Chloride Supplementation Research Articles

Supplementation with protected kapok seed oil and choline chloride to improve the performance and lipid status of thin-tailed sheep.

Healthy meat production is an important aspect of increasing sheep productivity. This study aimed to examine the influence of protected kapok seed oil (KSO) in combination with choline chloride (CC) on the feed utilization, lipid status, and performance of thin-tailed sheep. Thirty male thin-tailed sheep (approximately 6 months old, with an average body weight of 12.59 ± 1.48 kg) were divided into six treatment groups (five heads/treatment). Factor 1 consisted of two treatments: K1 (KSO supplementation at 10% supplementation and 75% protection level) and K0 (without KSO supplementation). Factor 2 consisted of three levels of CC: (C0: 0%; C1: 1.5% and C2: 3% feed dry matter (DM) basis supplementation levels). The variables measured were the DM consumption, DM digestibility, organic matter digestibility, nitrogen retention, daily body weight gain (DBWG), and blood and meat lipid status. The data were analyzed using analysis of variance in a completely randomized design in a factorial pattern of 2 × 3 × 5. Choline chloride supplementation (up to 3%) increased DM consumption in the K0C2 group. The CC and protected KSO (K1C2) supplementation combination resulted in the highest DM consumption level (p < 0.05). The protected KSO supplementation increased DBWG (the DBWG in the K1C0 group was higher than that in the K0C0 group, and the highest DBWG was found in the K1C2 group) (p < 0.05). Protected KSO and CC supplementation decreased cholesterol levels and increased the relative proportion of linoleic acid in meat (p < 0.05). Combined supplementation with protected KSO and CC improved the feed utilization and performance of male thin-tailed sheep. There were increases in DBWG, decreases in intramuscular fat and cholesterol levels, and increases in meat linoleic acid levels.

Effects of Short-Term Sodium Nitrate versus Sodium Chloride Supplementation on Energy and Lipid Metabolism during High-Intensity Intermittent Exercise in Athletes

The aim of this study was to investigate the possible effects of chronic nitrate supplementation on the metabolites of energy metabolism during high-intensity, high-volume intermittent training (HIHVT). In this placebo-controlled double-blind study, 17 participants exercised 3 times a week on a cycle ergometer. Sodium nitrate or sodium chloride as the placebo was supplemented daily at 8.5 mg/kg body weight for 10 days. The training exercise consisted of a warm-up, a 45-min interval period, and a post-exercise period. Oxygen uptake, respiratory exchange ratio, and various parameters were measured in the venous blood and plasma. During training, the oxygen uptake and respiratory exchange ratio did not differ between the nitrate and the placebo group. Venous plasma concentrations of nitrate and nitrite were significantly increased in the nitrate group (p &lt; 0.001 and p = 0.007, respectively). Triglyceride concentrations were significantly lower in the nitrate group than in the placebo group (p = 0.010). The concentration of free fatty acids in the plasma did not change upon nitrate supplementation and no significant differences were observed in the contribution of fat to energy metabolism during exercise. An increase in plasma ammonia concentration was observed in the nitrate group during and after exercise (p = 0.048). Metabolites of energy-rich phosphates did not differ between the nitrate and chloride groups, suggesting no improvement in efficiency through the supplemented nitrate. It was concluded that nitrate supplementation did not reduce oxygen uptake and adenosine triphosphate resynthesis by hydrolysis or through creatine kinase activity during high-intensity, high-volume intermittent exercise. Although, lipid metabolism as well as amino acid metabolism might be affected by nitrate supplementation during HIHVT.

A Nationwide Survey on Malaysian Hospital Physicians’ Practices of Intravenous Potassium Chloride Supplementation and Opinions on Premixed Formulation in the Treatment of Hypokalaemia

