Electrolyte Imbalance In Patients Research Articles

Multiple electrolytes imbalances in a patient with inflammatory bowel disease associated with vitamin D deficiency: a case report

BackgroundInflammatory bowel disease involves chronic inflammation and ulceration, primarily Crohn’s disease and ulcerative colitis. The prevalence of inflammatory bowel disease is rising in industrialized countries. We describe the case of a patient with inflammatory bowel disease and multiple electrolyte disturbances that emphasize the link between a vitamin D deficiency and electrolyte imbalances.CaseAn 86‐year‐old Japanese man with severe hypocalcemia, hypophosphatemia, hypokalemia, and hypomagnesemia was referred to the gastroenterology and hepatology department our university hospital for severe diarrhea and abdominal pain. Based on clinical symptoms and biochemical and endoscopic findings, Crohn’s disease, intestinal Behçet’s disease, and intestinal tuberculosis were considered as differential diagnoses, but a final diagnosis was not reached. Prednisolone, azathioprine, and metronidazole were administered, and no apparent electrolyte abnormality was observed at the patient’s admission to our hospital. On the 80th hospital day, marked hypocalcemia, hypophosphatemia, hypokalemia, and hypomagnesemia were noted and prolonged, despite daily supplementation with Ca and inorganic P. At his consultation with our department, we observed decreased fractional excretion of Ca, tubular reabsorption of phosphate, fractional excretion of K, and fractional excretion of Mg, suggesting the depletion of vitamin D and extrarenal wasting of K and Mg. The patient’s serum Ca and inorganic P were quickly elevated in response to treatment with an active form of vitamin D, and his serum levels of K and Mg were restored to the normal range by an intravenous administration of K and Mg. A vitamin D deficiency is not rare in inflammatory bowel disease and is caused primarily by the decreased intestinal absorption of vitamin D. In the management of electrolyte imbalances in patients with inflammatory bowel disease, clinicians must consider the possible development of vitamin D deficiency-related disorders.ConclusionVitamin D deficiency in entero-Behçet’s disease leads to severe hypocalcemia and hypophosphatemia, highlighting the importance of awareness in management.

Abstract 16169: Use of Ramen in Heart Failure: Correction of Severe Hyponatremia With Salt Intake

Background Hyponatremia (Na<136mmol) is the most common electrolyte imbalance in patients with heart failure (HF) and is associated with increased mortality, morbidity and rehospitalizations. The mechanisms of hyponatremia in heart failure are multifold and include an increased sympathetic tone and renin-angiotensin-aldosterone-system, salt and water retention in the proximal and distal tubules, high antidiuretic hormone coupled low glomerular filtration rate and diuretic use. We present a case highlighting the complexity of sodium balance in acute decompensated heart failure. Case Presentation A 65-year-old female with a medical history of heart failure with preserved ejection fraction (EF 60-65%), pulmonary hypertension, atrial fibrillation, and CKD presented to the Emergency Department with volume overload. We began diuresis with bumetanide on hospital day 1 (HD#), however given inadequate urine output chlorthalidone was added on HD #5 and metolazone on HD #7. On admission, her sodium was 134 and down trended to a low of 121 on HD#13. She had worsening BUN/Cr from 62/2.14 at admission to a peak 135/2.66. She developed oral intake intolerance, asterixis and encephalopathy. The management changed to halting diuretics, fluid restriction, and hypertonic saline without improvement. Urine electrolytes were used to tailor treatment, leading to cessation of hypertonic saline stopped and introducing Ramen (875 mg of Na) and salt tablets (394 mg of Na). While maintaining euvolemia, there was resolution of symptoms and improvement in Na=134, BUN 49, Cr 1.16. Discussion Treatment options for hyponatremia in HF, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The use of high oral salt intake with close monitoring of jugular vein pressure, weight, symptoms, and urine electrolytes can help a select group of patients with hyponatremia and advance heart failure despite traditional knowledge.

Prevalence of Electrolyte Imbalance in Patients With Acute Stroke: A Systematic Review.

