Changes In Potassium Research Articles

Changes in electrolyte concentrations and hydration status in endurance horses following transport and an overnight stay prior to competition.

To evaluate changes in electrolyte concentrations and hydration status that take place in endurance horses prior to the start of a competition and determine whether these changes would be associated with elimination. 19 horses entered in the 2016 Tevis Cup 100-Miles (160 km) One-Day Western States Trail Ride. Heparinized blood samples were collected at 5 time points: prior to transport to the ride (T0), during check-in the day before the ride (T1), 1 to 2 hours before the start of the ride (T2), at the 15-km mark (T3), and at the 55-km mark (T4). Packed cell volume and plasma sodium, potassium, chloride, urea nitrogen, glucose, bicarbonate, and total protein concentrations were determined and compared across time points and between finishers and nonfinishers. Signif icant differences were detected among plasma sodium, potassium, and urea nitrogen concentrations measured prior to the start of the ride (ie, T0, T1, and T2). For all variables except chloride and bicarbonate concentrations, significant differences were detected between values obtained prior to the start of the ride and values obtained during the ride (ie, T3 and T4). Only bicarbonate concentration at the 15-km mark of the ride was significantly associated with finishing status. Results suggested that significant changes in plasma sodium, potassium, and urea nitrogen concentrations can occur in endurance horses during transport to a competition and when horses are stabled overnight before an event. Additionally, a lower bicarbonate concentration following a steep climb early during the ride was associated with subsequent elimination.

Changes in Blood Potassium after Reperfusion during Living-Donor Liver Transplantation: An Exploratory Study.

The incidence of hyperkalemia (>5.5 mEq/L) or high blood potassium (5–5.5 mEq/L) during living-donor liver transplantation (LDLT) is reported to be more than 10%. It occurs more frequently in the early post-reperfusion period and is a major cause of post-reperfusion arrhythmia and cardiac arrest. Unlike deceased-donor liver transplantation, the pattern of blood potassium changes immediately after reperfusion has not been described in LDLT. From January 2021 to March 2021, fifteen consecutive patients were enrolled. Baseline blood potassium was measured from blood samples obtained 10-min (T-10) and immediately before (T0) reperfusion. During the first 5 min after reperfusion, blood potassium measurements were conducted every one minute (T1–T5). The blood potassium levels at T-10 and T0 were 3.8 ± 0.4 and 3.9 ± 0.4 mEq/L, respectively. After reperfusion, mean increases (95% CI) in blood potassium from T-10 and T0 were 0.5 (0.4–0.6) and 0.4 (0.3–0.5) mEq/L, respectively. Blood potassium peaked at T1, returned to baseline at T3, and fell below the baseline at T5. Peak blood potassium after reperfusion showed strong correlations with blood potassium measured at T-10 (p < 0.001) and T0 (p < 0.0001). These findings can support the establishment of future research plans and perioperative management of blood potassium in LDLT.

The effect of dietary phosphorus load and food matrix on postprandial serum phosphate in hemodialysis patients: a pilot study.

Background: Potential dietary strategies for controlling hyperphosphataemia include the use of protein sources with lower phosphorus bioavailability such as pulses and nuts, focus on phosphorus to protein ratios and the avoidance of all phosphate additives. Methods: We conducted a controlled crossover feeding study in 8 haemodialysis (HD) patients to investigate the acute postprandial effect of a modified versus standard low phosphorus diet for one day on serum phosphate, potassium and intact parathyroid levels in prevalent HD patients. Each participant consumed the modified diet on one day and the standard diet on a second day one week apart. The modified diet included beef and less dairy, with a lower phosphorus to protein ratio, as well as plant-based protein, whole grains, pulses and nuts containing phytates which reduces phosphorus bioavailability. Both diets were tailored for each participant to provide 1.1g protein/kg ideal body weight. Participants provided fasting bloods before breakfast, a pre-prandial sample before the lunch time main meal and samples at one-hour intervals for the four hours after the lunch time main meal, for analysis of phosphate, potassium and intact parathyroid hormone (iPTH). Results: At four hours post the lunch time main meal on each study day, individuals on the modified diet had serum phosphate readings 0.30 mmol/l lower than when on the standard diet (p-value = 0.015, 95% confidence interval [CI] -0.57, -0.04). The corresponding change in serum potassium at four hours was a decrease of 0.675 mmol/l (p-value = 0.011, CI -1.25, -0.10). Conclusions: Decreases in both serum phosphate and serum potassium readings on a modified low phosphorus diet encourage further larger studies to explore the possibility of greater food choice and healthier plant-based diets in HD patients. ClinicalTrials.gov registration: NCT04845724 (15/04/2021).

