Electrolyte Management Research Articles

(Invited) Advances in PEM and Phosphoric Acid Fuel Cells

After a long and very successful industrial career spanning over 4 decades, Russ Kunz joined the University of Connecticut in 1992 and was one of the most passionate and influential voices in energy and energy systems at the university. Russ not only was the principle investigator of numerous research projects and awards, he was also instrumental in the formation of the Connecticut Global Fuel Cell Center – since renamed the Center for Clean Energy Engineering – which remains today one of the premier academic facilities in the United States focusing on fuel cell technology. During his over 20 years at UConn, Russ contributed to a wide range of projects and touched the lives of young faculty and countless students. During this talk, we will share stories about Russ’ life and career at UConn, as well as discuss specific projects and concepts in recent years where he was an integral partner in our team. We will also discuss his influence on what we continue to do today. More specifically, we will highly Russ’ contributions to electrolyte management in phosphoric acid fuel cells, and manipulation of physical and chemical properties in low temperature and high temperature PEM fuel cells. Figure 1

Perioperative management of the patient with diabetes requiring emergency surgery

Perioperative management of the patient with diabetes requiring emergency surgery

Fluid and Electrolyte Considerations for the Pediatric Surgical Patient

Fluid and electrolyte management is critical to successful care of neonatal and pediatric surgical patients. Although infants and toddlers in particular are clearly different from adults in their fluid requirements, recent literature supports a shift away from hypotonic intravenous fluids to isotonic fluids. The importance of glucose regulation and electrolyte management in the development of neonates has been established, and they are essential goals in the care of these patients. Specific surgical diseases included in this review are hypertrophic pyloric stenosis, gastrointestinal atresia and bowel obstructions, ileostomy management, and burns. Key words: electrolyte replacement; fluid and electrolytes; neonatal surgical critical care; oral rehydration; pediatric hypernatremia; pediatric hyponatremia; pediatric maintenance fluids; pediatric surgical critical care; pediatric total body water

Fluid and electrolyte management in renal disorders: Best practices in nephrology

Background: The kidneys play a vital role in maintaining fluid, electrolyte, and acid-base balance. Disruptions in these functions are seen in both acute kidney injury (AKI) and chronic kidney disease (CKD). Effective management of fluid and electrolytes is crucial for patient outcomes in renal disorders. Aim: This review article aims to consolidate best practices in fluid and electrolyte management for patients with renal disorders, focusing on acute and chronic conditions. Also, to assist the roles for healthcare providers. Methods: A comprehensive review of current literature and clinical guidelines was conducted to outline fluid and electrolyte management strategies. Key areas covered include fluid therapy, hydration assessment, and the use of different fluid types and administration routes. Results: The review highlights that individualized fluid therapy is essential for both AKI and CKD patients. Accurate assessment of hydration status is critical, with various methods discussed. Intravenous fluid administration is preferred in hospitalized patients, though alternatives like intraosseous and subcutaneous routes are also noted. Balanced polyionic solutions are recommended for initial resuscitation, while dextrose solutions are used for maintenance. The review also emphasizes the importance of cautious fluid administration to prevent overhydration and its associated risks.

Influence of process conditions on gas purity in alkaline water electrolysis

In this paper the influence of operating conditions on the product gas purity of a zero-gap alkaline water electrolyzer was examined. Precise knowledge of the resulting gas purity is of special importance to prevent safety shutdown when the electrolyzer is dynamically operated using a renewable energy source. The investigation in this study involves variation of temperature, electrolyte concentration and flow rate as well as different electrolyte management concepts. The experiments were carried out in a fully automated lab-scale electrolyzer with a 150 cm2 zero-gap cell and approximately 31 wt% KOH at ambient and balanced cathodic and anodic pressure. The purity of the evolved gases was measured via online gas chromatography. It can be seen from the experiments that a temperature increase and flow rate decrease reduces the gas impurity when mixing catholyte and anolyte. A further reduction of gas impurity can be achieved when both cycles are being separated and a dynamic cycling strategy is applied.