Electrolyte abnormalities are common in acute stroke patients and have a substantial impact on the course and prognosis of the disease. Electrolyte imbalances such as hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, and phosphate abnormalities are frequently seen in this patient population. The incidence, root causes, and medical ramifications of electrolyte abnormalities in acute stroke patients are investigated in this comprehensive study. According to our research, hyponatremia is the most prevalent electrolyte imbalance. The most common reason for hyponatremia in stroke patients is the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Higher mortality rates, longer hospital admissions, and less favorable functional outcomes are all linked to hyponatremia. Acute stroke patients also typically experience hypokalemia, which affects the severity of the stroke and the recovery of functional abilities. The review furthermore emphasizes the incidence and clinical consequences of hypercalcemia, hypomagnesemia, hypophosphatemia, and hypocalcemia in patients with acute stroke. The results highlight the significance of early electrolyte imbalance detection and treatment in acute stroke patients. To better comprehend therapeutic approaches, evaluate their influence on stroke outcomes, and analyze prognostic implications, more research is required.

The Clinical Characteristics of Electrolyte Disturbance in Patients with Moderate and Severe Traumatic Brain Injury Who Underwent Craniotomy and Its Influence on Prognosis.

The present study aimed to investigate the clinical characteristics of electrolyte imbalance in patients with moderate to severe traumatic brain injury (TBI) who underwent craniotomy and its influence on prognosis. A total of 156 patients with moderate to severe TBI were prospectively collected from June 2019 to June 2021. All patients underwent craniotomy and intracranial pressure (ICP) monitoring. We aimed to explore the clinical characteristics of electrolyte disturbance and to analyze the influence of electrolyte disturbance on prognosis. A total of 156 patients with moderate and severe TBI were included. There were 57 cases of hypernatremia, accounting for 36.538%, with the average level of 155.788±7.686 mmol/L, which occurred 2.2±0.3 days after injury. There were 25 cases of hyponatremia, accounting for 16.026%, with the average level of 131.204±3.708 mmol/L, which occurred 10.2±3.3 days after injury. There were three cases of hyperkalemia, accounting for 1.923%, with the average level of 7.140±1.297 mmol/L, which occurred 5.3±0.2 days after injury. There were 75 cases of hypokalemia, accounting for 48.077%, with the average level of 3.071±0.302 mmol/L, which occurred 1.8±0.6 days after injury. There were 105 cases of hypocalcemia, accounting for 67.308%, with the average level of 1.846±0.104 mmol/L, which occurred 1.6±0.2 days after injury. There were 17 cases of hypermagnesemia, accounting for 10.897%, with the average level of 1.213±0.426 mmol/L, which occurred 1.8±0.5 days after injury. There were 99 cases of hypomagnesemia, accounting for 63.462%, with the average level of 0.652±0.061 mmol/L, which occurred 1.3±0.4 days after injury. Univariate regression analysis revealed that age, Glasgow coma scale (GCS) score at admission, pupil changes, ICP, hypernatremia, hypocalcemia, hypernatremia combined with hypocalcemia, epilepsy, cerebral infarction, severe hypoproteinemia were statistically abnormal (p<0.05), while gender, hyponatremia, potassium, magnesium, intracranial infection, pneumonia, allogeneic blood transfusion, hypertension, diabetes, abnormal liver function, and abnormal renal function were not statistically significant (p>0.05). After adjusting gender, age, GCS, pupil changes, ICP, epilepsy, cerebral infarction, severe hypoproteinemia, multivariate logistic regression analysis revealed that hypernatremia or hypocalcemia was not statistically significant, while hypernatremia combined with hypocalcemia was statistically significant (p<0.05). The incidence of hypocalcemia was the highest, followed by hypomagnesemia, hypokalemia, hypernatremia, hyponatremia and hypermagnesemia. Hypocalcemia, hypomagnesemia, and hypokalemia generally occurred in the early post-TBI period, hypernatremia occurred in the peak period of ICP, and hyponatremia mostly occurred in the late period after decreased ICP. Hypernatremia combined with hypocalcemia was associated with prognosis.

