake, fluid intake is increased in the first few days, but urine volume does not change. The extra fluid drunk is responsible for an increase in body weight.

Changes in the Sodium Content of Australian Processed Foods between 1980 and 2013 Using Analytical Data.

The objective of this study was to obtain analytical data on the sodium content of a range of processed foods and compare the levels obtained with their label claims and with published data of the same or equivalent processed foods in the 1980s and 1990s to investigate the extent of any change in sodium content in relation to reformulation targets. The sodium contents of 130 Australian processed foods were obtained by inductively coupled plasma optical emission spectrometry (ICP-OES) analysis and compared with previously published data. The sodium content between 1980 and 2013 across all products and by each product category were compared. There was a significant overall sodium reduction of 23%, 181 mg/100 g (p <0.001, 95% CI (Confidence Interval), 90 to 272 mg/100 g), in Australian processed foods since 1980, with a 12% (83 mg/100 g) reduction over the last 18 years. The sodium content of convenience foods (p < 0.001, 95% CI, 94 to 291 mg/100 g) and snack foods (p = 0.017, 95% CI, 44 to 398 mg/100 g) had declined significantly since 1980. Meanwhile, the sodium contents of processed meats (p = 0.655, 95% CI, −121 to 190) and bread and other bakery products (p = 0.115, 95% CI, −22 to 192) had decreased, though not significantly. Conversely, the sodium content of cheese (p = 0.781, 95% CI, −484 to 369 mg/100 g) had increased but also not significantly. Of the 130 products analysed, 62% met Australian reformulation targets. Sodium contents of the processed foods and the overall changes in comparison with previous data indicate a decrease over the 33 years period and suggest that the Australian recommended reformulation targets have been effective. Further sodium reduction of processed foods is still required and continuous monitoring of the reduction of sodium levels in processed foods is needed.

An Analysis of Systematic Elemental Changes in Decomposing Bone.

The aim of this pilot study was to investigate compositional changes in bone during decomposition. Elemental concentrations of barium, calcium, iron, potassium, magnesium, zinc and phosphorus in porcine bone (as an experimental analog for human bone) were analyzed by inductively coupled plasma optical emission spectroscopy (ICP-OES). The samples were taken from porcine bone subjected to shallow burial and surface depositions at 28-day intervals for a period of 140 days. Results indicated that ICP-OES elemental profiling has potential to be developed as a forensic test for determining whether a bone sample originates from the early stages of soft tissue putrefaction. Significant changes in iron, sodium and potassium concentrations were found over 140 days. These elements are known to be primarily associated with proteins and/or tissue fluids within the bone. Changes in their respective concentrations may therefore be linked to dehydration over time and in turn may be indicative of time since deposition.

Dietary sodium reduction in New Zealand: influence of the Tick label.

The Tick programme of the National Heart Foundation (NHF) is the longest standing voluntary front of pack signpost nutrition logo in New Zealand. It provides a platform for collaboration with the food industry to encourage development of healthier products. This study evaluated the impact of the Tick programme on sodium in processed food. Fifty-two Tick programme products from food categories known to contribute substantially to sodium intake were identified. Sales volumes (kg) from January 2011 to December 2013 were multiplied by changes in sodium content over that time, producing an estimate of programme impact. Five semi-structured interviews with industry representatives were conducted, to look at other influences for sodium reduction, and themes identified through methods of thematic analysis. Over the period, the Tick programme influenced food companies to remove approximately 16 tonnes of salt through the reformulation and formulation of 52 Tick-approved breakfast cereals, edible oil spreads, cooking sauces and processed poultry products. Other factors influencing sodium reduction reported by company representatives included increased consumer and industry interest in healthier product nutrition profiles and other sodium reduction programmes targeting reformulation/formulation. The Tick remains a credible and well-recognized brand and may provide a competitive edge for participating food manufacturers in the current market. The Tick programme is effective in influencing industry to reduce sodium in processed foods in New Zealand. The combined impact of the Tick and other NHF programmes has the potential to reduce population sodium intake and improve health outcomes.

Effects of Sodium Concentration and Dialysate Temperature Changes on Blood Pressure in Hemodialysis Patients: A Randomized, Triple-Blind Crossover Clinical Trial.

