Electrolyte Levels Research Articles

Reducing refeeding syndrome incidence among patients with head and neck cancer: A quality improvement initiative.

459 Background: Refeeding syndrome (RFS) constitutes a wide spectrum of electrolyte abnormalities and clinical symptoms following re-introduction of nutrition, specifically carbohydrate, in malnourished patients (pts). Refeeding phenomena (RFP) is the isolated decline in electrolyte levels (phosphate, potassium, or magnesium) following refeeding. Average incidence of RFS in head and neck cancer (HNC) pts is 20%. Early identification of high-risk pts and increasing awareness about RFP is crucial to avoid rapid nutritional replenishment and therefore reduce health care costs, morbidity, and mortality from RFS. We conducted a quality improvement (QI) project at a single academic university hospital with objective of reducing RFS incidence, length of hospital stay (LOS) and 30 day all-cause readmission and ED visit rates in HNC pts started on enteral nutrition (EN). Methods: We conducted a prospective observational study between Aug 2021 and Nov 2022 among pts with HNC admitted for feeding tube insertion. Pts determined to be high-risk for RFS according to ASPEN criteria were included. Serum electrolyte levels were obtained and monitored twice daily for 3 days following initiating continuous feeds with a standard, fiber free, 1.5 kcal/mL formula @ 20mL/h (’Safe start’). If low, electrolytes were promptly supplemented. Enteral thiamine supplements (100 mg daily for 5-7 days) were started. A registered dietitian conducted a nutrition assessment within 24 h of EN initiation to provide EN regimen and formula advancement recommendations, as well as EN needs for home. Case management was consulted within 24 h of EN initiation to facilitate timely discharge and delivery of home supplies. Data including LOS and 30-day all-cause readmission and ED visits were collected. ASPEN criteria were used to define mild, moderate, severe RFP. For comparison, similar data was retrospectively collected by reviewing medical records of 57 HNC pts (control group) admitted for feeding tube insertion between Dec 2017 and April 2021. Results: Of the 56 pts in the study group, 8 (14.3%) experienced RFS, 12 (21.4%) mild RFP, 7 (12.5%) moderate RFP, and 12 (21.4%) severe RFP. The average LOS in study group was 10 days compared to 13 in control group. 30-day all-cause readmission and ED visit rates were 21.4% and 12.5% in study group compared to 45.6% and 19.3% respectively in control group (Table 1). Conclusions: RFP/RFS is often underdiagnosed and undertreated in HNC pts. Through QI measures we were able to decrease RFS incidence rate to less than the reported average. Close collaboration between physicians, nurses, dietitians, and case managers facilitates timely intervention to prevent RFS, reduce LOS and readmissions.[Table: see text]

A cross-sectional study of the clinical profile of children admitted with yellow phosphorous poisoning in a tertiary care hospital

Background: Yellow phosphorous (YP) is a protoplasmic poison that is mainly used as a rodenticide. Aims and Objectives: The aim of the study is to describe the clinical profile of YP poisoning in children in a tertiary care hospital. Materials and Methods: This is a cross-sectional study done in a tertiary care hospital in Tamil Nadu. A convenience sample of all the cases admitted during the year 2022 was done. Demographic and clinical data were collected and analyzed. Results: The male: female ratio was 1.16:1 (n=13). The mean age of the children was 4.0769±1.373 years. About 84.61% of the children reported to the hospital within 6 h. On admission, fever (30.76%), vomiting (30.76%), abdominal pain (30.76%), bleeding (15.38%), and altered sensorium (15.38%) were the common symptoms. All the children ingested YP accidentally. Leukocytosis was observed in about 30.76%. The mean peak serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were 516.9231±685.976 IU/L and 161.9231±215.107 IU/L, respectively. There were no alterations in the Electrocardiographic tracings, levels of serum electrolytes, blood glucose, and serum creatinine in children with YP poisoning. Significant differences were observed between children who survived and children who died in the levels of mean peak AST, mean peak ALT, INR, and in the presence of encephalopathy and bleeding manifestations. Conclusion: YP is an uncommon but lethal poison in children. Creating awareness among parents about the dangers of YP and nationwide prohibition of the sale of YP will be an important step in eliminating deaths in children who are accidental victims.