Risk of pre-existing hyponatremia and mortality in patients with traumatic brain injury across age groups

Traumatic brain injurySodiumClinical outcomes.

Assessment of hypokalemia and clinical prognosis in Patients with COVID-19 in Yangzhou, China.

BackgroundHypokalemia is a frequent electrolyte imbalance in patients with COVID-19. The aim of this study was to estimate the association between hypokalemia and clinical prognosis in patients with moderate COVID-19.MethodsA single-center, retrospective, observational study was conducted on 81 non-ICU admitted patients with moderate COVID-19 according to the criteria issued by the Chinese Health Bureau in the Third People’s Hospital of Yangzhou (Northern Jiangsu People’s Hospital New District Branch) from 4th to 25th August 2021. The demographic, clinical, and laboratory data were reviewed and collected, then the correlation between hypokalemia and prognosis was determined.ResultsThe level of serum potassium of patients ranged from 2.80 mmol/L to 4.70 mmol/L. Hypokalemia was detected in 39 out of the 81 included patients (48.15%) during hospitalization. Patients with hypokalemia had prolonged days of negative nucleic acid conversion and hospital stay. Correlation analysis showed that the level of serum potassium was negatively correlated with days of negative nucleic acid conversion and length of hospital stay. Bivariate logistic regression analysis proved that hypokalemia was a risk factor for prolonged hospital stay in patients with moderate COVID-19.ConclusionHypokalemia was prevalent in patients with moderate COVID-19 in Yangzhou, China. Hypokalemia was associated with the prolonged hospital stay in patients with moderate COVID-19.

TO STUDY THE PREVALENCE OF ELECTROLYTE IMBALANCE IN PATIENTS WITH SEIZURES

Background: Seizure is dened as an episode of neurological dysfunction caused by abnormal neuronal activity that results in a sudden change in motor, behaviour and sensory perception1. Electrolytes seem to have a dominant role in the causation of seizures Electrolyte homeostasis in the central nervous system (CNS) is a characteristic essential feature behind brain functioning. “A number of clinical studies have also shown a relationship between electrolyte imbalance and seizures. OBJECTIVE: To Determine the Prevalence of electrolyte imbalance in patients with Seizures. RESEARCH DESIGN AND METHODS: A cross sectional study was conducted at , MLN Medical College associated SRN Hospital, Prayagraj. A total 100 patients were enrolled in the study. Patients with 18 years of age or older presented with seizure as the presenting complaint were included. Patients presenting with cerebrovascular accident ,subarachnoid hemorrhage, tuberculoma cavernous sinus thrombosis febrile seizures hypoglycemia alcohol withdrawal uremic encephalopathy and patients refusing to participate in the study. RESULT: Nearly two third (64%) patients had generalized tonic clonic seizures followed by focal seizures (27%) and status epilepticus (9%) respectively. Maximum electrolyte imbalance was seen for calcium (99%) followed by sodium (92%), potassium (63%) and magnesium (33%) respectively. A signicant association of serum sodium status was observed with type of seizures with hyponatremia being more common in GTCS and hypernatremia being more common in status epilepticus. Conclusion: In the present study, there was a high prevalence of hyponatremia (82%). Hyponatremia could be one of the most common factors leading to seizure activity. The ndings of the present study shows that both in adults as well as in children show that electrolyte imbalance is a frequent observation in seizure activity, primarily cation deciency is highly prevalent in seizure cases, however it is difcult to establish the role of a single electrolyte cation to be responsible for this activity