The present study investigated the effects of different temperatures and sodium dialysate concentration on blood pressure in hemodialysis patients. Following Williams' design, hemodialysis patients were randomly assigned into four dialysis modes. Dialysate temperature was set at 37°C for modes A and C and, 35°C for modes B and D. Sodium concentration was set at 138mmol/L in modes A and B, while it changed from 150mmol/L to 138mmol/L in modes C and D. Using analysis of variance for repeated measures, the mean values of systolic and diastolic blood pressure were investigated. The mean values of systolic and diastolic blood pressure in modes C and D had a significant difference with the values in mode A. The mean values of systolic and diastolic blood pressure in patients dialyzed with mode B had a significant difference with the values in those dialyzed with mode D. Moreover, there were significant differences in the incidence of hypotension between A and other modes and between B and modes C and D, but this difference was not significant between modes C and D. In order to reduce intradialytic blood pressure fluctuations and hypotension, the nursing staff are recommended to gradually reduce dialysate sodium concentration.

Quantification of nonosmotic sodium storage capacity following acute hypertonic saline infusion in healthy individuals

The assumption that sodium accumulation in the human body is always accompanied by water retention has been challenged by data showing that sodium can be stored nonosmotically. Here we investigated the contribution of nonosmotic sodium storage to short-term sodium homeostasis after hypertonic saline infusion in healthy individuals on a low-sodium diet. During four hours after infusion, we compared the observed changes in plasma sodium concentration and urinary cation excretion with changes that were calculated with the Adrogue-Madias and Nguyen-Kurtz formula, formulations widely implemented to guide the treatment of dysnatremias. We included 12 healthy non-smoking male individuals with normal blood pressure, body mass index, and kidney function. Right after infusion, the average observed plasma sodium change from baseline (3.5 mmol/L) was similar to the predicted changes by the Adrogue-Madias (3.3 mmol/L) and Nguyen-Kurtz formula (3.1mmol/L). However, the observed plasma sodium concentration change after four hours (-1.8 mmol/L) was very different from the changes as predicted by the Adrogue-Madias (0.4 mmol/L) and the Nguyen-Kurtz formula (-0.9 mmol/L). Moreover, only 47% and 55%, respectively, of the expected sodium and potassium excretion were retrieved in the urine. Thus, healthy individuals are able to osmotically inactivate significant amounts of sodium after hypertonic saline infusion. Further research is needed to uncover factors that determine nonosmotic sodium storage.

Adipsic diabetes insipidus in adult patients.

Adipsic diabetes insipidus (ADI) is a very rare disorder, characterized by hypotonic polyuria due to arginine vasopressin (AVP) deficiency and failure to generate the sensation of thirst in response to hypernatraemia. As the sensation of thirst is the key homeostatic mechanism that prevents hypernatraemic dehydration in patients with untreated diabetes insipidus (DI), adipsia leads to failure to respond to aquaresis with appropriate fluid intake. This predisposes to the development of significant hypernatraemia, which is the typical biochemical manifestation of adipsic DI. A literature search was performed to review the background, etiology, management and associated complications of this rare condition. ADI has been reported to occur in association with clipping of an anterior communicating artery aneurysm following subarachnoid haemorrhage, major hypothalamic surgery, traumatic brain injury and toluene exposure among other conditions. Management is very difficult and patients are prone to marked changes in plasma sodium concentration, in particular to the development of severe hypernatraemia. Associated hypothalamic disorders, such as severe obesity, sleep apnoea and thermoregulatory disorders are often observed in patients with ADI. The management of ADI is challenging and is associated with significant morbidity and mortality. Prognosis is variable; hypothalamic complications lead to early death in some patients, but recent reports highlight the possibility of recovery of thirst.

International Union of Basic and Clinical Pharmacology. C. Nomenclature and Properties of Calcium-Activated and Sodium-Activated Potassium Channels.

