Changes In Potassium Research Articles

Sodium polystyrene sulfonate versus sodium zirconium cyclosilicate for the treatment of hyperkalemia in the emergency department

BackgroundHyperkalemia accounts for over 800,000 emergency department (ED) visits in the United States each year, and has been associated with significant morbidity and mortality likely due to fatal cardiac dysrhythmias. Previous studies have demonstrated reductions in mortality when potassium levels are normalized in the ED. Cation exchange resins, such as sodium polystyrene sulfonate (SPS) and sodium zirconium cyclosilicate (SZC), may be administered as a means of definitively eliminating potassium from the body. This practice is based on physician preference and is not supported by high quality data. Two studies evaluating the use of cation exchange resins versus standard treatment in the ED demonstrated reductions in serum potassium levels within two hours of administration; however, there have been no published studies investigating these agents in a head-to-head comparison. ObjectiveThe purpose of this study was to evaluate the efficacy and safety of SPS versus SZC in lowering serum potassium in patients presenting to the ED with hyperkalemia. MethodsThis was an institutional review board-approved, retrospective cohort study conducted at a single-site ED. All patients who received medications under the “ED Hyperkalemia Treatment” order set between August 26, 2019 and May 13, 2021 were eligible for inclusion. The primary outcome was the change in serum potassium from baseline to first repeat level following SPS or SZC administration in the ED. ResultsA total of 885 patients were screened with 54 patients in the SPS group and 51 patients in the SZC group included in the final analyses. The mean change in serum potassium from baseline to first repeat level following administration of the cation exchange resin was −1.1 mEq/L for both groups. ConclusionAdministration of SPS or SZC for the treatment of hyperkalemia in the ED resulted in similar reductions in serum potassium.

Intravenous bolus-infusion versus sliding scale of insulin for intra-operative glycemic control in elective laparotomy surgeries

BackgroundThe aim of this study was to assess the bolus-infusion to the sliding scale of insulin approaches, regarding percentage of the operative time with the target capillary blood glucose (CBG) range, total insulin units given to the patients, development of hypoglycemia, and the peri-operative changes in serum potassium (s.k) in elective laparotomy surgeries. Sixty patients, American Society of Anesthesiologists (ASA) physical status II, were randomly divided to either the bolus-insulin infusion (BII) group, or the sliding scale of insulin (SSI) group.ResultsThe intra-operative target CBG range was achieved in both groups, with no statistically significant difference between them. However, in the post anesthesia care unit (PACU), the number of patients who achieved the target CBG range was significantly more in the BII group. The decrease in the CBG was statistically significant in the SSI group than in the BII group; starting from 30 minutes after the initial intra-venous (IV) insulin injected, to 240 minutes intra-operatively and in the PACU. No patient in either groups developed hypoglycemia. The mean intra-operative time needed to achieve the target CBG range was statistically significant less in the SSI group. The mean percentage of the operative time with the target CBG range was statistically non-significant higher in the SSI group. The mean total insulin units given were statistically non-significant higher in the SSI group. The peri-operative changes in s.k were statistically non-significant between the two groups.ConclusionsThe BII approach slowly achieved the target CBG range intra-operatively and maintained this target in the PACU, with mean 54.6 ± 28.9% operative time with the target CBG range, and with less mean total insulin units needed than the SSI approach.

Safety and Efficacy of Patiromer in Hyperkalemic Patients with CKD: A Pooled Analysis of Three Randomized Trials.