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.

Peritoneal dialysis modality transition and impact on phosphate and potassium serum levels.

Peritoneal dialysis (PD) modalities affect solute removal differently. However, the impacts of switching PD modalities on serum levels of biomarkers of different sizes are not known. Our objective was to analyze whether a change in the PD modality associates with the levels of two routine biochemical laboratories. In this multicentric prospective cohort study. we selected all patients who remained on a PD modality for at least 6 months and switched PD modality. Patients were also required to be treated with the same PD modality for at least 3 months before and after the modality change. The primary outcome was change in potassium and phosphate serum levels. We identified 737 eligible patients who switched their PD modality during the study. We found mean serum phosphate levels increased during the 3 months after switching from CAPD to APD and conversely decreased after switching to from APD to CAPD. In contrast, for potassium the difference in the mean serum levels was comparable between groups switching from CAPD to APD, and vice versa. In conclusion, CAPD seems to be as efficient as APD for the control of potassium serum levels, but more effective for the control of phosphate serum levels. The effect of a higher removal of middle size molecules as result of PD modalities in terms of clinical and patient-reported outcomes should be further explored.

Effects of canagliflozin on hyperkalaemia and serum potassium in people with diabetes and chronic kidney disease: insights from the CREDENCE trial

Abstract Background Hyperkalaemia is a common complication of type 2 diabetes mellitus (T2DM) and limits the optimal use of agents that block the renin-angiotensin aldosterone system (RAAS), particularly in patients with chronic kidney disease (CKD). In patients with CKD, sodium glucose cotransporter 2 (SGLT2) inhibitors provide cardiorenal protection, but whether they affect the risk of hyperkalaemia remains uncertain. Purpose We sought to assess the effect of canagliflozin on hyperkalaemia and other potassium-related outcomes in people with T2DM and CKD by conducting a post-hoc analysis of the CREDENCE trial. Methods The CREDENCE trial randomized 4401 participants with T2DM and CKD to the SGLT2 inhibitor canagliflozin or matching placebo. In this post-hoc analysis using an intention-to-treat approach, we assessed the effect of canagliflozin on a composite outcome of time to either investigator-reported hyperkalaemia or the initiation of potassium binders. We also analysed effects on central laboratory-determined hyper- and hypokalaemia (serum potassium ≥6.0 and &amp;lt;3.5 mmol/L, respectively) and change in serum potassium. Results At baseline the mean serum potassium in canagliflozin and placebo arms was 4.5 mmol/L; 4395 (99.9%) participants were receiving renin angiotensin system blockade. Canagliflozin reduced the risk of investigator-reported hyperkalaemia or initiation of potassium binders (HR 0.78, 95% CI 0.64–0.95, p=0.014; Figure 1). The incidence of laboratory-determined hyperkalaemia was similarly reduced (HR 0.77, 95% CI 0.61–0.98, p=0.031; Figure 2); the risk of hypokalaemia (HR 0.92, 95% CI 0.71–1.20, p=0.53) was not increased. Mean serum potassium over time with canagliflozin was similar to that of placebo. Conclusion Among patients treated with RAAS inhibitors, SGLT2 inhibition with canagliflozin may reduce the risk of hyperkalaemia in people with T2DM and CKD without increasing the risk of hypokalaemia. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Diet-dependent acid load is associated with mean arterial pressure in a cohort of non-obese, non-black, postmenopausal women.

