Plasma Sodium Concentration Research Articles

Pathophysiological Electrolyte Changes Connoted via Antagonism of Serotonin Receptor in Experimental Animals

Background: Atypical antipsychotics are a subclass of antipsychotics that have emerged primarily since the 1970s for the treatment of psychiatric disorders. They are sometimes referred to as second-generation antipsychotics (SGAs). Several atypical antipsychotics have received regulatory approval for the treatment of disorders such as bipolar disorder, schizophrenia, irritability in autism, and as adjunctive treatment for major depressive disorders. Objectives: The purpose of the following study was to evaluate the effect of two widely known atypical antipsychotics, aripiprazole, and risperidone, on pathophysiological fluctuations in electrolytes. Several other studies were based on the following ideas, which brought a variety of different perspectives. As can be seen in the following evaluation, although atypical antipsychotics reduce the chance of extrapyramidal symptoms, it leads to impairment of renal function and destruction of renal histo-morphology. Materials and Methods: Thirty rats (10 per group) were used for this study, control group received normal saline, aripiprazole group received 10mg/kg//day, and risperidone group received 20mg/kg//day. The duration of therapy was long up to 3 months. Results: the results confirmed that both drugs reduced plasma sodium and chloride concentration with no effects on plasma potassium and calcium concentration. Moreover, the histomorphology at microscopic level shown no defects after 3 months of therapy. Conclusion: the outcome confirmed no deleterious defects associated with aripiprazole and risperidone when used for 3 months.

Effects of brown seaweed products on growth performance, plasma biochemistry, immune response, and antioxidant capacity of broiler chickens challenged with heat stress

Brown seaweed (Ascophyllum nodosum) is an exceptional bioactive substance known for its excellent antioxidant ability. Given the potential benefits of brown seaweed, the current study was conducted to determine its efficacy on growth performance, blood biochemistry, immunoglobulins (IgG and IgM), and the antioxidant capacity of broiler chickens challenged with heat stress (HS). A total of 336 mixed-sex Ross 308 broiler chicks (one-day-old) were randomly assigned into two groups; The thermoneutral group (TN, broilers were raised at 24 ± 1°C); and the heat stress group (HS; broilers were exposed to 32°C to 34°C, 8 h/d from day 21 to 27; the temperature in the remaining time was same as TN group). All birds in each group were randomly allotted to 4 dietary treatments—Negative control (NC) (without seaweed), NC + 1 mL seaweed extract (SWE) in drinking water, NC + 2 mL SWE in drinking water, and NC + 2% seaweed meal (SWM) in feed. Each treatment was assigned to six replicates with 7 broilers/replicate. Average body weight gain (ABWG), average feed intake (AFI), average water intake (AWI), feed conversion ratio (FCR), and mortality were determined weekly. On day 28, two male birds/cage were euthanized to collect blood and immune organs for subsequent biochemical, antioxidant, and immune status analysis. Data were analyzed as a 4 × 2 factorial analysis of variance using the GLM procedure of Minitab software. Overall, 2% SWM inclusion significantly increased (P < 0.05) the AFI, ABWG, and AWI of broiler chickens irrespective of HS. HS significantly reduced (P < 0.05) AFI and increased (P < 0.05) the bird's rectal temperature, plasma concentrations of sodium, chloride, glucose, amylase, and uric acid compared to TN birds. HS increased (P < 0.05) serum IgM and IgG and decreased plasma glutathione reductase and glutathione peroxidase compared to TN birds, while the activity of superoxide dismutase was not affected by HS and dietary treatments. 1 mL SWE in water and 2% SWM in feed significantly reduced (P < 0.05) the plasma activity of alanine aminotransferase and gamma-glutamyl transferase of heat-stressed broilers, respectively compared to other treatments. Conclusively, dietary supplementation of brown seaweed improved the growth performance of birds irrespective of HS and may help to reduce the negative effects of HS by improving the plasma enzyme activities of heat-stressed birds.