A subset of potassium channels is regulated primarily by changes in the cytoplasmic concentration of ions, including calcium, sodium, chloride, and protons. The eight members of this subfamily were originally all designated as calcium-activated channels. More recent studies have clarified the gating mechanisms for these channels and have documented that not all members are sensitive to calcium. This article describes the molecular relationships between these channels and provides an introduction to their functional properties. It also introduces a new nomenclature that differentiates between calcium- and sodium-activated potassium channels.

Osmotically inactive sodium and potassium storage: lessons learned from the Edelman and Boling data.

Because changes in the plasma water sodium concentration ([Na(+)]pw) are clinically due to changes in the mass balance of Na(+), K(+), and H2O, the analysis and treatment of the dysnatremias are dependent on the validity of the Edelman equation in defining the quantitative interrelationship between the [Na(+)]pw and the total exchangeable sodium (Nae), total exchangeable potassium (Ke), and total body water (TBW) (Edelman IS, Leibman J, O'Meara MP, Birkenfeld LW. J Clin Invest 37: 1236-1256, 1958): [Na(+)]pw = 1.11(Nae + Ke)/TBW - 25.6. The interrelationship between [Na(+)]pw and Nae, Ke, and TBW in the Edelman equation is empirically determined by accounting for measurement errors in all of these variables. In contrast, linear regression analysis of the same data set using [Na(+)]pw as the dependent variable yields the following equation: [Na(+)]pw = 0.93(Nae + Ke)/TBW + 1.37. Moreover, based on the study by Boling et al. (Boling EA, Lipkind JB. 18: 943-949, 1963), the [Na(+)]pw is related to the Nae, Ke, and TBW by the following linear regression equation: [Na(+)]pw = 0.487(Nae + Ke)/TBW + 71.54. The disparities between the slope and y-intercept of these three equations are unknown. In this mathematical analysis, we demonstrate that the disparities between the slope and y-intercept in these three equations can be explained by how the osmotically inactive Na(+) and K(+) storage pool is quantitatively accounted for. Our analysis also indicates that the osmotically inactive Na(+) and K(+) storage pool is dynamically regulated and that changes in the [Na(+)]pw can be predicted based on changes in the Nae, Ke, and TBW despite dynamic changes in the osmotically inactive Na(+) and K(+) storage pool.

Can sodium NMR provide more than a tracer for brine in petrophysics?

Sodium has been suggested as a tracer for brine in reservoir formations, where sodium ions are found exclusively in the aqueous phase, and can be detected by time-domain nuclear magnetic resonance (NMR). To date, petrophysical applications of sodium-23 NMR have focused on concentrated NaCl electrolyte solutions where the nuclear spin relaxation time is related to ion concentration. Therefore, a measure of brine volume is achieved directly from the sodium signal amplitude and relaxation time, available in a single measurement. However, real reservoir formation or injection brines contain many different ionic moieties. Sodium-23 relaxation times and diffusion coefficients are measured using time-domain NMR and pulsed field gradient (PFG) NMR techniques, respectively, and shown to depend strongly on the ions present in solution. Correlations between sodium-23 relaxation times and sodium ion concentration are found to differ depending on the cations and other anions present in the brine. However, consistent correlations are obtained for sodium-23 relaxation times and diffusion coefficient, and brine viscosity, regardless of the ionic content of the brine. In general, sodium-23 NMR remains a qualitative technique for monitoring changes in sodium concentration or brine volume (at constant salinity) in reservoir formations. However, if knowledge of the brine chemistry is available, then sodium-23 NMR offers a non-invasive and quantitative method of robustly measuring brine volume and viscosity in petrophysical applications.

WATER-ELECTROLYTE DISTURBANCES POSTRESUSCITATION ACUTE MYOCARDIAL INFARCTION AND THEIR VALUE IN DISORDERS OF SYSTEMIC HEMODYNAMICS