Hyperkalemia is a common electrolyte abnormality in patients with CKD, which is associated with worse outcomes and limits use of renin-angiotensin-aldosterone system inhibitors (RAASi). This post hoc subgroup analysis of three clinical trials evaluated the efficacy and safety of the sodium-free, potassium-binding polymer, patiromer, for the treatment of hyperkalemia in adults with nondialysis CKD. Data from the 4-week treatment periods of AMETHYST-DN, OPAL-HK, and TOURMALINE studies were combined. Patients had baseline diagnosis of CKD, hyperkalemia (serum potassium >5.0 mEq/L), and received patiromer 8.4-33.6 g/day. Patients were stratified by baseline eGFR into two subgroups: severe/end-stage CKD (stage 3b-5; eGFR <45 ml/min per 1.73 m2) and mild/moderate CKD (stage 1-3a; eGFR ≥45 ml/min per 1.73 m2). Efficacy was assessed by the change in serum potassium (mean±SE) from baseline to week 4. Safety assessments included incidence and severity of adverse events (AEs). Efficacy analyses (n=626; 62% male, mean age 66 years) included 417 (67%) patients with severe/end-stage CKD and 209 (33%) with mild/moderate CKD. Most patients were receiving RAASi therapy at baseline (severe/end-stage CKD 92%; mild/moderate CKD 98%). The mean±SE change in serum potassium (baseline to week 4) was -0.84±0.03 in the severe/end-stage CKD subgroup, and -0.60±0.04 mEq/L in the mild/moderate CKD subgroup. AEs were reported for 40% and 27% patients in the severe/end-stage and mild/moderate CKD subgroups, respectively, with 16% and 12% reporting AEs considered related to patiromer. The most frequent AEs were mild-to-moderate constipation (8% and 3%) and diarrhea (4% and 2%). AEs leading to patiromer discontinuation occurred in 6% and 2% of patients with severe/end-stage CKD, and mild/moderate CKD, respectively. Patiromer was effective for treatment of hyperkalemia and well tolerated in patients across stages of CKD, most of whom were receiving guideline-recommended RAASi therapy.

Evaluation of Gigantochloa scortechinii and soil interaction in three study sites in Malaysia

Understanding the productivity and physiological status of an organ (rhizome) function can lead into a sustainable production of sympodial bamboo. Nutrient elements and ash content (AC) are among the indicators to indicate the productivity and physiological status of an individual bamboo organ. The present study aimed to (a) determine the concentration of macronutrient elements of Gigantochloa scortechinii's rhizomes at four different ages collected at three study sites, and (b) investigate their relationship with AC. The destructive sampling was conducted on a set of four consecutive rhizomes using the selective random sampling method. Middle rhizome wall portion was used to determine the macronutrient elements and AC. All primary and secondary macronutrients were found to be different (p ≤ 0.01) at different study sites, except for the magnesium (Mg). The changes in nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), and Mg from new sprout to mature rhizome showed a strongly positive relationship with AC. Thus, the N, P, K, Ca, and Mg concentrations decreased with rhizome age, resulting in a decrease in AC. The present study suggests that the suitable harvesting of individual bamboo culm and rhizome is at mature and older age while the remaining younger age bamboo is kept being grown so that the bamboo production is sustainable in terms of the physiological functions.

In Primary Aldosteronism Acute Potassium Chloride Supplementation Suppresses Abundance and Phosphorylation of the Sodium-Chloride Cotransporter.

Elevated abundance of sodium-chloride cotransporter (NCC) and phosphorylated NCC (pNCC) are potential markers of primary aldosteronism (PA), but these effects may be driven by hypokalemia. We measured plasma potassium in patients with PA. If potassium was <4.0 mmol/L, patients were given sufficient oral potassium chloride (KCl) over 24 hours to achieve as close to 4.0 mmol/L as possible. Clinical chemistries were assessed, and urinary extracellular vesicles (uEVs) were examined to investigate effects on NCC. Among 21 patients with PA who received a median total dose of 6.0 g (2.4-16.8 g) of KCl, increases were observed in plasma potassium (from 3.4 to 4.0 mmol/L; P<0.001), aldosterone (from 305 to 558 pmol/L; P=0.01), and renin (from 1.2 to 2.5 mIU/L; P<0.001), whereas decreases were detected in uEV levels of NCC (median fold change(post/basal) [FC]=0.71 [0.09-1.99]; P=0.02), pT60-NCC (FC=0.84 [0.06-1.66]; P=0.05), and pT55/60-NCC (FC=0.67 [0.08-2.42]; P=0.02). By contrast, in 10 patients with PA who did not receive KCl, there were no apparent changes in plasma potassium, NCC abundance, and phosphorylation status, but increases were observed in plasma aldosterone (from 178 to 418 pmol/L; P=0.006) and renin (from 2.0 to 3.0 mU/L; P=0.009). Plasma potassium correlated inversely with uEV levels of NCC (R 2=0.11; P=0.01), pT60-NCC (R 2=0.11; P=0.01), and pT55/60-NCC (R 2=0.11; P=0.01). Acute oral KCl loading replenished plasma potassium in patients with PA and suppressed NCC abundance and phosphorylation, despite a significant rise in plasma aldosterone. This supports the view that potassium supplementation in humans with PA overrides the aldosterone stimulatory effect on NCC. The increased plasma aldosterone in patients with PA without KCl supplementation may be due to aldosterone response to posture challenge.