Induction of Caspase-dependent Apoptosis in Rat Bone Marrow Mesenchymal Stem Cells Due to Di-2-Ethylhexyl Phthalate Toxicity was Found to Arrest the Cell Cycle at the G1 Stage.

Di-(2-ethylhexyl) phthalate (DEHP) is used as a plasticizer in polyvinyl chloride products which is widely utilized. Previously we found, DEHP reduced the viability and proliferation ability of bone marrow mesenchymal stem cells (BMSCs). In the present study, the mechanism of DEHP toxicity was investigated. Rat BMSCs were cultured up to 3rd passage and their viability was determined after treatment with 100 and 500 μM of DEHP for 24 and 48 hours. The levels of sodium, potassium, and calcium as well as induction of apoptosis were investigated. Using flow cytometry, cell cycle analysis was performed and the expression of genes involved in the cell cycle was evaluated using reverse transcriptase-PCR. Data were analyzed and p < 0.05 was taken as the level of significance. Although the viability and electrolyte level of BMSCs were not affected with 100 μM of DEHP, this environmental pollution induced caspase-dependent apoptosis in a concentration-dependent manner. In both of the concentrations, DEHP arrests the cell cycle at the G0/G1 phase, and the expression of Cdk2 and Cdk4 was significantly reduced whereas an over-expression of P53 was observed. However, the expression of the raf1 gene remained unchanged. DEHP induces caspase-dependent apoptosis in BMSCs and arrests the cell cycle due to the reduction of Cdk2 and Cdk4 expression via over-expression of P53.

Correlation of Serum Electrolytes and Ovarian Hormones Levels in Premenstrual Syndrome

Background: Premenstrual syndrome (PMS) is a recurrent psychological and physical symptom that may occur during the late luteal phase of menstrual cycle and resolve with menstruation in the women. Alteration of serum electrolyte levels in accordance with ovarian hormonal fluctuations has some association with PMS which affect their regular activities and reproductive life. Methods: A cross-sectional study was conducted to assess the correlation of serum electrolytes and ovarian hormones levels in premenstrual syndrome among the 30 young unmarried women with PMS from July 2016 to June 2017 in the Department of Physiology, Sir Salimullah Medical College, Bangladesh. Results: In the non-PMS and PMS group, the mean of serum sodium level was 139.97±1.30 and 140.93±1.68 mmol/L, and serum potassium level was 4.20±0.32 and 4.17±0.31 mmol/ L. The mean of serum estrogen level was 177.10±6.90 and 283.53±5.73 pg/ml and serum progesterone was 19.35±2.55 and 14.67±2.20 ng/ml in the group A and B. Premenstrual scores of irritability, abdominal bloating, backache, depression, fatigue, breast tenderness, headache, anxiety were significantly higher in comparison to those of postmenstrual scores in PMS group (p&lt;0.05). Serum estrogen level (r= +0.558) and serum progesterone level (r= -0.408) were correlated with PMS symptoms scores in PMS group (p&lt;0.05). Conclusion: The results of the current study showed that the PMS group has some physical and psychological symptoms as a result of fluctuations in ovarian hormone levels and biochemical markers during the late luteal phase of the menstrual cycle. Sir Salimullah Med Coll J 2023; 31: 21-25

The frequency of hypernatremia at presenting to the Emergency Department with acute bronchiolitis

&lt;b&gt;Aim:&lt;/b&gt; Acute bronchiolitis is a common lower respiratory tract disease in children. In addition to its common clinical findings, it may also cause extrarenal water losses. Deficiency in total body water is a risk for hypernatremia. This study aimed to analyze the frequency of concomitant hypernatremia in children suffering from acute bronchiolitis.&lt;br /&gt; &lt;b&gt;Material and methods&lt;/b&gt;: This retrospective study was conducted with 1317 children who presented to the pediatric emergency department with acute bronchiolitis and whose sodium levels were measured from January 1, 2019, to March 1, 2020. The age, gender, and application season of the patients were recorded.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;Hypernatremia was detected in 193 (14.7%) patients, and hyponatremia was detected in 99 (7.5%). There was no statistical difference in age or gender between the hyponatremia, hypernatremia, and normonatremia groups (p&amp;gt;0.05). The frequency of hypernatremia was the highest in winter and spring (p&amp;lt;0.05).&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Patients with acute bronchiolitis may be accompanied not only by hyponatremia but also by hypernatremia. To prevent dysnatremia in patients with acute bronchiolitis, each child's intravenous hydration regimen must be ordered to electrolyte levels.