Higher sodium (Na+) intake is associated with higher blood pressure (BP). Whether this relationship is stronger with diet-dependent acid load (DAL) and in patients diagnosed with hypertension or normal BP is not well determined. We studied 170 postmenopausal women randomized to receive potassium bicarbonate or placebo for 36months, after which 24-hour urine and arterialized blood samples were collected. We investigated the association between DAL estimated as urinary potential renal acid load (UPRAL) and mean arterial pressure (MAP) using a mixed-effects model, adjusting for age, anthropometrics, creatinine clearance, and treatment. Adjusted regression estimates for changes in Na+ and UPRAL on MAP after 12months of follow-up were calculated, and further adjustments were made for changes in potassium (K+) and body mass index (BMI). MAP was inversely associated with UPRAL (β [95%confidence interval]: -0.11[-0.25, -0.001]). There was an effect modification by hypertension (p-interaction = 0.04); MAP decreased significantly in normotensives, but the association was not significant in hypertensives. A decrease of 0.70mmHg in MAP [0.13, 1.69] per 50 mmol/24 hour reduction in Na+ was noted when the model was adjusted for change in K+. Our results with UPRAL exhibited a stronger dose-response for MAP, which remained significant after adjusting for BMI. UPRAL was independently associated with MAP even after adjusting for potential confounders, and the data showed that this association was more pronounced in normotensive patients. Novelty: First longitudinal study on the association of UPRAL and MAP. Association was a more robust relationship than that between U[Na+/K+] ratio and MAP. UPRAL may play a significant role in the pathogenesis of primary hypertension.

Serum Potassium Changes in US Veterans Receiving Patiromer with Dialysis-Dependent ESKD and Hyperkalemia

Serum Potassium Changes in US Veterans Receiving Patiromer with Dialysis-Dependent ESKD and Hyperkalemia

Effects of long-term straw returning on distribution of aggregates and nitrogen, phosphorus, and potassium in paddy

In order to understand the composition and stability of soil aggregate in paddy filed, as well as the changes of soil aggregate-associated nitrogen (N), phosphorus (P) and potassium (K) after straw addition combined with chemical fertilization, soil samples were collected from a 34-year positioning experiment with three treatments, including no chemical fertilizer (CK), chemical fertilizer only (NPK), and straw addition plus chemical fertilizer (NPKS). The composition of water-stable aggregates at the soil layers of 0-20 cm and 20-40 cm were analyzed with the wet sieving method, as well as the distribution characteristics, contribution rate and activation rate of soil aggregate-associated N, P, and K. Results showed that the fractions of >2 mm and 0.25-1 mm aggregates dominated the soil water-stable aggregates in paddy field, while the contribution of <0.053 mm aggregates was lowest. Compared with CK, NPKS treatment increased the contents of >2 mm and 1-2 mm aggregates at the layers of 0-20 and 20-40 cm, and reduced the contents of 0.053-0.25 mm and <0.053 mm. Similar result in NPK treatment was observed at the layer of 0-20 cm. Compared with tat under the NPK treatment, mean weight diameter (MWD) and geometric mean diameter (GMD) increased by 3.9%-15.5% and 6.3%-41.7% in NPKS treatment, respectively. However, the unstable aggregate index (ELT) reduced by 5.7%-28.7% in the NPKS treatment. NPKS significantly increased the contents of total N (TN), available P (AP), and available K (AK) in soil aggregates, especially in the >0.25 mm aggregates. There were no significant diffe-rences about alkali-hydrolysable N (AN) and total K (TK) between NPK and NPKS treatments. The nutrient contribution of soil aggregates in paddy field was affected by aggregate composition. NPKS significantly increased the contribution of AN, AP, and AK within >1 mm aggregates. In all, straw addition combined with chemical fertilizer could increase the stability of soil aggregates at the layers of 0-20 cm and 20-40 cm, and increase the contents of soil aggregate-associated N, P and K, especially for the >1 mm aggregates. Our results provided insights into ensuring soil quality and sustainable development of resources in paddy field by adjusting the ratio of soil C to N.