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Human immunodeficiency virus HIV infected individuals on national AIDS control organization NACO India based highly active antiretroviral therapy (HAART) regimen often continue experiencing neurological complications referred to as HIV associated neurocognitive disorders (HAND).The cognitive impairment is attributed to HIV replication in the brain and liberation of inflammatory neurotoxins leading to neuronal dysfunction.The American academy of neurology task force on the acquired immune deficiency syndrome AIDS defined two level of neurological impairment in HIV patients: 1.HIV associated dementia(HAD)and 2.minor cognitive motor disorder (MCMD).A core difference between the two is the degree of functional impairment present . Patient with HAD have more impairment than those with MCMDTimely detection of Cognitive dysfunction in patients with HIV infection is very crucial as HAND could affect patient’s activities of daily living such as medication adherence, employment; driving and so on this worsens disease indirectly.Methods:A Cross sectional Study on Patients with immune compromised states infected by HIV/AIDS was the main aim. The study includes 75 HIV infected patients attending ART centre in Victoria hospital. Patients taken into study were aged above 18years, of both sexes, then MINI Screening for Psychiatric diagnosis will be applied to rule out Axis I Psychiatric illnessIHDS scale will be applied to know the neurocognitive severity (score less than <=10) patients will be considered.Results:More than half of the HIV patients had scored less in IHDS SCALE, reported.Conclusion:the results show that patients with HIV states have the high prevalence of prevalence of HIV associated neurocognitive impairment.Introduction:Electrolyte abnormalities are common in chronic alcoholics as a result of chronic alcohol consumption, acute alcohol intoxication. They are especially significant during alcohol withdrawal. We should be aware of these clinically important disturbances caused by alcohol abuse for their appropriate management.Material and methods:A cross-sectional observational study was conducted for a period of 18 months and 126 patients of alcohol dependence in withdrawal state were included. Diagnosis of alcohol withdrawal were confirmed using ICD-10 and patients were evaluated using CIWA-Ar. Venous blood was obtained for the determination of serum potassium, sodium and magnesium, calcium, phosphates, bicarbonates concentrations and LFT.Results:The prevalence of electrolyte imbalance was 71%. Hyponatraemia was noted in 28.6% and hypernatremia in 11.9% of individuals with alcohol dependence syndrome. Hypokalemia was noted in 42.1% and hyperkalemia was noted in 1.6% of individuals with alcohol dependence syndrome. 14.3% of the individuals have decreased magnesium levels and 15.1% have increased magnesium levels. 67.5% of individuals have normal calcium levels and hypocalcaemia was noted in 31.7%, while hypercalcaemia was noted in only one patient. Hypophosphatemia was present in 15.1% of individuals while in rest the serum phosphorous levels were normal. Metabolic acidosis was found in 19.8% and metabolic alkalosis in 3.2% patients.Conclusion:The prevalence of electrolyte imbalance in patients of alcohol dependance in alcohol withdrawal state was 71%. The most frequent electrolyte disturbances in these patients were hypokalemia (42.1%) followed by hypocalcemia (31.7%), hyponatremia (28.6%), and hypomagnesemia (14.3%). The metabolic disturbances ware present in 23% patients. The patients consuming 7/weeks were significantly more likely to have electrolyte imbalance and deaarranged liver function tests than in individuals consuming 4/weeks or less.

Akut Renal Yetmezliği Olan Hastalarda QT Dispersiyon Varlığının ve Elektrolit Dengesizliği ile İlişkisinin Araştırılması

Aim: This study aims to investigate the relationship between QT dispersion and electrolyte imbalance in patients with acute kidney injury (AKI), and whether QT dispersion is associated with the severity of AKI.&#x0D; &#x0D; Material and Methods: A total of 400 patients over the age of 18 presenting to a tertiary emergency department over a 3-month period were prospectively examined. While 200 of the participants were diagnosed with AKI, 200 were in the control group. Presence of QT dispersion, potassium values, age and sex data, and blood urea nitrogen (BUN) /Creatinine (Cr) ratio parameters were examined and comparisons were made.&#x0D; &#x0D; Results: The mean age of patients diagnosed with AKI was 55.9±16.7 years, while it was 54.8±18.2 in the control group. QT dispersion was significantly higher in the AKI group (p

Correction of electrolyte balance in surgical patients with urgent surgical interventions

