Electrolyte Supplementation Research Articles

Gitelman Syndrome in a 37-Years Old Woman with Urinary Tract Syndrome and History of Caesarean Section: A Case Report

Gitelman Syndrome (GS) is a rare genetic disorder often underdiagnosed due to its non-specific symptoms that can appear from neonatal stages to adulthood. It is more frequently observed in Asians, with a prevalence of approximately 1 in 40,000 people. Accurate diagnosis requires a comprehensive clinical interview and laboratory examinations. This report presents the case of a 37-year-old woman with GS who also experienced a urinary tract infection and had a history of cesarean section. Upon admission, she reported feeling fatigued and weak in all extremities. She had undergone a cesarean section a month prior due to pre-eclampsia. Initial laboratory tests revealed hypokalaemia, hyponatremia, and hypochloraemia. Further evaluation during hospitalization detected a urinary tract infection, hypocalciuria, and hypomagnesemia. The patient also suffered from carpopedal spasms and muscle cramps. Treatment included magnesium sulfate, calcium gluconate, potassium chloride, and sodium chloride infusions to restore electrolyte balance. The patient was discharged after six days, with a diagnosis of Gitelman Syndrome, which was unusual given her late onset of symptoms, as most cases are identified in childhood. The clinical presentation was largely driven by the patient’s electrolyte imbalances, especially hypokalaemia and hypomagnesemia, with hypomagnesemia further contributing to hypocalcemia and vitamin D deficiency. The patient’s symptoms improved after appropriate electrolyte supplementation. This case emphasizes the importance of a detailed clinical history and laboratory assessments in diagnosing GS, along with timely correction of electrolyte disturbances to improve the patient’s condition and prevent complications.

Strategies, challenges, and outcomes of heat stress resilience in sub-Saharan African community-based cattle feedlots: a systematic review.

In sub-Saharan Africa, cattle feedlots face a significant challenge in dealing with heat stress. However, there is a lack of inclusive strategies for resilience in these situations. The aim of this systematic review is to investigate the strategies, challenges, and outcomes related to heat stress resilience in community-based cattle feedlots in sub-Saharan Africa. The PRISMA approach, which is a method for reporting systematic reviews and meta-analyses, was used to identify, screen, and analyze 30 peer-reviewed articles published over the last 20 years from Google Scholar and Scopus. The review found that key strategies to mitigate heat stress include providing shade through natural and artificial means, ensuring constant access to cool, clean water using water spraying systems and cooling ponds, and implementing nutritional adjustments such as high-energy feeds and electrolyte supplements. Additionally, genetic selection for heat-tolerant breeds and management practices like adjusting feeding times and improving ventilation were found to be effective in dealing with heat stress. In particular, local germplasm and genetic traits of cattle in sub-Saharan Africa play a crucial role in heat stress resilience. Indigenous breeds, which have adapted to the region's harsh climate over centuries, exhibit traits such as higher heat tolerance, better water-use efficiency, and improved feed conversion rates under heat stress conditions. This genetic resilience can be enhanced through targeted breeding programs aimed at amplifying these beneficial traits. Implementing these strategies resulted in improved cattle health and productivity, as evidenced by enhanced weight gain, better reproductive performance, and lower mortality rates. The socio-economic benefits of these strategies included reduced economic losses and increased farmer incomes, which in turn contributed to improved community health and nutrition. However, the review also identified significant challenges, including financial constraints, limited access to knowledge and training, and cultural resistance. To address these barriers, the review recommends increased investment in affordable cooling technologies, farmer education, and community-based initiatives. Additionally, leveraging the genetic strengths of local cattle breeds should be prioritized to maximize the effectiveness of heat stress resilience strategies.

Feed additives supplementation: a potential strategy to ameliorate heat stress in sheep

