Electrolyte Alterations Research Articles

Neurological manifestations of hypermagnesemia: a narrative review.

Hypermagnesemia is a rare but potentially fatal electrolyte disorder. High serum magnesium levels have been associated with the development of neurological manifestations such as dysautonomia, muscle weakness, respiratory failure, and altered level of consciousness from drowsiness to coma. Although rare, some subjects, such as those with chronic renal failure and those taking magnesium supplements or medications, are at risk of developing this condition. Recognizing this electrolyte alteration promptly allows for an immediate initiation of a therapeutic strategy that is often resolutive when addressed in time. This paper aims to review the neurological complications associated with hypermagnesemia, their pathophysiology, and management.

Evaluation of Serum Electrolytes among Geriatric and Non-Geriatric Men in Osisoma, ABA, Nigeria

Background: Ageing is a progressive development associated with a decline in the physiological functions, which increases susceptibility to organ dysfunction (especially the kidney) in geriatrics. This facilitates the risk of electrolyte imbalance, as the kidneys play a crucial role in maintaining these electrolyte concentration. Aim: This was a cross-sectional study designed to evaluate serum sodium ( ), potassium ( ), chloride ( ), and bicarbonate ( ) levels, and understand their prevalence among apparently healthy geriatric and non-geriatric men residing in Osisoma, Aba. Methodology: A total of 100 apparently healthy participants were enrolled for this study, comprising of 50 geriatric men aged 65 years and above, and 50 non-geriatric men aged 20-30 years. From both groups, serum samples were used for the analyses of sodium ( ), potassium ( ), chloride ( ), and bicarbonate ( ) using Spectrophotometer. The data obtained was analyzed statistically using Statistical Package for Social Science (SPSS version 25), student’s t-test, one way analysis of variance (ANOVA), pearson correlation coefficient and P values less than 0.05 were considered statistically significant. Results: The mean values of sodium (136.6+3.9mmol/L), potassium (3.9+0.5mmol/L), chloride (100.2+3.9mmol/L) and bicarbonate (24.4+4.3 mmol/L) levels in geriatric subjects showed no statistical significant difference (P > 0.05) when compared to the mean values of sodium (136.9+2.3 mmol/L), potassium (3.9+0.4 mmol/L), chloride (100.8+2.8 mmol/L) and bicarbonate (24.9+3.9 mmol/L) in non-geriatric subjects. The study also revealed a significant difference (P = 0.001) in the mean value of bicarbonate (24.8+4.3 mmol/L; 25.8+1.9mmol/L, and 18.1 +3.3 mmol/L) among geriatric subjects, when compared based on age range using ANOVA. There was a significant negative correlation between the ages and bicarbonate levels (r = -0.4, P = 0.008), a non-significant positive correlation between ages and sodium levels (r = 0.1, P = 0.498), and chloride levels (r = 0.2, P = 0.125), and a non-significant negative correlation between the ages and potassium levels (r = -0.1, P = 0.691) in geriatric subjects. Conclusion: The result from this study showed no significant alteration of serum electrolytes between geriatric and non-geriatric subjects, and a significant alteration of bicarbonate levels among the geriatric subjects. This present study has shown that ageing without any comorbidities has lesser effect on serum electrolytes.

Electrolyte Alteration in Bartter Syndrome: Case Report

Bartter syndrome is a clinical condition that presents with hyperaldosteronism, however, blood pressure is normal, this is associated with hypovolemia and high levels of PGE2. The clinical case of a pediatric patient who initially presents with significant electrolyte alterations with recurrently associated symptoms is presented. After several laboratory, imaging and genetic studies, she was diagnosed with Bartter Syndrome, for which she has been managed by several specialists. such as pediatric nephrology, genetics, and urology. The patient is currently under control and carries out her daily activities normally, under strict monitoring. It is the first clinical case of this characteristic reported in Ecuador, and contributes to those already registered worldwide, with the experience to contribute to a consensual management of this rare pathology.

