Serum Sodium Concentration Research Articles

Exploring the predictive value of serum lipids for short‐term prognosis in patients with acute‐on‐chronic liver failure

AbstractAimsAcute‐on‐chronic liver failure (ACLF) is defined as acute liver injury superimposed on chronic liver disease, resulting in a significantly increased short‐term mortality rate. Serum lipids are associated with the severity of liver disease and contribute to the prognostic assessment for cirrhosis and liver failure. However, the presentation of serum lipids varies in different studies, making it difficult to draw definitive conclusions. This study aimed to investigate the predictive value of serum lipids for short‐term prognosis in patients with ACLF.MethodsThis retrospective analysis was conducted using the clinical data of patients hospitalized for ACLF between January 2018 and December 2021. The collected data were subjected to Least Absolute Shrinkage and Selection Operator and logistic regression analyses to identify the independent predictors of 28‐day and 90‐day mortality. Separate regression models were developed for each identified serum lipid. These models were combined with the Model for End‐Stage Liver Disease (MELD), MELD combined with serum sodium concentration (MELD‐Na), Chronic Liver Failure Consortium Acute‐on‐chronic Liver Failure (CLIF‐C ACLF), and Chinese Group on the Study of Severe Hepatitis B‐ACLF (COSSH‐ACLF) scores to construct new models. The performance of these models was evaluated using the area under the receiver operating characteristic curve (AUC), Nagelkerke R2, Brier score, net reclassification index (NRI), and integrated discrimination improvement (IDI) to assess the prognostic ability of serum lipids.ResultsThis study included 266 patients with ACLF, of whom 25.9% (69/266) died within 28 days and 38.5% (102/265, with 1 lost to follow‐up) died within 90 days. The independent predictors of 28‐day mortality were age, the presence of overt hepatic encephalopathy at admission, high‐density lipoprotein cholesterol (HDL‐C) levels, and international normalized ratio (INR). The independent predictors of 90‐day mortality were age, albumin levels, serum creatinine levels, and INR. The comparative analysis revealed that the AUC of all other models exceeded that of HDL‐C (p < 0.001). The COSSH‐ACLF model demonstrated superior predictive ability compared with the MELD and HDL‐MELD models (p = 0.013 and 0.017, respectively). Furthermore, the HDL‐COSSH‐ACLF model exhibited a similar trend in predictive ability compared with the latter two models (p = 0.009). No significant differences were observed in the AUC performances of the other models. A comparison of NRI calculated using the cutoff values assigned by equal assignment revealed that the addition of HDL‐C improved the predictive ability of the MELD score by 4.6% (NRI = 0.0460, p = 0.036). The MELD‐Na score exhibited an 8.4% improvement (NRI = 0.0844, p = 0.047), while the COSSH‐ACLF score demonstrated a 14.4% improvement (NRI = 0.1443, p = 0.015). However, these changes did not significantly impact the capacity of the CLIF‐C ACLF score (NRI = 0.0350, p = 0.141). No significant differences were observed in the IDI comparisons between the models with different cutoff values (all p > 0.050).ConclusionsSerum HDL‐C is an independent predictor of 28‐day mortality in patients with ACLF. Although it has inferior predictive ability when considered alone, HDL‐C enhances the predictive capacity of MELD, MELD‐Na, and COSSH‐ACLF when incorporated into these models.

Serum Sodium Concentration During Arginine Vasopressin Infusion in Critically Ill Children

Background: Intravenous arginine vasopressin is increasingly used for the treatment of critically ill children. It bears the risk of hyponatraemia with potential severe long-term sequelae, but data on hyponatraemia as a side effect of continuous vasopressin infusion for paediatric intensive care patients is scarce. Methods: In this retrospective analysis performed at a tertiary care paediatric intensive care unit with 2000 annual admissions, patients were included if they were treated with intravenous vasopressin between 2016 and 2022. Baseline sodium concentrations, lowest sodium concentrations during arginine vasopressin treatment, and time to lowest sodium concentration (nadir) were derived. Results: In total, 170 patients with a median age of 4 months [interquartile range, IQR, 0–33] were included, 92.4% underwent surgery, and 28.8% died. Median arginine vasopressin dose rate was 0.027 IU/kg/h [0.019–0.036] and arginine vasopressin was started 3.2 [0–26] h after intensive care admission. Median arginine vasopressin application duration was 13.6 h [6.2–32.6]. Baseline sodium was 141 mmol/L [138–145], and lowest median sodium during arginine vasopressin infusion was 137 mmol/L [132–141] (nadir at 8.4 h [1.0–28.1] after arginine vasopressin start). Hyponatraemia (<135 mmol/L) occurred in 38.2% of patients during AVP treatment, and physicians administered a median of 10.2 mmol/kg/d [6.2–16.4] sodium during arginine vasopressin therapy. Conclusions: Under arginine vasopressin infusion, hyponatraemia was common, although high daily doses of sodium were administered to keep the serum values in physiologic ranges. This emphasises the need for close electrolyte monitoring and sodium substitution in children and adolescents under arginine vasopressin treatment to avoid hyponatraemia and related sequelae.