Abstract Given a significant climate-flexible and socio-economic role in developing nations, environmental heat stress imposes a major financial impact on sheep production systems globally endangering their production, reproduction, and growth. In this regard, the adverse effects of heat stress on sheep production systems have to be addressed through adoption of effective heat alleviation measures like animal management, nutritional management and genetic interventions of which the nutritional interventions seems to be the most cost effective way to alleviate heat stress. Nutritional manipulation for heat stress alleviation in sheep involves the use of antioxidant supplements (Vitamin B; Vitamin E and Selenium; Selenium; Zinc sulphate and folic acid; Vitamin C, Vitamin E, Selenium and Zinc; Naringin; Opuntia ficus-indica f. inermis; Açai oil and Brown seaweed like Ascophyllum nodosum and Sargassum latifolium). Further, electrolyte supplements (Dietary Electrolyte Balance (DEB); Sodium bicarbonate and potassium bicarbonate; Sodium hydroxide) have a beneficial effect on thermal responses, respiratory activities, gas exchange parameters, rumen fermentation, blood buffering capacity and acid-base balance. The mineral mixture supplements (Mineral blocks; Mineral mixture and antioxidants; Chromium; Zinc) play a crucial role in increasing the efficiency of antioxidant defence system, immunity-related parameters, production, reproduction, feed digestibility and insulin sensitivity. Probiotic supplements (Lactobacillus acidophilus, Saccharomyces cervisiae, Propionibacterium freudenreichii, Lactobacillus casei, Enterococcus faecium, Lactobacillus lactis, Bacillus subtilis, Propionibacterium freudenreichii, Pediococcus cerevisiae, Megaspha eraelsdenii, Bacillus licheniformis, Aspergillus oryzae, Schizochytrium limacinum, Trichoderma reesei and Saccharomyces cerevisiae) improve lactational performance, dietary energy utilization and productivity. The probiotics (live Saccharomyces cerevisiae) and prebiotics (mannan oligosaccharide plus b-glucans) used in heat stress alleviation improve dietary energy utilisation. Furthermore, the vital role of herbal supplements (Rosemary, Cinnamon, Turmeric, Clove, Naringin, Chestnut tannins, Giloy stem powder, Curcumin, Rocket oil (watercress oil), Flaxseed, Cornus, Oregano, Thyme, Chamomile flowers, Moringa oleifera, Betaine) has been highlighted to promote feed intake, antioxidant status, growth performance, feed utilization, reproductive performance and immune response. Effective adoption of nutritional strategies can thus ensure sustainable sheep production in this changing climate scenario.

Intermittent micafungin dosing schedule in pediatric oncology patients ‐ safe for outpatient parenteral antimicrobial therapy?

IntroductionAntifungal prophylaxis is an important preventative strategy for high-risk pediatric oncology patients. When triazoles are contraindicated, micafungin is an alternative to polyenes, due to improved tolerability and limited drug-drug interactions. An intermittent dosing schedule is advantageous for outpatient parenteral antimicrobial therapy (OPAT), but studies assessing safety in pediatric patients are limited. MethodsThis single-centre, retrospective, observational study compared the safety and tolerability of daily (1 mg/kg) and intermittent (3 mg/kg) dosing of amphotericin B liposomal (AmB) and micafungin in children under 18 years, with high-risk leukemia. ResultsOf 51 patients, with 76 individual dosing schedules, hepatoxicity and nephrotoxicity were comparable across all four dosing schedules. Severity of hypokalemia was significantly higher amongst patients receiving AmB (p = 0.041), with higher rates of intravenous electrolyte supplementation required. Infusion-related reactions occurred only in the AmB group (22 %). Intermittent administration and dosing of micafungin was well tolerated, with similar effects on liver function and reduced rates of hypokalemia. ConclusionThis study supports the positive safety profile of intermittent micafungin compared with AmB and describes successful OPAT implementation. Prospective studies assessing efficacy are needed to validate these findings.

Chinese expert consensus on the application of electrolytes in parenteral nutrition (2024 edition)

As essential nutrients for human beings, electrolytes play a central role in nutritional and metabolic support treatment. To further standardize the use of electrolyte preparations in parenteral nutrition, the China International Exchange and Promotive Association for Medical and Health Care Clinical Nutrition Health Branch, Chinese Medical Doctor Association Nutritionist Professional Committee, Chinese Society of Parenteral and Enteral Nutrition, and Chinese Nutrition Society Branch of Clinical Nutrition, invited authoritative experts in the fields of critical medicine, emergency medicine, internal medicine, surgery, and pharmacology in China to create this expert consensus. This consensus was based on the latest guidelines and evidence-based medicine at home and abroad, and combined with the actual clinical medical environment in China. This consensus covered the following topics: electrolytes monitoring during parenteral nutrition, risk assessment and nutritional treatment of refeeding syndrome, electrolytes supplementation during parenteral nutrition for various diseases (including severe diseases, heart failure, post-surgical short bowel syndrome, perioperative period, trauma, diabetic foot, chronic kidney disease, liver disease, neonates), and the compatibility principles of electrolyte preparations in parenteral nutrition. Finally, 13 clinical questions and 26 recommendations were proposed aiming at providing scientific, standardized, and practical guidance for the rational application of electrolytes in parenteral nutrition.