Prevalence of Hyperkalemia and Familial Hyperkalemic Hypertension in 5100 Patients Referred to a Tertiary Hypertension Unit.

Hyperkalemia is a frequent electrolyte alteration whose prevalence varies widely, depending on the adopted cutoff, the setting (inpatients versus outpatients), and the characteristics of the study population. Familial hyperkalemic hypertension (FHH) is a rare cause of hypertension, hyperkalemia, and hyperchloremic metabolic acidosis. In this retrospective observational study, we investigated the prevalence of hyperkalemia (serum K+ >5.2 mmol/L on 2 repeated measurements) in 5100 referred patients affected by arterial hypertension, the potential causes, and the associated cardiovascular risk profile. Overall, 374 (7.3%) patients had hyperkalemia. This was associated with drugs known to increase K+ levels (74.6%), chronic kidney disease (33.7%), or both (24.3%). Among the 60 patients with unexplained hyperkalemia, 3 displayed a clinical and biochemical phenotype suggestive of FHH that was genetically confirmed in 2 of them (0.04% in the entire cohort). FHH prevalence rose to 3.3% in patients with unexplained hyperkalemia and up to 29% (2/7) if they had serum K+>5.8 mmol/L. The genetic cause of FHH was a missense variant affecting the acidic motif of WNK1 in 1 family and a rare CUL3 splicing variant, whose functional significance was confirmed by a minigene assay, in another. Finally, we observed a significant association between hyperkalemia and the occurrence of cardiovascular events, metabolic syndrome, and organ damage, independent of potential confounding factors. The identification of hyperkalemia in patients with hypertension has prognostic implications. A timely diagnosis of FHH is important for effective management of hypertension, electrolyte imbalance correction with tailored treatment, and genetic counseling.

Syndrome of inappropriate antidiuresis/hyponatremia in COVID-19.

Hyponatremia is the most frequent electrolyte alteration among hospitalized patients and it has been reported in 20-40% of patients with SARS-CoV-2 (COVID-19) infection. Multiple causes of hyponatremia have been hypothesized in these patients. The syndrome of inappropriate antidiuresis (SIAD) has been considered one of the main reasons leading to hyponatremia in this condition. SIAD can be secondary to cytokines release, in particular IL-6. Positive pressure ventilation can be another cause of hyponatremia due to SIAD. Other possible etiologies of hyponatremia in COVID-19 patients can be related to secondary hypocortisolism, nausea, vomiting, heart and kidney damage. Similar to many other clinical conditions, there is strong evidence that hyponatremia is associated with a worse prognosis also in patients with COVID-19 infection. In particular, hyponatremia has been identified as an independent risk of ICU transfer, need of non-invasive ventilation and death. Hyponatremia in COVID-19 patients is in principle acute and symptomatic and should be treated as such, according to the published guidelines. Therefore, patients should be initially treated with i.v. hypertonic saline (3% NaCl) infusion and serum [Na+] should be frequently monitored, in order to remain within a safe rate of correction. There is evidence showing that serum [Na+] correction is associated with a better outcome in different pathologies, including COVID-19 infection.

Infections and gender: clues for diagnosis of adrenal insufficiency—a case report and a review of the literature

The clinical presentation of adrenal insufficiency, a condition causing adrenal hormone deficiency, is characterised by non-specific symptoms and signs: consequently, an important diagnostic delay is often evident which correlates with an increased mortality. This case report shows how the clustering of some symptoms and signs may hamper the diagnostic suspicion for this condition: serum electrolyte alterations and weight loss, when associated to recurrent infections and, in female patients, an empty sella may further guide the clinician towards a diagnosis of adrenal insufficiency. Accordingly, a clinical approach taking into account gender medicine could improve the diagnostic workup.