Characteristics of sodium and water retention in rats with nephrotic syndrome induced by puromycin aminonucleoside

IntroductionNephrotic syndrome (NS) is characterized by renal sodium and water retention. The mechanisms are not fully elucidated.MethodsThe NS rat model was established by single intraperitoneal injection of 100 mg/kg puromycin aminonucleoside (PAN). The plasma electrolyte level and urinary sodium excretion were monitored dynamically. The changes of some sodium transporters, including epithelial Na+ channel (ENaC), Na+/H+ exchanger 3 (NHE3), Na+-K+-2Cl− cotransporter 2 (NKCC2) and Na+-Cl− cotransporter (NCC) in renal cortex at different time points and the level of peripheral circulation factors were detected.ResultsThe urinary sodium excretion of the model group increased significantly on the first day, then decreased compared with the control group, and there was no significant difference between the model group and the control group on the 12th day. The changes of peripheral circulation factors were not obvious. Some sodium transporters in renal cortex increased in varying degrees, while NKCC2 decreased significantly compared with the control group.ConclusionsThe occurrence of NS edema may not be related to the angiotensin system. The decrease of urinary sodium excretion is independent of the development of albuminuria. During the 18 days of observation, it can be divided into three stages: sodium retention, sodium compensation, and simple water retention. The mechanism is related to the increased expression of α-ENaC, γ-ENaC, NHE3 and NCC in a certain period of time, the compensatory decrease of NKCC2 expression and the continuous increase of aquaporin 2 (AQP2) expression.

Acid-base Status and Electrolyte Changes During Propofol Based General Anesthesia in Patients Undergoing Septoplasty

Propofol is a widely used hypnotic agent globally; however, it may have adverse effects on critical patient outcomes, potentially by interfering with the organ-protective properties of other interventions. Propofol anesthesia can lead to disruptions in metabolic balance. This research aims to examine alterations in acid-base and electrolyte levels during septoplasty surgery when propofol-based anesthesia is administered. In this prospective, observational cohort study, a total of 30 patients between the ages of 18 and 65 with an American Society of Anesthesia physical status I-II were included. Arterial blood samples were collected both before the administration of propofol and five minutes after propofol injection, with the purpose of evaluating the acid-base status and electrolyte parameters including sodium, chloride, calcium and potassium. No cases of acidosis or statistically significant alterations in electrolyte levels were observed in patients following the administration of propofol. Furthermore, none of the patients exhibited any adverse effects such as cardiac failure, rhabdomyolysis, severe metabolic acidosis, or renal failure attributable to propofol during the study. We suggest that the induction dose of propofol for general anesthesia does not lead to metabolic acidosis or electrolyte disturbances. Keywords: Propofol, Arterial, Metabolic acidosis, Anesthesia, Acid-base balance, Potassium, Anion gap

Sleep architecture and vitamin D in hypertensives with obstructive sleep apnea: A polysomnographic study.

Obstructive sleep apnea (OSA) and arterial hypertension (AH) are closely linked disorders with common pathophysiological features. The present study aimed to investigate the relationship between AH and OSA by examining sleep architecture, vitamin D concentration and electrolyte levels in patients with these coexisting conditions. A total of 133 patients suspected of having OSA were recruited for examination. The participants were divided into 2 groups: hypertensives (n = 52); and normotensives (n = 81). One full-night polysomnographic examinations were conducted, followed by the statistical analysis of the collected data. Hypertensive individuals displayed increased apnea-hypopnea index (AHI), oxygen desaturation index (ODI), respiratory arousal index (RAI), and periodic limb movement index (PLMI) as compared to non-hypertensive individuals. Moreover, sleep efficiency (SE), the bruxism arousal index (BAI) and oxygen saturation (SpO2)level were decreased in the hypertensive group. In terms of biochemical parameters, hypertensive individuals exhibited a lower magnesium (Mg) level, and higher levels of C-reactive protein (CRP), uric acid (UA) and glucose. Notably, there were no statistical differences in vitamin D concentration between hypertensive and normotensive individuals. The study explored the potential influence of calcium (Ca), Mg, vitamin D, and UA concentrations on the sleep architecture of patients with comorbid AH and OSA. The findings revealed several notable associations. Firstly, sleep fragmentation correlated with Ca level, suggesting a potential role for both Ca and vitamin D in sleep arousals. Secondly, a higher UA concentration was linked to a higher AHI and increased sleep fragmentation. Additionally, alterations in Mg concentration were observed among hypertensive individuals with OSA. However, further research is needed to fully comprehend the potential impact of these factors on the sleep architecture of hypertensive individuals with apnea.