This study aims to evaluate the Malaysian hospital physicians’ practices of intravenous potassium chloride in the treatment of hypokalaemia and their opinions on using premixed formulation. This was a nationwide online survey using a self-administered questionnaire. The survey link was sent to the practising hospital physicians in Malaysia through email (n = 1,455), Facebook Messenger (n = 2,734) and posted on Facebook as well. A total of 207 responses were received. The physicians were mostly males (63.8%), aged between 30 years old–39 years old (51.2%) and worked in the government sectors (76.8%). The most preferred dosage of potassium chloride for mild, moderate and severe hypokalaemia was 10 mmol (44.4%), 20 mmol (55.1%) and 30 mmol (37.7%), respectively. The mostly chosen infusion rate of potassium chloride for mild hypokalaemia was over 24 h (41.1%) while for both moderate and severe hypokalaemia were over 1 h–2 h (63.8% and 89.9%, respectively). The concentration of intravenous potassium chloride is the main factor (68.1%) which would influence the infusion route choice. Serum potassium monitoring of every 24 h was chosen by 52.7% of the respondents for mild hypokalaemia while every 1 h–2 h was mostly chosen for moderate and severe hypokalaemia (49.3% and 87.4%, respectively). Cardiac monitoring was mostly opted in severe hypokalaemic patients (70.0%). Majority of physicians agreed that a premixed formulation is easier to administer (64.7%) and safer for the patients (51.7%). In conclusion, there were variations in the prescribing practices among Malaysian physicians to treat hypokalaemia. Most physicians were in favour of premixed formulation.

Low-dose lithium chloride supplementation protects cardiac SERCA function during heat stress

Background: The sarco(endo)plasmic reticulum calcium (Ca2+)-ATPase (SERCA) is responsible for ~70% of intracellular Ca2+ removal in cardiac muscle contributing to the regulation of cardiac relaxation and contractility. SERCA is susceptible to heightened oxidative stress that is often observed with aging and disease resulting in reduced activity and cardiac dysfunction. Under normal physiological conditions, the inhibition of the enzyme glycogen synthase kinase 3 (GSK3) via low-dose lithium chloride (LiCl) supplementation (10 mg/kg/day) improved SERCA function in murine cardiac muscle via an increase in SERCA and decrease in its regulator, phospholamban. However, GSK3 also represses the transcription of the heat shock protein 70 (Hsp70), which can bind to SERCA and protect it from oxidative damage. Here, we sought to determine whether lithium treatment could protect murine cardiac SERCA function against heat stress by increasing Hsp70 content. Methods: Young (3-6 month old) male C57BL6 mice were provided water with or without low-dose (10 mg/kg/day) LiCl for 6-12 weeks ad libitum. High frequency ultrasound was done to assess cardiac morphology and contractility. Left ventricles (LV) were collected and SERCA activity assays were performed at baseline, and 30 and 60 min after heat treatment (40˚C incubation). Western blots were performed on non-heated and heated (60 min) samples for SERCA2, PLN, Hsp70 and GSK3 phosphorylation status. Results: Assessment of cardiac function indicated functional eccentric hypertrophy after 12 weeks of LiCl treatment with greater LV internal diameter during systole and diastole (Ctrl vs LiCl: 2.74 vs. 2.99mm, p&lt;0.05; 3.99 vs. 4.32mm, p&lt;0.01, respectively) as well as increases in end-diastolic volume and stroke volume (Ctrl vs LiCl: 70.1 vs. 84.4μL, p&lt;0.05; 41.8 vs 49.1μL, p&lt;0.05, respectively). This was associated with an increase in Ser9 inhibitory phosphorylation of GSK3β in the LiCl-treated mice. With respect to SERCA, after 6 weeks of treatment, LiCl mitigated reductions in absolute maximal SERCA activity at 30 and 60 minutes of heat stress (Ctrl vs LiCl: 46.2% vs 66.4% and 30.6% vs 43%, respectively; p&lt;0.05). However, markers of oxidative stress (protein nitration and nitrosylation) and Hsp70 levels were not different between control and LiCl hearts. Conclusions: Low-dose LiCl supplementation can improve cardiac function potentially through its improvements in SERCA function in both physiological and heat stress conditions. The exact mechanisms leading to the apparent protection against heat stress are still under investigation, with future directions including measurements of total and oxidized glutathione levels. SIH holds a Vanier Canada Graduate Scholarship. VAF is a Tier 2 Canada Research Chair in Muscle Plasticity and Tissue-Remodelling. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Evaluation of Increasing Concentrations of Supplemental Choline Chloride on Modern Broiler Chicken Growth Performance and Carcass Characteristics.