Electrolyte Management after Massive Intestinal Resection

Electrolyte Management after Massive Intestinal Resection

Association of Serum Creatinine and Electrolyte Abnormalities in Preterm Low Birth Weight Neonates

Introduction: Being born prematurely is a threat to survival and the subsequent quality of life ICDDR,B Health and Science Bulletin published in March 2006 reported that prematurity and low birth weight contributes to 27.8% of neonatal deaths in rural areas of Bangladesh Premature infant are at increased risk of developing dehydration or over hydration. Therefore, high index of suspicion, prompt recognition and thorough understanding of common electrolyte abnormalities are necessary to improve neonatal outcome. The investigation of renal function in pretenn neonate is complicated because of continuing renal development, rise in creatinine is transient and may not be clinically significcmt. Serum creatinine is most widely used marker of renal function in adults and children but its validity as a marker of GFR/ renal function is doubtful a few studies have been conducted on assessment of renal function and electrolytes in the context of prematurity in Bangladesh. But it seems to be essential for immediate management for planning appropriate fluid and electrolyte therapy and thereby for improved outcome. Information was collected who gave consent and participated in the study willingly. The sample size was 50. Duration of data collection was approximately 6 (Six) months.Patients admitted to the Holy Family Red Crescent Medical College and hospital and after meeting the inclusion and exclusion criteria a simple random sampling technique was applied for selecting the sample patients. Total 50 pretenn LBW neonates fulfilling the inclusion criteria were studied during this study period. Mean creatinine level was .82 mmoKrange was 0.40-1.90 mg/d1. Abnormal electrolytes were documented in 20(40%) pretenn LBW neonates of which hyperkalemia was the predominant electrolyte abnormality found in 8(16.0%) neonates, hyponatremia was found in 7 (14.0%), hypokalemia in 3 (6.0%) and hypernatremia 2 (4.0%). In the present study 20 of preterm LBW babies have electrolyte abnormalities. Hyperkalemia was found in 8(16.0%) babies in this study from above findings it is evident that prematurity causes transient renal impairment, in preterm neonates which is inversely related to gestational age. Renal impairment should be suspected if the serum creatinine rises or fails to show normal post-natal fall. It was observed that electrolyte abnormalities are common in preterm LBW neonates and transient renal failure also occurs in a large number of preterm LBW babies. So, identification of renal failure and associated electrolyte abnormalities and proper management of fluid and electrolytes and close monitoring are important.

Physical assessment of preoperative water electrolyte management in older people or acute hospital

Physical assessment of preoperative water electrolyte management in older people or acute hospital

Physical assessment of water electrolyte management in elderly person nursing facility

Physical assessment of water electrolyte management in elderly person nursing facility

A multifaceted intervention to reduce drug-related complications in surgical patients.

The P-REVIEW study was a prospective, multicenter, open intervention study, designed to determine whether a multifaceted intervention of educating the prescriber combined with medication review and pharmaceutical visits to the ward by the hospital pharmacist could lead to a reduction in drug-related complications among surgical patients. A total of 6780 admissions of 5940 patients to surgical, urological and orthopaedic wards during the usual care period and 6484 admissions of 5711 patients during the intervention period were included. An educational programme covering pain management, antithrombotics, fluid and electrolyte management, prescription in case of renal insufficiency and antibiotics was developed. National and local hospital guidelines were included. Hospital pharmacists performed medication safety consultations, combining medication review of high-risk patients and a visit to the physician on the ward. A significantly lower proportion of admissions with one or more clinically relevant, potentially preventable, drug-related problems (including death, temporary or sustained disability, increased length of hospital stay or readmission within 30 days) occurred in the intervention period (1.1% (73/6484) compared to the usual care period [1.6% (106/6780)] (P=0.029). The relative risk (RR) was 0.72 (95% CI 0.53-0.97). Several types of drug-related problems occurred less frequently. Costs incurred as result of time spent on study-related activities were not different before and after the intervention. The P-REVIEW study shows that education and support of the prescribing physician with respect to high-risk patients in surgical departments leads to a significant, clinically relevant benefit for patients without generating additional costs.