In situ electrolyte replenishment with atmospheric pressure-chemical/electrochemical vapour deposition for molten carbonate fuel cells

Molten carbonate fuel cells (MCFCs) offer several advantages in energy applications, but their lifetime is limited especially by electrolyte depletion. In this study, a novel in situ method for replenishing the electrolyte in MCFCs by injecting gaseous electrolyte precursors (EP) that form liquid electrolyte through reactions with CO2/O2 gases or CO32- ions is introduced. The selection of EP species (LiI, NaI, and KOH) are guided by thermodynamic considerations including high vapour pressures and conversion rates to Li/K or Li/Na carbonates. The proposed approach addresses two electrolytic depletion stages: consumption of the electrolyte in the electrode (Stage 1) and in the matrix pores (Stage 2). Atmospheric-pressure electrochemical vapour deposition (AP-EVD) and atmospheric-pressure chemical vapour deposition (AP-CVD) are demonstrated to replenish electrolyte in the electrode and matrix pores, respectively. The applied techniques sustained a cell with a low (Li/Na)2CO3 electrolyte level for long-term operation (>1,000 h) while maintaining stable performance (>0.8 V at 150 mA cm−2). The method also returned an inactive cell to its normal operating conditions (OCV: 1.054 V, RΩ: 0.61 Ω cm2, (Li/K)2CO3 electrolyte). These results promise enhanced durability of MCFCs and render them much more viable for use in energy applications.

The Impact of Transfer-Related Ischemia on Free Flap Metabolism and Electrolyte Homeostasis-A New In Vivo Experimental Approach in Pigs.

Free flap tissue transfer represents the gold standard for extensive defect reconstruction, although malperfusion due to thrombosis remains the leading risk factor for flap failure. Recent studies indicate an increased immune response and platelet activation in connection with pathologic coagulation. The underlying cellular and molecular mechanisms remain poorly understood, however. The presented study, therefore, aims to investigate if transfer-related ischemia alters intra-flap metabolism and electrolyte concentrations compared to central venous blood after free flap transfer in pigs to establish a novel experimental model. Free transfer of a myocutaneous gracilis flap to the axillary region was conducted in five juvenile male pigs. The flap artery was anastomosed to the axillary artery, and intra-flap venous blood was drained and transfused using a rubber-elastic fixed intravenous catheter. Blood gas analysis was performed to assess the effect of transfer time-induced ischemia on intra-flap electrolyte levels, acid-base balance, and hemoglobin concentrations compared to central venous blood. Time to flap reperfusion was 52 ± 10 min on average, resulting in a continuous pH drop (acidosis) in the flaps' venous blood compared to the central venous system (p = 0.037). Potassium (p = 0.016), sodium (p = 0.003), and chloride (p = 0.007) concentrations were significantly increased, whereas bicarbonate (p = 0.016) and calcium (p = 0.008) significantly decreased within the flap. These observations demonstrate the induction of anaerobic glycolysis and electrolyte displacement resulting in acidosis and hence significant tissue damage already after a short ischemic period, thereby validating the novel animal model for investigating intra-flap metabolism and offering opportunities for exploring various (immuno-) thrombo-hemostatic issues in transplantation surgery.