Joint association of serum sodium and frailty with mild cognitive impairment among hospitalized older adults with chronic diseases: a cross-sectional study.

To examine the associations of serum sodium and frailty with the risk of mild cognitive impairment (MCI) among hospitalized older adults with chronic diseases. A cross-sectional study was conducted in 403 hospitalized older adults with chronic diseases. Serum sodium concentration was assessed by the ion-selective electrode method, frailty status was evaluated by the FRAIL scale, and MCI was determined by the Montreal Cognitive Assessment (MoCA). Multiple logistic regression models were used to estimate the associations of serum sodium and frailty with MCI. Participants with the lowest tertile of serum sodium had a higher risk of MCI than those in the middle tertile group (OR = 1.75, 95% CI: 1.01-3.04). Below 143 mmol/L, the risk of MCI was 1.38 (95% CI: 1.03-1.84) for per 1 SD decrease in serum sodium. Compared with the robust group, frailty was significantly associated with an increased risk of MCI (OR = 3.94, 95% CI: 1.92-8.10). Moreover, in comparison with participants with the middle tertile of serum sodium and who were robust/prefrail, those with frailty and either the lowest (OR = 5.53, 95% CI: 2.08-14.67) or the highest tertile of serum sodium (OR = 3.48, 95% CI: 1.20-10.05) had higher risks of MCI. Both lower and higher serum sodium impose a significantly higher risk for MCI in older adults with frailty. This could inform the design of clinical trials and the development of guidelines and recommendations for correcting serum sodium and frailty in hospitalized older adults with chronic diseases.

Central diabetes insipidus in two related juvenile deerhounds

AbstractTwo related juvenile deerhounds were evaluated 2 years apart because of polydipsia, pollakiuria and periuria. Until shortly before presentation, each dog lived outdoors from 6 weeks of age with its littermates, and each litter shared a single drinking water source. Physical examination findings were unremarkable. The most noteworthy laboratory finding was hyposthenuria, although both dogs also had serum sodium concentrations at the upper end of the laboratory reference range. Both dogs responded to treatment with desmopressin acetate eye drops, which relieved their clinical signs and increased their urine specific gravities, confirming a diagnosis of central diabetes insipidus. To the best of the authors’ knowledge this is the first report of diabetes insipidus in deerhounds and only the third report to suggest that central diabetes insipidus might be heritable in dogs, as it is in humans.

Serum sodium concentration predicting mortality in patients with aneurysmal subarachnoid hemorrhage

BackgroundTo date, inconsistent evidence exists on the role of hypernatremia in patients with aneurysmal subarachnoid hemorrhage (aSAH) who underwent surgical clipping. We aimed to investigate the association between serum sodium and mortality in these patients. MethodsA cohort study was performed to include adult patients with aSAH who underwent surgical clipping in a university hospital. The primary outcome was follow-up mortality. Propensity score matching (PSM) was used for matching patients’ baseline characteristics. Net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess and compare the reclassification and discrimination capacity of different models. Trends in serum sodium over time were detected by the ordinary least squares model. ResultsOf 618 aSAH patients with surgical clipping during the study period, normal serum sodium was observed in 467 patients (75.6 %), and admission hypernatremia was noted in 151 patients (24.4 %). After adjustment with multivariate regression analysis, patients with hypernatremia had significantly higher odds for follow-up mortality (aOR: 2.86, 95 % CI: 1.54 to 5.30; P = 0.001). PSM analysis observed similar results (aOR: 2.38, 95 % CI: 1.29 to 4.55; P = 0.009). The incorporation of serum sodium during hospitalization markedly enhanced the IDI (P < 0.001) and NRI (P < 0.001) for the prediction of mortality. ConclusionsIn conclusion, the findings from this cohort study of aSAH patients with surgical clipping indicated that serum sodium can be an independent predictive factor of all-cause mortality, and inferior sequelae in aSAH patients. These findings endorsed the importance of managing hypernatremia and monitoring serum sodium in patients with aSAH.