Abstract 13593: Rates of Acute Kidney Injury or Discontinuation After SGLT2 Inhibitor Initiation in a Real-World Cohort of Patients With Heart Failure With Reduced Ejection Fraction

Background: SGLT2 inhibitors (SGLT2i) decrease mortality and risk of hospitalizations in patients with HFrEF. SGLT2i have a natriuretic effect shortly after initiation, followed by a lasting osmotic diuretic effect. We sought to evaluate real-world rates of acute kidney injury (AKI) in our clinical setting that includes patients concurrently receiving high doses of loop diuretics. Methods: We abstracted patient level data on 200 patients with HFrEF initiated on a SGLT2i in the outpatient setting in the University of Michigan (1/7/2016 - 2/7/2022). Our co-primary endpoints were rate of AKI and discontinuation of SGLT2i. Secondary end points consisted of diuretic dose reduction, change in potassium, change in serum creatinine (SCr), and other side effects not requiring discontinuation. Results: The majority of patients were male (64%) with a mean LVEF of 27%. A total of 104 (52%) patients had diabetes mellitus. The majority of patients (54%) were taking an angiotensin-receptor neprilysin inhibitor. The mean daily furosemide equivalent diuretic dose was 93.3 mg. Twenty-two (11%) patients had AKI and 18 patients (9%) discontinued their SGLT2i. Yeast infection (3%), hypotension (2.5%), and AKI (2%) were the most common reasons for discontinuation. Using ROC curve analysis, the strongest predictors for AKI were A1C (AUC = 75.8, empirical confidence interval [ECI] 66.5-83.5); baseline SCr (AUC = 72.0 ECI 65.7-78.7); LVEF (AUC = 67.6 ECI 58.4-75.8); and furosemide equivalent diuretic dose (AUC = 66.0 ECI 57.5-74.6). Similarly, the strongest positive predictors for SGLT2i discontinuation were A1C (AUC = 81.1 ECI 74.8-87.2); baseline Scr (AUC = 67.4 ECI 58.7-75.5); LVEF (AUC = 68.7 ECI 58.9-76.5); and furosemide equivalent diuretic dose (AUC = 67.2 ECI 58.2-76.0). Conclusions: A1C was the strongest predictor of AKI and SGLT2i discontinuation in HFrEF patients started on SGLT2i. Glucosuria may be related to this effect. SCr, LVEF, and furosemide equivalents also predicted these outcomes.

Abstract 13133: Effect of Ocedurenone in Patients With Uncontrolled Hypertension and Stage 3b/4 Chronic Kidney Disease - Subgroup Analysis of a Phase 2b Clinical Trial

Introduction: BLOCK-CKD is a Phase 2b, multicenter, randomized, double-blind, placebo-controlled study evaluating the safety, efficacy, and pharmacokinetics of the nonsteroidal MRA Ocedurenone (KBP-5074) in patients with stage 3b/4 CKD and uncontrolled hypertension while taking 2 or more antihypertensive medications. Hypothesis: Although the study is not powered for subgroup analysis, it is of interest to examine the consistency of results across various subgroups. Methods: Of 162 patients randomized, 138 (85.2%) completed the study. Effect of Ocedurenone on SBP reduction and serum potassium levels by baseline eGFR &lt; 30, eGFR ≥ 30, and diabetic status was explored. Results: Consistent and clinically meaningful SBP reduction at Day 84 was observed in the subgroups analyzed. SBP mean (SE) change from baseline to day 84 in the eGFR &lt; 30 group were 0.2 (3.03), -12.7 (5.45), and -15.4 (5.01) for placebo, 0.25mg, and 0.5mg doses respectively. In the ≥ 30 group, the changes were -9.7 (3.38), -10.8 (3.29), and -16.1 (4.08), respectively. In the diabetic patient group, the changes were -4.2 (4.22), -11.8 (5.91), and -13.0 (6.5) respectively. In the non-diabetic patient group, the changes were -6.0 (2.93), -11.4 (3.34), and -17.1 (3.51) respectively. Similar small dose-dependent increases in serum potassium were observed in nearly all subpopulations. Changes from baseline to day 84 in SBP by baseline eGFR and diabetic status and the corresponding changes in serum potassium and eGFR by baseline eGFR and diabetic status are shown in Figure 1. Conclusions: In this Phase 2 trial, the effect of Ocedurenone on SBP reduction and serum potassium levels was consistent among clinically important subgroups. Due to the relatively small number of patients these conclusions need to be confirmed in the larger ongoing Phase 3 trial.