Effect of P-glycoprotein inhibitor (Carvedilol) on pharmacological and hematological effects of its substrate (methotrexate) on pregnant and lactating rat mothers

Sixty albino rats (40 female rats and 20 males) were allocated into four dosing groups administered orally carvedilol (T1) 0.72mg/kg, methotrexate (T2) 0.36mg/kg, combined doses (T3) carvedilol + methotrexate and control group (Distilled water) for 2 months in male and 2 weeks in female rats before mating and after copulation and approval of pregnancy, dosing continued in female groups during pregnancy and lactation periods. Half of the animal groups were euthanized one day before parturation to determine P-gp concentration in the placenta and liver of pregnant mothers. In contrast, the other half was left for parturition and lactation to study the effects of carvedilol (P-gp inhibitor) on methotrexate (P-gp substrate) when given alone and in combination with some pharmacological, hematological, and biochemical parameters in lactating mothers and pups at the end of lactation. The pharmacological results showed the highest significant antinociceptive responses both in the early and late phase in the T3 (CV+MTX) followed by the T2 (MTX) group. In contrast, the T1 (Cv) animal group showed nearly resembling results as that of the control group in the early and late phases of the formalin test. The written test also recorded the same result as the Formlin test, indicating a significantly higher analgesic effect in T3 followed by T2 in comparison to T1 and control groups. The TNF alpha results supported the anti-inflammatory effect, recording a significant decline mainly in the T3 and T2 groups. The hematological results recorded significantly more reduction in WBC levels in mother and their pups in comparison with T1 and control groups. The serum electrolyte levels (Na+, K+, Ca+2) recorded in all treated groups and pups showed a significant increase in potassium levels in the T1 and T2 mother rat groups. The P-glycoprotein (P-gp) concentration measured in liver and placenta of euthanized pregnant mother before delivery recorded potent inhibition of P-gp in T1 &amp; T3 groups which might altered pharmacokinetic and pharmacodynamic effects of substrate by carvedilol that considered a potent P-gp inhibitor drugs, this might explain our results of increase in pharmacological effect of methotrexate and their side effect on electrolyte concentration and hematology in combined group of CV+ MTX. Keywords: Carvedilol, Methotrexate, p-gp inhibitor, Anti-inflammatory, Hematology, Electrolyte.

A Case Report on Recurrent Episodes of Dyselectrolytemia Diagnosed as Gitleman Syndrome

Background: Gitleman syndrome (GS) is also known as familial hypokalaemia-hypomagnesemia, which is a rare genetic disorder. It is an autosomal recessive disease that is characterized by hypokalaemia, hypomagnesemia, metabolic alkalosis, hypocalciuric hypercalcemia and hyperaldosteronism.&#x0D; Case Report: 70-year-old female patient who was diagnosed with Gitelman syndrome with the symptoms of loss of appetite, muscle weakness, and abdominal pain. Electrolyte levels were low. After inconclusive evidence from laboratory investigation, genetic testing was performed. The detection of the SLC12A3 gene mutation encoding thiazide diuretic sensitive sodium chloride cotransporter located in DCT of kidney, confirmed the diagnosis of GS with c.1331delA variant. No pathological variant of CLCNKB for Bartter syndrome has been found. The patient was treated with parenteral normal saline, potassium chloride, Arachitol, spironolactone, metoclopramide, and MgD3 (magnesium glycinate and vitamin D3), the symptoms was significantly relieved. After discharge the intravenous medicines were shifted to oral and followed up with serum electrolyte levels in our institute.

Unraveling the Enhancement of Confined Water on the Li‐Ion Transport of Solid Electrolytes

AbstractOxide solid electrolytes are attractive for the implementation of solid‐state Li‐ion batteries. However, constrained by the large ion‐transport hindrance inside the densely packed lattice, their Li‐ion conductivity can hardly reach the level of liquid electrolytes. A strategy of introducing confined water into the lattice paves a new way for enhancing the Li‐ion transport, which has been reported in the previous studies. To further verify the universality of this strategy and unravel the facilitation mechanism, here this work establishes an ideal model using Li‐H‐Cl‐O quaternary compounds with a wide electrochemical stability window. As a major kind of confined water, the content and type of ─OH groups are crucial parameters affecting the Li‐ion conductivity. Through a controllable dehydration technique, the hydrogen‐bonded ─OH groups can be mostly removed, leaving the free ─OH groups in lattice, which is beneficial to the increase of free volume and acceleration of rotation response. The 1–2 orders of magnitude enhancement of Li‐ion conductivity ensures full cells good rate and cycling performance. This work not only addresses the controversy in Li‐H‐Cl‐O about the hydrogen effect on Li‐ion transport, but also provides detailed theoretical insights for the rational design of solid electrolytes.