A randomized, cross-over trial assessing effects of beverage sodium concentration on plasma sodium concentration and plasma volume during prolonged exercise in the heat

PurposeThis study assessed whether increasing sodium in a sports drink above that typical (~ 20 mmol L−1) affects plasma sodium and volume responses during prolonged exercise in the heat.MethodsEndurance trained males (N = 11, 36 ± 14 y, 75.36 ± 5.30 kg, {dot{text{V}}}O2max 60 ± 3 mL min−1 kg−1) fulfilled requirements of the study including one 1-h exercise pre-trial, to estimate fluid losses (to prescribe fluid intake), and two, experimental trials (3-h or until tolerance), in random order, cycling (55% {dot{text{V}}}O2max, 34 °C, 65% RH). Beverages contained 6% carbohydrate and either 21 mmol L−1 (Low Na+) or 60 mmol L−1 sodium (High Na+). Analyses included linear mixed models and t-tests.ResultsCycling time was similar 176 ± 9 min (Low Na+); 176 ± 7 min (High Na+). Fluid intake was 1.12 ± 0.19 L h−1; 1.14 ± 0.21 L h−1, resp. Body mass change was − 0.53 ± 0.40%; − 0.30 ± 0.45%, resp. Sodium intake was 69 ± 12 mmol; 201 ± 40 mmol, resp. Plasma sodium concentration was greater in High Na+ than Low Na+ (p < 0.001); decreasing in Low Na+ (− 1.5 ± 2.2 mmol L−1), increasing in High Na+ (0.8 ± 2.4 mmol L−1) (p = 0.048, 95% CI [− 4.52, − 0.02], d = 0.99). Plasma volume decreased in Low Na+ (− 2 ± 2%) but remained unchanged in High Na+ (0 ± 3%) (p = 0.01, 95% CI [− 3.2, − 0.5], d = 0.80).ConclusionsWhen conducting prolonged exercise in the heat, those who fully hydrate would benefit by increased sodium content of the beverage by improved plasma volume and sodium maintenance.Australian New Zealand Clinical Trials Registry (ACTRN12616000239460) 22/02/16.

Inverse relationship between IL-6 and sodium levels in patients with COVID-19 and other respiratory tract infections: data from the COVIVA study.

ObjectiveHyponatremia in COVID-19 is often due to the syndrome of inadequate antidiuresis (SIAD), possibly mediated by interleukin-6 (IL-6)-induced non-osmotic arginine vasopressin (AVP) secretion. We hypothesized an inverse association between IL-6 and plasma sodium concentration, stronger in COVID-19 compared to other respiratory infections.DesignSecondary analysis of a prospective cohort study including patients with COVID-19 suspicion admitted to the Emergency Department, University Hospital of Basel, Switzerland, between March and July 2020.MethodsWe included patients with PCR-confirmed COVID-19 and patients with similar symptoms, further subclassified into bacterial and other viral respiratory infections. The primary objective was to investigate the association between plasma sodium and IL-6 levels.ResultsA total of 500 patients were included, 184 (37%) with COVID-19, 92 (18%) with bacterial respiratory infections, and 224 (45%) with other viral respiratory infections. In all groups, median (IQR) IL-6 levels were significantly higher in hyponatremic compared to normonatremic patients (COVID-19: 43.4 (28.4, 59.8) vs 9.2 (2.8, 32.7) pg/mL, P < 0.001; bacterial: 122.1 (63.0, 282.0) vs 67.1 (24.9, 252.0) pg/mL, P < 0.05; viral: 14.1 (6.9, 84.7) vs 4.3 (2.1, 14.4) pg/mL, P < 0.05). IL-6 levels were negatively correlated with plasma sodium levels in COVID-19, whereas the correlation in bacterial and other viral infections was weaker (COVID-19: R = −0.48, P < 0.001; bacterial: R = −0.25, P = 0.05, viral: R = −0.27, P < 0.001).ConclusionsIL-6 levels were inversely correlated with plasma sodium levels, with a stronger correlation in COVID-19 compared to bacterial and other viral infections. IL-6 might stimulate AVP secretion and lead to higher rates of hyponatremia due to the SIAD in these patients.

Transient alterations in plasma sodium concentrations with NER1006 bowel preparation: an analysis of three phase III, randomized clinical trials