Choline has been demonstrated to partially substitute methionine in broiler chicken diets due to their interconnected biosynthesis pathways. Yet, research on the impacts of dietary choline supplementation on modern strains of high-yielding broilers is limited. The objective was to evaluate the effect of increasing additions of choline chloride on the performance and carcass characteristics of broilers fed reduced methionine diets and reared under summer environmental conditions. Ross 708 x Yield Plus male broilers were reared for 41 days on used litter in floor pens (n = 2232; 31 birds per pen). Birds were fed one of six corn and soybean meal-based, reduced methionine diets containing 0, 400, 800, 1200, 1600, or 2000 mg of added choline chloride per kg of feed. Diets were provided in three phases. On day 43, 10 birds per pen were processed. Increasing dietary choline resulted in similar body weight gain, reduced feed intake, and improved feed efficiency. Choline chloride supplementation linearly increased both breast and carcass yields while concomitantly increasing the incidence and severity of wooden-breast-affected fillets. These results indicate that supplementing reduced-methionine broiler diets with choline chloride during high environmental temperatures may improve feed efficiency and increase carcass and breast yields but may also increase wooden breast.

Shift from severe hypotension to salt-dependent hypertension in a child with autosomal recessive polycystic kidney disease after bilateral nephrectomies: a case report

BackgroundAutosomal recessive polycystic kidney disease (ARPKD) is a significant cause of morbidity and mortality in infants and children. In severe cases bilateral nephrectomies are considered but may be associated with significant neurological complications and life-threatening hypotension.Case presentationWe describe a case of a 17 months old boy with genetically confirmed ARPKD who underwent sequential bilateral nephrectomies at the age of 4 and 10 months. Following the second nephrectomy the boy was started on continuous cycling peritoneal dialysis with blood pressure on the lower range. At the age of 12 months after a few days of poor feeding at home the boy experienced a severe episode of hypotension and coma of Glasgow Come Scale of three. Brain magnetic-resonance imaging (MRI) showed signs of hemorrhage, cytotoxic cerebral edema and diffuse cerebral atrophy. During the subsequent 72 h he developed seizures requiring anti-epileptic drug therapy, gradually regained consciousness but remained significantly hypotensive after discontinuation of vasopressors. Thus, he received high doses of sodium chloride orally and intraperitoneally as well as midodrine hydrochloride. His ultrafiltration (UF) was targeted to keep him in mild-to-moderate fluid overload. After two months of stable condition the patient started to develop hypertension requiring four antihypertensive medications. After optimizing peritoneal dialysis to avoid fluid overload and discontinuation of sodium chloride the antihypertensives were discontinued, but hyponatremia with hypotensive episodes reoccurred. Sodium chloride was reintroduced resulting in recurrent salt-dependent hypertension.ConclusionsOur case report illustrates an unusual course of blood pressure changes following bilateral nephrectomies in an infant with ARPKD and the particular importance of tight regulation of sodium chloride supplementation. The case adds to the scarce literature about clinical sequences of bilateral nephrectomies in infants, and as well highlights the challenge of managing blood pressure in these patients. Further research on the mechanisms and management of blood pressure control is clearly needed.

Randomized Trial on the Effect of Oral Potassium Chloride Supplementation on the Thiazide-Sensitive Sodium Chloride Cotransporter in Healthy Adults

The putative "renal-K switch" mechanism links dietary potassium intake with sodium retention and involves activation of the sodium chloride (NaCl) cotransporter (NCC) in the distal convoluted tubule in response to low potassium intake, and suppression in response to high potassium intake. This study examined NCC abundance and phosphorylation (phosphorylated NCC [pNCC]) in urinary extracellular vesicles (uEVs) isolated from healthy adults on a high sodium diet to determine tubular responses to alteration in potassium chloride (KCl) intake. Healthy adults maintained on a high sodium (∼4.5 g [200 mmol]/d) low potassium (∼2.3 g [60 mmol]/d) diet underwent a 5-day run-in period followed by a crossover study, with 5-day supplementary KCl (active phase, Span-K 3 tablets (potassium 24 mmol) thrice daily) or 5-day placebo administrated in random order and separated by 2-day washout. Ambulatory blood pressure (BP) and biochemistries were assessed, and uEVs were analyzed by western blotting. Among the 18 participants who met analysis criteria, supplementary KCl administration (vs. placebo) was associated with markedly higher levels of plasma potassium and 24-hour urine excretion of potassium, chloride, and aldosterone. KCl supplementation was associated with lower uEV levels of NCC (median fold change (KCl/Placebo)= 0.74 [0.30-1.69], P< 0.01) and pNCC (fold change (KCl/Placebo)= 0.81 [0.19-1.75], P< 0.05). Plasma potassium inversely correlated with uEV NCC (R2= 0.11, P= 0.05). The lower NCC and pNCC in uEVs in response to oral KCl supplementation provide evidence to support the hypothesis of a functional "renal-K switch" in healthy human subjects.