A high-performance aluminum-feed microfluidic fuel cell stack

Abstract In this paper, a six-cell microfluidic fuel cell (MFC) stack is demonstrated. Low-cost aluminum is fed directly to the stack, which produces hydrogen fuel on site, through the Al-H 2 O reaction. This design is not only cost-efficient, but also eliminates the need for hydrogen storage. Unlike the conventional MFC stacks which generally require complex electrolyte distribution and management, the present Al-feed MFC stack requires only a single electrolyte stream, flowing successively through individual cells, which is finally utilized for hydrogen generation. In this manner, the whole system is greatly simplified while the operational robustness is also improved. With 2 M sodium hydroxide solution as electrolyte and kitchen foil Al as fuel, the present six-cell stack (in series) exhibits an open circuit voltage of nearly 6 V and a peak power density of 180.6 mWcm −2 at room temperature. In addition, an energy density of 1 Whg −1 (Al) is achieved, which is quite high and comparable with its proton exchange membrane-based counterparts. Finally, pumpless operation of the present stack, together with its practical applications are successfully demonstrated, including lightening LED lights, driving an electric fan, and cell phone charging.

Pharmacists' guide to the management of organ donors after brain death.

This article reviews organ donor pathophysiology as it relates to medication use with the goal of maximizing the successful procurement and transplantation of donor organs. The number of patients requiring organ transplantation continues to grow, yet organ donation rates remain flat, making it critical to appropriately manage each organ donor in order to ensure viability of all transplantable organs. The care given to one organ donor is tantamount to the care of several transplant recipients. Aggressive donor management ensures that the largest number of organs can be successfully procured and improves the organs' overall quality. Hospital pharmacists are responsible for processing orders and preparing the medications outlined in donor management algorithms developed by their respective medical systems. It is important that pharmacists understand the details of the medications used in these protocols in order to critically evaluate each medication order and appropriately manage the donor. Typical medications used in organ donors after brain death include medications for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. It is essential to provide optimal pharmacotherapy for each organ donor to ensure organ recovery and donation. Typical medications used in organ donors include agents for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions.

APPLICATION OF PHARMACEUTICAL KNOWLEDGE TO THE UNCONVENTIONAL USE OF A RARELY USED ANAESTHETIC AGENT

Case summaryA 6 yr old 45 kg child with severe Cushinoid features was admitted to PICU with probable hypertensive encephalopathy. She presented with increasing headaches, vomiting and seizures becoming unresponsive...

Reciprocal Control of Drinking Behavior by Median Preoptic Neurons in Mice.

Stimulation of glutamatergic neurons in the subfornical organ drives drinking behavior, but the brain targets that mediate this response are not known. The densest target of subfornical axons is the anterior tip of the third ventricle, containing the median preoptic nucleus (MnPO) and organum vasculosum of the lamina terminalis (OVLT), a region that has also been implicated in fluid and electrolyte management. The neurochemical composition of this region is complex, containing both GABAergic and glutamatergic neurons, but the possible roles of these neurons in drinking responses have not been addressed. In mice, we show that optogenetic stimulation of glutamatergic neurons in MnPO/OVLT drives voracious water consumption, and that optogenetic stimulation of GABAergic neurons in the same region selectively reduces water consumption. Both populations of neurons have extensive projections to overlapping regions of the thalamus, hypothalamus, and hindbrain that are much more extensive than those from the subfornical organ, suggesting that the MnPO/OVLT serves as a key link in regulating drinking responses. Neurons in the median preoptic nucleus (MnPO) and organum vasculosum of the lamina terminalis (OVLT) are known to regulate fluid/electrolyte homeostasis, but few studies have examined this issue with an appreciation for the neurochemical heterogeneity of these nuclei. Using Cre-Lox genetic targeting of Channelrhodospin-2 in transgenic mice, we demonstrate that glutamate and GABA neurons in the MnPO/OVLT reciprocally regulate water consumption. Stimulating glutamatergic MnPO/OVLT neurons induced water consumption, whereas stimulating GABAergic MnPO neurons caused a sustained and specific reduction in water consumption in dehydrated mice, the latter highlighting a heretofore unappreciated role of GABAergic MnPO neurons in thirst regulation. These observations represent an important advance in our understanding of the neural circuits involved in the regulation of fluid/electrolyte homeostasis.