5147 Use of hypertonic saline in severe symptomatic hyponatraemia; results from a national survey from United Kingdom

Abstract Disclosure: M. Arshad: None. A. Iqbal: None. Background: Acute severe symptomatic hyponatraemia is potentially life-threatening. Irrespective of the underlying aetiology, hypertonic saline (HTS) is effective at rapidly correcting serum sodium. Several clinical treatment guidelines have aimed to standardise the administration of HTS. The European Society of Endocrinology (ESE) guidelines (2014) recommend two boluses of 150 mL 3% HTS with an aim to raise serum sodium concentration by 5 mmol/L([1]). It is important to note that the evidence supporting this approach is limited, and concerns have been raised regarding the potential for overcorrection using this protocol(2). Aim: To assess the practices and perceptions surrounding hypertonic saline (HTS) use in severe symptomatic hyponatraemia among United Kingdom (UK) endocrinologists and specialty trainees (fellows). Methods: An anonymous online survey was disseminated to all clinical members of the Society for Endocrinology (UK) between 24/10/2023 and 30/11/2023 using Survey Monkey ®, a web-based multiple-choice questionnaire. Results: Of 133 respondents (60.1% consultants, 33.1% specialty trainees, 6.8% other), 85% employed bolus treatment with HTS only, with 9.8% using both bolus and continuous infusions. Most (50.4%) preferred 150 mL boluses, followed by 100 mL boluses (18.8%). Commonly used HTS strengths were 2.7% (45.1%), followed by 1.8% (31.6%), while the 3% HTS strength recommended by ESE guidance was used by 21.8%. Only 7 (5.3%) respondents used weight-based HTS dosage. Contrary to guidelines, 74.4% did not administer a second bolus without waiting for sodium result from the first bolus. Also, 86% have experience using venous blood gas sodium readings for monitoring, even though this has not been mentioned or recommended in the guidelines. HTS was always administered in high-dependency settings by 16.5% and mostly administered in this setting by 49.6%. Overcorrection targets defined by 10 and 8 mmol/24 hours cut-offs were used by 48.9% and 39.9%, respectively. For definite or expected overcorrection, 75.9% preferred 5% dextrose, while 40.6% had experience with desmopressin (DDAVP). Conclusion: Significant variation exists in HTS use for severe symptomatic hyponatraemia in the UK, deviating from guidelines, especially regarding a second bolus without assessing the first bolus's biochemical impact. European guidelines warrant an evidence-based revision to harmonize clinical practice.

6611 ACTH deficiency due to TBX19 mutation mimics complete adrenal insufficiency in a newborn

Abstract Disclosure: T. Reinehr: None. P.M. Holterhus: None. S.A. Wudy: None. A. Richter-Unruh: None. C. Spratte: None. C. Roll: None. Isolated ACTH deficiency (IAD) is a rare cause of adrenocortical insufficiency. T-box transcription factor 19 (TBX19) mutations are responsible for more than 60% of neonatal cases of IAD. To the best of our knowledge, we present for the first time a newborn with ACTH deficiency due to a TBX19 mutation with almost steroid-free plasma and urine: At day 2 of life, the female newborn (birth weight 3190g, length 52 cm, 40+1 gestational age) was transferred to our neonatal intensive care unit for severe hypoglycemia (12 mg/dl), which responded to intravenous glucose infusion. Surprisingly, the sodium serum concentrations decreased from 140 mmol/l at day 2 of life to 126 mmol/l at day 7 of life. There were no clinical signs of adrenal insufficiency such as vomiting or hypotonia. Treatment with oral sodium-chloride 5.85% was started. Endocrine diagnostic work-up performed at day 8 of life demonstrated normal values of fT4, HGH and IGFBP-3 ruling out pituitary involvement of these axes, while ACTH serum concentrations were markedly decreased (1.5 pg/ml). Liquid- chromatography-mass spectrometry (LC-MS/MS) revealed nearly absent glucocorticoids (17-hydroxyprogesterone &amp;lt;0.12 nmol/l, 11-deoxycortisol &amp;lt;0.08 nmol/l, cortisol &amp;lt;4.2 nmol/l, and cortisone 1.3 nmol/l (norm value [nv]: 17-138 nmol/l)). Androgens were undetectable (testosterone &amp;lt;0.02 nmol/l, androstenedione &amp;lt;0.08 nmol/l). Mineralocorticoids were severely reduced (11-desoxycorticosterone 0.1 nmol/l (nv: 0.2-1.0 nmol/l), corticosterone 0.6 nmol/l (nv: 1-24 nmol/l), aldosterone 0.1 nmol/l (nv: 0.8-2.3 nmol/l)). In urine spot, gas chromatography-mass spectrometry (GC-MS) demonstrated subnormal excretion of C19 and C21 steroids including fetal zone steroids. Serum and urine measurements were interpreted by the labs as a typical finding similar to StAR defect. The genetic analyses revealed a normal female karyotype (46,XX) and ruled out CYP11A1 and StAR, mutations but demonstrated a homozygous missense mutation in TBX19 (c.172A&amp;gt;G, p.(Thr58Ala)). After 3 months of life under treatment with hydrocortisone (10mg/m² divided in 3 doses) and fludrocortisone (0.05 mg divided in 2 doses), cortisol was normal (320 nmol/l) and DHEAS was undetectable (&amp;lt;3 nmol/l). While androgens were in normal range (testosterone 2.6 nmol/l, androstenedione 0.28 nmol/l), 11-deoxycorticosterone was normal (0.74 nmol/l), corticosterone was undetectable (&amp;lt;0.5 nmol/l) and aldosterone was decreased (0.12 nmol/l nv: 0.8-1.2 nmol/l). At this time point, ACTH was &amp;lt;4 pg/ml, renin 1.6 mIU/l, LH 0.7 mIU/l and FSH 24.5 mIU/ml. This case demonstrated that isolated ACTH deficiency should be considered as a potential differential diagnosis in complete adrenal steroid insufficiency in newborns. Our data suggest that ACTH is not only necessary for cortisol biosynthesis but also for sufficient mineralocorticoid and androgen production by the adrenals in neonates. Presentation: 6/3/2024

Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis

Rationale & ObjectiveThe use of urea to treat hyponatremia related to the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) has not been universally adopted due to questions about effectiveness, safety, and tolerability. This systematic review and meta-analysis of observational studies aimed to address these questions. Study DesignThis PRISMA-guided study examined published research across four electronic databases. Study PopulationsPatients with SIADH-related hyponatremia. Selection CriteriaClinical trials and observational studies reporting at least one outcome related to serum sodium concentration, symptom resolution, or adverse effects after oral or nasogastric urea administration. Data ExtractionData extraction was performed independently by two reviewers using a standardized form recording study characteristics, participant demographics, intervention details, and treatment outcomes. Analytical ApproachA meta-analysis was conducted using the restricted maximum likelihood method for the random-effects model to assess the effect of urea treatment on serum sodium and serum urea compared to other treatment modalities. Subgroup analyses were conducted based on treatment duration and SIADH severity. ResultsUrea treatment significantly increased serum sodium [mean difference (MD) = 9.08 (95%CI 7.64-10.52), p < 0.01] and urea [MD = 31.66 (95%CI 16.05-47.26), p < 0.01] in patients with SIADH albeit with significantly high heterogeneity. Subgroup analysis based on the treatment duration showed a significant rise in the serum sodium level after 24 hours, two, five, seven, and fourteen days, as well as after one year of treatment. Greater increases in serum sodium levels after treatment with urea occurred in patients with severe (<120 mEq/L) [MD = 18.04 (95%CI 13.68-22.39)] than with moderate (120-129 mEq/L [MD = 7.86 (95%CI 6.78-8.94)] or mild (130-135 mEq/L) [MD = 8.00 (95%CI 7.31-8.69)] SIADH induced hyponatremia. Urea treatment was comparable to fluid restriction [MD = 0.81 (95%CI: -0.93-2.55), p = 0.36) and vaptans [MD = -1.96 (95%CI: -4.59-0.66, p = 0.14) but superior to no treatment [MD = 7.99 (95%CI 6.25-9.72), p < 0.01]. Urea was associated with minor adverse events, with poor palatability being most common. LimitationsAs no RCTs investigating urea as a treatment for hyponatremia were identified for inclusion, these analyses were based on observational studies. ConclusionsUrea is safe and effective for managing SIADH-induced hyponatremia. These finding suggest that urea may be a useful treatment modality in resource-limited settings or when other treatments are contraindicated or poorly tolerated.

A recent ongoing effect: Hyponatremia in neurologically ill patients

Different variables altering the volume of extracellular fluid might result in hyponatremia, which is defined as a serum sodium content below 136 millimoles per liter. Depending on the volume status, it can be classified as hypovolemic, euvolemic, or hypervolemic. Hyponatremia is caused by a number of risk factors and drugs, such as diuretics, NSAIDs, and antidepressants. Hyponatremia is more common in patients with neurological conditions, especially those with head trauma, subarachnoid hemorrhage, or acute meningitis. Recent advancements in analysis for disorder of antidiuretic hormone syndrome (SIADH), a prevalent cause, include vasopressin-2 receptor antagonists. The intricate regulation of sodium and water balance by humoral, neurological, and renal mechanisms is a part of normal physiology. Hyponatremia may result from medications such as tramadol, sacubitril/valsartan, antidepressants, and anticonvulsants interfering with these mechanisms. Drug-induced hyponatremia is managed by stopping the offending agent, limiting fluid intake, and occasionally administering hypertonic saline. For chronic hyponatremia, the use of vaptans, like tolvaptan, in conjunction with urea therapy is growing. A risky complication of hyponatremia is osmotic demyelination syndrome, which can occur when the condition is treated too quickly. To avoid negative consequences, close observation and the right amount of fluids must be administered during treatment. To summarize, treating hyponatremia effectively entails determining the underlying causes, treating them, and making sure that serum sodium levels are carefully corrected to avoid consequences such as osmotic demyelination syndrome.