Extent of Fall in Serum Potassium by Medical Therapy in End Stage Renal Disease

Aim: To observe the mean alteration in potassium levels one-hour post-antihyperkalemic treatment in end stage renal disease patients presenting with hyperkalemia. Study design: Quazi interventional (experimental) study. Place and duration of study: Department of Medicine, Sir Ganga Ram Hospital Lahore from 28th June 2018 to 27th December 2018. Methodology: Sixty patients of both genders with age range between 14 to 70 years having stage 5 CKD (thrice-weekly dialysis dependent) for at least 6 months with raised serum potassium (&gt;5.5 mEq/L). These patients were given medical treatment in the form of salbutamol nebulization, injectable calcium gluconate, and 100ml 25% dextrose water solution neutralized with Humulin R Insulin 12 units. Serum potassium was reassessed 1 hour after the treatment. Mean change in serum potassium was observed and was compared across various subgroups of patients. A written informed consent was taken from each patient. Results: In the current study, mean age of our studied population was 50.6±10.4 years with male-gender dominance (81.7%). Mean ESRD duration was 11.8±3.7 months while the mean BMI was 27.6±3.6Kg/m2. 15 (25.0%) patients were obese. The serum potassium level at presentation ranged from 5.6mEq/L to 6.9mEq/L with a mean of 6.25±0.39mEq/L. The serum potassium level 1 hour after medical treatment ranged from 4.8mEq/L to 6.3mEq/L with a mean of 5.58±0.43mEq/L. This change in mean serum potassium was significant (p-value&lt;0.001) on paired sample t-test. The change in serum potassium level ranged from 0.5-0.9mEq/L with a mean of 0.676±0.123mEq/L. Similar mean change in serum potassium level was observed when stratified for age, gender, BMI and duration of ESRD. Keywords: End Stage Renal Disease, Hemodialysis, Hyperkalemia, Medical Treatment

Effects of canagliflozin on serum potassium in people with diabetes and chronic kidney disease: the CREDENCE trial.

Hyperkalaemia is a common complication of type 2 diabetes mellitus (T2DM) and limits the optimal use of agents that block the renin-angiotensin-aldosterone system, particularly in patients with chronic kidney disease (CKD). In patients with CKD, sodium‒glucose cotransporter 2 (SGLT2) inhibitors provide cardiorenal protection, but whether they affect the risk of hyperkalaemia remains uncertain. The CREDENCE trial randomized 4401 participants with T2DM and CKD to the SGLT2 inhibitor canagliflozin or matching placebo. In this post hoc analysis using an intention-to-treat approach, we assessed the effect of canagliflozin on a composite outcome of time to either investigator-reported hyperkalaemia or the initiation of potassium binders. We also analysed effects on central laboratory-determined hyper- and hypokalaemia (serum potassium ≥6.0 and <3.5 mmol/L, respectively) and change in serum potassium. At baseline, the mean serum potassium in canagliflozin and placebo arms was 4.5 mmol/L; 4395 (99.9%) participants were receiving renin-angiotensin system blockade. The incidence of investigator-reported hyperkalaemia or initiation of potassium binders was lower with canagliflozin than with placebo [occurring in 32.7 vs. 41.9 participants per 1000 patient-years; hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.64-0.95, P = 0.014]. Canagliflozin similarly reduced the incidence of laboratory-determined hyperkalaemia (HR 0.77, 95% CI 0.61-0.98, P = 0.031), with no effect on the risk of hypokalaemia (HR 0.92, 95% CI 0.71-1.20, P = 0.53). The mean serum potassium over time with canagliflozin was similar to that of placebo. Among patients treated with renin-angiotensin-aldosterone system inhibitors, SGLT2 inhibition with canagliflozin may reduce the risk of hyperkalaemia in people with T2DM and CKD without increasing the risk of hypokalaemia.

