Electrolyte Disturbances In Patients Research Articles

Correction of electrolyte disorders – a component of effective therapy of hypertension

The article deals with the role of the K+ and Mg2+ levels in the body of patients with arterial hypertension, the causes of the imbalance of these electrolytes are examined, the need for monitoring and correction of the K+ and Mg2+ levels is shown. In particular, the medication containing potassium aspartate and magnesium asparaginate (trade name Panangin) is the drug of choice for correction of electrolyte disturbances in patients with arterial hypertension, its inclusion in the complex therapy is pathogenetically justified for the purpose of more effective control of blood pressure

Nutritional status among peritoneal dialysis patients after oral supplement with ONCE dialyze formula.

BackgroundMalnutrition is an important problem in patients treated with long-term dialysis, and most dialysis patients have lower dietary energy and protein intake. This study was undertaken to examine whether orally administered Otsuka Nutrition Pharmaceutical (ONCE) dialyze formula (ODF) supplement would improve energy intake without mineral and electrolyte disturbances in patients with continuous ambulatory peritoneal dialysis (CAPD).MethodsThe effects of ODF supplementation on nutrition markers including serum albumin and prealbumin concentrations and inflammatory stress in patients with chronic CAPD were evaluated. All patients received daily oral ODF supplements for 15 days. During follow-up, all patients were evaluated clinically and biochemically, and nutritional status was assessed.ResultsThirty patients with mean age 61.9±12.3 years and weekly Kt/V 2.2±0.4 were studied. The mean values for nutritional parameters included a body weight of 53.7±9.5 kg, a serum albumin level of 3.3±0.4 g/dL, a serum prealbumin level of 33.8±11.1 mg/dL, a dietary energy intake of 21.9±7.1 kcal/kg/day, and a dietary protein intake of 0.9±0.3 g/kg/day. After 15-day ODF treatment, these patients had significant dietary energy and protein, carbohydrate, fat, fiber, potassium, calcium, and magnesium intake from baseline (P<0.05). Furthermore, significant improvements were found in nutritional markers including body weight, blood urea nitrogen, and prealbumin levels, but no changes were observed in serum albumin and high-sensitivity C-reactive protein levels. At the end of follow-up, the frequency of patients with moderate malnutrition decreased from 24.2% to 18.2%, and no increased incidence was observed of hyperkalemia, hyperphosphatemia, and metabolic acidosis.ConclusionODF supplementation ameliorates low dietary energy and nutrient intake as well as improves serum prealbumin and body weight in patients with long-term CAPD.

Serum Electrolyte Disturbances in Benign Prostate Hyperplasia after Transurethral Resection of the Prostate

Objectives: The objective of this study was to determine the frequency of serum electrolyte disturbances in patients with benign prostate hyperplasia after transurethral resection of the prostate. Material and Methods: The cross sectional and descriptive study was carried out at the department of urology, Liaquat university hospital Jamshoro/Hyderabad. An informed consent was taken from all patients who were diagnosed as benign prostate hyperplasia in the department of urology by consultant urologist. All such patients were assessed for their serum electrolytes plstoperatively (on the first postoperative day) by taking 3cc venous blood sample in a sterilized disposable syringe and send to laboratory for analysis. The data were collected on pre-designed proforma. Results: The mean age ± SD (range) was 61.25 years ± 8.86 (50 to 90 years). Most of the patients i.e. 44 (29.3%, n=150) were between were seen in the age group 61 to 65 years. 57(38.0%) patients had the frequency of electrolyte disturbance. Mean preoperative and postoperative Hyponatremia was (129.29 ± 1.94) mmol/L and (132.05 ± 2.41) mmol/L (P>0.0001) whereas mean preoperative and postoperative Hypernatremia was (149.8 ± 0.3) mmol/L and (147.2 ± 1.1) mmol/L (P>0.02). Mean preoperative and postoperative Hypochloremia was (2.82 ± 0.5) mmol/L and (3.8± 1.6) mmol/L (P>0.03) whereas mean preoperative and postoperative Hyperkalemia was (110 ± 12.5) mmol/L and (106 ± 9.5) mmol/L (P>0.04). Mean preoperative and postoperative Hypochloremia was (80.0 ± 10.6) mmol/L and (95.0 ± 11.2) mmol/L (P>0.0001) whereas mean preoperative and postoperative Hyperchloremia was (130 ± 7.6) mmol/L and (110 ± 9.6) mmol/L (P>0.05). Mean preoperative and postoperative sodium bicarbonate (HCO3) at lower was (20.0± 1.4) mmol/L and (29.0 ± 2.1) mmol/L (P>0.002) and mean preoperative and postoperative Hyperchloremia was (38.1 ± 2.5) mmol/L and (31.02 ± 3.6) mmol/L (P>0.006). Conclusion: The further research should be required in advance and extended phase at different and wide clinical setting to gives more and better knowledge related to electrolyte disturbances in transurethral resection of prostate.