Long-term outcome of Bartter syndrome in 54 patients: A multicenter study in Korea.

Bartter syndrome (BS) is a rare salt-wasting tubulopathy caused by mutations in genes encoding sodium, potassium, or chloride transporters of the thick ascending limb of the loop of Henle and/or the distal convoluted tubule of the kidney. BS is characterized by polyuria, failure to thrive, hypokalemia, metabolic alkalosis, hyperreninemia, and hyperaldosteronism. Potassium and/or sodium supplements, potassium-sparing diuretics, and nonsteroidal anti-inflammatory drugs can be used to treat BS. While its symptoms and initial management are relatively well known, long-term outcomes and treatments are scarce. We retrospectively reviewed 54 Korean patients who were clinically or genetically diagnosed with BS from seven centers in Korea. All patients included in this study were clinically or genetically diagnosed with BS at a median age of 5 (range, 0-271) months, and their median follow-up was 8 (range, 0.5-27) years. Genetic diagnosis of BS was confirmed in 39 patients: 4 had SLC12A1 gene mutations, 1 had KCNJ1 gene mutations, 33 had CLCNKB gene mutations, and 1 had BSND mutation. Potassium chloride supplements and potassium-sparing diuretics were administered in 94% and 68% of patients, respectively. The mean dosage of potassium chloride supplements was 5.0 and 2.1 mEq/day/kg for patients younger and older than 18 years, respectively. Nephrocalcinosis was a common finding of BS, and it also improved with age in some patients. At the last follow-up of 8 years after the initial diagnosis, 41% had short stature (height less than 3rd percentile) and impaired kidney function was observed in six patients [chronic kidney disease (CKD) G3, n = 4; CKD G5, n = 2]. BS patients require a large amount of potassium supplementation along with potassium-sparing agents throughout their lives, but tend to improve with age. Despite management, a significant portion of this population exhibited growth impairment, while 11% developed CKD G3-G5.

Evaluation of Parenteral Potassium Supplementation in Pediatric Patients.

The primary objective was to evaluate the effect of parenteral potassium chloride (KCl) supplementation on potassium (K+) concentrations in a non-cardiac pediatric population. Secondary outcomes were to identify variables that may influence response to KCl supplementation (i.e., change in K+ concentration after KCl administration) and assess the incidence of hyperkalemia. This single-center, retrospective study evaluated infants and children who received parenteral KCl supplementation of 0.5 or 1 mEq/kg between January 2017 and December 2019. The study included 102 patients with a median age of 1 year (IQR, 0.4-3.9) and weight of 9.1 kg (IQR, 4.9-14.2) who received 288 parenteral KCl administrations. One hundred seventy-three administrations were in the 1 mEq/kg group, and 115 administrations were in the 0.5 mEq/kg group. The median changes in K+ were 0.8 and 0.5 mEq/L in the 1 mEq/kg and 0.5 mEq/kg groups, respectively. Patients who had a repeat K+ concentration within 4 hours of the end of a 1 to 2-hour infusion had a higher median change in K+ compared with those who had a concentration drawn after this time frame (0.8 vs 0.6 mEq/L; p < 0.01). There is a paucity of data on the correlation between parenteral KCl supplementation and change in K+ concentrations in pediatric patients. Our study demonstrated an association between KCl supplementation doses of 1 and 0.5 mEq/kg and changes in K+ of 0.8 and 0.5 mEq/L, respectively, in non-cardiac pediatric patients, with low observed incidence of hyperkalemia.