Reciprocal Changes in Voltage-Gated Potassium and Subthreshold Inward Currents Help Maintain Firing Dynamics of AVPV Kisspeptin Neurons during the Estrous Cycle.

Kisspeptin-expressing neurons in the anteroventral-periventricular nucleus (AVPV) are part of a neural circuit generating the gonadotropin-releasing hormone (GnRH) surge. This process is estradiol-dependent and occurs on the afternoon of proestrus in female mice. On proestrus, AVPV kisspeptin neurons express more kisspeptin and exhibit higher frequency action potentials and burst firing compared with diestrus, which is characterized by a pulsatile rather than a prolonged surge of GnRH secretion. We hypothesized changes in voltage-gated potassium conductances shape activity profiles of these cells in a cycle-dependent manner. Whole-cell voltage-clamp recordings of GFP-identified AVPV kisspeptin neurons in brain slices from diestrous and proestrous mice revealed three subcomponents of the voltage-sensitive K+ current: fast-transient slow-transient, and residual. During proestrus, the V50 of inactivation of the fast-transient current was depolarized and the amplitude of the slow-transient component was reduced compared with diestrus; the residual component was consistent across both stages. Computational models were fit to experimental data, including published estrous-cycle effects on other voltage-gated currents. Computer simulations suggest proestrus-typical K+ currents are suppressive compared with diestrus. Interestingly, larger T-type, persistent-sodium, and hyperpolarization-activated currents during proestrus compensate for this suppressive effect while also enabling postinhibitory rebound bursting. These findings suggest modulation of voltage-gated K+ and multiple subthreshold depolarizing currents across the negative to positive feedback transition maintain AVPV kisspeptin neuron excitability in response to depolarizing stimuli. These changes also enable firing in response to hyperpolarization, providing a net increase in neuronal excitability, which may contribute to activation of this population leading up to the preovulatory GnRH surge.

The Optimal Cell Salvage Settings to Maximize Hematocrit and Minimize Potassium Using the Cobe BRAT2 Autologous Blood Recovery Unit

The objective was to determine the optimal cell saver device settings (infusion rate and wash rate) at which hematocrit is preserved and potassium and lactate are removed from banked red blood cells (RBC). Red cells were washed using the Cobe BRAT 2 Autologous Blood Recovery Unit and sampled for electrolyte composition and hematocrit pre- and postwash. This was a single-center study. Red cells were washed using six infusion rates (100-1,000 mL/min) and six wash rates (100-1,000 mL/min) for a total of 36 combinations. Hematocrit, potassium, glucose, and lactate were evaluated before and after washing. At wash rates ≤400 mL/min, hematocrit increased independent of infusion rate. At wash rates ≥400 mL/min, slower infusion rates were associated with higher hematocrit compared to faster infusion rates (p < 0.0001 for a wash rate 400-800 mL/min, p < 0.0005 for a wash rate 1,000 mL/min). Maximal wash speeds were associated with decreasing hematocrit. Infusion and wash rate were both independent predictors of potassium change; slower rates were associated with a larger decrease in potassium. Glucose decreased proportionally as infusion and wash rate decreased. Lactate did not show an association with either infusion or wash rate. Red-cell washing produces higher hematocrit and lower potassium as infusion rate and wash rate decrease. A 340-mL unit of RBC can be processed in 4.26 minutes without loss of hematocrit or an increase in potassium when both infusion and wash rates are set to 400 mL/min.