Annotation. Acute appendicitis is one of the most common acute pathologies of the abdominal cavity, which requires immediate surgical intervention and can lead to water-electrolyte imbalance. The aim of the study was to investigate the clinical significance of electrolyte imbalance in patients operated on for acute appendicitis and their correction. We examined 20 urgent surgical patients who were part of the control group and received “traditional” postoperative therapy and 23 patients of the study group who received oral rehydration therapy in the postoperative period to correct water-electrolyte disorders. To analyze the results of the study, profile analysis was used as a modification of multidimensional covariance analysis with repeated measurements. As can be seen from the results of testing the hypothesis of normalization of homeostasis due to the use of oral rehydration therapy schemes, the hypothesis was confirmed with a threshold significance of p=0.0642. The only significant effect of the rate of normalization of potassium concentration in blood plasma is the appointment of oral rehydration therapy with p=0.045. Also, the appointment of oral rehydration therapy is a significant effect of the rate of normalization of sodium and glucose in plasma (normalization of plasma glucose is significantly better in the dynamics of younger patients (p=0.045)). Thus, normalization of potassium and glucose, which correlates with the patient's age, was better in patients receiving oral rehydration mixture in the postoperative period than in patients receiving “traditional” postoperative therapy. Oral rehydration therapy is an acceptable alternative to infusion therapy in patients undergoing surgery for acute appendicitis in the postoperative period.

Electrolyte imbalance in patients with COVID-19 pneumonia

Introduction: Electrolyte abnormalities are among the most common complications among the patients admitted with coronavirus disease 2019 (COVID 19) pneumonia and maybe contributed to its course of disease and severity. Objectives: The current study aims to assess the prevalence and association of electrolyte imbalance among patients with COVID 19 pneumonia. Patients and Methods: The current observational study has been conducted on 323 patients with COVID 19 pneumonia. On-admission blood samples were taken to assess electrolytes (sodium, potassium, calcium, and magnesium), complete blood count and differentiation (CBC with diff), and other biomarkers. Further measurements of electrolytes were conducted during the period of hospitalization if needed. The frequency and association of electrolyte imbalance with diverse demographic, clinical, laboratory, and in-hospital characteristics was assessed. Results: Hypo/hypernatremia, hypo/hyperkalemia, hypo/hypermagnesemia and hypo/ hypercalcemia were presented in 14.5%/9.4%, 3.8%/10.3%, 7.9%/9.3%, and 10.9%/10.8%, respectively. Time to discharge was remarkably higher among the patients with hypernatremia (P=0.031). The patients with hypermagnesemia were significantly younger than the other cases (P=0.016). The C-reactive protein (CRP) level was statistically less among the patients with hypercalcemia (P=0.025). There was no associative outcome between potassium abnormalities and patients’ characteristics. Conclusion: The present study showed that electrolyte imbalances are common laboratory abnormalities during COVID-19. However, we found no associative role, since ions balance plays a crucial prognostic role for COVID-19.

Frequency of Electrolyte Imbalance in Patients Presenting With Acute Stroke.

IntroductionElectrolyte disturbances are commonly reported in acute stroke in studies conducted in the western world. Presently, the data available about the prevalence of electrolyte disturbance in patients with stroke are not sufficient, especially from developing countries. The purpose of our study is to determine the frequency of occurrence of electrolyte imbalance in patients presenting with acute stroke in a tertiary care hospital.MethodsThis descriptive cross-sectional study was conducted in the department of internal medicine and neurology in a tertiary care hospital, Pakistan, from December 2019 to March 2021. A total of 300 patients, aged between 30 and 70 years, with either ischemic or hemorrhagic stroke, as diagnosed on contrast tomography (CT) scan of the head or magnetic resonance imaging (MRI) of the brain, were enrolled in the study. The biochemical analysis of the stroke patients was done.ResultsOut of the 300 participants, 139 (46.3%) participants were from the ischemic stroke group while 161 (53.7%) were from the hemorrhagic stroke group. The mean sodium level was significantly lower in the ischemic group as compared to the hemorrhagic group (129.41 ± 3.12 mEq/L vs. 134.42 ± 3.46 mEq/L; p-value: <0.0001). Potassium level was significantly higher in the hemorrhagic group compared to the ischemic group (6.27 ± 1.12 mmol vs. 4.31 ± 0.71 mmol; p-value: <0.0001).ConclusionPatients coming to emergency with stroke should be screened immediately for electrolyte imbalance. Early identification of rapid imbalances of serum electrolytes may aid in prompt medical intervention and resultant improved outcomes in stroke patients. It is crucial that electrolyte imbalances in these patients are closely monitored to avoid any complications.