Abstract 30: Acute Effects Of Sodium Chloride Or Its Substitute Potassium Chloride On Microvascular Function In Healthy Volunteers

Dietary high sodium intake is a modifiable risk factors for cardiovascular (CV) diseases including vascular dysfunction and subsequently arteriosclerosis. A partial sodium substitution by potassium is associated with a lower risk of CV events and death. Our aim was to investigate the acute impact of sodium and potassium on retinal microvascular function, an established biomarker for systemic CV risk stratification. Eighteen male and 27 female healthy individuals (mean age 31years) were randomized to eat a salty soup containing either 9g sodium chloride (high salt group), 6g sodium chloride (intermediate salt group) or 6g sodium chloride plus 3g potassium chloride (substitution group). Microvascular measurements were performed before (t0) as well as four (t4) and 24 hours (t24) after soup intake. Microvascular health was measured by investigating retinal vessel diameters. A higher arteriolar-to-venular diameter ratio (AVR) is associated with improved vascular health. Microvascular endothelial function was quantified by flickerlight-induced retinal arteriolar dilation. The 9g (139±2mmol/l vs. 141±2mmol/l, p&lt;0.001) and 6g salt group (140±1mmol/l vs. 141±2 mmol/l, p=0.028) had higher serum sodium concentrations at t4 compared to baseline. Serum sodium concentrations of the substitution group showed no significant difference between time points, but a significant increase in serum potassium (3.7±0.3mmol/l vs. 3.9±0.2mmol/l, p=0.019). Microvascular endothelial function was significantly decreased in the high salt group from baseline to t4 (4.5±2.2% vs. 3.7±2.2%, p=0.041), without significant changes in the other groups. In the sodium groups, there was a strong correlation between the increase in serum sodium concentration from t0 to t4 and an impaired endothelial function after t4 (R 2 =0,255, p=0,005). The substitution group showed improved microvascular health, quantified by higher AVR at t4 compared to t0 (0,83±0,07 vs. 0,86±0,07, p&lt;0,001). An increase in serum sodium was negatively associated with AVR (R 2 =0,14, p=0,013) whereas an increase in serum potassium was positively correlated with AVR (R 2 =0,19, p=0,003). An acute increase in serum sodium is associated with impaired microvascular endothelial function. Replacement of sodium by potassium seems to improve microvascular function already after a single potassium intake. These results might explain the beneficial effects of potassium on CV outcomes as well as the harmful effects of sodium on vascular function.

Predictive Factors and Scoring System for Delayed Symptomatic Hyponatremia Following Endoscopic Endonasal Surgery: A Single-Center Retrospective Study

BackgroundsDelayed symptomatic hyponatremia (DSH) is one of the common complications following endoscopic endonasal surgery (EES). Currently, published studies have predominantly focused on delayed postoperative hyponatremia, while there is relatively limited research on DSH. MethodsWe analyzed 175 consecutive cases from a single center between 2019 and 2023, involving patients who underwent endoscopic endonasal surgery (EES) for pituitary adenoma or Rathke's cleft cyst (RCC), all histopathologically confirmed. We collected preoperative, intraoperative, and postoperative data, and performed statistical analysis to determine the incidence of postoperative diabetes insipidus (DI) and identify significant predictive factors. Based on these factors, we developed a simplified scoring system. ResultsThere were 29 cases (16.6%) of DSH occurrence. In the binary logistic regression analysis, Knosp grade ≥3 (OR, 4.19; 95% CI, 1.26-13.92; P=0.019), intraoperative cerebrospinal fluid leaks (OR, 3.93; 95% CI, 1.49-10.34; P=0.006), serum sodium on the second day after surgery (OR, 0.88; 95% CI, 0.78-1.00; P=0.049), and postoperative diabetes insipidus (OR, 2.88; 95% CI, 1.10-7.53; P=0.031) were factors with independent predictive value for DSH. The scoring system achieved a maximum area under the ROC curve (AUC) of 0.789 (95% CI, 0.697-0.881), with a cutoff value of 1, sensitivity of 86.2%, and specificity of 59.6%. ConclusionThe incidence rate of DSH after EES in patients was 16.8%. Knosp grade ≥3, intraoperative cerebrospinal fluid leaks, serum sodium concentration on the second day after surgery, and postoperative diabetes insipidus were associated with the occurrence of DSH.

Comparative Outcomes of Monopolar and Bipolar Transurethral Resection of the Prostate: An Institutional Perspective.