Clinico-Biochemical Parameters, Treatment, and Prognostic Indicators of Peritonitis in Buffaloes

Background: The present study aimed to describe clinical findings, hemato-biochemical changes, response to medical treatment, and outcomes for buffaloes suffering from peritonitis. Another objective of this study was to determine the prognosis of the disease.&#x0D; Methods: The study was conducted on 25 buffaloes suffering from peritonitis and presented to the Large Animal Hospital of Guru Angad Dev Veterinary and Animal Science University, Ludhiana, Punjab, India. The buffaloes were subjected to detailed clinical examination. Hematological, biochemical, and peritoneal fluid analysis was carried out along with treatment.&#x0D; Results: Peritonitis was more prevalent in pregnant buffaloes, being septic peritonitis in 60% of cases. The important clinical findings were depression, anorexia, reduced water intake, scanty feces, dehydration, and absence of rumen motility. The hematological findings were hemoconcentration, left shift, and toxic changes in neutrophils. Biochemical analysis revealed increased total bilirubin, AST, ALP, GGT, glucose, triglycerides, BUN, creatinine, lactate, fibrinogen, and rumen chloride, whereas albumin, fibrinogen ratio, potassium, chloride, calcium, and phosphorus were decreased. Abnormal peritoneal fluid changes were altered physical parameters and the presence of degenerated neutrophils, bacteria, and gut contents. Nucleated cell count and total peritoneal fluid protein were not reliable indicators of peritonitis. The absence of rumen motility, marked left shift, toxic changes in neutrophils, higher BUN, lower potassium (≤3.6 mmol/L), and unfavorable peritoneal fluid changes were the negative prognostic signs. Treatment with broad-spectrum antibiotics and supportive therapy led to a recovery in about 50 percent of cases, with diffuse peritonitis cases being unresponsive. Long time survival rate was good, and there was no recurrence.&#x0D; Conclusion: The prognosis of peritonitis in buffaloes has to be precisely assessed on the basis of clinical, hemato-biochemical, and peritoneal fluid alterations. Standard classification of transudate and exudate did not apply in the majority of buffaloes with peritonitis.

Correction of Vascular Calcification and Hyperphosphatemia in CKD Rats Treated with ASARM Peptide.