Evaluation of Electrolyte Imbalance in Patients With Traumatic Brain Injury Admitted in the Central ICU of a Tertiary Care Centre: A Prospective Observational Study.

IntroductionElectrolyte imbalance is a salient finding in traumatic brain injury which can derail their clinical course of recovery in physical and cognitive health while prolonging the hospital stay.ObjectiveThis study aims to understand the variation in electrolyte profile that occurs in traumatic brain injury patients which can help in better patient management.Materials and method50 trauma patients with head injury (Group A) and 50 patients without head injury (Group B) admitted in Central ICU (CICU) under the Department of Anaesthesiology, Assam Medical College and Hospital (AMCH) were selected and analysed with regard to their electrolyte variability.ResultAll trauma patients with head injury developed an imbalance to one or more electrolytes. Then mean electrolyte level in trauma patients with a head injury and in trauma patients without head injury were 139.3±7.45 vs 143.65±8.89, p<0.05 (sodium), 3.49±0.44 vs 3.88±0.49, p<0.05 (potassium), 7.81±0.5 vs 8.9± 0.35, p<0.05 (calcium) and 2±0.33 vs 2.47±0.41, p<0.05 (magnesium) respectively. Also, patients in the head injury group had a higher incidence of hypoalbuminemia than patients without head injury 2.47±0.67 vs 2.83±0.74 (p<0.05).ConclusionWe conclude that traumatic brain injury patients have a greater risk of electrolyte imbalance, viz. hyponatremia, hypokalaemia, hypocalcaemia as well as hypomagnesemia, and hypophosphatemia along with hypoalbuminemia.

Electrolyte abnormalities in diabetes mellitus in the presence of normal serum creatinine

Aim: Diabetes mellitus is a metabolic disorder that causes disturbances in the electrolyte regulating mechanisms of our body. The purpose of the study was to determine the pattern of electrolyte imbalance in patients with diabetes mellitus and compare with healthy individuals; and to correlate the degree of electrolyte imbalance with control and duration of diabetes. Methods: This cross-sectional study was conducted over a period of 6 months. It included 90 cases with diabetes mellitus and 50 cases without diabetes mellitus. All subjects had normal serum creatinine level. Serum electrolytes (sodium, potassium, chloride and bicarbonate) were measured in each subject by automated methods. The normal levels of sodium, potassium, chloride and bicarbonate were taken as 136-146, 3.5-5, 102-109 and 22-30 mmol/L respectively. Levels above or below this reference were taken as abnormal. Control of diabetes was determined by measuring HbA1c using high-performance liquid chromatography. Result: The most common abnormalities in patients with diabetes mellitus were hypochloraemia (48.89%), low serum bicarbonate (23.33%) and hyponatraemia (11.11%), though the mean values of serum electrolytes were within the normal reference range. Serum bicarbonate level was significantly lower in the group with diabetes mellitus (p = 0.010). There were a significantly greater number of cases with hyponatraemia and hypochloraemia among cases with diabetes mellitus (p < 0.016). Serum sodium was negatively correlated with glycaemic control (r = -0.39; p <0.001) and duration of diabetes (r = -0.31; p = 0.003). Conclusion: Electrolyte abnormalities are more common in patients with diabetes mellitus even with normal serum creatinine, and this correlates with control and duration of diabetes.