Colina herbal como alternativa ao cloreto de colina em dieta de leitões na creche

Abstract The objective of this work was to evaluate the replacement of choline chloride supplementation by herbal choline in the diet of nursery piglets. The experimental design was randomized complete blocks (initial weight and sex) with 80 piglets, in five treatments, with eight replicates. The treatments consisted of: negative control, basal diet supplemented with 300 mg kg-1 choline via choline chloride, basal diet supplemented with 600 mg kg-1 choline via choline chloride, basal diet supplemented with 100 mg kg-1 herbal choline, and basal diet supplemented with 200 mg kg-1 herbal choline. Zootechnical performance data, blood parameters, and economic viability were analyzed. Herbal choline supplementation increases the body weight and daily feed intake of nursery piglets. The supplementation with 100 mg kg-1 herbal choline presents the highest return on investment. Herbal choline can be used as a source of choline supplementation in the diet of nursery piglets to replace choline chloride.

Multifarious feed additives on lamb performance on Kuwait farms

A change in the livestock feeding strategy is of utmost importance for the stability of animal health and sustainable livestock productivity to overcome the problem of subsiding the environmental effects of sheep production. Supplementing dietary feed with safe and efficient additives provides optimal animal performance and maximizes productivity. This study aimed to assess the effects of adding various feed additives to lamb rations for optimizing feed efficiency in weaned lambs for meat production in Kuwait. The feed additives, namely, ammonium chloride, urea, algae, fishmeal, and humic acid, were investigated on the physical performance of lambs for their effect on body weight, length, height, and waist length. The total feed consumption rate and feed efficiency were also measured. Each treatment comprising five healthy lambs was randomly allocated into six treatments comprising 30 lambs. The six treatments were the basal ration supplemented with ammonium chloride (50-100 g/day/head), urea (30 g/day/head), fishmeal (35 g/day/head), algae (Spirulina platensis) powder (50 g/day/head), humic acid (2.5 g/day/head), control group with only basal ration. The study was conducted for around 27 months and the data were recorded once in 2 weeks. The results indicated a positive elevation in the physique of lambs with all tested additives, showing an affirmative insignia for lamb fattening. The growth parameters in terms of augmented length, height, and waist length of lambs' bodies amplified significantly with ammonium chloride and fishmeal supplement, while the other additives reported a non-significant increment. The feed consumption was significantly elevated for ammonium chloride, algae, and fishmeal supplementation, while humic acid was recorded the least. Concerning feed efficiency of young lambs, fish meal and ammonium chloride were reported best, followed by urea. In contrast, algae and humic acid exhibited a non-significant effect on feed efficiency. This study exposed noteworthy influence on a lamb body's performance with the addition of fish meal and ammonium chloride in lamb rations, trailed by urea and algae.

Amelioration of mercuric chloride-induced physiologic and histopathologic alterations in rats using vitamin E and zinc chloride supplement

The drastic effects of mercuric chloride and the protective efficiency of vitamin E and zinc chloride co-supplementation were clearly investigated in this study. Male rats were divided into four groups. The first was the control. The second received vitamin E (100 mg/kg) and zinc chloride (30 mg/kg) daily. In comparison, the third received mercuric chloride (1 mg/kg) daily, and the fourth received the same mercuric chloride dose supplemented with the same vitamin E and zinc chloride doses. Mercury promotes a significant decline in body weight. It causes a considerable reduction in total red blood cells (RBCs) count and hemoglobin concentration; however, white blood cells (WBCs) increased significantly. Significant mercury-induced elevations in hepatic and renal functions were observed. Mercury induced substantial reductions in catalase (CAT) and superoxide dismutase (SOD). Mercury caused apoptotic DNA fragmentation. It induced degeneration and necrosis in the liver and kidney. It induced necrosis, leukocyte infiltration and blood vessel congestion in the cerebral cortex. Shrinkage and deterioration of Purkinje cells of the cerebellum were observed in response to mercuric chloride toxicity. Mercuric chloride enhanced shrinking in seminiferous tubules and Leydig cells. It reduced sperm count, sperm motility, and testosterone concentration; however, it promoted abnormal sperm morphology. Administration of vitamin E and zinc chloride showed marked improvement in different parameters under investigation, however, further research is needed to determine fate of mercury.