BackgroundThis analysis characterized changes in sodium levels in patients receiving the 1 L polyethylene glycol-based preparation NER1006.MethodsData were pooled from three phase III, randomized clinical trials. A post hoc subanalysis included adults who received a 2-day split-dose (evening/morning) NER1006 regimen, a 1-day split-dose (morning only) regimen, or evening-before regimen and had an increase in sodium concentrations from normal to above the upper limit of normal (143–148 mmol/L) at ≥ 1 of three post-treatment visits. Blood samples were collected at baseline, day of colonoscopy (visit 2), 2 ± 1 days post-colonoscopy (visit 3), and 7 ± 1 days post-colonoscopy (visit 4).ResultsA total of 214 of 1028 patients were included. Of the 214 patients, sodium concentration increased from a mean baseline value of 141.8 mmol/L to a mean of 147.1 mmol/L (median increase from baseline of approximately 5 mmol/L). The mean sodium concentration was within normal range at visit 3 (142.3 mmol/L) and visit 4 (142.4 mmol/L), as was the median sodium concentration. Overall, ~ 90% of patients had a normal serum concentration at visits 3 and 4. Based on day of colonoscopy test results, there were four adverse events involving hypernatremia (0.4% of 1028), which were mild and did not require medical intervention; sodium levels returned to normal range by visit 3.ConclusionNER1006 was associated with small, transient increases in sodium levels that were not considered clinically significant.Trial registration NOCT (ClinicalTrials.gov: NCT02254486 [registered October 2, 2014]), MORA (ClinTrials.gov: NCT02273167 [registered October 23, 2014]; EudraCT number: 2014-002185-78 [registered August 13, 2014]), DAYB (ClinicalTrials.gov: NCT02273141 [registered October 23, 2014]; EudraCT Number: 2014-002186-30 [registered August 12, 2014])

A first proof-of-concept for the non-invasive, time-efficient measurement of the plasma sodium concentration for individualized dialysis.

Dialysis-induced changes in plasma sodium concentration may cause undesirable side effects. To prevent these, the sodium content in dialysis fluid has to be individualized based on the patient's plasma sodium concentration. In this paper, we describe a simple conductivity based method for measuring the plasma sodium concentration. The method is based on performing a bypass during which the residual volume on the dialysate side of the dialyzer at least partially adopts the sodium concentration on the blood side. The conductivity at dialysate outlet of the dialyzer after the end of bypass corresponds to the sodium concentration. We show that already 14 s of bypass are sufficient to subsequently measure a conductivity that correlates with the blood-side sodium concentration. Thus, the short bypass method allows a time saving of 88% compared to the long bypass of 120 s. In vitro experiments with bovine blood show that plasma sodium concentration can be non-invasively and time-efficiently measured during dialysis. Bland Altman analysis reveals a bias of 0.28 mmol/l and limits of agreement of -3.17 and 3.74 mmol/l for the long bypass. For the short bypass, bias is 0.09 mmol/l and limits are -3.90 and 4.08 mmol/l. Since the method presented is based on established conductivity cells, no additional sensors are required, so that the method could be easily implemented in dialysis machines. In future, performing a bypass at the beginning of a treatment may be used to adjust the composition of dialysis fluid individually for each patient.

Hyponatremia in horses with septic pneumopathy.

BackgroundHyponatremia is common in horses with bacterial pleuropneumonia, but no further characterization of this abnormality has been reported.ObjectivesDescribe admission plasma sodium concentration ([Na]) in horses with septic pneumopathy and evaluate any association of plasma [Na] with markers of systemic inflammation.AnimalsMedical records of horses >1 month of age that between 2008 and 2021 had a transtracheal aspirate (TTA) performed, abnormal TTA cytology, positive TTA culture, pulmonary disease on ultrasonography, radiography or both, and plasma [Na] assessed by direct ion‐selective‐electrode (dISE). Horses with concurrent diarrhea or azotemia were excluded.MethodsClinical and clinicopathological variables of interest between hypo‐ and normonatremic horses were compared. Spearman correlation and Fisher exact tests were used to identify significant associations (P < .05).ResultsTwenty of 35 horses had hyponatremia (median, 132 mmol/L; 25‐75th interquartile range [IQR], 129.7‐133.1 mmol/L; reference range, 134.2‐138.4 mmol/L). A higher proportion of horses with systemic inflammatory response syndrome (SIRS) had hyponatremia (P = .01). Hyponatremic patients had higher mean plasma fibrinogen concentration (461 ± 160.5 mg/dL; P = .01) and higher rectal temperature (38.8 ± 0.7°C; P = .02) than normonatremic horses. Negative correlations were found between plasma [Na] and fibrinogen (P = .001; ρ = −0.57) concentrations and between plasma [Na] and rectal temperature (P = .001; ρ = −0.51). Presence or absence of pleural effusion did not influence severity of hyponatremia. Mean duration of hospitalization was longer (P = .04) in hyponatremic horses (9.8 ± 6.6 days).Conclusions and Clinical ImportanceHyponatremia at admission is associated with the presence of inflammation, SIRS, and with longer duration of hospitalization.