#1786 Correlation of electrolyte disturbances in community-acquired acute kidney injury

Abstract Background and Aims Acute renal injury can cause electrolyte disorders that increase patient morbidity and mortality. There are few data in the literature describing these alterations and the possible correlation between them in patients with community-acquired AKI (CA-AKI). The purpose of this study is to analyze the correlation between electrolyte disorders in a cohort of patients with CA-AKI admitted to the nephrology service of a tertiary level hospital. Method This is a single-center, observational, longitudinal, and retrospective study based on a cohort of patients with CA-AKI admitted to the Nephology Service of a third level hospital from January 2010 to December 2018. We analyzed the incidence of changes in sodium, potassium, chloride, bicarbonate, calcium, and phosphorus in these patients and their correlations. Results A total of 639 patients were included in the final analyses. The mean age was 72.93 ± 13.38 years. 61.7% were men. Charlson comorbidity index was 5.87 ± 2.4 points. The length of stay was 11.63 ± 10.14 days. In view of the Etiology of AKI, 72.1% had prerenal AKI and 27.9% non-prerenal. 436 patients had a history of previous chronic kidney disease (CKD) (68.23%). AKI KDIGO stages were: stage I, 105 cases (16.4%); stage II, 67 cases (10.5%); stage III 467 cases (63.1%). Hemodialysis (HD) was required in 114 patients (17.8%). 62 patients (9.7%) died during hospital stay. The most frequent ionic alterations at a global level were low bicarbonate (78.3%), hyperkalemia (53.05%), hypocalcemia (49.6%) and hyponatremia (41.5%). When analyzing whether electrolyte alterations occurred simultaneously: 2.2% of cases did not present any, 6.3% only one, 18.2% two, 26.4% three, 26.1% four, 14.9% five and 5.9% six simultaneous alterations. There were no statistically significant differences between groups on mortality during admission. Higher mortality at discharge has been found in patients with a greater number of ionic alterations (p = 0.046). In our sample, positive correlations were found between sodium-bicarbonate (r = 0.184; p < 0.001), peak creatinine-potassium (r = 0.182; p < 0.001), potassium-chloride (r = 0.167 p < 0.001), sodium-chloride (r = 0.614; p < 0.001), phosphorus-peak creatinine (r = 0.394; p < 0.001), pH-bicarbonate (r = 0.747, p < 0.001) and phosphorus–PTH (r = 0.330; p < 0.001). Negative correlations were found between sodium–potassium (r = −0,123; p = 0.002), bicarbonate-potassium (r = −0.354; p < 0.001), potassium-pH (r = −0.390; p < 0.001), peak creatinine–chlorine (r = −0.013; p = 0.004), bicarbonate–chlorine (r = −0.236; p < 0.001), calcium–phosphorus (r = −0.174; p < 0.001), calcium–peak creatinine (r = −0.138; p = 0.001) and bicarbonate–peak creatinine (r = −0.274; p < 0.001). Conclusion In our series of patients with CA-AKI, many statistically significant correlations were found between altered electrolytes in acute renal failure. Most of these associations can be explained by the pathophysiology of acute kidney injury. However, it should be noted that not all cases have such a clear explanation. It is important to consider that all patients in our study had already developed acute renal failure upon admission. Therefore, these results should be interpreted with caution and confirmed through further evaluations. We suggest that additional research in this area is necessary to improve the management and prognosis of this condition.