SAT-372 A Case of Hypercalcemia Secondary to Rhabdomyolysis Induced by Heroin Use

Background: Rhabdomyolysis is a potential life threatening condition defined as injury of the skeletal muscle, which results in the release of intracellular contents into the circulation. This muscle injury is often associated with the development of myoglobinuria, electrolyte abnormalities, and often ARF; it can be caused by diverse mechanisms including drugs and toxins. We present a case of rhabdomyolysis complicated by hypercalcemia and ARF in a patient with a history of polysubstance abuse after using intravenous heroin. Case: A 28 y/o male with h/o polysubstance comes to the ED with c/o fatigue, nausea, vomiting and decreased urine output for about 5 days; patient acknowledged using heroin and afterwards he developed weakness and tenderness in upper and lower extremities. Additionally he admitted cocaine and marijuana abuse. On physical exam vital signs were unremarkable and he had some mild tenderness to palpation mostly of the quadriceps bilaterally. Laboratory data was significant for acute kidney injury (cr 11.33 mg/dl, n: 0.7–1.5 mg/dl) and CPK 171920 u/l (n: 22–269 u/l). He received 2 L of NS in the ED and was started on NS at 100cc/hour.He underwent hemodialysis on day 2; initially he was treated for hypocalcemia with calcium and vitamin D supplementation until day 11 were hypercalcemia (calcium 12.7 mg/dl, n: 8.7–10.3 mg/dl; ionized calcium 1.7 mmol/l, n: 1.12–1.32) was noted; this was associated with concomitant suppression of PTH (5 pg/ml, n: 10–65 pg/ml). He remained asymptomatic from calcium abnormalities during his hospitalization, his urine output recovered progressively, hemodialysis was discontinued on day 13. Upon discharge was recommended to f/u with nephrology. Discussion: Various neurological and neuromuscular complications of heroin abuse have been described; one of these is rhabdomyolysis; its pathophysiology in heroin abuse is thought to be multifactorial; including acidosis, hypoxia, muscle compression and adulterants found in heroin. Narcotics may also have direct cell toxicity and alter membrane transport. Usually upon initial presentation hypocalcemia is one of the most common electrolyte imbalances seen with rhabdomyolysis. The proposed mechanism is precipitation of serum calcium salts in necrotic muscle. This may be followed by hypercalcemia during the diuretic phase of ARF which appears to be a relatively unusual complication associated with the presence of severe muscle damage due to metastatic calcium salts that are liberated from the necrotic muscle and the return to the serum. Conclusion: This case report highlights the importance of recognizing potential electrolyte imbalances in patients with rhabdomyolysis; it appears, that concomitant rhabdomyolysis and ARF are needed for a patient to develop hypercalcemia.Serum calcium should always be routinely measured and the appropriate treatment should be implemented to improve outcomes.

Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19).

Early studies have reported various electrolyte abnormalities at admission in patients who progress to the severe form of coronavirus disease 2019 (COVID-19). As electrolyte imbalance may not only impact patient care, but provide insight into the pathophysiology of COVID-19, we aimed to analyse all early data reported on electrolytes in COVID-19 patients with and without severe form. An electronic search of Medline (PubMed interface), Scopus and Web of Science was performed for articles comparing electrolytes (sodium, potassium, chloride and calcium) between COVID-19 patients with and without severe disease. A pooled analysis was performed to estimate the weighted mean difference (WMD) with 95% confidence interval. Five studies with a total sample size of 1415 COVID-19 patients. Sodium was significantly lower in patients with severe COVID-19 (WMD: -0.91 mmol/L [95% CI: -1.33 to -0.50 mmol/L]). Similarly, potassium was also significantly lower in COVID-19 patients with severe disease (WMD: -0.12 mmol/L [95% CI: -0.18 to -0.07 mmol/L], I2=33%). For chloride, no statistical differences were observed between patients with severe and non-severe COVID-19 (WMD: 0.30 mmol/L [95% CI: -0.41 to 1.01 mmol/L]). For calcium, a statistically significant lower concentration was noted in patients with severe COVID-19 (WMD: -0.20 mmol/L [95% CI: -0.25 to -0.20 mmol/L]). This pooled analysis confirms that COVID-19 severity is associated with lower serum concentrations of sodium, potassium and calcium. We recommend electrolytes be measured at initial presentation and serially monitored during hospitalization in order to establish timely and appropriate corrective actions.