Objective This prospective comparative study aimed to highlight and compare two types of transurethral resection of the prostate (TURP), namely M-TURP (monopolar) and B-TURP (bipolar), in the endoscopic management of benign prostatic hyperplasia (BPH). Methods and materials This research was conducted between 2022 and 2023 at a tertiary care health center. Included in the investigation were 100 consenting study participants undergoing M-TURP and B-TURP at our center. All referred patients presenting with clinical, ultrasound, or uroflowmetry features of BPH and those with failed attempts at medical management were included in the study. Patients with carcinoma of the prostate were excluded from the study. Post-operatively, the endpoints for comparison included maximal urinary flow rate (Qmax), prostate volume, duration of hospital stay, duration of catheterization, drop in serum sodium concentration, and drop in hemoglobin levels. Descriptive statistics were computed to delineate the study sample. After the completion of data collection, data analysis was performed using SPSS for Windows, Version 16.0 (Released 2007; SPSS Inc., Chicago, IL, USA), and the correlations sought were achieved using the Chi-square test of significance. Results The peak incidence of BPH was seen in the sixth decade of life: the M-TURP group was 65.16 ± 7.07 years (mean ± standard deviation), while that in the B-TURP group was 62.32 ± 8.16 years (mean ± standard deviation). Nine percent of the study participants did not show any comorbidities. The most frequent symptom of BPH at presentation was a poor urinary stream (78%, n = 100), followed by nocturia (67%, n = 100). In our study, patients undergoing M-TURP had a mean serum prostate-specific antigen (PSA) level of 4.31 ± 1.03 ng/mL, while patients undergoing B-TURP had a mean serum PSA of 4.24 ± 0.99 ng/mL (p = 0.820; p > 0.05). The study found that patients undergoing M-TURP had a mean prostate size of 35.04 ± 3.57 cc, while those undergoing B-TURP had a mean prostate size of 35.72 ± 3.22 cc (p = 0.765). For the B-TURP group, the mean decrease in postoperative serum sodium concentration was 4.3 mEq/L, while for the M-TURP group, it was 6.4 mEq/L (p = 0.903). In the M-TURP group, there were three cases of transurethral resection (TUR) syndrome, while the B-TURP group had only one case. Conclusion BPH is a common problem affecting the quality of life of several male patients. Both M-TURP and B-TURP are comparable in their efficacy in treating BPH, with the exception of a higher incidence of hyponatremia and TUR syndrome in the M-TURP group.

Unveiling the Patterns of Water Diuresis in Profound Hyponatremia Management in Intensive Care Unit Settings.

Hyponatremia treatment guidelines recommend avoiding excessive increases in serum sodium concentration (s[Na]) to prevent osmotic demyelination syndrome. Although an unexpected rise in s[Na] has been attributed to water diuresis during the treatment of hyponatremia, clinical courses of water diuresis are unclear. We conducted this study to investigate the clinical characteristics of water diuresis during profound hyponatremia management. In this retrospective observational study, we examined patients with profound hyponatremia (s[Na] ≤120 mEq/L) admitted to the intensive care unit of a Japanese hospital. The manifestation of water diuresis was defined as a urine volume ≥2 ml/kg/h and a urinary sodium plus potassium concentration (u[Na+K]) ≤50 mEq/L. We analyzed changes in urine volume and u[Na+K] over time for patients experiencing water diuresis. This analysis employed a mixed-effects model with spline terms for time, and the results are graphically presented. Among 47 eligible patients, 30 (64%) met the criteria for water diuresis. The etiologies of hyponatremia were drug-related hyponatremia (n=10; 33%), primary polydipsia (n=8; 27%), hypovolemic hyponatremia (n=7; 23%), syndrome of inappropriate secretion of antidiuresis (n=7; 23%), and acute heart failure (n=1; 3%). Among patients with water diuresis, 27 (90%) experienced the manifestation of water diuresis within 24 hours after the start of correction. The increased urine volume and decreased u[Na+K] levels began several hours before the peak manifestation of water diuresis. Within 6 hours after the manifestation of water diuresis, 29 patients (97%) received electrolyte-free infusions and 14 (47%) received desmopressin. One patient (3%) with water diuresis experienced overcorrection. Water diuresis is common during the treatment for profound hyponatremia and typically occurs within the first 24 hours, preceded by changes in urinary characteristics. Early detection and prompt response to water diuresis through urine monitoring during the early periods of hyponatremia treatment may be effective for managing water diuresis.

Association of baseline serum sodium with long-term outcomes in newly diagnosed coronary heart disease patients without heart failure: a prospective cohort study

Sodium is crucial for maintaining cardiovascular health, especially in relation to heart failure. The impact of baseline serum sodium concentrations on the outcomes of newly diagnosed coronary heart disease (CHD) without heart failure remains unclear. This prospective cohort study included 681 patients who were newly diagnosed with CHD. Cox proportional hazards models and restricted cubic spline (RCS) analysis were used to assess the relationship between serum sodium concentrations and major adverse cardiovascular events. The improvement in traditional prediction models by the addition of serum sodium concentrations was assessed using changes in the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). During a median follow-up of 51.04 months (IQR: 40.88–53.80 months), 131 events were recorded. Multivariate Cox proportional hazards models showed that the L2 group (136–138.9 mmol/L) had the highest MACE risk. Compared to L2, the hazard ratios (HRs) and 95% confidence intervals (CIs) for the L1 (130–135.9 mmol/L), L3 (139–140.9 mmol/L), L4 (141–142.9 mmol/L), and L5 (143–147.0 mmol/L) groups were 0.31 (0.14–0.70, P = 0.005), 0.48 (030–0.78, P = 0.003), 0.56 (0.34–0.92, P = 0.022), and 0.37 (0.22–0.64, P < 0.001), respectively. Including serum sodium concentrations in the prediction model significantly improved the C-statistic from 0.647 to 0.679 (P = 0.022), with an NRI of 0.338 (P < 0.001) and an IDI of 0.026 (P < 0.001). RCS analysis showed a nonlinear relationship: within the 130–138 mmol/L sodium range, MACE risk gradually increased with higher sodium levels (HR 1.39, 95% CI 1.09–1.76, P = 0.008); whereas within the 138–147 mmol/L range, the risk gradually decreased (HR 0.88, 95% CI 0.80–0.98, P = 0.014). Baseline serum sodium concentrations are significantly associated with long-term cardiovascular risk in newly diagnosed CHD patients, showing an inverted U-shaped relationship, whereas low serum sodium may be specifically linked to higher risks of death and nonfatal myocardial infarction. Further research is needed to explore the impact of long-term changes in serum sodium concentrations on disease prognosis.