The sodium correction factor for dogs undergoing treatment for a hyperglycemic crisis is a 1.6-mEq/L decrease in sodium per 100-mg/dL increase in glucose.

To determine the sodium correction factor for clinical use in hyperglycemic diabetic dogs. Retrospective analysis of 76 hospitalization episodes from 67 different dogs presenting to the University of Georgia Veterinary Teaching Hospital between January 1, 2015, and January 1, 2023. For each hospitalization episode, paired blood sodium and glucose concentration measurements were recorded from the time of presentation until glucose concentration was ≤ 201 mg/dL. Therapies administered, primary diagnosis, and concurrent diseases were also recorded for each episode. A linear mixed model was used to determine the sodium correction factor per 100-mg/dL increase in glucose. Piecewise linear mixed models were also constructed for blood glucose measurements ≤ 400 mg/dL and > 400 mg/dL to explore potential correction factor differences between low and high glucose concentrations. A sodium correction factor of a 1.6-mEq/L (95% CI, 1.3 to 1.9 mEq/L) decrease in sodium concentration per 100-mg/dL increase in blood glucose concentration was calculated. Differences in the correction factor between conditions of low and high glucose concentrations could not be determined due to a small sample size of blood glucose values > 400 mg/dL. Most dogs received similar treatments throughout the study period, including balanced isotonic crystalloids (97% [74/76]), electrolyte supplementation (84% [64/76]), and regular insulin (97% [74/76]). Almost all patients (93% [71/76]) had 1 or more concurrent diseases. A sodium correction factor of 1.6 mEq/L (decrease in sodium per 100-mg/dL increase in glucose) is recommended for clinical use in hyperglycemic diabetic dogs.

An International Survey of the Management of Atrial Fibrillation in Critically Unwell Patients.

To evaluate the current management of new-onset atrial fibrillation and compare differences in practice regionally. Cross-sectional survey. United States, Canada, United Kingdom, Europe, Australia, and New Zealand. Critical care attending physicians/consultants and fellows. None. A total of 386 surveys were included in our analysis. Rate control was the preferred treatment approach for hemodynamically stable patients (69.1%), and amiodarone was the most used antiarrhythmic medication (70.9%). For hemodynamically unstable patients, a strategy of electrolyte supplementation and antiarrhythmic therapy was most common (54.7%). Physicians responding to the survey distributed by the Society of Critical Care Medicine were more likely to prescribe beta-blockers as a first-line antiarrhythmic medication (38.4%), use more transthoracic echocardiography than respondents from other regions (82.4%), and more likely to refer patients who survive their ICU stay for cardiology follow-up if they had new-onset atrial fibrillation (57.2%). The majority of survey respondents (83.0%) were interested in participating in future studies of atrial fibrillation in critically ill patients. Significant variation exists in the management of new-onset atrial fibrillation in critically ill patients, as well as geographic variation. Further research is necessary to inform guidelines in this population and establish if differences in practice impact long-term outcomes.

Fatal coinfection of blastocystosis and intestinal trichomoniasis in a rhesus macaque (Macaca mulatta).