Growth rate, haematology and serum biochemistry of broilers fed diets supplemented with choline chloride

The study evaluated the effect of choline chloride (CC) supplementation on growth rate, haematology and serum biochemistry of broilers. 120-day-old broiler chicks were randomly divided into four groups of 30 birds each and these were further sub-divided into 3 replicates of 10 birds each. Group A served as the control while the diets of groups B, C and D were supplemented with 0.5 g/kg, 0.75 g/kg and 1 g/kg of CC respectively. 6weeks post-supplementation, haematology, serum biochemistry, total weight gain, feed efficiency and carcass characteristics were determined. Group C (0.75 g/kg choline) had a significantly (p&lt;0.05) higher feed efficiency (49.18%) than other choline-supplemented groups and control. There was no significant difference (p&gt;0.05) in the mean values of AST, ALT, total protein and creatinine across all groups. However, the ALP and cholesterol values of group D (4.42 U/L and 1.68 mg/dl respectively) were significantly (p&lt;0.05) higher than other groups. Lymphocyte counts of Group D was significantly (p&lt;0.05) lower than all other groups. The spleen weight (0.27 g) of group D was significantly (p&lt;0.05) higher than all other groups, but there was no significant difference (p&gt;0.05) in the relative weights of other organs of all four groups. The values of the breast weight/width, drumstick length/width, wing length and carcass length did not vary significantly across the supplemented-groups, but the breast-length, thigh weight/length/width, drumstick-weight, wing weight/width and carcass-weight of the control group were significantly higher than the supplemented-groups. Choline chloride supplementation at 0.75 g/kg may have contributed to improved feed efficiency but not with a corresponding excellent carcass yield.

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.

Beneficial effects of adding magnesium to desalinated drinking water on metabolic and insulin resistance parameters among patients with type 2 diabetes mellitus: a randomized controlled clinical trial

There is evidence that increasing the consumption of water containing magnesium can improve glucose metabolism and insulin resistance in patients with type 2 diabetes mellitus (T2DM). This trial was undertaken with the objective of evaluating the effect of adding different concentrations of magnesium chloride to the desalinated drinking water on the glycemic, metabolic, and insulin resistance parameters among patients with T2DM. A randomized cross-sectional controlled clinical trial was conducted to evaluate the effects of adding magnesium chloride supplement to desalinated drinking water consumed by patients with T2DM on the glycemic and metabolic parameters and indicators of insulin sensitivity. The total number of patients with T2DM who successfully completed the trial is 102. Patients were randomly allocated into three groups: the first group received bottled water without added magnesium (0 mg/L) (Group A, n = 37); the second group received bottled water with a low level of magnesium (20 mg/L) (Group B, n = 33); and the third group received drinking water with a high level of magnesium (50 mg/L) (Group C, n = 32). The daily consumption of elemental magnesium for a period of 3 months resulted in significant improvement in HbA1C (8.0 vs 8.2%, p = 0.04), insulin level (7.5 vs 9.9 μIU/mL, p = 0.03), and homeostasis model assessment-estimated insulin resistance (HOMA.IR) (2.5 vs 2.9, p = 0.002) in group C. However, there was no significant improvement in fasting blood glucose (FBS) level or lipid profile. The results of this study suggest that oral magnesium supplementation at the given dose of 50 mg/L daily added to drinking water could improve long-term glycemic control indicators and reduce insulin resistance in patients with T2DM.

Short-Term Effects of Potassium Chloride Supplementation on Fibroblast Growth Factor 23 and Phosphate in CKD.

Short-Term Effects of Potassium Chloride Supplementation on Fibroblast Growth Factor 23 and Phosphate in CKD.