Predictors of prolonged supratherapeutic serum lithium concentrations: a retrospective chart review

Introduction The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup suggests hemodialysis in severe lithium poisoning if specific criteria are met. One criterion is if the expected time to obtain a lithium concentration <1.0 mEq/L with optimal management is >36 h. There are a lack of data regarding which patient characteristics are associated with the rate at which patients achieve a lithium concentration <1.0 mEq/L. Methods We conducted a retrospective chart review analyzing hospital electronic medical records. Inclusion criteria consisted of a lithium concentration >1.2 mEq/L during hospitalization. We excluded patients who received extracorporeal treatment before 36 h elapsed from time of initial lithium concentration >1.2 mEq/L. The primary analysis consisted of a Cox regression and a secondary analysis evaluated the nomogram method described by Buckley and colleagues for predicting prolonged supratherapeutic lithium concentration. Results One hundred and one patients were included in the study. The median time to reach a lithium concentration <1.0 mEq/L was 42.5 h (IQR: 33.8–51.1). Older patients, patients taking a thiazide, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, patients with a higher initial lithium concentration, and patients with higher sodium concentrations achieved a lithium concentration <1 mEq/L at a slower rate. For the nomogram analysis, sensitivity (61.5%) and specificity (54.5%) were moderate, the positive predictive value (16.7%) was poor, and the negative predictive value (90.6%) was excellent. Discussion The results from our primary analysis suggest that identifying higher serum sodium concentration and use of certain antihypertensives that decrease glomerular filtration rate as predictors of an increased time to reach a therapeutic lithium concentration may help identify patients who meet the Extracorporeal Treatments in Poisoning criteria for hemodialysis. The nomogram method performed similarly to prior validation studies. Conclusions In this retrospective chart review of patients with supratherapeutic lithium concentrations, we identified several risk factors for prolonged supratherapeutic lithium concentrations.

Mortality risk factors for crush syndrome after an earthquake in Türkiye: Do systemic inflammatory parameters play any role?

The aim of our study is to assess the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) on 28-day mortality in patients admitted to the intensive care unit with crush syndrome following the Kahramanmaraş earthquake in Türkiye. A total of 63 adult patients with crush syndrome admitted to the intensive care unit after the earthquake were enrolled in this study. The medical records of the patients were examined using follow-up forms and the hospital data system. The mean age of the patients was 38.9±17.3 years, and the median time under debris was 31.5 hours. The 28-day mortality rate was 27%. In univariate generalized estimating equations (GEE) and other analyses, variables that are significant (or candidate variables) between 28-day mortality groups included age as a biological factor. These variables were included in the multivariate GEE model. The effects of continuous renal replacement therapy (CRRT), serum sodium concentration, Sequential Organ Failure Assessment (SOFA) score, and PLR on mortality were statistically significant. Elevated SOFA scores, the necessity for CRRT, increased serum sodium levels, and decreased PLR values are associated with increased 28-day mortality in patients with crush syndrome after an earthquake.

Evaluation of Hyponatremia in Infants on Vasopressin Therapy.

Vasopressin has systemic vasoconstrictive yet pulmonary vasodilatory effects, making it an ideal agent for hypotension management in infants with congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension. The side effects of vasopressin in this population, such as hyponatremia, are understudied. This study aims to characterize the effect of vasopressin on sodium concentrations in infants with and without CDH. This was a retrospective review of patients who received vasopressin while admitted to a level IV neonatal intensive care unit. The primary outcome was the incidence of hyponatremia (blood sodium <135 mmol/L) during vasopressin therapy. Secondary outcomes included time to hyponatremia, dose and duration of vasopressin, incidence of severe hyponatremia (blood sodium <125 mmol/L), and hypertonic saline use. Both blood serum and blood gas sample sodium concentrations were used to compare CDH vs non-CDH patients. The average difference between baseline and lowest blood sodium was significant for both CDH and non-CDH patients for all samples (p < 0.001). There was no significant difference in the primary outcome, nor in the secondary outcomes of time to hyponatremia or duration of vasopressin infusion. The average dose of vasopressin was higher in the CDH vs non-CDH group (p = 0.018). The incidences of severe hyponatremia and hypertonic saline use were greater in the CDH vs non-CDH group for patients who had blood serum sodium samples collected (p = 0.049 and p = 0.033, respectively). This study showed that severe hyponatremia occurred more frequently in CDH vs non-CDH patients. Extreme caution is necessary when managing total body sodium in patients with CDH.