Abnormalities in calcium, phosphorus, PTH, vitamin D metabolism, bone, and vascular calcification occur in chronic kidney disease mineral bone disorder (CKD-MBD). Calciphylaxis, involving painful, ulcerative skin lesions, is also a major problem associated with CKD-MBD. There are no quality medical interventions to address these clinical issues. Bone ASARM peptides are strong inhibitors of mineralization and induce hypophosphatemia by inhibiting phosphate uptake from the gut. We hypothesize treatment of CKD-MBD rats with ASARM peptides will reverse hyperphosphatemia, reduce soft-tissue calcification, and prevent calciphylaxis. To test our hypothesis, we assessed the effects of synthetic ASARM peptide in rats that had undergone a subtotal 5/6th nephrectomy (56NEPHREX), a rodent model of CKD-MBD. All rats were fed a high phosphate diet (2% Pi) to worsen mineral metabolism defects. Changes in serum potassium, phosphate, BUN, creatinine, PTH, FGF23, and calcium were assessed in response to 28 days of ASARM peptide infusion. Also, changes in bone quality, soft-tissue calcification, and expression of gut Npt2b (Slc34a2) were studied following ASARM peptide treatment. Rats that had undergone 56NEPHREX treated with ASARM peptide showed major improvements in hyperphosphatemia, blood urea nitrogen (BUN), and bone quality compared with vehicle controls. Also, ASARM-infused 56NEPHREX rats displayed improved renal, brain, and cardiovascular calcification. Notably, ASARM peptide infusion prevented the genesis of subdermal medial blood vessel calcification and calciphylaxis-like lesions in 56NEPHREX rats compared with vehicle controls. ASARM peptide infusion corrects hyperphosphatemia and improves vascular calcification, renal calcification, brain calcification, bone quality, renal function, and skin mineralization abnormalities in 56NEPHREX rats. These findings confirm our hypothesis and support the utility of ASARM peptide treatment in patients with CKD-MBD.

Evaluation of a prescribing pharmacist-led heart failure (HF) up-titration clinic

Abstract Background/Introduction Pharmacotherapy is considered the cornerstone of treatment for patients with heart failure with reduced ejection fraction (HFrEF). Modulation of the renin-angiotensin-aldosterone (RAAS) and sympathetic nervous system have been shown to improve survival, reduce the risk of heart failure (HF) hospitalisations and improve quality of life. Unless contraindicated or not tolerated, these patients should be prescribed angiotensin-converting enzyme inhibitor (ACEi)/angiotensin-receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA) and sodium-glucose co-transporter 2 (SGLT2) inhibitor and up-titrated to guideline directed dosages.1 Despite the availability of effective treatments, patients are often sub-optimally dosed and experience a prolonged optimisation process. Pharmacist-led clinics can complement existing services and increase uptake of guideline directed medical therapies (GDMT). Purpose To evaluate the effectiveness of pharmacist-led heart failure clinics in the Princess of Wales Hospital, supported by the Heart Failure team, in optimisation of patients with HFrEF. Methods Patients who attended HF pharmacist led clinic between November 2020 and November 2021 were included in the analysis. Baseline demographics, left ventricular ejection fraction (LVEF), biomarkers, vital signs and medications were documented at baseline and after optimisation of GDMT. Number of clinics appointments and rate of hospitalisation and mortality were captured during the study period. Results 76 patients were reviewed over a total of 318 consultations (34% virtual), averaging 4 consultations per patient. The mean age was 71 years, 36% of patients were female, mean LVEF was 32% and NT-proBNP 3078ng/L with 15% of patients on “quadruple therapy” at baseline. 93% of patients were referred by cardiologists and the average time from referral to first appointment was 42 days. Post-optimisation, 67% of patients were receiving “quadruple therapy”, with increased uptake of ACEi/ARB/ARNI, beta-blocker, MRA and SGLT2i from baseline (100%, 77%, 93% and 90% respectively). Mean LVEF increased to 42% and mean NT-proBNP reduced to 1695ng/L. No significant changes in creatinine clearance, blood pressure, heart rate or serum potassium (sK+) were recorded. The hospitalisation rate was 11% for heart failure, 6% for other cardiovascular causes and the mortality rate was 7%. Conclusions The pharmacist-led HF clinic demonstrated a high uptake of optimally dosed GDMT and improvements in NT-proBNP and LVEF. Pharmacist-led clinics can enhance the provision of existing heart failure services to improve patient outcomes and heart failure care. Funding Acknowledgement Type of funding sources: None.

A CASE OF CORTICOSTEROID-ASSOCIATED SUPRAVENTRICULAR TACHYCARDIA STORM

A CASE OF CORTICOSTEROID-ASSOCIATED SUPRAVENTRICULAR TACHYCARDIA STORM

Development of Mechanistic Neural Mass (mNM) Models that Link Physiology to Mean-Field Dynamics.