Association between dextrose-containing maintenance fluids and phosphorus supplementation during total parenteral nutrition initiation in adult patients who were hospitalized: A retrospective cohort study.

Use of dextrose-containing maintenance fluids prior to parenteral nutrition (PN) initiation is speculated to reduce the risk for refeeding syndrome. We aimed to assess if the use of dextrose vs nondextrose maintenance fluids before PN initiation changes electrolyte supplementation requirements and shifts during initiation. This retrospective cohort study included patients who received nothing by mouth but received maintenance fluids ≥72 h before PN. The major end point was phosphorus supplementation over 48 h following nutrition initiation. Minor end point included other electrolyte supplementation, changes in electrolyte levels, time to discharge, and goal kilocalories per day. Fifty-three patients between August 1, 2019, and August 26, 2020, met criteria for analysis; 60% (n = 32) used a dextrose and 40% (n = 21) used a nondextrose maintenance fluid. Baseline characteristics were similar between fluid groups except for body mass index (25.1 dextrose vs 27.5 kg/m2 nondextrose), sex (43.8% female vs 52.4% male), and severe malnutrition (46.9% vs 28.6%), respectively. Phosphorus (52.5 vs 50 mmol; P = 0.33) and magnesium (24 vs 22 g; P = 0.63) supplementation 48 h following nutrition initiation were similar between groups; however, potassium supplementation was lower in the dextrose group (165.0 vs 208.7 mEq; P = 0.01). No difference was observed between groups for time to discharge following nutrition initiation or time to goal kilocalories per day. After controlling for patients who were malnourished between fluid groups using linear regression, phosphorus repletion differences remained nonsignificant. This study did not detect a difference in phosphorus supplementation between groups, even after controlling for patients who were malnourished.

SAT211 PTH-secreting Endometrial Carcinoma: A Rare Cause of Hypercalcemia

Abstract Disclosure: E. Fanous: None. P. Park: None. L. Rakhlin: None. Introduction: Hypercalcemia of malignancy (HCM) is a common occurrence in advanced cancer, but it is rare for gynecological malignancies to be the cause (1). Case Presentation: Our patient is a 48-year-old postmenopausal female with diabetes mellitus and obesity who presented with pelvic pain and vaginal spotting over the course of 2 months. She also reported unintentionally losing approximately 60 lbs over the past year. A CT scan of the pelvis revealed a 6.1 cm uterine mass and thickening of the endometrium up to 2.4 cm. Her electrolyte levels were normal at the time of presentation. A biopsy of the endometrium was performed, and the pathology report indicated endometrial carcinoma. The patient was scheduled for a total hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO). A few weeks prior to her scheduled surgery, the patient reported increased thirst and urination, which she attributed to her diabetes and intake of an SGLT2 inhibitor. On the day of surgery, she was found to have a calcium level of 15.4 mg/dl and an albumin level of 3.6 g/dl. She denied taking calcium supplements or Vitamin D3. The workup for hypercalcemia revealed a PTH level of 338 pg/ml, an undetectable PTH-rp level, and normal levels of Vitamin D1,25 and Vitamin D25. Additional imaging showed numerous pulmonary nodules, which were later confirmed to be metastases from endometrial carcinoma. The thyroid gland and surrounding soft tissue were noted to be unremarkable on available CT images. The patient received a single dose of zolendronic acid and was started on cinacalcet 30 mg twice a day. The calcium gradually normalized. She was initiated on chemotherapy with paclitaxel and carboplatin and underwent a palliative TAH/BSO. Cinacalcet was discontinued after several cycles of chemotherapy. Two months later, the PTH level was checked and found to be 34 pg/ml, with a normal calcium level of 9.5 mg/dl and an albumin level of 4.1 g/dl. Given that the hypercalcemia resolved and the PTH level normalized after chemotherapy and hysterectomy, it is believed that the endometrial carcinoma was the source of ectopic PTH. Conclusion: Approximately 5% of gynecological malignancies are associated with paraneoplastic hypercalcemia [1]. We present a rare case of PTH-secreting endometrial carcinoma, in which surgery and chemotherapy resulted in complete resolution of hypercalcemia and normalization of PTH. Clinicians should consider ectopic PTH production as part of the differential diagnosis in patients who present with malignancy and hypercalcemia.