Diagnostic and therapeutic approach to hypernatremia.

Hypernatremia occurs when the plasma sodium concentration is greater than 145mmol/L. Depending on the duration, hypernatremia can be differentiated into acute and chronic. According to severity: mild, moderate and threatening hypernatremia. Finally, depending on pathogenesis, hypernatremia can be defined as hypervolemic, hypovolemic, and euvolemic. Acute hypervolemic hypernatremia is often secondary to increased sodium intake (hypertonic NaCl and NaHCO3 solutions). Instead, chronic hypervolemic hypernatremia may be an expression of primary hyperaldosteronism. Euvolemic hypernatremia occurs in diabetes insipidus: depending on the underlying pathogenesis, it can be classified into two basic types: neurogenic (or central) and nephrogenic. The neurogenic form may be triggered by traumatic, vascular or infectious events; the nephrogenic form may be due to pharmacological causes, such as lithium, or non-pharmacological ones, such as hypokalemia. For hypovolemic hypernatremia, possible explanations are renal or extrarenal losses. The main goal of treatment of hypernatremia is the restoration of plasma tonicity. In particular, if the imbalance has occurred acutely, rapid correction improves the prognosis by preventing the effects of cellular dehydration; if hypernatremia has developed slowly, over a period of days, a slow correction rate (no more than 0.4mmol/L/h) is recommended.

Higher Parenteral Electrolyte Intakes in Preterm Infants During First Week of Life: Effects on Electrolyte Imbalances.

Objectives:This study aimed to investigate the effects of a higher intake of electrolytes from parenteral nutrition (PN) on plasma electrolyte concentrations in very low birth weight (VLBW, <1500 g) infants.Methods:This was a single-center cohort study including all VLBW infants born before (n = 81) and after (n = 53) the implementation of a concentrated PN regimen. Daily nutritional intakes and plasma concentrations of sodium, chloride, potassium, phosphate, and calcium were collected from clinical charts.Results:During the first postnatal week, electrolyte intakes were higher in infants who received concentrated PN compared with infants who received original PN. Infants who received concentrated PN had a lower incidence of hypokalemia (<3.5 mmol/L; 30% vs 76%, P < 0.001) and severe hypophosphatemia (<1.0 mmol/L; 2.2% vs 17%, P = 0.02). While the relatively high prevalence of severe hypophosphatemia in infants who received original PN can be explained by a phosphorus intake below the recommendation, the potassium intake during the first 3 postnatal days (mean ± SD: 0.7 ± 0.2 mmol/kg/d) was within the recommendation. The prevalence of early hypernatremia was not affected by the different sodium intake in the 2 groups.Conclusions:In VLBW infants, a sodium-containing PN solution (about 2.7 mmol/100 mL) does not cause hypernatremia during the first days of life. Furthermore, providing at least 1 mmol potassium/kg/d during the first 3 postnatal days might be necessary to prevent early hypokalemia.

Sodium supply from administered blood products was associated with severe intraventricular haemorrhage in extremely preterm infants.

AimThe aim of this study was to investigate the associations between sodium supply, fluid volume, sodium imbalances and severe intraventricular haemorrhage (IVH) in extremely preterm (EPT) infants.MethodsWe used data from the EXtremely PREterm infants in Sweden Study (EXPRESS) cohort consisting of all infants born at 22 to 26 gestational weeks from 2004 to 2007 and conducted a nested case–control study. For every infant with severe IVH (grade 3 or peri‐ventricular haemorrhagic infarction), one IVH‐free control infant with the birthday closest to the case infant and matched for hospital, sex, gestational age and birth weight was selected (n = 70 case–control pairs).ResultsTotal sodium supply and fluid volume were higher in infants with severe IVH compared with controls [daily total sodium supply until postnatal Day 2: mean ± SD (mmol/kg/day): 5.49 ± 2.53 vs. 3.95 ± 1.91, p = 0.009]. These differences were accounted for by sodium and fluid from transfused blood products. High plasma sodium concentrations or large sodium fluctuations were not associated with severe IVH.ConclusionOur results suggest a relationship between sodium‐rich transfusions of blood products and severe IVH in EPT infants. It is unclear whether this is an effect of sodium load, volume load or some other transfusion‐related factor.