A 3-year-old male rhesus macaque was presented at Referral Veterinary Polyclinic-Teaching Veterinary Clinical Complex, with a chief complaint of chronic diarrhoea and swelling of dependent body parts. The patient's history indicates that the monkey had been experiencing diarrhoea for the past month, with 2-3 episodes of vomiting in the last 2days. Additionally, oedema has developed within the last 2weeks. The clinical examination findings revealed dullness and depression, the mucus membrane appeared pale, with a temperature-102.1°F, a respiration rate-28/min, and a heart rate-92/min. The capillary refill time was 4s. During the physical examination, the animal exhibited oedema on the dependent part of the body and faecal staining around the perineum along with loose yellow stool. Direct saline and iodine mount faecal smear examination revealed the presence of many motile pear-shaped flagellated protozoa and round vacuolated Blastocystis organisms. Giemsa-stained faecal smear cytology confirmed the presence of Pentatrichomonas sp. and Blastocystis sp. along with many microbes. The faecal culture was negative for all pathogenic microbes. The case was diagnosed as co-infection Blastocystosis and intestinal trichomoniasis. The treatment was initiated with a combination of sulfamethoxazole + trimethoprim @ 35mg/kg body weight and metronidazole @25mg/kg administered orally once daily for 7days. Supportive therapy includes hematinic injection (iron sorbitol, folic acid and vitamin B12) @ 1ml total dose, administered intramuscularly on alternate days for four occasions as well as intravenous infusion of crystalline amino acid @ 5ml total dose on alternate days for four occasions. To manage vomition, injection ondansetron was administered@0.5mg/kg intramuscularly, twice daily for 3days and H2 blockers, including injection ranitidine@2mg/kg intramuscularly twice daily for 3days. Electrolyte and probiotic supplementation were administered orally. After 7days of therapy, the oedema had significantly improved and episodes of vomition were stopped but there was no significant improvement in the episode of diarrhoea and consistency of faeces. Unfortunately, on the 10th day of therapy, the animal suddenly collapsed. Understanding the virulence pattern of opportunistic protozoa in primates is crucial, and identifying suitable therapeutic candidates to prevent fatal outcomes is the need of the hour, especially considering protozoal infections as an important differential diagnosis in gastrointestinal tract-related ailments. Our study successfully demonstrated the co-occurrence of blastocystosis and intestinal trichomoniasis, both uncommon infections with potential zoonotic implications.

Oral electrolyte supplementation and prevention of dehydration in horses

Dehydration is common in equine disciplines and can be avoided by effective oral rehydration strategies. Thermoregulatory loss of heat in horses requires sweating which, in turn, can result in considerable loss of water and electrolytes. Maintenance of hydration and prevention of dehydration requires the continuous replacement of lost electrolytes and water. The stomach and small intestine can function as reservoirs to facilitate the uptake of water and electrolytes consumed 1–2 hours prior to competitions, training and transport. Ions and water are rapidly absorbed in the small intestine and taken up by muscles and the skin, where they serve to replace losses resulting from muscle contraction and sweating. An effective electrolyte supplement replaces electrolytes in the proportion that they are lost through sweating; failure to do this results in an electrolyte imbalance. Electrolyte solution osmolality must be maintained at less than that of bodily fluids to promote gastric emptying and intestinal absorption. Palatability of the electrolyte supplement should be high, and horses should be trained to drink the solution voluntarily before any dehydrating event to try to prevent dehydration from occurring.

Use of electrolyte and betaine water supplementation to support improved liveweight gain of commercial Pekin ducks exposed to adverse high temperature in the week prior to processing

Context Commercial Pekin Ducks housed in conventional open-sided sheds often experience heat stress in summer. Electrolyte or osmolyte supplements can help birds cope under heat stress. Aims To assess the effects of water electrolyte/betaine supplementation or betaine in feed on the growth performance of Pekin ducks exposed to high ambient temperature. Methods Commercial Cherry Valley Pekin ducks were fed diets with a dietary electrolyte balance (DEB) of 160 (L-DEB) or 209 (H-DEB) over Days 15–41 (D15–41) of age. Over D36–41, ducks were provided with water alone or supplemented with betaine in the feed (BF), or betaine and an ‘in-house’ electrolyte (E) formulation at 50%, 100% or 150% (D36–41) or at 100% for only 36 h on D40–41. There were 12 treatments with four replicate pens for each treatment. On D36–41 of age, temperature was increased to 28–32°C for 9 h (from 08:30 hours to 17:30 hours) and then returned to 22–24°C for the remainder of the day. Individual liveweights were taken on D28, D35, D41. During these times, feed intake and water consumption were determined. On D41, one male and one female from each pen were weighed, euthanised and breast muscle was removed and weighed. Birds were collected for commercial processing at 04:00 hours on D42. Key results Over D15–35, the DEB had no effect on bird performance. Over D36–41, for liveweight gain (LWG) there were significant interactions between treatment × week (P < 0.001) and treatment × diet (P = 0.017). Supplements E150 and E100 + 36 h supported LWG more than did other treatments, while treatments BF, E50 and E100 supported higher LWG than in controls. On the L-DEB diet, the control birds had a LWG lower than in other treatments (P < 0.05). On the H-DEB diet, the E50 supplement had highest LWG, but comparable to that in E100 + 36 h. The supplements had no effects on breast muscle yield, weight losses during transport and lairage or processed carcass weights. Conclusions The electrolyte supplements supported higher LWG during exposure to moderately adverse high temperature. Supply for 36 h supported LWG equivalent or better than did other treatments given over 6 days. The benefits could be related to increased water intake and not just electrolyte supply. Implications Water electrolyte plus betaine supplementation supports improved Pekin duck performance during a moderately high temperature challenge.