A PARTICULAR CASE OF CARDIAC ARREST

Abstract 88–year–old man with arterial hypertension, cognitive impairment, carrier of dual–chamber PM due to sinus node disease. Diagnosis of congenital long QT syndrome (LQT1) approximately 20 years ago during family screening (syncopal episodes in his son positive for LQT1), no history of syncope or major arrhythmias. In home therapy with mirtazapine and norvasc. He arrived in our cardiac intensive care unit for ACC on torsade de pointes trated with two cycles of CPR and 1 DC shock at 200 Joules with ROSC. On arrival ECG evidence of electrically induced ventricular rhythm, QTc 850 msec. On echocardiogram akinesia of the mid–basal segments of all the LV walls (takotsubo–like) with EF 25–30%. On coronary angiography non critical multivessel coronary disease. At laboratory tests increase of WBC, PCR and PCT, slight plateau movement of troponin, normal electrolytes. The patient underwent a chest CT scan with evidence of an inflammatory focus for which antibiotic therapy was started. Congenital long QT syndrome (LQTS) is an inherited condition characterized by prolongation of the QT interval (more than 450 ms in men and 460 ms in women), associated with repolarization abnormalities. There are three main forms transmitted via AD: LQT1, LQT2 and LQT3. The most common variant is LQT1 caused by a loss of function mutation in the KCNQ1 gene which causes a reduction in the outgoing potassium current during phase 3 of the action potential. In these patients, episodes of syncope caused by torsade de pointes, major arrhythmias and sudden cardiac death are frequent. Patients with LQTS should avoid taking drugs that can prolong the QT interval such as some antipsychotics, antidepressants (like mirtazapina that can cause QT prolongation, torsade de pointes, ventricular tachycardia and sudden cardiac death if administered at high doses or in patients with predisposing factors), antibiotics. Furthermore, there are various factors that can influence the QT prolongation: electrolyte alterations, physical stress, cerebrovascular events. The use of mirtazapine for a long period in association with takotsubo syndrome (probably triggered by underlying pneumonia) in a patient with LQTS, may have resulted in massive lengthening of the QT interval causing torsade de pointes and therefore ACC. During the hospitalization, mirtazapine was suspended and nadolol was introduced with a progressive reduction of the QT segment. No new arrhythmic events were recorded.

Effects of Reduced Extracellular Sodium Concentrations on Cisplatin Treatment in Human Tumor Cells: The Role of Autophagy.

Hyponatremia is the prevalent electrolyte imbalance in cancer patients, and it is associated with a worse outcome. Notably, emerging clinical evidence suggests that hyponatremia adversely influences the response to anticancer treatments. Therefore, this study aims to investigate how reduced extracellular [Na+] affects the responsiveness of different cancer cell lines (from human colon adenocarcinoma, neuroblastoma, and small cell lung cancer) to cisplatin and the underlying potential mechanisms. Cisplatin dose-response curves revealed higher IC50 in low [Na+] than normal [Na+]. Accordingly, cisplatin treatment was less effective in counteracting the proliferation and migration of tumor cells when cultured in low [Na+], as demonstrated by colony formation and invasion assays. In addition, the expression analysis of proteins involved in autophagosome-lysosome formation and the visualization of lysosomal areas by electron microscopy revealed that one of the main mechanisms involved in chemoresistance to cisplatin is the promotion of autophagy. In conclusion, our data first demonstrate that the antitumoral effect of cisplatin is markedly reduced in low [Na+] and that autophagy is an important mechanism of drug escape. This study indicates the role of hyponatremia in cisplatin chemoresistance and reinforces the recommendation to correct this electrolyte alteration in cancer patients.

Effects Of Magnesium Oxide Treatment On Serum Electrolyte Levels In Constipated Children

Background: Magnesium oxide (MgO) is a standard treatment for functional constipation. However, this medication has not been evaluated extensively for possible alterations of plasma magnesium (Mg) levels and other electrolytes. This retrospective study aimed to appraise the effects of serum magnesium with some other electrolyte levels after oral MgO treatment in children with functional constipation.
 Methodology: After the approval of the local ethical committee, archives of the patients who had been admitted to two different Pediatric Surgery outpatient clinics in different cities between 2014-2018 were evaluated. The demographic findings of the patients were recorded. For the diagnosis of chronic constipation, Rome-III classification criteria were used. After complete physical examinations, if there were no possible organic reasons other than chronic dietary problems, serum electrolyte levels were obtained and evaluated. Findings were evaluated statistically and discussed with the literature.
 Result: The magnesium value was significantly higher in the constipation group (p

Evaluating Nutritional Risk Factors for Delirium in Intensive-Care-Unit Patients: Present Insights and Prospects for Future Research.