Modelling sodium requirements of athletes across a variety of exercise scenarios – Identifying when to test and target, or season to taste

ABSTRACT Evidence suggests the focus for sodium replacement during exercise should be maintenance of plasma sodium concentration ([Na+]plasma) for any given total body water (TBW) volume. The sodium intake to achieve stable [Na+]plasma given known fluid and electrolyte intakes and losses can be mathematically estimated. Therefore the aim of this investigation was to model sodium requirements of athletes during exercise, observing the influence of sweat rate, exercise duration, body mass, baseline [Na+]plasma and sweat potassium [K+]sweat, and relevance to competition (soccer, elite marathon, and 160 km ultramarathon running). Models were constructed across a range of sweat sodium concentrations ([Na+]sweat) (20–80 mmol·L−1), sweat rates (0.5–2.5 L·h−1) and fluid replacement (10–90% of losses). In the competition-specific scenarios, fluid replacement was calculated to achieve 2% TBW losses. Sodium requirements were driven by fluid replacement (% of losses) and [Na+]sweat, with minimal or no influence of other variables. Replacing sodium was unnecessary in all realistic scenarios modelled for a soccer match and elite marathon. In contrast, the 160 km ultramarathon required ≥47% sodium replacement when [Na+]sweat was ≥40 mmol·L−1 and >80% of fluid losses were replaced. In conclusion, sodium requirements to maintain stable [Na+]plasma during exercise depend on both the proportion of fluid losses replaced, and [Na+]sweat. Only when prolonged exercise is coupled with aggressive fluid replacement (>80%) and whole body [Na+]sweat ≥40 mmol·L−1 does sweat composition testing and significant, targeted sodium replacement appear necessary. Highlights Modelling sodium intake requirements with sodium and fluid intake expressed as a proportion of losses, allows robust models to be constructed that are not influenced by sweat rate, exercise duration, body mass, and only to a minor extent by baseline plasma sodium and sweat potassium. When applied to specific sporting scenarios, targeted sodium replacement, and therefore sweat composition testing, appears unnecessary in all realistic scenarios modelled for a soccer match or elite marathon race. Athletes can therefore choose sodium intake according to taste preferences rather than physiological need. During a 160 km ultramarathon, targeted sodium replacement may be necessary because fluid replacement needs are greater as a proportion of losses. However the required quantity remains <50% of losses unless sweat rate is ≥1.5 L·hr−1, sweat sodium is ≥40 mmol·L−1, and fluid replacement is ≥90% of losses. The modelling technique described could be utilised by researchers to personalise sodium replacement in intervention studies for each participant, or by practitioners to either estimate the likely sodium needs of athletes during exercise, or to decide when sweat composition testing is or is not likely to be useful.

MO1059: A Case Series of 2 Patients with Perdialytic Dialysis Headache: Is There a Role for Isonatremic Dialysis?

Abstract BACKGROUND AND AIMS Per-dialytic headache (PDH) is a frequent complication of hemodialysis (HD) and often a challenge for nephrologists. Its pathophysiology has been though to involve sodium and/or osmotic variation during HD session. We assess here the effect of an Automatic Individualized Sodium Module Management (Na Mngt module) embedded into the dialysis machine on the PHD of two patients. Na Mngt module assesses pre-dialytic plasma sodium concentration and measures it through all the HD duration. Na Mngt module automatically controls the sodium concentration of the dialysate fluid and limits the diffusive sodium load during the HD session. METHOD 2 women aged of 87 and 76 years consistently reported unbearable PDH and nausea during several Online-Hemodiafiltration (HDF) sessions. They did not present other possible causes of PHD, including migraine, nervous depression, disequilibrium syndrome, and arterial hypertension. We suspected that the PDH was favored by dialysis-induced high plasma osmolarity (conductivity) in both patients (conductivity: 135–140 and 138 mmol/L) and decided to put them on Na Mngt module to align the sodium concentration of the dialysate fluid with their predialytic plasma sodium concentration. RESULTS After Na Mngt's activation, The PDH observed in both patients disappeared almost instantly. For both patients ‘1’ and ‘2’, the evolution of the main dialysis parameters before and after Na Mngt activation where respectively: Dry Weight (patient1: 42/41 Kg; patient2: 61/60.5 Kg); Pre-dialysis Sodium (patient1: 131/133 mmol/L; patient2: 143/138 mmol/L); Conductivity (patient1: 135–140/136+/-4 mmol/l; patient2: 140/139 mmol/L); IDWG (patient1: 2.5/2, patient2: 2/1.8 Kg); UF (patient1: 2/1.5 L/session; patient2: 2/1.6 L/session); Diffusive sodium balance (patient1: 10/2 g/session; patient2: 8/0 g/session). The Fig. 1 depicts the evolution of pre- and post-dialysis plasma sodium concentration before and after Na Mngt module activation for patient 1. The Fig. 2 shows for patient 2 the conductivity of the dialysate (in blue) throughout the session compared to the plasma conductivity (in red) with activation of Na Mngt module: the diffusive Na transfer remained around 0 g during ALL the session. For Patient 2, the predialytic plasma Na + was 139 mmol/L, and total Na removed was 18.8 g for the entire session. To obtain these results the dialysis machine module adjusted the dialysate Na within the range of 140–144 mmol/L. CONCLUSION This case report suggests that the Na Mngt module controls the diffusive sodium transfer during HD, reduces sodium load, osmotic fluctuations, and prevents PHD. Na Mngt activation allows isonatremic prescription of sodium with less variation between pre- and post- dialysis plasma sodium concentrations and decreases diffusive Na when isonatremic mode is selected. ‘Patient 2’ shows (Fig. 2) that the Na Mngt tool set a dialysate conductivity slightly higher than Na plasma to obtain an iso-natremic profile. Further controlled clinical study are needed to confirm the effect of the Na Mngt tool on intradialytic (PDH, hypotension) and interdialytic (thirst, IDWG) symptoms.