Effects of electrolyte supplementation on performance and physiological responses of preconditioning beef calves.

The objective of this study was to evaluate the effects of electrolyte solution supplementation on the performance and physiological responses of beef calves during a 45-d preconditioning phase. Forty Angus × Hereford steers (230.4 ± 4.8kg body weight [BW]) were sorted into 20 pens (2 steers/pen) following weaning (day 0). Treatments were randomly assigned to pens: (1) control: access to water only and (2) electrolyte: access to water and electrolyte solution supplementation (10% of total daily water intake) from days 1 to 14. Calf BW and blood samples were collected on days 0, 1, 3, 7, 14, 21, and 44 of the study. Blood samples were analyzed for sodium, potassium, albumin, haptoglobin, ceruloplasmin, and cortisol. All variables were analyzed using the MIXED procedure of SAS. Electrolyte solution consumption was estimated at 0.70kg/calf daily (SEM ± 0.21). Calves assigned to the Electrolyte treatment had greater water and total liquid intake than control (P < 0.05). No effects of treatment were observed on ADG or BW (P > 0.05). Effects of day (P < 0.004), but not treatment or treatment × day were observed for sodium, potassium, albumin, cortisol, ceruloplasmin, and haptoglobin. Electrolyte solution supplementation during the preconditioning period did not improve performance nor influenced stress-related markers, however improved liquid intake.

Hydration Methods for Cisplatin Containing Chemotherapy: A Systematic Review.

Cisplatin-induced nephrotoxicity (CIN) can be prevented by fluid hydration, electrolyte supplementation, or forced diuresis; however, the best way to prevent CIN is still unknown. The aim of this study was to provide objective evidence on the optimal design of hydration schemes to prevent CIN based on an update of the literature. A Pubmed and Embase search were conducted in December 2021 and repeated in April 2022 and March 2023. Two independent reviewers screened the articles. The included articles were categorized and reviewed per category. Twenty-seven articles met the inclusion criteria. The included studies varied widely. Four out of seven studies investigating diuretics found a protective effect of adding mannitol to the hydration scheme. All six studies investigating duration and amount of volume of hydration found that a short-hydration scheme resulted in less CIN than a longer hydration scheme. Seven out of nine articles evaluating the role of electrolytes found that magnesium supplementation reduced the risk of nephrotoxicity. Three studies investigated the safety of oral hydration and concluded that nephrotoxicity did not occur more frequently after oral hydration. The hydration scheme of cisplatin should be short and consist of a relatively small amount of volume. The scheme should include mannitol and magnesium supplementation. Head-to-head studies are needed to investigate the safety of furosemide compared with mannitol and the dose of mannitol and magnesium.

Multi-electrolyte disturbance and supplementation in severely malnourished hospitalized adolescents with restrictive eating disorders

BackgroundThis study describes the prevalence of hypophosphatemia, hypokalemia, and/or hypomagnesemia and resulting electrolyte supplementation during refeeding in severely malnourished youths hospitalized for restrictive eating disorders.MethodsHospitalized patients between 11-26y (N = 81) at < 75% treatment goal weight (TGW) were assessed through retrospective chart review. Outcomes were compared between participants < 70% TGW and those 70–75% TGW. Nutritional rehabilitation started at 1750 kcals/day and advanced by 500 kcal every other day until target intake was achieved. Associations between %TGW on admission; hypophosphatemia, hypokalemia, and/or hypomagnesemia; and electrolyte supplementation were examined.ResultsOf the 24 (29.6%) participants with hypophosphatemia, hypokalemia, and/or hypomagnesemia, 7 (8.6%) received supplementation; the remainder corrected without supplementation. Participants < 70% TGW did not differ from those 70–75% TGW on rates of these conditions or need for supplementation.ConclusionsHospital-based nutritional rehabilitation did not confer increased rates of hypophosphatemia, hypokalemia, and/or hypomagnesemia or need for electrolyte supplementation in patients < 70% TGW compared to those 70–75% TGW. While additional research is needed to establish clinical practice guidelines on electrolyte management in this population, our findings suggest that nutritional rehabilitation may be reasonably undertaken without prophylactic electrolyte supplementation, even in patients < 70% TGW.