Malnutrition, hypercatabolism, and metabolic changes are well-established risk factors for delirium in critically ill patients. Although the exact mechanisms are not fully understood, there is mounting evidence suggesting that malnutrition can cause a variety of changes that contribute to delirium, such as electrolyte imbalances, immune dysfunction, and alterations in drug metabolism. Therefore, a comprehensive metabolic and malnutrition assessment, along with appropriate nutritional support, may help to prevent or ameliorate malnutrition, reduce hypercatabolism, and improve overall physiological function, ultimately lowering the risk of delirium. For this aim, bioelectrical impedance analysis can represent a valuable strategy. Further research into the underlying mechanisms and nutritional risk factors for delirium is crucial to developing more effective prevention strategies. Understanding these processes will allow clinicians to personalize treatment plans for individual patients, leading to improved outcomes and quality of life in the intensive-care-unit survivors.

Fluid and Electrolyte Alteration for Post-Surgical (ICU)Patients’

Fluid and Electrolyte Alteration for Post-Surgical (ICU)Patients’

Impact of Preparticipation Hypohydration on Cognitive Performance and Concussion-like Symptoms in Recreational Athletes.

Sports-related concussion is a relevant risk of contact sports, with several million cases per year worldwide. Prompt identification is crucial to prevent complications and late effects but may be impeded by an overlap with dehydration-associated impairment of cognitive function. Researchers have extensively studied the effects of pronounced dehydration in endurance sports, especially in the heat. However, little is known about the effects of isolated and mild dehydration. Healthy recreational athletes underwent a standardized fluid deprivation test. Hypohydration was assessed by bioelectrical impedance analysis (BIA) and laboratory testing of electrolytes and retention parameters. Participants underwent cardiopulmonary exercise testing (CPET) with a cycle ramp protocol. Each participant served as their own control undergoing CPET in a hypohydrated [HYH] and a euhydrated [EUH] state. Effects were assessed using a shortened version of Sport Concussion Assessment Tool 3 (SCAT3). Fluid deprivation caused a mild (2%) reduction in body water, resulting in a calculated body mass loss of 0.8% without alterations of electrolytes, serum-osmolality, or hematocrit. Athletes reported significantly more (1.8 ± 2.2 vs. 0.4 ± 0.7; p < 0.01) and more severe (4.4 ± 6.2 vs. 1.0 ± 1.9; p < 0.01) concussion-like symptoms in a hypohydrated state. Balance was worse in HYH by trend with a significant difference for tandem stance (1.1 ± 1.3 vs. 0.6 ± 1.1; p = 0.02). No relevant differences were presented for items of memory and concentration. Mild dehydration caused relevant alterations of concussion-like symptoms and balance in healthy recreational athletes in the absence of endurance exercise or heat. Further research is needed to clarify the real-life relevance of these findings and to strengthen the differential diagnosis of concussion.

Refeeding Hypophosphatemia in Oldest Old Critically Ill Patients.

Refeeding syndrome is characterized by metabolic and electrolyte alterations that result from the initiation of feeding after a period of inadequate caloric intake. Especially, in the elderly with acute and/or chronic illness, nutritional deficiencies are common, and diminished oral intake with effects of catabolic status yields malnutrition. This study was conducted to evaluate refeeding hypophosphatemia and its consequences on outcomes in the oldest old critically ill patients. This study was designed as a retrospective cohort study that included patients who were 80 years old or older admitted to ICU. Patients were grouped depending on whether hypophosphatemia occurred after 48 hours of admission who started feeding. The median age of all patients was 87[82-90] years and 61(73%) of them were female. Refeeding hypophosphatemia was observed in 25(30%) patients. When patients were grouped depending on the occurrence of hypophosphatemia, groups were similar according to the severity scores, and comorbidities. Neither ICU mortality nor hospital mortality was different between groups (p=0.76 and p=0.19, respectively). Refeeding hypophosphatemia incidence was similar to previous studies, although study patients were the highest risk group. Outcome parameters including mortality rate and length of ICU stay were not different between patients with or without refeeding hypophosphatemia.

Diagnosing and managing heat exhaustion: insights from a systematic review of cases in the desert climate of Mecca.