PMON316 Novel Mutation Causing Pseudohypoaldosteronism Type 1 and Transient Hypercalcemia: A Patient Report

Abstract Background Autosomal dominant pseudohypoaldosteronism Type 1 (PHA-1) is a salt-wasting syndrome due to mutation in the renal mineralocorticoid receptor. Here, we report an infant with a novel mutation in NR3C2 causing PHA and associated with transient hypercalcemia. Clinical Case An ex-28 weeks (birth weight 1.35 kg) male infant admitted to the NICU had increased urine output of 6 mL/kg/hr on days of life (DOL) 9-10. Initial laboratory tests showed hyponatremia (121-127 mEq/L), hyperkalemia (5.4-8.4 mEq/L), hypochloremia (89-94 mEq/L), and hypercalcemia (11.2-11.6 mg/dL). Weight had decreased 4% from birth. On exam he was normotensive with no midline defect or hyperpigmentation; he had palpable testes bilaterally and 2 cm penile length. Sodium chloride (NaCl) supplementation 2.5 mEq/day was started on DOL 10. State newborn screen 17-OHP levels were normal. His family history was unremarkable. To further investigate the hyponatremia and hyperkalemia, serum ACTH, cortisol, aldosterone, and renin were obtained. ACTH and cortisol were 33 pg/mL and 11.4 mcg/dL, respectively. While awaiting the results of the aldosterone and renin assays, fludrocortisone was started with minimal improvement in serum sodium and hypercalcemia worsening to 12.0 mg/dL. Laboratory tests obtained to investigate the hypercalcemia included phosphorus 5.5 mg/dL, hypercalciuria (urine calcium to creatinine ratio 0.4), 25-OH vitamin D 21.0 ng/mL (normal 30-100 ng/mL), and PTH 29 pg/mL (normal 10-65 pg/mL). PTH was inappropriately normal, concerning for primary hyperparathyroidism. While awaiting the aldosterone level, it was therefore recommended to decrease fludrocortisone dose. Plasma renin activity resulted at 319 ng/mL/hr (normal 2-37 ng/mL/hr) and aldosterone at 612 ng/dL (normal 5-90 ng/dL), suggesting a diagnosis of PHA. Fludrocortisone was discontinued and NaCl supplementation was increased. A heterozygous pathogenic variant, c.2457C&amp;gt;A (p.Tyr819Ter), was identified in the mineralocorticoid receptor gene, NR3C2, confirming the diagnosis of autosomal dominant PHA-1. This variant has not been previously reported but meets the American College of Medical Genetics and Genomics and the Association for Molecular Pathology's criteria for pathogenicity. At his outpatient follow up at 4 months, sodium was 134 mEq/L and calcium was 10.5 mg/dL. He was continued on 1.5 grams NaCl supplementation. Conclusion We report a patient with a novel mutation in the NR3C2 gene resulting in autosomal dominant PHA-1 and associated with transient hypercalcemia. Further exacerbation of hypercalcemia was seen with addition of fludrocortisone. We suspect the etiology of the transient hypercalcemia to be secondary to excess mineralocorticoids (exogenous or endogenous) that drives PTH to increase serum calcium levels, as previously described by Vaidya et al. (1) Reference (1) Vaidya A, Brown JM, Williams JS. The renin-angiotensin-aldosterone system and calcium-regulatory hormones. J Hum Hypertens. 2015 Sep;29(9): 515-21. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

ODP043 Hypokalemia in Autoimmune Polyglandular Syndrome: A Case of Newfound Type I (Distal) Renal Tubular Acidosis