The LIFT trial: study protocol for a double-blind, randomised, placebo-controlled trial of K+-binder Lokelma for maximisation of RAAS inhibition in CKD patients with heart failure

BackgroundCKD is common in heart failure (HF) and associated with morbidity and mortality, yet life-prolonging medications such as renin-angiotensin-aldosterone inhibitors (RAASi) are underused due to risk of hyperkalaemia. Sodium zirconium cyclosilicate (SZC) is a potassium-binding medication that has been shown to reduce incidence of hyperkalaemia in CKD, non-CKD, and HF populations, which we propose will support maximisation of RAASi therapy.MethodsWe propose a 1:1 randomised, double-blind, placebo-controlled trial in which participants will receive either SZC or placebo. We will up-titrate participants’ RAASi therapy while monitoring their serum potassium levels and adjusting their SZC dose if necessary. Participants with CKD and HF will be recruited from CKD and HF clinics at St George’s Hospital. The total study period will be 18 months; 130 participants will be enrolled for approximately two months each following screening. Our primary outcome will be the proportion of participants who achieve maximum RAASi dose while maintaining normokalaemia. Secondary outcomes include participants reaching maximum RAASi dose without severe hyperkalaemia; time from randomisation to hyperkalaemia; time from randomisation to severe hyperkalaemia; number of RAASi dose escalations per participant; final doses of RAASi therapy; changes in quality of life score, eGFR, ACR, serum sodium, troponin T; number and duration of hospital admissions; and within-participant change in serum potassium compared to baseline.DiscussionThis trial will be the first to examine the use of SZC for the maximisation of RAASi dosing in patients with advanced CKD and HF. We will assess the impact of achieving target RAASi dosing on hospital admission rates and duration of stay, with the hope that optimum RAASi treatment will translate into reduced morbidity and improved QoL. If clinical benefit is demonstrated, we hope that the joint multidisciplinary CKD-HF approach will be expanded.Trial registrationEudraCT number 2020–002946-18. Registered on 08 June 2020. Online record pending.

Effects of weathering and silicic acid uptake by rice plants on weathered products -Quantitative changes in potassium, silica, and aluminum in granitic Fluvisol-

ABSTRACT Potassium (K) fertilizers have been widely used to promise agricultural production, yet rice (Oryza sativa L.) showed healthy growth for long periods under K-deficient conditions. These findings imply that rice could take up minerals-bound K as non-exchangeable K. When the weathering of primary silicate minerals occurs in the rhizosphere of rice, the rice takes up not only dissolved K but also dissolved silicic acid (SiO2). We grew three rice cultivars with different Si-uptake abilities (Hokuriku 193, Oochikara, and Lsi-1) in granitic Fluvisol under K- and Si-deficient conditions to quantitatively reveal the significance of the Si-uptake by rice for the mineral weathering in the rhizosphere. As a result, the Si-uptake quantity by rice was positive linearly correlated with the amount of Al accumulation in soil, suggesting a substance containing a certain ratio of Si and Al was decomposed by rice. The K:Al:Si molar ratio of the decomposed substance by rice was 0.2:1:2.6, and the ratio is suggestive of silicate minerals such as K-feldspar. Because silicate minerals such as K-feldspar (e.g., KAlSi3O8) contain a large amount of aluminum (Al), Al release alongside K ions and silicic acid in their weathering. Dissolved Al is highly active and can be stabilized by combining with organic matter (OM) or silicic acid in the rhizosphere. The Si-uptake levels and mineral decomposing abilities of rice affected the variety of the accumulated substances (i.e., Al hydroxy oxide with OM, clay minerals) in the soil after cultivation. In particular, the Al hydroxy oxide with OM accumulates as persistent soil organic carbon. Thus, it appears that the Si-uptake abilities of plants have a great influence on the weathering of minerals and their products.

Irradiating stored blood and storing irradiated blood: Is it different? - A study of serial changes in biochemical parameters of red blood cell units.