Brain rhythms emerge from the mean-field activity of networks of neurons. There have been many efforts to build mathematical and computational embodiments in the form of discrete cell-group activities-termed neural masses-to understand in particular the origins of evoked potentials, intrinsic patterns of activities such as theta, regulation of sleep, Parkinson's disease related dynamics, and mimic seizure dynamics. As originally utilized, standard neural masses convert input through a sigmoidal function to a firing rate, and firing rate through a synaptic alpha function to other masses. Here we define a process to build mechanistic neural masses (mNMs) as mean-field models of microscopic membrane-type (Hodgkin Huxley type) models of different neuron types that duplicate the stability, firing rate, and associated bifurcations as function of relevant slow variables - such as extracellular potassium - and synaptic current; and whose output is both firing rate and impact on the slow variables - such as transmembrane potassium flux. Small networks composed of just excitatory and inhibitory mNMs demonstrate expected dynamical states including firing, runaway excitation and depolarization block, and these transitions change in biologically observed ways with changes in extracellular potassium and excitatory-inhibitory balance.

Petrogenesis of siliciclastic sediments and sedimentary rocks explored in three-dimensional Al2O3–CaO*+Na2O–K2O–FeO+MgO (A–CN–K–FM) compositional space

Quantitatively determining the amount of chemical weathering within sedimentary rocks (and weathering profiles) took a major step forward with the creation of the chemical index of alteration (CIA) 40 years ago. The CIA relates the proportion of immobile aluminum to the mobile cations of calcium, sodium, and potassium and is grounded in empirical and modeled geochemical data for mineral reactions that occur during hydrolysis. However, the CIA should be applied cautiously because it is a one-dimensional value that in the most complex situations, as with clastic sedimentary rocks, homogenizes the compositional inputs of source, weathering, sorting, and diagenesis. Subsequently developed two-dimensional (2D) ternary diagrams (Al2O3–CaO*+Na2O–K2O; Al2O3–CaO*+Na2O+K2O–FeO+MgO) permitted the capacity to explore mineralogical-geochemical pathways in data sets that may separate those inputs, but interpreting the ternary diagrams may be complicated because they differentiate and group certain elements. Here we develop a three-dimensional tetrahedral diagram (Al2O3–CaO*+Na2O–K2O–FeO+MgO, A–CN–K–FM) that incorporates the same critical elements and permits the simultaneous assessment of felsic and mafic rocks and minerals on the same diagram while retaining the ability to separate plagioclase from alkali feldspar and monitor post-depositional potassium changes. Using the tetrahedral plot, we show that both the CIA value and positions on the 2D ternary diagrams can generate potentially misleading interpretations without properly budgeting the ferromagnesian components in parallel. We first show how the tetrahedron works, then use it with numerous previously published examples to identify how the competing mafic and felsic inputs shape the composition of source rocks, weathering profiles, actively transporting sediment, paleosols, and sedimentary rocks in sedimentary petrogenesis.

Integrated analysis of transcriptome and metabolome reveals molecular mechanisms of salt tolerance in seedlings of upland rice landrace 17SM-19.

Salt stress is a major abiotic stress that threatens global rice production. It is particularly important to improve salt tolerance in upland rice because of its growth environment. Upland rice landrace 17SM-19 with high salt tolerance was obtained from a previous study. In this study, an integrated analysis of transcriptome and metabolome was performed to determine the responses of the rice seedling to salt stress. When treated with 100 mm NaCl, the rice seedling growth was significantly inhibited at 5 d, with inhibition first observed in shoot dry weight (SDW). Changes in potassium (K+) content were associated with changes in SDW. In omics analyses, 1,900 differentially expressed genes (DEGs) and 659 differentially abundant metabolites (DAMs) were identified at 3 d after salt stress (DAS), and 1,738 DEGs and 657 DAMs were identified at 5 DAS. Correlation analyses between DEGs and DAMs were also conducted. The results collectively indicate that salt tolerance of upland rice landrace 17SM-19 seedlings involves many molecular mechanisms, such as those involved with osmotic regulation, ion balance, and scavenging of reactive oxygen species.