Heat exhaustion (HE) is a common, yet obscure, heat-related illness that affects millions of people yearly and its burden is projected to rise due to climate change. A comprehensive literature synthesis is lacking despite previous studies on various HE aspects. This systematic review aims to fill this gap by identifying and synthesizing available evidence on the risk factors, symptoms, biomarkers, treatment options, and outcomes for HE. The review focused on HE during the Muslim (Hajj) pilgrimage where the condition is endemic. We conducted a structured search of MEDLINE/PubMed, Embase, Web of Science Core Collection, SCOPUS, and CINAHL databases. We summarized the data from eligible studies and synthesized them in narrative form using pooled descriptive statistics. Ten studies were included between 1980 and 2019, reporting over 1,194 HE cases. HE cases presented with elevated core temperature (up to 40°C) and mainly affected older males from the Middle East and North Africa region, with overweight individuals at a higher risk. Clinical symptoms included hyperventilation, fatigue, dizziness, headaches, nausea, and vomiting, but not central nervous system disturbances. HE was associated with cardiac stress, and with water, electrolyte, and acid-base alterations. Cooling and hydration therapy were the primary management strategies, leading to a low mortality rate (pooled case fatality rate=0.11 % [95 % CI: 0.01, 0.3]). Most cases recovered within a few hours without complications. HE is associated with cardiac stress and changes in homeostasis, leading to distinct clinical symptoms. Early diagnosis and treatment of HE are crucial in reducing the risk of complications and mortality. The review provides insights into the pathophysiology and outcomes of HE, adding to the scarce literature on the subject. Prospero registration number: CRD42022325759.

Impact of Preparticipating Hypohydration on Cardiopulmonary Exercise Capacity in Ambitious Recreational Athletes.

Heat induces a thermoregulatory strain that impairs cardiopulmonary exercise capacity. The aim of the current study is to elucidate the effect of isolated dehydration on cardiopulmonary exercise capacity in a model of preparticipating hypohydration. Healthy recreational athletes underwent a standardised fluid deprivation test. Hypohydration was assessed by bioelectrical impedance analysis (BIA) and laboratory testing of electrolytes and retention parameters in the blood and urine. The participants underwent cardiopulmonary exercise testing (CPET) with a cycle ramp protocol. Each participant served as their own control undergoing CPET in a hypohydrated [HYH] and euhydrated [EUH] state. Fluid deprivation caused a mild (2%) but significant reduction of body water (38.6 [36.6; 40.7] vs. 39.4 [37.4; 41.5] %; p < 0.01) and an increase of urine osmolality (767 [694; 839] vs. 537 [445; 629] mosm/kg; p < 0.01). Hypohydration was without alterations of electrolytes, serum osmolality or hematocrit. The oxygen uptake was significantly lower after hypohydration (-4.8%; p = 0.02 at ventilatory threshold1; -2.0%; p < 0.01 at maximum power), with a corresponding decrease of minute ventilation (-4% at ventilatory threshold1; p = 0.01, -3.3% at maximum power; p < 0.01). The power output was lower in hypohydration (-6.8%; p < 0.01 at ventilatory threshold1; -2.2%; p = 0.01 at maximum power). Isolated hypohydration causes impairment of workload as well as peak oxygen uptake in recreational athletes. Our findings might indicate an important role of hypohydration in the heat-induced reduction of exercise capacity.

Blood analysis for screening of electrolyte and kidney function alterations in patients with febrile urinary tract infection.