Electrolyte Imbalance in Patients with Sheehan's Syndrome

BackgroundWe investigated the prevalence of electrolyte imbalance and the relationship between serum electrolyte and anterior pituitary hormone levels in patients with Sheehan's syndrome.MethodsIn a retrospective study, we investigated 78 patients with Sheehan's syndrome. We also included 95 normal control subjects who underwent a combined anterior pituitary hormone stimulation test and showed normal hormonal responses.ResultsIn patients with Sheehan's syndrome, the serum levels of sodium, potassium, ionized calcium, magnesium, and inorganic phosphate were significantly lower than those in control subjects. The prevalence of hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, and hypophosphatemia in patients with Sheehan's syndrome was 59.0% (n=46), 26.9% (n=21), 35.9% (n=28), 47.4% (n=37), and 23.1% (n=18), respectively. Levels of sodium and ionized calcium in serum were positively correlated with levels of all anterior pituitary hormones (all P<0.05). Levels of potassium in serum were positively correlated with adrenocorticotrophic hormone (ACTH) and growth hormone (GH) levels (all P<0.05). Levels of inorganic phosphate in serum were positively correlated with levels of thyroid-stimulating hormone, prolactin, and GH (all P<0.05), and levels of magnesium in serum were positively correlated with delta ACTH (P<0.01).ConclusionElectrolyte imbalance was common in patients with Sheehan's syndrome. Furthermore, the degree of anterior pituitary hormone deficiency relates to the degree of electrolyte disturbance in patients with this disease.

Renal function in children with febrile convulsions.

Febrile convulsions (FC) are the most frequent seizure disorder in children. Some studies have detected serum electrolyte disturbances in patients with FC. This study determines serum electrolytes, renal function tests, and frequency of urinary tract infection in hospitalized children with FC. In this descriptive, cross sectional study, we evaluated 291 children with FC admitted to the Neurology ward of Ali-Asghar Children's Hospital from 2008- 2013. Data was recorded on age, sex, type (simple, complex), and recurrence of seizures, family history of FC and epilepsy, serum electrolytes, renal function tests, and urinary tract infections. A total of 291 patients with diagnosis of FC were admitted to our center. Of these 291 patients, 181 (62.2%) were male. The mean age was 24.4 ± 14.6 months. There were simple, complex, and recurrent FCs in 215 (73.9%), 76 (26.1%) and 61 (21%) of patients, respectively. Urinary tract infections (UTI) were found in 13 (4.5%) patients, more present in females (p-value = 0.03) and under 12 months of age (p-value = 0.003). Hyponatremia, hypocalcemia, and hypokalemia was detected in 32 (11%), 16 (5.5%), and 4 (1.4%) of cases, respectively. Twentyfour (8.2%) patients had a glomerular filtration rate less than 60 ml/min/1.73m2. There were no abnormalities in serum magnesium, BUN, and creatinine levels. During FCs, mild changes may occur in renal function but a serum electrolyte evaluation is not necessary unless patients are dehydrated. In children with FC, urinary tract infections should be ruled out.

A study of electrolyte disturbances in patients with chronic stable asthma and with asthma attacks

Study ObjectiveTo detect electrolyte disturbances in patients with chronic stable asthma and patients with asthma exacerbation and to assess the relation between serums electrolyte levels and pulmonary function parameters and therapeutic agents. DesignProspective, hospital-based, cross-sectional study. SettingOutpatient chest clinic and in-patient chest department; Alminya university hospitals Alminya-Egypt. PatientsOne hundred asthmatic patients. Study methodsPatients were divided into two groups: group I that included 50 patients presented with chronic stable asthma and group II that included 50 consecutive patients presented with acute severe asthma. Data collected included sex, age, residence, medication used, clinical examination, serum level of electrolytes (Na, K, Ca, Mg), and chest X ray, Spirometer was used to assess pulmonary function according to ATS/ERS standards. ConclusionHypomagnesemia and hypocalcemia were found to be the two most common electrolyte disturbances in patients with chronic stable asthma and also in those with acute asthma exacerbation. Therapeutic agents used to treat patients with chronic asthma have a role on abnormal electrolyte levels.