Group A Streptococcus Infection in Neonatal Population: A Systematic Review of The Literature.

(1) Background: The importance of group A streptococcus (GAS) infection severity has been recognized in children and adults. However, to our knowledge, there have been no systematic reviews or pooled assessments of the incidence and outcome of invasive GAS (iGAS) disease in neonates, a potentially high-risk population. Therefore, we performed a systematic review of available data regarding the risk factors, clinical presentation, and outcome of GAS infection in neonates. (2) Methods: An electronic search of the existing literature was carried out during the period July 2023-September 2023 in the PubMed and Scopus databases, considering studies referring to GAS infection in the neonatal population. (3) Results: Overall, 39 studies met all the inclusion criteria and were included in this review, evaluating data from 194 neonates. Unfortunately, there were a lot of missing data among the retrieved studies. Our systematic review highlighted the presence of differences with regards to clinical presentation, infection sites, and outcome of GAS invasive disease between neonates with early-onset (EOS) or late-onset sepsis (LOS). Common characteristics of EOS included respiratory distress, rapid deterioration, and high mortality rate irrespective of the infection site, while rash, gastrointestinal tract symptoms, and fever appeared to be the most frequent symptoms/clinical signs and manifestations of LOS disease. The management of severe invasive iGAS disease consists mainly of specific antimicrobial treatment as well as supportive care with fluids and electrolyte supplementation, minimizing or counteracting the effects of toxins. Furthermore, a mortality rate of approximately 14% was recorded for iGAS disease in the total of all studies' neonates. (4) Conclusions: Although iGAS is a rare entity of neonatal infections, the potential severity of the disease and the rapid deterioration requires the development of quick analysis methods for the detection of GAS allowing the prompt diagnosis and administration of the indicated antibiotic treatment. Furthermore, given the exceptional risk for both the pregnant woman and the neonate, it is very important to raise awareness and create easily accessible guidelines that could facilitate the prevention and management of maternal as well as the subsequent neonatal severe iGAS disease.

PSVII-26 Effects of an Electrolyte Drinking Solution on Performance and Physiological Responses of Preconditioning Beef Calves

Abstract Weaning and transport are the major stressor events for beef cattle production. Strategies to mitigate weaning stress responses and promote quick recovery of homeostasis are always warranted to improve welfare and productivity of beef cattle. This study evaluated the effects of an electrolyte drinking solution on the performance and physiological responses of pre-conditioning beef calves. Forty Angus × Hereford steers [230.4 ± 4.8 kg body weight (BW), 195 ± 30 days of age] were sorted into 20 pens (2 calves/pen) immediately after weaning for a 45-d preconditioning period. Pens were randomly assigned to two treatments: 1) control: water; and 2) electrolyte solution: water and electrolyte drinking solution on one additional trough per pen. A total of 10% of the estimated daily water intake of calves was fortified with the electrolyte solution on the ratio of 31.6 g/L of water. The electrolyte composition contained calcium, phosphorus, salt, magnesium, potassium, and a mix of carbohydrates. Treatments were provided from d 1 to 14, and thereafter electrolyte supplementation was ceased. Assigning weaning as day 0, calf BW was recorded and blood samples were collected via jugular vein puncture into commercial heparinized vacuum tubes on d 0, 1, 3, 7, 14, 21, 44 of the experiment. Plasma samples were analyzed for haptoglobin, ceruloplasmin and cortisol. Variables were analyzed considering pen as the experimental unit and pen(treatment) as a random effect. Blood parameters were evaluated as repeated measurements and effects of treatment, day, and treatment and day interaction were analyzed with the MIXED procedure of SAS. Significance was set at P ≤ 0.05. Calves consumed 700 mL of electrolyte solution daily which consisted of 20% of the offered. No effects (P = 0.61) were observed on ADG (0.82 kg, SEM: 0.050) or final BW (P = 0.81; 267 kg SEM: 5.36). No differences in cortisol (P = 0.64; 2.30 ng/mL SEM: 0.147), ceruloplasmin (P = 0.29; 26.9 mg/mL SEM: 0.659) and haptoglobin (P = 0.57; 0.64 µg/mL SEM: 0.029) concentrations were observed. Electrolyte solution supplementation during preconditioning did not improve performance or influenced acute response markers of beef calves.