Protective Role of Angiotensin II type 2 receptor (AT2R) in High Salt Diet‐Induced Low Molecular Weight Proteinuria and Loss of Megalin in the Kidney

Proteinuria is a cause and a risk factor for tubulointerstitial injury with the progression of end‐stage kidney disease. Proteinuria is a function of the glomerular filtration of protein and the reabsorption of protein from the post‐glomerular filtrate by the endocytic receptors, megalin and cubilin, localized in the renal proximal tubules. We have shown that treatment with the angiotensin‐II type 2 receptor (AT2R) agonist compound 21 (C21) for 2 weeks reduces proteinuria in obese Zucker rats (OZR) fed with high salt diet (HSD). OZR is a salt‐sensitive model but has no effect on blood pressure in the first 3 days of HSD treatment. However, the early cellular and molecular mechanism of proteinuria in response to HSD and the protective effect of AT2R activation is unknown. Therefore, the present study is designed to determine the molecular/cellular mechanism of AT2R‐mediated protection against HSD‐induced proteinuria, independent of glomerular injury in obesity. We hypothesize that AT2R activation prevents the loss of megalin in proximal tubule epithelial cells and thereby decreases the urinary excretion of low molecular weight (LMW) proteins in HSD fed obese rats. Male OZR (11–14 weeks of age) were fed on normal salt diet (NSD) (0.4%) or HSD (4%) for 2 days with and without treatment with C21. The animals were placed in metabolic cages for collecting urine at various time intervals namely 6, 12, 24 and 48 hours. We observed that HSD caused proteinuria at 24 hrs. and was prevented by C21 treatment. Further analysis by gel electrophoresis revealed that proteinuria was based on LMW protein (&lt;60 kDa) excretion in the urine. This observation was confirmed by no change in albuminuria by HSD and C21. Dot blot analysis and confocal immunofluorescence microscopy revealed that megalin and not cubilin, was significantly decreased in HSD treatment group and the remaining megalin was mostly present in the cytosolic compartment with negligible expression on plasma membrane, suggesting megalin recycling impairment. The C21 treatment restored megalin back to the plasma membrane. FcRn is an exclusive receptor for albumin transport, which remained unaltered by HSD and C21. Western blot of nephrin and podocin, indices of glomerular filtration apparatus, remained unchanged suggesting structural integrity of the glomerular filtration assembly. Consistent to this notion, GFR measured by creatinine clearance method remained same in all the three groups. HSD caused a significant increase in the urinary sodium excretion, which was not affected by C21 treatment and the plasma sodium concentration in all the groups remained the same. Overall, the data suggest that acute feeding of HSD causes LMW proteinuria due to reduction as well as cytosolic expression of megalin in proximal tubule and not due to the change in the glomerular filtration. AT2R activation restores megalin expression and prevents proteinuria with a potential of long‐term protection against tubule‐interstitial injury and kidney disease.