The Relationship between Serum Sodium Concentration and Albuminuria: A Retrospective Cohort Study.

Lowering dietary salt intake reduces albuminuria, an early marker of renal damage and a sensitive predictor of adverse cardiovascular outcomes. The mechanisms underlying this effect are uncertain but small changes in serum sodium concentration may be important: this retrospective cohort study investigated the hypothesis that higher serum sodium concentration is a risk factor for albuminuria (defined as a urine albumin:creatinine ratio [UACR], ≥3 mg/mmol). Primary care data from the Royal College of General Practitioners Research and Surveillance Centre were used to identify 47,294 individuals with a UACR result available between April 2010 and March 2015, and no known albuminuria prior to this. Exclusion criteria were missing or abnormal serum sodium concentration at baseline (&lt;135 or &gt;146 mmol/L); age &lt;18 years; diabetes mellitus; decompensated liver disease; heart failure; and stage 5 chronic kidney disease. After adjustment for known risk factors, there was a significant "U-shaped" relationship between serum sodium concentration and albuminuria. The lowest risk was associated with a serum sodium of 138-140 mmol/L. In comparison, the risk of albuminuria was 18% higher with a serum sodium of 135-137 mmol/L and 19% higher with a serum sodium of 144-146 mmol/L. There was no association between serum sodium concentration and blood pressure. The finding of a positive association between higher serum sodium concentration and albuminuria is in support of the hypothesis, but the inverse relationship between serum sodium concentration and albuminuria at lower concentrations warrants further explanation.

Mortality risk factors in children with influenza-associated encephalopathy admitted to the paediatric intensive care unit between 2009 and 2021.

The purpose of this study was to determine the risk factors for death in children with influenza-associated encephalopathy (IAE) in the paediatric intensive care unit (PICU). Forty-six paediatric patients with IAE admitted to the PICU at shenzhen Children's Hospital between December 2009 and December 2021 were evaluated. Their clinical characteristics were retrospectively analysed. A total of 46 patients were diagnosed with influenza A virus infection and encephalopathy. The cases were concentrated in children <5 years of age (27/46, 58.7%). Twenty-nine patients (63.0%) survived and 17 patients (37.0%) died, of which 70.6% (12/17) of the patients died within 1 week of hospitalisation. Thirty-two patients (69.6%) developed neurological symptoms within 1-2 days of fever onset. Common symptoms included fever (45/46, 97.8%), loss of consciousness (39/46, 84.8%), seizures (31/46, 67.4%), cough (19/46, 41.3%), and vomiting (16/46, 34.8%). Multivariate logistic regression analysis indicated that vomiting (odds ratio [OR], 11.005), loss of consciousness (AVPU score: P; OR, 15.871), lymphopenia (OR, 8.964), alanine aminotransferase (>80 IU/L; OR, 32.060) and serum sodium concentration (>145 mmol/L or <135 mmol/L; OR, 16.264) were related to mortality. The mortality in this study population was 37.0%. Children with IAE who have corresponding clinical manifestations and abnormal examination results in PICU should be warned of the high mortality rate.

Examining the Influence of Respiratory Disorders on Some Hematobiochemical Parameters in Al-Jabal Al-Akhdar Libyan Sheep

The aim of this study was evaluate some the Changes in blood indicators and selected biochemical variables in the serum of infected sheep Respiratory diseases are indistinguishable in terms of cause. This study was carried out on 60 native sheep in Elgabal Alakhdar province in Libya; Divided into tow group (group1)- 20 clinically healthy sheep,second groups including 40 animals( Experimental group ) the animals showed symptoms of respiratory disease, including a higher than normal temperature, an increase in pulse and respiratory rate , and the presence of nasal discharge. The animals were aged more the six month and weighed from 35-60 kg.Two blood samples were collected: whole blood samples for hematological picture, while serum samples for biochemical analysis which included, glucose Total protein (TP), albumin (Alb), Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Serum concentrations of sodium (Na), potassium (K) and chloride. Significant changes between diseased animals and healthy animals were observed in values of hemogram and biochemical parameters including, WBCs ,RBCs ,HG and show significant change in biochemical parameter glucose,AST ,ALT ,Total protein (TP), albumin (Alb), and Serum concentrations of sodium (Na), potassium (K) and chloride.