Enhancement of Carbon Assimilates and Macronutrients in Legumes under Elevated CO2 Concentration

Impact of elevated carbon dioxide (Free Air Carbon dioxide Enrichment) was studied on the plant chlorophyll, plant growth, plant macronutrients, total starch, total carbohydrate and the activity of phosphoenol pyruvate carboxylase (Pep C) enzymatic assays in leaves, pods and seeds in leguminous plant Cyamopsis tetragonoloba. Plants of Cyamopsis tetragonoloba (C3) were exposed to different atmospheric CO2 concentrations 420 ± 20 ppm (ambient) and 550 ± 20ppm (elevated). An average increase in the plant total chlorophyll (+39.17%), total starch (+43.73%, +25.44% and +26.35% in leaves, pods, and seeds), sucrose (+69.77%, +22.27% and +33.77% in leaves, pods and seed) and total carbohydrate (+58.88%, +30.54% and +28.38 % in leaves, pods and seeds) content were found in plant grown under elevated condition when compared to ambient counterpart. More over overall plant growth (+40% height and +25% biomass) increased in [CO2] concentration. Plant total nitrogen (N) content decreased (−12.55% in leaves) under the elevated condition where as total phosphorus (P) decreased (−3.15% in leaves) along with total potassium (K) (−46.63% in leaves). In soil, total potassium (+60.23%) and phosphorous (+48.88%) were found to increase with (−16%) decrease in soil nitrogen content. In seed total nitrogen content increased (+18.15%) on an average with no significant change in total potassium and phosphorus content under e[CO2]. Phosphoenolpyruvate carboxylase enzyme (Pep C) (+139.5% in leaves) activity and total organic carbon (TOC) (+19.12%, +17.85% in leaves and seeds) increases in elevated concentration thus promoting and indicating higher photosynthesis via enhanced CO2 fixation. Thus our studies showed that [CO2] positively promotes sugars, carbohydrates synthesis, translocation and partitioning in plant tissues and enhanced macronutrients level in leaves and seeds tissue which is contradictory to other C3 plants. Thus [CO2] works as the boon for Cyamopsisvarieties and the seeds are nutritionally rich, healthy, balanced in proteins and carbohydrates (C/N) and so these varieties have future implication for industrial use in the agricultural country like India.

The Effects of Magnesium Coadminstration During Treatment of Hypokalemia in the Emergency Department

BackgroundHypokalemia is a common disorder that can negatively affect organ function. Magnesium supplementation is frequently recommended despite limited evidence to support its use. ObjectivesThe purpose of this study was to evaluate the clinical effects of magnesium coadministration in patients treated for hypokalemia in the emergency department (ED). MethodsThis retrospective, single-center study evaluated adults treated with intravenous (i.v.) potassium for hypokalemia (serum potassium <3.5 mMol/L) in the ED between July 1, 2016 and June 30, 2020. Patients given magnesium supplementation within 4 h of potassium administration (MG+) were compared with those not given concurrent magnesium (MG−). The primary outcome was time to potassium normalization (≥ 3.5 mMol/L). Secondary outcomes included clinical effects, adverse effects, and dosing of magnesium and potassium. ResultsTwo hundred patients were included (MG+ = 100; MG− = 100). Patients in the MG− group more frequently had history of myocardial infarction (16% vs. 6%; p = 0.02) and alcoholism (16% vs. 6%; p = 0.02). Patients in the MG+ group had higher incidence of symptomatic hypokalemia (34% vs. 19%; p = 0.02) and severe hypokalemia (serum potassium < 2.5 mMol/L) (15% vs. 8%; p = 0.03). There were no differences in time to serum potassium normalization, change in serum potassium after treatment, or incidence of potassium normalization within 24 h of treatment. MG+ patients required more potassium within 24 h of treatment and more frequently developed hypermagnesemia (serum magnesium >1.1 mMol/L). ConclusionsMagnesium coadministration during hypokalemia treatment did not affect time to serum potassium normalization but was associated with more hypermagnesemia.