Reconsidering the Edelman equation: impact of plasma sodium concentration, edema and body weight

BackgroundGuidelines recommend treatment of dysnatremias to be guided by formulas based on the Edelman equation. This equation describes the relation between plasma sodium concentration and exchangeable cations. However, this formula does not take into account clinical parameters that have recently been associated with local tissue sodium accumulation, which occurs without concurrent water retention. We investigated to what extent such clinical factors affect the Edelman equation and dysnatremia treatment. MethodsWe performed a post-hoc analysis with original data of the Edelman study. Linear regression was used to examine the effect of age, sex, weight, edema, total body water (TBW) and heart and kidney failure on the Edelman equation. With attenuated correction, we corrected for measurement errors of both variables. Using piecewise regression, we analyzed whether the Edelman association differs for different plasma sodium concentrations. ResultsData was available for 82 patients; 57 males and 25 females with a mean (SD) age of 57 (15) years. The slope of the Edelman equation was significantly affected by weight (p=0.01) and edema (p=0.03). Also, below and above plasma sodium levels of 133 mmol/L the slope of the Edelman equation was significantly different (1.25 x0025vs 0.58x0025, p<0.01). ConclusionEdelman's equation's coefficients are significantly affected by weight, edema and plasma sodium, possibly reflecting differences in tissue sodium accumulation capacity. The performance of Edelman-based formulas in clinical settings may be improved by taking these clinical characteristics into account.

Acute waterborne strontium exposure to rainbow trout: Tissue accumulation, ionoregulatory effects, and the modifying influence of waterborne calcium.

Flowback and produced water (FPW) is an end-product of the hydraulic fracturing method of oil and gas extraction that is highly enriched in alkaline earth metals such as strontium (Sr). While Sr concentrations in FPW can exceed toxic thresholds for fish, the accompanying high concentrations of calcium (Ca) in FPW may ameliorate any toxicity. In this study, Sr bioaccumulation and molecular, biochemical, and physiological changes in ionoregulatory endpoints were investigated in rainbow trout (Oncorhynchus mykiss). Exposures were conducted over a 96-h period at Sr concentrations ranging from 1.7 to 1948µM, with effects at the highest Sr exposure concentration also separately examined in waters of varying Ca concentration (10 to 958µM). Plasma and gill Sr burdens increased as a function of increasing waterborne Sr, and accumulation increased further as water Ca concentrations were lowered. Despite this, there was no consistent, dose-dependent effect of Sr on plasma or gill Ca concentrations, although impacts on plasma and branchial sodium (Na) concentrations were observed. Waterborne Sr significantly inhibited branchial Ca2+-ATPase activity, albeit only at the highest tested Sr concentration (1948µM). In exposure treatments where Sr was highly elevated and water Ca was reduced, the hepatic gene expression of Ca signaling receptors β-2 adrenergic receptor (Adrb2) and inositol-1,4,5-triphosphate receptor-2 (Itpr2) were inhibited, highlighting novel potential pathways of Sr toxicity in rainbow trout. Overall, these data indicate that water Ca has a strong effect on Sr bioavailability, but over an acute exposure period there is limited evidence for an effect of Sr on Ca homeostasis. Although Sr is elevated in effluents associated with the oil and gas industry, the co-occurrence of high Ca concentrations might protect freshwater fish against acute effects related to Sr exposure.

Multicentre randomised controlled trial: protocol for Plasma-Lyte Usage and Assessment of Kidney Transplant Outcomes in Children (PLUTO)

IntroductionAcute electrolyte and acid–base imbalance is experienced by many children following kidney transplantation. When severe, this can lead to complications including seizures, cerebral oedema and death. Relatively large volumes of...

Effectiveness of Isotonic Beverages and Mineral Water Beverages to Recovery Time after Cooper Test

Exercise is one way that can be done towards a healthy life. When exercising the body will lose a lot of fluid in the form of electrolytes through sweat. Most people after exercise will consume mineral water which causes a decrease in the concentration of sodium in the blood plasma thus reducing thirst further delaying the rehydration process. Currently popular with isotonic beverages that have a similar osmolarity value of body fluids, and have the benefit of restoring lost body fluids so that the body avoids dehydration. This study aims to determine the effectiveness of isotonic drinks and mineral water to the recovery of physical exercise after conducting a Cooper Test. The method used is experimental research Pretest - posttest Control Group Design.