To describe the prevalence, severity, risk factors, and clinical relevance of electrolyte disturbances and acute kidney injury (AKI) during febrile urinary tract infection (fUTI). Retrospective observational study of well/fair-appearing patients between 2 months and 16 years, with no previous relevant medical history, diagnosed with fUTI in the paediatric emergency department (PED) with subsequent microbiological confirmation. Analytical alteration (AA) data were considered: AKI (creatinine elevation × 1.5 the median for age), plasma sodium alteration (≤130 or ≥150 mEq/L), and potassium alteration (≤3 or ≥6 mEq/L). We included 590 patients, 17.8% presented AA (13 hyponatremia, 7 hyperkalaemia, and 87 AKI). No patient presented severe analytic alterations or a higher frequency of symptoms potentially attributable to these alterations (seizures, irritability, or lethargy). Risk factors associated with these AA were clinical dehydration (OR = 3.5 95% CI: 1.04-11.7; p = 0.044) and presenting a temperature >39°C (OR = 1.9 95% CI: 1.14-3.1; p = 0.013). Electrolyte and renal function disturbances are infrequent in the previously healthy paediatric population with a fUTI. If present, they are asymptomatic and not severe. Based on our results, performing systematic blood analysis to rule out AA appears no longer justified, especially in the absence of risk factors.

#3235 ELECTROLYTE DISORDERS IN COMMUNITY-ACQUIRED ACUTE KIDNEY INJURY

Abstract Background and Aims The kidney plays a decisive role in regulating the homeostasis of the internal environment. Acute kidney injury (AKI) compromises the kidney's ability to maintain this regulation intact, and the appearance of various electrolyte disorders is to be expected in this situation. There are few data in the literature that describe these alterations in patients with community-acquired AKI (CA-AKI). The purpose of this study is to analyze the incidence of electrolyte disorders in a cohort of patients with CA-AKI admitted to the nephrology service of a tertiary level hospital. Method This is a single-center, observational, longitudinal, and retrospective study based on a cohort of patients with CA-AKI admitted to the Nephology Service of a third level hospital from January 2010 to December 2018. We analyzed the incidence of changes in sodium, potassium, chloride, bicarbonate, calcium, and phosphorus in these patients and their clinical consequences during admission and follow-up after hospital discharge. Results A total of 639 patients were included in the final analyses. The mean age was 72,93±13,38 years. 61,7% were men. Charlson comorbidity index was 5,87 ±2,4 points. The length of stay was 11,63±10,14 days. In view of the Etiology of AKI, 72,1% had prerenal AKI and 27,9% non-prerenal. 436 patients had a history of previous chronic kidney disease (CKD) (68.23%). AKI KDIGO stages were: stage I, 105 cases (16.4%); stage II, 67 cases (10.5%); stage III 467 cases (63.1%). Hemodialysis (HD) was required in 114 patients (17.8 %). 62 patients (9.7 %) died during hospital stay. The percentage of patients with alterations in the different ions was: chlorine 54%, potassium 60.1%, sodium 45.23%, bicarbonate 85.67%, calcium 52.68%, phosphorus 54.49%. The most frequent ionic alterations at a global level were low bicarbonate (78.3%), hyperkalemia (53.05%), hypocalcemia (49.6%) and hyponatremia (41.5%). No significant differences were observed in these percentages when comparing patients with previous CKD with respect to carriers of normal baseline renal function (glomerular filtration rate &amp;gt; 60 ml/min). When analyzing whether electrolyte alterations occurred simultaneously: 2.2% of cases did not present any, 6.3% only one, 18.2% two, 26.4% three, 26.1% four, 14.9% five and 5.9% six simultaneous alterations. In the univariate analysis, patients with hypernatremia (Chi square 22.7; p &amp;lt; 0.001), hyperkalemia (Chi square 9.7; p = 0.008) and hyperphosphatemia (Chi square 18.5; p &amp;lt; 0.001) had higher mortality during admission. In the multivariate analysis using logistic regression, the variables that were independently associated with mortality during hospitalization were phosphorus (OR 1.425; 95% CI 1.212 - 1.676) and chlorine (OR 1.045; 95% CI 1.002 - 1.089). In the follow-up after hospital discharge, the Kaplan-Meier curves in the univariate analysis showed higher mortality in patients who presented hyperkalemia (log rank test: Chi square 15.5; p &amp;lt; 0.0001), hypernatremia (log rank test: Chi square 47.7; p &amp;lt; 0.0001), hypocalcemia (log rank test: Chi square 6.73; p &amp;lt; 0.034) and hyperphosphatemia (log rank test: Chi square 10.24; p &amp;lt; 0.006). In the multivariate analysis using Cox regression, the variables that were independently associated with mortality after hospital discharge were sodium (Exp(B) 1.001; 95% CI 1.002 - 1.048; p = 0.048), potassium (Exp(B) 1.140; 95% CI 1.055 - 1.233; p = 0.001) and phosphorus (Exp(B) 1.087; 95% CI 1.023 - 1.048; p = 0.154). Conclusion In our series of patients with CA-AKI, we detected a high prevalence of electrolyte disorders, without a history of previous CKD having any influence on it. The most frequent was the finding of three or four simultaneous alterations. Phosphorus and chlorine independently influenced mortality during admission. In the follow-up after hospital discharge, sodium, potassium, and phosphorus were independent predictors of mortality. The clinician who treats cases of CA-AKI must expect the appearance of frequent electrolyte disorders and must be prepared for their correct management.