Slipping up on the sliding scale: fluid and electrolyte management in variable rate intravenous insulin infusions

AbstractThis study aimed to analyse variations in intravenous fluid therapy and electrolyte management with variable rate intravenous insulin infusions (VRIIIs); and to quantify serum electrolyte changes pre‐ versus post‐VRIII and variations therein depending on supplemented fluid electrolyte compositions.A retrospective study was undertaken involving 174 VRIIIs prescribed over a 10‐week period at a tertiary teaching hospital. Each VRIII had their associated fluid prescription and serum electrolytes analysed.The results showed that 5% dextrose (46%) and 0.9% NaCl (34%) were the most commonly prescribed fluids; 64% of fluids did not have the recommended potassium supplementation. Administration of a VRIII resulted in a significant drop in serum potassium levels (p < 0.0001) for those who did not receive supplementation. There was no drop in serum potassium for those patients who did receive supplemental potassium. Eleven patients (6.4%) developed new‐onset hypokalaemia (K ≤3.5 mmol/L) after implementation of a VRIII.Our study supports the hypothesis that VRIIIs cause hypokalaemia and that this can be averted by supplemental potassium, thus preventing potentially avoidable hypokalaemic complications. A large variation exists in prescribing fluids with VRIIIs. Introduction of the national surgical and medical VRIII guidelines, together with improved availability to recommended fluids, and a quality improvement project, are our next steps to improve patient outcomes. Copyright © 2016 John Wiley & Sons.

Diabetic Ketoacidosis in the Obstetric Population: A Simulation Scenario for Anesthesia Providers

Abstract Introduction This simulation on diabetic ketoacidosis (DKA) in the obstetric population presents learners with one of the more commonly encountered etiologies of critical illness in the pr...

0.9% saline is neither normal nor physiological.

The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline (henceforth: saline) and to discuss the impact of saline infusion, specifically on systemic acid-base balance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume (>2 L) saline infusion in healthy adults induces hyperchloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload (80 ml/kg) in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger (NHE) and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemodynamics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising O2 delivery to the renal parenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, increases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastrointestinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.

Dizziness systemic metabolic disorders

Auditory and vestibular symptoms and signs are common in patients with diabetes mellitus. Although it has been suggested that auditory and vestibular dysfunctions occur in the prediabetic state,as with the retinal and renal changes. The single most important aspect in preventing auditory and vestibular dysfunctions in patients with uraemia is to avoid the use of potential ototoxic drugs. Careful management of electrolytes in patients undergoing chronic renal dialysis will prevent fluctuating auditory and vestibular symptoms. The bilateral sensorineural hearing loss associated with acquired hypothyroidism improves in a small percentage of patients after thyroid hormone replacement.

Venetoclax (ABT-199/GDC-0199) Monotherapy Induces Deep Remissions, Including Complete Remission and Undetectable MRD, in Ultra-High Risk Relapsed/Refractory Chronic Lymphocytic Leukemia with 17p Deletion: Results of the Pivotal International Phase 2 Study

Venetoclax (ABT-199/GDC-0199) Monotherapy Induces Deep Remissions, Including Complete Remission and Undetectable MRD, in Ultra-High Risk Relapsed/Refractory Chronic Lymphocytic Leukemia with 17p Deletion: Results of the Pivotal International Phase 2 Study

Providing nursing care to Ebola virus disease patients: China Ebola Treatment Unit experience.

Providing nursing care to Ebola virus disease patients: China Ebola Treatment Unit experience.