Вплив альтерації гомеостазу глюкози на водно-електролітний баланс та кислотно-основний стан у пацієнтів із цукровим діабетом

Незважаючи на успіхи в терапії цукрового діабету, частота виникнення ускладнень, зокрема порушення водно-електролітного та кислотно-основного стану, останніми роками не зменшилась. Цікаво відмітити той факт, що клінічні прояви такого грізного ускладнення, як діабетичний кетоацидоз, уперше описав Дрешфельд у 1886 році. Відтоді і до початку застосування інсуліну (в 1922 р.) смертність від цього ускладнення сягала 100 %. Широке впровадження в практику інсулінотерапії знизило смертність до 30 %, а з удосконаленням методів лікування, зокрема інфузійної терапії, відбулось подальше її зниження. На сьогодні рівень летальності пацієнтів із порушеннями водно-електролітного та кислотно-основного стану залишається високим (близько 5 % у спеціалізованих центрах). Тільки в США щорічно від цього ускладнення помирає близько 4000 хворих на цукровий діабет. Прогноз перебігу захворювання значно погіршується з віком, при розвитку коми та артеріальної гіпотензії. Поширеність цукрового діабету стрімко зростає і на сьогодні становить від 20 до 50 % випадків вперше виявленого захворювання в молодих людей. Порушення електролітів є частими в пацієнтів із даною патологією і можуть бути результатом зміненого розподілу електролітів, пов’язаного з індукованою гіперглікемією осмотичних зрушень рідини, або загального дефіциту, спричиненого осмотичним діурезом. Ускладнення від пошкодження органів-мішеней і методи лікування цукрового діабету можуть також сприяти електролітним порушенням. Порушення регуляції гомеостазу глюкози призводить до великої кількості прямих і непрямих впливів на електролітний і кислотно-основний баланс, оскільки велика поширеність діабету гарантує, що лікарі практично кожної спеціальності мають справу з пацієнтами, хворими на цукровий діабет, а знання, пов’язані зі змінами електролітів, є необхідними. У статті розглянуто, як впливають зміни гомеостазу глюкози при цукровому діабеті на водно-електролітний баланс та кислотно-основний стан пацієнта.

Clinical diagnosis and surgical management of bovine with primary omasal impaction

The present study was conducted on 15 bovine (10 buffaloes, 5 cattle) suffering from omasal impaction. The diagnosis of omasal impaction was made on the basis of clinical examination, haematobiochemical evaluation, ultrasonography and exploratory laparotomy, and treated surgically by thorough flushing and removing most of impacted contents. Omasal impaction in bovine was characterized by low concentration of sodium, potassium and chloride levels in plasma and higher concentration of total protein. Ultrasonography (showing crescent shaped omasal wall with an anechoic acoustic shadow originating from 7th to 11th intercostal space) was a reliable technique for diagnosis of omasal impaction. Left flank laparo-rumenotomy, flushing with water and administration of oil directly into the omasum was a suitable surgical technique for the management of omasal impaction in bovine.

Role of dialysate sodium and serum sodium gradient in intradialytic hypertension of regular hemodialysis patients

Background and aim Sodium (Na+) balance largely depends on interdialytic dietary salt intake and intradialytic Na+ removal during hemodialysis (HD) for chronic renal failure cases. To preserve a normal Na+ equilibrium, interdialytic Na+ increase should be filtered during HD. Sodium gradient (Na+ G) is obtained by subtraction of the dialysate Na+ concentration and the patient's own pre-HD plasma sodium concentration. The aim was to evaluate the role of dialysate and serum Na+ G in patients with intradialytic hypertension (IDH). Patients and methods A cross-sectional observational study was done to evaluate the role of Na+ G in IDH in a cohort of HD patients followed in the dialysis center of Damanhur Fever Hospital. Among 119 prevalent patients on MHD in our center during period from March 2021 to July 2021, we found 26 patients with IDH, so we selected a control group of 26 patients with intradialytic normotension (age and sex matched). So, the study included 52 patients (age and sex matched) who were divided into two groups: group A included 26 patients who were intradialytic normotensive, and group B included 26 patients with IDH. Results A total of 52 patients were included in our final analysis. The sample included patients who are diagnosed with ESRD and under regular HD schedule, with a mean±SD age of 54.4±12.3 years. Comparison of different sodium concentrations revealed that there was no significant difference between pre-dialytic, and postdialytic Na serum levels, along with no difference in sodium gradients, with P values greater than 0.05. Conclusion IDH was not significantly associated with sodium gradient, age, sex, hemoglobin level, and predialytic and postdialytic serum sodium concentrations.