SAT212 Collateral Damage A Case Of Refractory Hyperparathyroidism In A Young Woman With End Stage Renal Disease

Abstract Disclosure: E.W. Alvarado: None. V. Alia: None. H. Reinhart: None. R. Giese: None. Background: The Rio Grande Valley (RGV) is a community with the highest incidence of ESRD in the USA. Hyperparathyroidism (HPT), defined as a serum PTH &amp;gt;65 pg/mL, HPT is a secondary complication of ESRD affecting 80% of individuals in this population. Although hyperparathyroidism may be asymptomatic, a severe form, refractory to medication can occur. Refractory HPT is defined as a PTH level 9 times the upper-limit or a serum level &amp;gt;800 pg/mL. This disease causes mutations in parathyroid cells causing parathyroid-gland hyperplasia. Once PTH levels increase to this extent, systemic issues including electrolyte derangements, weight loss, pathologic fractures, osteoporosis, and death can ensue. Due to the high mortality associated with this condition; it is paramount that patients are referred for surgery when medical management is inadequate. Clinical Case: A 31-year-old female with a significant medical history of ESRD on hemodialysis presented for evaluation of a suspected parathyroid carcinoma. Physical examination revealed a frail, short-statured woman who ambulated with a walker. Patient endorsed a 13-year history of uncontrolled HTN on antihypertensives, with a BP of 226/124. The patient presented with a BMI of 16.7, and endorsed a history of multiple fractures, musculoskeletal-pain, fatigue, palpitations, and a 33 pound weight loss over 1.5-years. Labs showed a total calcium of 9.4, phosphorus 6.9, ALP 652, and a PTH of 2423, meeting criteria for refractory HPT. Of note, records received five-months prior to referral showed a PTH of 5343 pg/ml, suggesting earlier surgery could have minimized disease progression. Based on the patient's presentation, MEN was suspected, however workup was negative. The patient was referred to a nearby ER for hemodynamic-stability and further workup of her underlying conditions. Ultrasound revealed two putative inferior parathyroid-glands presumptive for a diagnosis of severe tertiary HPT, but due to PTH&amp;gt;1000 carcinoma could not be excluded. Patient was taken to surgery and intra-operatively 4-gland hypertrophy was noted and a 3.5-gland excision was performed. Intraoperative PTH decreased to 120, and pathology showed benign parathyroid hyperplasia. Post-op day 1 the patient received hemodialysis and lab values revealed severe hypocalcemia prompting close monitoring and aggressive calcium supplementation. The patient’s electrolyte levels stabilized, she was discharged, and follow-up 2-weeks later revealed a PTH of 14.5. Conclusion: This case of a young patient with refractory HPT highlights the region's early onset of ESRD and its subsequent conditions. Noteworthy, the RGV is associated with a multitude of socioeconomic factors that precipitate neglect of chronic illnesses, indicating the substantial need for early identification and intervention to prevent long-term complications to disease in this vulnerable population. Presentation: Saturday, June 17, 2023

New-onset severe Diabetic Ketoacidosis in a 13-months old Nepali Toddler: a case report

Diabetes mellitus (DM) is a glucose metabolism disorder with diabetic ketoacidosis (DKA) being the most common complication associated with significant morbidity and mortality. Unlike other patients with typical symptoms of abdominal discomfort, pain, nausea and emesis of DKA, our patient presented with atypical symptoms such as cough, runny nose and fast breathing. This symptoms would have initially misled with diagnosis of respiratory tract infection, which would have caused delay in the treatment of DKA. In our patient DKA was treated with intravenous fluid replacement followed by intravenous insulin infusion, along with monitoring of blood glucose and electrolyte levels. We would like to emphasize that DKA can be precipitated by simple upper respiratory tract infection in toddlers with undiagnosed type 1 DM. Hence, random blood sugar measurement and urine for ketone bodies test should be performed if feasible in sick patients presenting with respiratory tract illness-like symptoms.