Purpose. The establishment of the role of water and electrolyte disorders in the pathogenesis postresuscitation hemo circulatory disorders after removal from the clinical death caused by acute myocardial infarction. Materials and methods. In experiments with 158 dogs studied under Nembutal anesthesia recovery processes of life after 5 minutes of clinical death caused by myocardial infarction. Results. It is found that dogs in the early postresuscitative after myocardial infarction occurs movement of sodium ions in the red blood cells, which is accompanied by gipoosmiey blood plasma and interstitial fluid. This causes the movement of water in the cell sector, which leads to the development of hypovolemia and drop in cardiac output. Movement of potassium and calcium ions from cell sector into the extracellular defines violation of myocardial, vascular tone, and increases the risk of arrhythmia postresuscitation myocardial infarction. Сonclusion. In postresuscitative in dogs undergoing clinical death with acute myocardial infarction, there is a redistribution of electrolytes sector body. During the first 9 hours after resuscitation sodium and calcium concentration in the cell sector increase and decrease in the extracellular. Changes in the potassium content of the opposite. By the end of 1st day recovery period increases plasma sodium concentration, and the corresponding potassium and calcium indicators reduced. The osmolarity of the extracellular space is reduced by 5 min postresuscitative period and increases toward the end of 1 day. It is associated with similar changes in sodium concentration. sodium retention in the cell movement causes the space portion therein, and development of extracellular fluid volume depletion, which leads to a decrease in venous return and cardiac output drop. In the interval of 9–24 hours after resuscitation begins a long period of stabilization of the circulatory system. This is due to the normalization of the water distribution sector, which leads to the restoration of intravascular volume and resolution of hemodynamic disturbances.

Protocol for a cluster-randomised trial to determine the effects of advocacy actions on the salt content of processed foods.

BackgroundCorporate decisions affecting the composition of processed foods are a potent factor shaping the nutritional quality of the food supply. The addition of large quantities of salt to foods is incompatible with Australian Dietary Guidelines and the reformulation of processed foods to have less salt is a focus of non-governmental organisations (NGOs). There is evidence that advocacy can influence corporate behaviour but there are few data to define the effects of NGOs working in the food space. The aim of this study is to quantify the effects of advocacy delivered by a local NGO on the salt content of food products produced or marketed by companies in Australia.Methods/DesignThis is a cluster-randomised controlled trial that will be done in Australia from 2013 to 2015 which includes 45 food companies. The 23 companies in the control group will receive no specific intervention whilst the 22 companies in the intervention group will receive an advocacy program based upon an established theory of change model. The primary outcome will be the mean change in sodium content (mg/100 g) of processed foods produced or marketed by intervention compared to control companies assessed at 24 months. Interim outcomes (statements of support, published nutrition policies, level of engagement, knowledge and use of technology to reduce salt, salt reduction plans, and support for national initiatives) will also be assessed and a qualitative evaluation will provide more detailed insight.DiscussionThis novel study will provide robust randomised evidence about the effects of advocacy on food company behaviour and the quality of the processed food supply. A finding of improved food company behaviour will highlight the potential for greater investment in advocacy whilst the opposite result will reinforce the importance of government-led initiatives for the improvement of the food supply.Trial registrationClinicalTrials.gov: NCT02373423. 26/02/2015Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2743-4) contains supplementary material, which is available to authorized users.

Acute serum sodium concentration changes in pediatric patients undergoing cardiopulmonary bypass and the association with postoperative outcomes.

The objective of this study is to investigate the degree of serum sodium changes and its association with patient outcomes in pediatrics undergoing heart surgery with cardiopulmonary bypass (CPB). We reviewed the medical records of 275 pediatric patients who underwent heart surgery with CPB. Prior to CPB, hyponatremia (≤135 mmol/L) was observed in 21 of 275 patients. After initiation of CPB, serum sodium decreased significantly and severe hyponatermia (≤130 mmol/L) subsequently developed in 32 patients. At the end of CPB, however, hypernatremia (≥145 mmol/L) developed in 86 patients. The degree of acute serum sodium change during CPB was not associated with patient outcomes. However, the patients with preoperative hyponatremia and those with hypernatremia at the conclusion of CPB had longer hospital stays and higher postoperative complication rates. Lower serum sodium prior to CPB and higher serum sodium at the end of CPB, along with age and duration of the operation, were independently associated with worse in-hospital outcomes. Acute and transient hyponatremia occurred frequently after initiation of CPB, and then serum sodium immediately increased above preoperative levels at the end of CPB. Caution is required to avoid serum sodium overcorrection on the conclusion of CPB.