INTRODUCTION:Gamma Irradiation of blood products accentuates biochemical changes in the blood stored at 4°C. This study tried to compare the changes in potassium, sodium, glucose, lactate, and lactate dehydrogenase (LDH) levels in packed red blood cell (PRBC) units irradiated at various time points and then stored versus those stored for a particular period then irradiated.METHODOLOGY:One hundred and eighty units of RBCs were randomly assigned equally to be irradiated or not. Eighteen units each were irradiated by gamma irradiator using cobalt 60 (BI 2000) on day 1, 7, 14, 21, and 28 of their storage, respectively, in the irradiation group. All the units were assessed for their plasma levels of potassium, sodium, glucose, LDH, and lactate by clinical chemistry auto analyzer Beckman coulter AU680 weekly. The values were documented and analyzed by SPSS.RESULTS:Baseline values on day 1 for studied biochemical parameters were comparable between irradiated and nonirradiated groups. Mean values of potassium, lactate and LDH were higher in irradiated than nonirradiated PRBC bags. In contrast, Sodium and Glucose mean values were lower than baseline values. Maximum cumulative mean values were noted in day-21 irradiated bags when the parameters were measured on day-28 for potassium and lactate levels. This was followed by day 14 irradiated bags, followed by day 7 irradiated bags.CONCLUSION:The study indicates that irradiation of red cells later in their storage period had comparatively more detrimental changes in relation to potassium and lactate than irradiation in earlier days. Consideration of irradiation to be performed as close to the issue as possible to reduce a lesser number of days of storage postirradiation is to be explored.

Safety profile of low-titer group O whole blood in pediatric patients with massive hemorrhage.

Low-titer Group O Whole Blood (LTOWB) is used with increasing frequency in adult and pediatric trauma and massive bleeding transfusion protocols. There is a risk of acute hemolytic reactions in non-group O recipients due to the passive transfusion of anti-A and anti-B in the LTOWB. This study investigated the hemolysis risk among pediatric recipients of LTOWB. Blood bank records were queried for pediatric recipients of LTOWB between June 2016 and August 2020 and merged with clinical data. The primary outcome was laboratory evidence of hemolysis as manifested by changes in lactate dehydrogenase (LDH), haptoglobin, total bilirubin, reticulocyte count, potassium, and creatinine. Per protocol, these values were collected on hospital days 0-2 for recipients of LTOWB. Transfusion reactions were reported to the hospital's blood bank. Forty-seven children received LTOWB transfusion between 2016 and 2020; 21 were group O and 26 were non-group O. The groups were comparable in terms of the total volume of transfused blood products, demographics, and clinical outcomes. The most common indication for LTOWB transfusion was hemorrhagic shock due to trauma. There were no clinically or statistically significant differences in baseline, post-transfusion day 1, or post-transfusion day 2 hemolysis markers between the group O and non-group O LTOWB recipients. There were no adverse events or transfusion reactions reported. Use of up to 40 ml/kg of LTOWB appears to be serologically safe for children in hemorrhagic shock.

Intracellular potassium depletion enhances apoptosis induced by staurosporine in cultured trigeminal satellite glial cells