Outcomes Related to Electrolyte Imbalance in Patients Undergoing Chemotherapy; an Observational Study Focusing on Cancer Patients

Cancer patients are generally challenged with a myriad of issues, electrolyte imbalance being one of them [1]. An ongoing chemotherapeutic regimen or paraneoplastic syndrome is also responsible for electrolyte imbalance [2].

Significance of Hyponatremia as an Independent Factor in Predicting Short-term Mortality in Patients with Hemorrhagic Stroke.

IntroductionHyponatremia is the most common electrolyte imbalance in patients with acute cerebrovascular insults. In patients with acute non-traumatic hemorrhagic stroke, the role of hyponatremia as a negative prognostic indicator has been controversial. The aim of this study is to evaluate the frequency of hyponatremia in patients with hemorrhagic stroke and determine its impact on their in-hospital disease outcome.MethodsThis was a prospective observational study, which included all patients with non-traumatic hemorrhagic stroke. Serum sodium concentration <135 mmol/L was labeled as hyponatremia. The etiology of hyponatremia was determined as syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSWS). The outcome was categorized as “complete recovery,” “motor/sensory deficit but not wheelchair/bed bound,” “wheelchair/bed bound,” and “in-hospital mortality.” SPSS for Windows version 22.0 (IBM Corp., Armonk, NY, US) was used to analyze the data.ResultsOut of 234 patients of hemorrhagic stroke, 45.3% (n=106) were hyponatremic, 58.5% had SIADH and 41.5% had CSWS. The overall mortality rate of hemorrhagic stroke was 16.2%. The mortality rate was 36.5% in the SIADH group, 50% in the CSWS group, and 13.1% in the normonatremic group (p<0.00001). The mean hospital stay in the SIADH group was 7.04 ± 2.57, in the CSWS group, it was 6.50 ± 1.55, and in the normonatremic group, it was 3.88 ± 2.74 (p=0.000).ConclusionHyponatremia is an independent predictor of short-term mortality in patients with acute hemorrhagic stroke.

Electrolyte Imbalance in Patients of Acute Myocardial Infarction: A Study from Central India

Electrolyte Imbalance in Patients of Acute Myocardial Infarction: A Study from Central India

Pattern of electrolyte imbalance and their response to corticosteroid therapy in stroke patients admitted in a tertiary care hospital

This prospective, single center, case-control study was designed to see the response of electrolyte imbalance in admitted stroke patients receiving corticosteroid therapy in a tertiary care hospital. In IPD, still in many cases of stroke with cerebral edema, injectable corticosteroids are given frequently. Our aim was to find out the common electrolyte imbalances in different type of acute stroke, and, if there was any difference between the patterns of electrolyte imbalance in patients receiving corticosteroids for management, with those who did not receive.Methods: The source population of this study comprised stroke patients attending the DMCH, between 1st January to 30th June 2014. Total 70 patients, 35 as control and 35 as case group, who received steroids, were randomly enrolled for the study. Detail demographic data were collected from the informant was recorded in structured case report form.Result: In our study, 48 (68.55%) patients had infarction and 22 (31.45%) patients had hemorrhagic stroke. Hyponatremia was detected in majority 51 (72.85%), others imbalances are hypernatremia 9(12.85%), hypokalaemia 31(44.28%), hyperkalaemia 2(2.85%) and hypochloraemia 37(52.85%). Out of 48 ischemic stroke, hypernatraemia, hypokalaemia and hypochloraemia was present among 8(16.66%), 19(39.58%) and 24(50%) patients respectively. Out of 22 haemorrhagic stroke patients, 1(4.54%), 12(54.54%), 2(9.09%) and 13(59.09%) cases were found to have hypernatraemia, hypokalaemia, hyperkalaemia and hypochloraemia respectively. After giving injectable steroids, differences were statistically significant between two group, p-value was 0.016 (p&lt;0.05). Among control group 24(68.57%); improvement observed was insignificant.Conclusion: It was statistically evident that, patients receiving injectable corticosteroids in acute stroke, showed improvement and had better outcome than of those who did not receive.Bangladesh J Medicine Jul 2017; 28(2) : 75-80