Posterior pituitary (PP) evaluation in patients with anterior pituitary defect associated with ectopic PP and septo-optic dysplasia

Controversies exist about posterior pituitary (PP) function in subjects with ectopic PP (EPP) and with cerebral midline defects and/or their co-occurrence. We investigate water and electrolyte disturbances in patients at risk for PP dysfunction. The study was conducted in a single Pediatric Endocrinology Research Unit. Forty-two subjects with childhood-onset GH deficiency were subdivided into five groups: normal magnetic resonance imaging (n=8, group 1); EPP (n=15, group 2); septo-optic dysplasia (SOD) with normal PP (n=4, group 3); EPP and SOD without (n=7, group 4), and with additional midline brain abnormalities (n=8, group 5). At a mean age of 16.0±1.1 years, they underwent a 120 min i.v. infusion with hypertonic 5% saline and evaluation of plasma osmolality (Posm), arginine vasopressin (AVP), thirst score (in groups 1 and 2), and urinary osmolality were performed. Mean Posm and AVP significantly increased from baseline scores (284.7±4.9 mosm/kg and 0.6±0.2 pmol/l) to 120 min after saline infusion (300.5±8.0 mosm/kg and 10.3±3.3 pmol/l, P<0.0001). Group 5 showed higher mean Posm and lower mean AVP at all time points (P<0.0001). Mean thirst score did not show a significantly different trend between the groups 1 and 2. Urine osmolality was above 750 mosm/kg in all but seven patients after osmotic challenge. Patients with midline brain abnormalities and EPP have defective osmoregulated AVP. Patients with EPP and congenital hypopituitarism have normal PP function.

Pathophysiology and Management of Fluid and Electrolyte Disturbances in Patients on Chronic Dialysis with Severe Hyperglycemia

The mechanisms of fluid and solute abnormalities that should be considered in any patient with severe hyperglycemia include changes in the total amount of extracellular solute, osmotic diuresis, intake of water driven by thirst, and influences from associated conditions. The absence of osmotic diuresis distinguishes dialysis-associated hyperglycemia (DH) from hyperglycemia with preserved renal function (HPRF). Mainly because of this absence, comparable degrees of hyperglycemia tend to produce less hypertonicity and less severe intracellular volume contraction in DH than in HPRF, while extracellular volume is expanded in DH but contracted in HPRF. Ketoacidosis can develop in both DH and HPRF. Among DH patients, hyperkalemia appears to be more frequent when ketoacidosis is present than when nonketotic hyperglycemia is present. Among HPRF patients, the frequency of hyperkalemia appears to be similar whether ketoacidosis or nonketotic hyperglycemia is present. Usually patients with severe DH have no symptoms or may exhibit a thirst. Infrequent clinical manifestations of DH include coma and seizures from hypertonicity or ketoacidosis and pulmonary edema from extracellular expansion. Insulin infusion is usually the only treatment required to correct the biochemical abnormalities and reverse the clinical manifestations of DH. Monitoring of the clinical manifestations and biochemical parameters during treatment of DH with insulin is needed to determine whether additional measures, such as administration of saline, free water, or potassium salts, as well as emergency hemodialysis (HD) are needed. Emergency HD carries the risk of excessively rapid decline in tonicity; its benefits in the treatment of DH have not been established.

Electrolyte Disturbances in Patients with Hyponatremia

Electrolyte abnormalities are frequently observed in patients with hyponatremia. The aim of this study was to determine the incidence of various electrolyte abnormalities encountered in hyponatremic patients admitted to an internal medicine clinic, as well as to investigate the possible pathogenetic mechanisms responsible for these abnormalities. We prospectively studied 204 adult patients who either on admission to our clinic or during their hospitalization were found to have hyponatremia. Ninety-two patients (45.5%) had at least one additional electrolyte abnormality. Hypophosphatemia was the most frequent electrolyte disorder observed (35 patients, 17%). Hypokalemia was seen in 32 patients (15.8%), hypomagnesemia in 31 patients (15.2%) and hyperkalemia in 12 patients (5.9%). Moreover, 5 patients (2.5%) had hyperphosphatemia, 4 patients (1.9%) exhibited hypermagnesemia, 3 patients (1.4%) had hypercalcemia, and 6 patients (2.9%) had true hypocalcemia. There were no statistically significant differences regarding the incidence of these electrolyte abnormalities (as a whole) between the main subgroups of hyponatremic patients (diuretic-induced, syndrome of inappropriate antidiuretic hormone, hypovolemia-induced and edematous state-related). However, hypokalemia and hypomagnesemia were more frequently observed in patients with diuretic-induced hyponatremia, while hyperkalemia was more frequently seen in edematous state-related hyponatremia. Additional electrolyte abnormalities are frequently encountered in patients with hyponatremia of any origin admitted to an internal medicine clinic.