Alterations of serum electrolytes and biochemical indices of Panagasianodon gigas subjected to different water temperatures and the appropriate temperature range for sustaining life

ABSTRACT The effects of cold and heat shocks on serum electrolyte and biochemical changes in Panagasianodon gigas. Cold shock was conducted as follows: 25–22°C, 25–19°C and 25–13°C; and heat shock: 25–28°C, 25–31°C and 25–37°C. The lowest Na+ was found in the group exposed to 25–13°C and 25–37°C, while the highest Na+ was observed in the 25–31°C group. The K+ significantly increased with decreases in water temperature. The Cl- was significantly decreased and increased when decreasing and increasing water temperature, respectively. The serum CO2 level was affected by cold shock but was not affected by heat shock. The highest and lowest Na+/K+ ratio was found in the group exposed to 25°C–31°C and 25°C–13°C, respectively. Moreover, the Na+/Cl- ratio showed a similar trend to that of the Na+/K+ ratio. Furthermore, the highest (Na+ + K+)/Cl- ratio was found in 25–31°C group. The highest glucose was found in all the cold shock groups. Albumin, globulin, total protein, triglyceride and cholesterol levels were significantly decreased after exposure to cold and heat shocks. These results demonstrated that 25–28°C is the appropriate temperature range for this species whilst other ranges influenced biochemical and physiological indices.

Effect of Carica papaya Leaves and Seeds on Electrolyte and Hematological Parameters in Albino Wistar Rats Exposed to Lead Nitrate

Background: Exposure to lead produces a variety of adverse health effects. This study evaluated the effect of aqueous extracts of Carica papaya leaves and seeds on electrolyte and hematological parameters in albino Wistar rats exposed to lead nitrate.&#x0D; Methods: Thirty male albino Wistar rats weighing between 174- 196g were assigned to six groups of five animals. Group 1 served as control, group 2 received 50mg/kg body weight lead nitrate (PbNO3), groups 3 and 4 received 500 mg/kg body weight aqueous extract of Carica papaya leaves (CPL) and Carica papaya seed (CPS) respectively, groups 5 and 6 received 50mg/kg body weight PbNO3 + 500mg/kg body weight CPL and CPS respectively for 31 days by oral gavaging. Animals were sacrificed and blood collected for various assay using standard methods. ANOVA on SPSS version 25 was used to determine variations within and between groups.&#x0D; Results: Increases in sodium and potassium, and decreases in chloride, calcium and bicarbonate levels were observed in the lead intoxicated group. Treatment with CPL and CPS reversed the alterations in electrolytes. Levels of RBC, PCV, Hb, MCH, MCHC and lymphocytes were lower in the lead intoxicated group relative to the lead intoxicated groups complemented with CPL and CPS, while WBC, MCV and platelet counts were higher in the lead intoxicated group when compared to the group complemented with CPL and CPS.&#x0D; Conclusion: This finding suggests that CPL and CPS could be protective against lead induced alterations in electrolytes and hematological parameters and could be harnessed for these potentials.