Purpose Satellite glial cells (SGC) surrounding neurons in sensory ganglia can buffer extracellular potassium, regulating the excitability of injured neurons and possibly influencing a shift from acute to neuropathic pain. SGC apoptosis may be a key component in this process. This work evaluated induction or enhancement of apoptosis in cultured trigeminal SGC following changes in intracellular potassium [K]ic. Materials and methods We developed SGC primary cultures from rat trigeminal ganglia (TG). Purity of our cultures was confirmed using immunofluorescence and western blot analysis for the presence of the specific marker of SGC, glutamine synthetase (GS). SGC [K]ic was depleted using hypo-osmotic shock and 4 mM bumetanide plus 10 mM ouabain. [K]ic was measured using the K+ fluorescent indicator potassium benzofuran isophthalate (PBFI-AM). Results SGC tested positive for GS and hypo-osmotic shock induced a significant decrease in [K]ic at every evaluated time. Cells were then incubated for 5 h with either 2 mM staurosporine (STS) or 20 ng/ml of TNF-α and evaluated for early apoptosis and late apoptosis/necrosis by flow cytometry using annexin V and propidium iodide. A significant increase in early apoptosis, from 16 to 38%, was detected in SGC with depleted [K]ic after incubation with STS. In contrast, TNF-α did not increase early apoptosis in normal or [K]ic depleted SGC. Conclusion Hypo-osmotic shock induced a decrease in intracellular potassium in cultured trigeminal SGC and this enhanced apoptosis induced by STS that is associated with the mitochondrial pathway. These results suggest that K+ dysregulation may underlie apoptosis in trigeminal SGC.

Dynamics of soil aggregate stability as induced by potassium in a soil-plant system

ABSTRACT Electrolytes have been verified as a vital internal factor controlling soil aggregate stability (SAS). Several reports have focused on whether potassium promotes or demotes SAS and have shown contradictory results in different soils and clay mineralogy. Only a few studies have investigated such an effect on a soil-plant system, even though this information is critical for soil management practices to maintain soil structural stability. This research studied the dynamics of SAS as influenced by potassium in a soil-plant system. Corn as a test plant was grown on Haplic Acrisols (Typic Paleustults) in a greenhouse. The potassium adsorption ratio (PAR), cation ratio of structural stability (CROSS), and SAS were recorded on the day before planting (day 0), the day of planting (day 1), days 10, 20, 30, and the day of harvesting (day 55) at the tasseling stage. The corn growth, biomass, and potassium uptake were also examined. The relationship between soil and plant parameters was statistically tested. The results showed the existence of SAS dynamics caused by soil potassium change, with agreement among the responses for PAR, CROSS, and plant uptake. Within 24 h of soil treatment with potassium, the SAS move rapidly from 74% to 96%. It remained steady at 96–97% when the corn was in the vegetative stage and then fell significantly (α = 0.05) to 88% when the corn was in the tasseling stage, where the potassium uptake was maximized. The results implied that SAS is a sensitive index of soil physical quality associated with potassium, especially for tropical kaolinitic soils.

Bicarbonate Therapy in Renally Compromised Critically Ill Patients with Metabolic Acidosis: Study of Clinical Outcomes and Mortality Rate

BackgroundMetabolic acidosis is the most frequent medical condition occurring in critically ill renally compromised patients. This study was aimed to determine clinical outcomes of bicarbonate therapy in renally compromised critically ill patients having metabolic acidosis.MethodsA prospective longitudinal cohort study was undertaken in three military hospitals in Rawalpindi, Pakistan. All patients fulfilling the inclusion criteria who were admitted to the ICU of any of the three study hospitals from July 2019 to March 2020 were studied for clinical outcomes of bicarbonate therapy using an evidence-based clinical checklist. Outcome measures include changes in blood pH, serum potassium, and sodium levels, blood pressure and weight, along with other clinically significant laboratory parameters.ResultsEighty-one patients fulfilling the inclusion criteria were evaluated. The mean age of the patients was 55.61±19.5 years, while the mean weight was 63.43±14.19 Kg. A mortality rate of 45.7% was observed. Disease-related complications including hypoxia, cardiac failure, multiple organ failure, elevated blood pressure, and ischemic heart disease (IHD) were found to be associated with a higher mortality rate (P<0.005). Whereas using Fisher’s exact test, concomitant administration of sodium chloride, along with bicarbonate therapy was associated with a low mortality rate and had no significant impact on sodium loading or weight gain. Moreover, various drug–drug interactions were found to be associated with a higher mortality rate (P<0.05).ConclusionBicarbonate therapy was not found to affect the mortality rate in critically ill renally compromised patients with metabolic acidosis.