SIADH Caused by the Synergistic Effect of S-1 and Thiazide

Hyponatremia is a dangerous electrolyte disturbance in patients on chemotherapy and may cause sudden death if not detected early. SIADH (syndrome of inappropriate antidiuretic hormone) is one of the known causes of hyponatremia in patients undergoing chemotherapy. Few chemotherapeutic agents, however, are reported to cause SIADH. The current study reports that SIADH developed in a 55 year old woman on S-1 () and cisplatin () chemotherapy for the peritoneal metastasis of gastric cancer. The patient underwent a total gastrectomy, a splenectomy, and a segmental resection of the transverse colon for gastric cancer. She had used thiazide and to treat hyperiension for 12 years. She admitted to our hospital with complaining of general weakness, dysarthria, loss of appetite, and urinary discomfort. The serum level of sodium and potassium were 94 mEq/L and 2.2 mEq/L respectively. The hyponatremia completely resolved uneventfully after 3% saline infusion, which led to normalized electrolyte balance. The patient was discharged on the 13th hospital day.

Electrolyte Disturbances in Patients With Chronic, Stable Asthma: Effect of Therapy

To determine the prevalence of electrolyte disturbances in patients with chronic, stable asthma, and to assess whether the therapeutic agents used to treat chronic asthma have an effect on abnormal electrolyte levels. Prospective, hospital-based, cross-sectional study. University teaching hospital in Jeddah, Saudi Arabia. Patients with chronic, stable asthma. Ninety-three consecutive patients with chronic, stable asthma were involved in the study. On the day of the visit to the asthma clinic, particulars such as age, sex, duration of asthma, and details of drug therapy were obtained from each asthmatic patient. Serum potassium, magnesium, phosphorus, calcium, and sodium levels were measured. Normal values were as follows: potassium, 3.5 to 5 mmol/L; magnesium, 0.74 to 1.2 mmol/L; phosphorus, 0.8 to 1.4 mmol/L; and calcium, 2.1 to 2.6 mmol/L. Electrolyte disturbances were found in 43% of the patients; 85% of the patients had one electrolyte disturbance, 10% had two electrolyte disturbances, and 5% had three electrolyte disturbances. The highest proportions were for magnesium (26.9%) and phosphorus (15.1%) [serum levels were 0.69 +/- 0.04 mmol/L and 0.64 +/- 0.09 mmol/L, respectively], the lowest proportions were for potassium (5.4%) and sodium (4.3%) [serum levels were 3.3 +/- 0.01 mmol/L and 133 +/- 0.01 mmol/L, respectively], and no patient had a calcium disturbance. Logistic regression analysis showed no statistically significant association between the therapy used and electrolyte disturbances. Hypomagnesemia and hypophosphatemia were found to be the two most common electrolyte disturbances in patients with chronic, stable asthma. Therapeutic agents used to treat patients with chronic asthma have no effect on abnormal electrolyte levels. The underlying cause still remains unclear.

Further Studies on the Treatment of Congenital Adrenal Hyperplasia with Cortisone: IV. Effect of Cortisone and Compound B in Infants With Disturbed Electrolyte Metabolism, by John F. Crigler Jr, MD, Samuel H. Silverman, MD, and Lawson Wilkins, MD,Pediatrics, 1952;10:397–413

Three infants with female pseudohermaphrodism attributable to the salt-losing form of congenital adrenal hyperplasia (CAH; adrenogenital syndrome) followed for 14 to 20 months are described in detail. The first infant was admitted at the age of 7 weeks in adrenal crisis and studied intensively during a 557-day hospitalization; the second, an infant 7 weeks of age, was hospitalized for 7½ months; and the third, a 9-week-old infant, was studied over a 5-month period. The effects of cortisone and corticosterone on the suppression of the abnormal adrenals, as reflected in the urinary excretion of 17-ketosteroids (17-KS) and on the electrolyte disturbance as manifested by changes in serum and urinary electrolytes and body weight, are described. Cortisone acetate produced more marked suppression of the adrenal overactivity per milligram (as assessed by the urinary excretion of 17-KS), but less sodium retention than corticosterone. Both steroids, however, improved the electrolyte abnormality significantly. The possible mechanism of action of cortisone on the disturbed electrolyte metabolism is considered. We suggest that cortisone can serve as a substitute for deficient “Na-retaining hormone,” and/or it may act by suppressing secretions of the abnormal adrenals that possibly cause salt loss actively, either from the production of a specific “Na-losing” factor or from an antagonistic action of some of the steroids secreted by the abnormal adrenal gland against those hormones that normally regulate electrolyte metabolism. The studies in the three infants lead us to conclude that the electrolyte disturbance in patients with the salt-losing form of CAH is not merely simple deficiency of the adrenal salt hormone that appears to be associated with the zona glomerulosa of the adrenal cortex. The approach to the initial and long-term management of infants with the salt-losing form of CAH derived from the intensive study of these three infants is described. The critical importance of the use of adequate NaCl and fluids by intravenous administration initially to repair the electrolyte and fluid deficiencies and the hemodynamic abnormalities without the use of deoxycorticosterone acetate (DCA), if possible, in the initial treatment is emphasized because suppression of the adrenal with cortisone seems to alter materially the requirement for DCA. The final combination of the maintenance dose of cortisone acetate (either intramuscularly or orally) after initial high-dose priming, the amount of added NaCl, and the requirements for DCA (as long-acting subcutaneous pellets preferably), however, must be decided in each patient individually. Too high a dose of glucocorticoid resulted in impaired growth and cushingoid features as we described earlier; an inadequate dose of cortisone did not protect the infant from an adrenal crisis and was associated with rapid growth and skeletal maturation and the undesirable clinical signs of excess androgen production.*