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 effectiveness of acupressure combination neiguan and zuzanli points to decrease emesis gravidarum in the first trimester of pregnancy

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background:&lt;/em&gt;&lt;/strong&gt; Emesis gravidarum is the most common symptoms&lt;em&gt; in pregnancy&lt;/em&gt;&lt;em&gt; which about&lt;/em&gt;&lt;em&gt; 50-90% causing a decrease in appetite and will affect changes in potassium, calcium and sodium electrolyte balance, thus will impact on changes in body metabolism. As much as 2% of pregnant women experienced excessive nausea and vomiting (hyperemesis gravidarum) which can harm the mother and fetus. The current management of emesis gravidarum still uses pharmacological therapy, but pharmacological methods are more expensive, and more potential to have side effects. Instead of pharmacological methods, non-pharmacological methods are cheap, simple, effective, and have no side effects. One of the non-pharmacological methods to treat nausea and vomiting is acupressure. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objectives:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; was to determine the effectiveness of the combination Neiguan point (PC6) &amp;amp; Zusanli point (ST 36) to decrease emesis Gravidarum in &lt;/em&gt;&lt;em&gt;the &lt;/em&gt;&lt;em&gt;first trimester of pregnancy in midwives independent practice Sidoarjo.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; This research used quasi-experimental with one group pretest-posttest design. The study population are pregnant women in the first trisemester who experienced emesis gravidarum, who met inclusion criteria and were willing to be studied and had no with consecutive sampling technique from February 2 to March 20, 2022 totaling 40 respondents. Measurement of emesis gravidarum using the Rhodes index instrument. Data analysis using Wilcoxon test with &lt;/em&gt;α&lt;em&gt; 0.05.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; The results showed that the score for emesis gravidarum before acupressure was Mean+SD 22.0+4.01, while the score for emesis gravidarum after acupressure was Mean+SD 13.0+3.14. The results of the Wilcoxon test showed P value = 0.001 &lt;/em&gt;&amp;lt; &lt;em&gt;0.05 so there was a significant difference in the emesis gravidarum score before and after acupressure was given. &lt;strong&gt;Conclusions:&lt;/strong&gt; Acupressure at the Neiguan point (PC6) and Zusanli point (ST 36) is effective in reducing emesis gravidarum in first trimester of pregnant women. &lt;/em&gt;&lt;/p&gt;&lt;em&gt;Health workers, especially midwives, can apply and teach acupressure to pregnant women to reduce nausea and vomiting complaints.&lt;/em&gt;

Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women.

Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women.

Short-Term Changes in Serum Potassium and the Risk of Subsequent Vascular Events and Mortality: Results from a Randomized Controlled Trial of ACE Inhibitors.

Hyperkalemia after starting renin-angiotensin system inhibitors has been shown to be subsequently associated with a higher risk of cardiovascular and kidney outcomes. However, whether to continue or discontinue the drug after hyperkalemia remains unclear. Data came from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, which included a run-in period where all participants initiated angiotensin-converting enzyme inhibitor-based therapy (a fixed combination of perindopril and indapamide). The study population was taken as patients with type 2 diabetes with normokalemia (serum potassium of 3.5 to <5.0 mEq/L) at the start of run-in. Potassium was remeasured 3 weeks later when a total of 9694 participants were classified into hyperkalemia (≥5.0 mEq/L), normokalemia, and hypokalemia (<3.5 mEq/L) groups. After run-in, patients were randomized to continuation of the angiotensin-converting enzyme inhibitor-based therapy or placebo; major macrovascular, microvascular, and mortality outcomes were analyzed using Cox regression during the following 4.4 years (median). During active run-in, 556 (6%) participants experienced hyperkalemia. During follow-up, 1505 participants experienced the primary composite outcome of major macrovascular and microvascular events. Randomized treatment of angiotensin-converting enzyme inhibitor-based therapy significantly decreased the risk of the primary outcome (38.1 versus 42.0 per 1000 person-years; hazard ratio, 0.91; 95% confidence interval, 0.83 to 1.00; P=0.04) compared with placebo. The magnitude of effects did not differ across subgroups defined by short-term changes in serum potassium during run-in (P for heterogeneity =0.66). Similar consistent treatment effects were also observed for all-cause death, cardiovascular death, major coronary events, major cerebrovascular events, and new or worsening nephropathy (P for heterogeneity ≥0.27). Continuation of angiotensin-converting enzyme inhibitor-based therapy consistently decreased the subsequent risk of clinical outcomes, including cardiovascular and kidney outcomes and death, regardless of short-term changes in serum potassium. Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), NCT00145925.