Assessment of Electrolytes Level Among Type 2 Diabetes Patients

Assessment of Electrolytes Level Among Type 2 Diabetes Patients

Assessment of refeeding syndrome definitions and 30-day mortality in critically ill adults: A comparison study.

Patients in the intensive care unit (ICU) are at high risk for refeeding syndrome (RFS), yet there is uncertainty regarding how RFS should be operationalized in the ICU. We evaluated different definitions for RFS and tested how they associated with patient-centered outcomes in the ICU. This was a retrospective comparison study. Patients age ≥18 years were eligible if they were newly initiated on enteral feeding while hospitalized in the ICU. Eight definitions for RFS were operationalized, including that from the American Society for Parenteral and Enteral Nutrition (ASPEN), all based on electrolyte levels from immediately before until up to 5 days after the initiation of enteral nutrition. Patients were followed for death or for ICU-free days, a measure of healthcare utilization. In all, 2123 patients were identified, including 406 (19.1%) who died within 30 days of ICU admission and 1717 (80.9%) who did not. Prevalence of RFS varied from 1.5% to 88% (ASPEN definition) depending on the RFS definition used. The excess risk for death associated with RFS varied from 33% to 92% across definitions. The development of RFS based on the ASPEN definition was associated with a greater decrease in ICU-free days compared with other definitions, but the relationship was not statistically significant. Eight definitions for RFS were evaluated, none of which showed strong associations with death or ICU-free days. It may be challenging to achieve a standardized definition for RFS that is based on electrolyte values and predicts mortality or ICU-free days.

Application of neural network and nomogram for the prediction of risk factors for bone mineral density abnormalities: A cross-sectional NHANES-based survey

BackgroundThe risk of bone mineral density abnormalities is inconsistent between eastern and western regions owing to differences in ethnicity and dietary habits. A diet comprising carbohydrates and dietary fiber is not the common daily diet of the American population. Thus far, no studies have assessed the risk of bone mineral density abnormalities in the American population, and no predictive model has considered the intake of carbohydrates, dietary fiber, and coffee, as well as levels of various electrolytes for assessing bone mineral density abnormalities, especially in the elderly. This study conducted a neural network analysis and established a predictive nomogram considering an unusual diet to determine risk factors for bone mineral density abnormalities in the American population, mainly to provide a reference for the prevention and treatment of related bone mineral density abnormalities. MethodsOverall, 9871 patients who had complete data were selected from the National Health and Nutrition Examination Survey database during 2017–2020 as the research object, and patients’ general clinical characteristics were compared. Neural networks and nomograms were analyzed to screen for and quantify risk factors for bone mineral density abnormalities. Finally, the receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and community indifference curve (CIC) were constructed to comprehensively verify the accuracy, differential ability, and clinical practicability of the neural network and nomogram. ResultsThe important risk factors for bone mineral density abnormalities were caffeine intake, carbohydrate consumption, body mass index (BMI), height, blood sodium, blood calcium, blood phosphorus, blood potassium, dietary fiber, vitamin D, participant age, weight, race, family history, and sex. The nomogram revealed that caffeine intake, carbohydrate consumption, blood potassium, and age were positively correlated with bone mineral density abnormalities, whereas BMI, height, blood phosphate, dietary fiber, and blood sodium were negatively correlated with bone mineral density abnormalities. Women were more prone to these abnormalities than men. The area under the ROC curve values of the neural network and nomogram were 85.8 % and 77.7 %, respectively. The Youden index was 58.04 % and 41.87 %, respectively. The detection sensitivity was 75.73 % and 65.06 %, respectively, and the specificity was 82.31 % and 76.81 %, respectively. Calibration curves of the neural network and nomogram showed better discrimination ability from the standard curve (P > 0.05). DCA and CIC analyses showed that the application of the neural network and nomogram to explore risk factors for bone mineral density abnormalities had certain clinical practicability, and the overall predictive effect of the model was good. ConclusionThe outcomes of the neural network and nomogram analyses suggested that diet structure and electrolyte changes are important significant risk factors for bone mineral density abnormalities, especially with increasing carbohydrate and caffeine intake and decreasing dietary fiber intake. The established model can also provide a reference for future risk prediction.