Acid-base and electrolyte disturbances in patients with diabetic ketoacidosis

We undertook the present study to examine the acid-base and electrolyte disturbances in relation to hydration status in patients with diabetic ketoacidosis (DKA). A total of 40 insulin-dependent diabetes mellitus patients (22 male, 18 female), aged 18–61 years with DKA admitted to our hospital during the last 2 years, were studied. The duration of diabetes averaged 9 ± 2 years. In all cases a detailed investigation of the acid-base status and electrolyte parameters was performed. Twenty-one patients had a pure metabolic acidosis with an increased serum anion gap, seven had DKA combined with hyperchloremic metabolic acidosis, nine had DKA coexisting with metabolic alkalosis, while three had DKA with a concurrent respiratory alkalosis. Hydration status as evidenced by the ratio of urea/creatinine seems to play an important role in the development of mixed acid-base disorders (detected by changes in the ratios Δ anion gap/Δ bicarbonate ( ΔAG ΔHCO 3 ) and sodium/chloride ( Na Cl )). In fact, hyperchloremic acidosis developed in the patients with the better hydration status. However, contradictorily, the severely dehydrated patients who experienced recurrent episodes of vomiting developed DKA with a concurrent metabolic alkalosis. Finally, patients with pneumonia or gram-negative septicemia exhibited DKA combined with a primary respiratory alkalosis. We conclude that patients with DKA commonly develop mixed acid-base disorders, which are partly dependent on patients' hydration status.

Ventricular arrhythmias in patients with myocardial infarction and ischaemia. Relationship to serum potassium and magnesium.

Alterations in serum electrolytes may frequently accompany ischaemic heart disease. Many of these patients are hypertensive and receive diuretic therapy which results in chronic lowering of serum potassium and magnesium. In addition, acute catecholamine-induced shifts of potassium into cells may also occur in the setting of acute myocardial ischaemia. An association between low serum potassium concentrations and ventricular arrhythmias has been observed by a number of investigators in patients with acute myocardial infarction. The increased frequency of ventricular fibrillation with low serum potassium concentrations is particularly relevant as this arrhythmia is associated with poor prognosis, even in the setting of a coronary care unit. Ventricular fibrillation also occurs with increased frequency in patients with angina who have low serum potassium levels. The possibility that low serum potassium concentrations may be a risk factor in the increased incidence of sudden death in such patients should be considered. Diuretic-induced magnesium deficiency may be yet another factor favouring the emergence of ventricular arrhythmias in patients with ischaemic heart disease. While such electrolyte disturbances do not account for all of the ventricular irritability seen in patients with ischaemic heart disease, they represent easily identifiable and treatable risk factors. Primary prevention of these electrolyte disturbances in patients at risk for coronary ischaemia is recommended.

Fluid and electrolyte disturbances in patients with long-established ileostomies.

Salt and water depletion has been noted in 10 patients with long-established ileostomies. Marked renal conservation of sodium and water was present in a number of apparently healthy ileostomy patients. The sodium and potassium concentrations of ileostomy material showed little variation when these patients were in good health but there was a decrease in the sodium concentration and an increase in the potassium concentration during episodes of salt depletion. Greater attention needs to be paid to the fluid and electrolyte requirements of ileostomy patients after they have left hospital.

Electrolyte disturbances in patients with uretero-sigmoidostomy.

Electrolyte disturbances in patients with uretero-sigmoidostomy.