Abstract Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy Type 1 (APECED) is a rare autosomal recessive disorder predisposing to early development of chronic mucosal candidiasis and progressive development of various endocrinopathies, such as Addison's disease, Primary Hypoparathyroidism, and Type 1 Diabetes (T1D). Few cases described in literature regarding renal involvement in this disorder, with most common manifestation being tubulo-interstitial nephritis, however, there is limited evidence regarding presentation of APECED with hypokalemia due to concomitant Type I Renal Tubular Acidosis (RTA). Case of a 47-year-old female with past medical history of APECED Type 1 (consisting of hypoparathyroidism, adrenal insufficiency, and chronic mucocutaneos candidiasis), T1DM on honeymoon, hypothyroidism, and nephrolithiasis presenting to the emergency department complaining of bilateral upper and lower extremity weakness of one week in evolution, but worsening on day of admission. Denies associated constitutional symptoms. Strong positive first-degree relative history for autoimmune diseases. Physical examination: 2/5 strength in all four extremities, deep tendon reflexes grossly intact, no gross sensory or motor deficits. Patient on oral steroid therapy for her Addison's, calcitriol supplementation for hypoparathyroidism, and potassium chloride supplementation since a prior hypokalemic episode 17 years ago. Laboratory workup results remarkable for sodium: 140 mmol/L (N: 135-144 mmol/L), chloride: 110 mmol/L (N: 95-105 mmol/L), potassium: 2. 0 mmol/L (N: 3.4-4.5 mmol/L), central bicarbonate: 18mmol/L (N: 23-31 mmol / L), anion gap: 12 (N: 10-12), glycosylated hemoglobin: 5.2% (N: 4.7-6.2%) and anti-glutamic acid decarboxylase antibodies &amp;gt;25,000 U/mL (N: &amp;lt;5 U/mL). Adrenal insufficiency was ruled out by laboratory findings, but she had normal anion gap metabolic acidosis (NAGMA) and hypokalemia. Urinalysis was negative for urinary tract infection but with pH: 7. 0 (N: 4.5-8. 0). Urine spots, measured to find the cause of her NAGMA, showed urine sodium: 92 mmol/L, urine potassium: 10 mmol/L, urine chloride: 90 mmol/L, and urine anion gap of 12 mEq/L, which is positive and suggests low urinary NH4+, consistent with Type I (Distal) RTA as the main etiology. Patient started on IV potassium replacement, which increased potassium to 3.8 mmol/L, and improved acidotic state, with central bicarbonate of 29mmol/L, and overall symptoms. Patient was discharged home with alkali therapy (Sodium citrate) for Type I (Distal) RTA. RTA is an underrecognized condition that may be inherited or acquired. Diagnosis is difficult but can be verified with a thoughtful workup. RTA should be considered for any patient with otherwise unexplained hyperchloremic metabolic acidosis and may be the presenting manifestation of autoimmune diseases. Regular renal monitoring for any APECED patient should be performed. We present this case as evidence for the coexistence of several different immune-mediated diseases in the clinical context of APECED with an unusual concomitant Type I (Distal) RTA, where there is few documented evidence of association with this disorder. Presentation: No date and time listed

Congenital chloride diarrhea presenting as dilated fetal bowel loops.

Congenital chloride diarrhea presenting as dilated fetal bowel loops.

206 Efficacy of Using Ammonium Chloride Supplements During Crisis Management to Stop Growth in Various Ages of Pigs

Abstract This project aimed to develop nutritional strategies to “hold” pigs at no growth for 2-6 weeks during crisis management. Previously, growth was reduced in 25-kg pigs fed hold-growth (HG) diets formulated with reduced nutrients +2%NH4Cl (HG+2). Recovery was only monitored for 11-days. The current experiment assessed HG+2 diets fed at 25, 50, and 75kg for 28-days followed by recovery to market weight. Eighty crossbred pigs were allotted (20kg) to 16 pens. Other than during the 28-d hold, pigs were fed standard diets and marketed at a constant weight. Compared with ADG of Ctl (0.963, 1.086, and 1.094 kg/d) growth was reduced (P&amp;lt; 0.01) by 81.9, 77.1, and 79.9% at 25, 50, and 75 kg in pigs fed HG+2 (0.174, 0.249, and 0.220 kg/d). Pigs fed HG+2 recovered and only required 14 extra days to reach market weight (128.6 kg). During the 28-d hold phase feed intake was reduced (P&amp;lt; 0.01). However, feed efficiency (0.310, 0.184, and 0.132 G:F) was reduced compared with Ctl (0.689, 0.397, 0.351 G:F) pigs at 25, 50 and 75 kg, respectively. Dramatic shifts occurred in growth and feed intake during initial recovery phases. Over the entire trial, gain was only reduced by 13.0, 12.6, 12.7% and total feed intake was increased by 1.9, 5.3 and 6.0% for HG+2 pigs held at 25, 50 and 75 kg, respectively. Whole body DXA scans (n=4/treatment) revealed reduced %bone mineral of Ctl vs. HG+2 (2.06 vs. 1.84, 1.82, and 1.83%) at 25, 50, and 75 kg, respectively. No differences were detected in DXA %Fat, %Lean, or traditional carcass traits (fat depth, loin depth, % lean). No adverse effects associated with treatments were observed. Thus, HG+2 diets provided a successful strategy to hold pigs during crisis management. This empirical data will be used to generate dynamic models to guide decisions on economic consequences.