Phosphorus Disruption Is Associated with the Incidence and Severity of Neurotoxicity Symptoms in CD19-Targeted CAR-T Cell Therapy: A Pooled Clinical Trial Analysis

Background Hypophosphatemia due to increased cell metabolic activity as seen in refeeding syndrome and sepsis, has a similar neurologic presentation to immune effector cell-associated neurotoxicity syndrome (ICANS), an associated risk of CAR-T cell therapy. CAR-T patients who develop ICANS are observed to have a higher incidence and more severe degrees of hypophosphatemia (Tang et al, 2022). We further explored the association of hypophosphatemia and other electrolyte disturbances with ICANS incidence across pooled CAR-T clinical trial patients to assess how serum electrolytes correlated with risk of ICANS. Methods We analyzed 593 patients with relapsed/refractory B-cell acute lymphoblastic leukemia or non Hodgkin's lymphoma, with ICANS (n=325), and without ICANS (n=268) treated with CD19-targeted CAR-T cell therapy across pooled clinical trial data from the Medidata Enterprise Data Store. Patients were grouped by ICANS status. A Fisher exact test was performed for categorical variables. A Mann-Whitney was performed for numerical variables. Variables of interest were baseline patients characteristics (age, gender, indication) and ICANS status. Common lab values investigated were nadir values and time to nadir for phosphate (Phos), magnesium (Mg), calcium (Ca), and potassium (K), peak value for C-reactive protein (CRP), and creatinine (Cr) at the time of infusion. To assign a hypo- phosphatemia, -kalemia, -magnesemia and -calcemia status to each patient, we used thresholds of &amp;lt;2 mg/dL, 3.5 mmol/L, 1.5 mg/dL and 2.0 mmol/L respectively. We performed a univariable logistic regression with ICANS status as the outcome variable and the following: Baseline value at infusion for Mg, K, Phos, Ca, CrNadir values between day 0 and 14 for Mg, K, Phos, Ca, CrSlope (between baseline and nadir) for Mg, K, Phos, Ca, CrPeak CRP, Cr and Urate between day 0 and 14 The odds ratios were calculated. Kaplan Meier curves were plotted. The log rank test was performed for time to event of ICANS, grouped by hypo- phosphatemia, -kalemia, -magnesemia and -calcemia status. We performed an analysis on the effect of the preemptive use of electrolyte replacement. We defined preemptive use as any electrolyte replacement given to patients either before the occurrence of ICANS or if patients did not get ICANS. For those with hypophosphatemia, we examined the preemptive use of electrolyte replacements for any electrolyte excluding Phos and any electrolyte with Phos. For those 2 groups we compared the rates of ICANS. Results CRS, and hypo- phosphatemia, -kalemia, -magnesemia and -calcemia status were statistically significantly different between ICANS and no ICANS groups. When looking at the nadir values, these 4 electrolyte disturbances were also statistically significant, with lower values associated with ICANS. For the time to nadir, only K was significant and higher for the ICANS group. Peak CRP was also higher for patients with ICANS, but did not meet the 0.05 threshold to be statistically significant. For the univariate logistic regression, variables positively associated with ICANS and significant were peak values for creatinine and CRP, OR of 3.8 (1.6-9.2) and 2.1 (0.9 - 5.0) respectively. Variables negatively associated with ICANS and significant were nadir values for Phos (OR 0.3 (0.1 - 0.8)), K (OR 0.2 (0.1-0.7)), Ca (OR 0.2 (0.1-0.6)), Mg (OR 0.17(0.1-0.5)) and urate (0.3(0.1-1)), and slope for Mg (OR 0.0 (0.0-0.2)). When plotting the Kaplan Meier curves, ICANS seems to develop sooner for patients with either hypo- phosphatemia, -kalemia, -magnesemia or -calcemia and the log rank test showed to be statistically significant (Figure 1). Among the patients with hypophosphatemia, the use of Phos as part of electrolyte replacement reduces the ICANS rate: 52% (0.39-0.65) versus 71% (0.58-0.84) for the electrolyte replacement without Phos. Conclusion Our data demonstrate that ICANS incidence is associated with disruptions in serum phosphorus levels, and that supplementation of phosphorus is able to mitigate the incidence of ICANS as well. Monitoring phosphorus may serve as a useful biomarker for ICANS, while goal directed phosphorus supplementation may serve as an inexpensive and readily available means to treat or prevent ICANS. Prospective studies with goal-directed phosphorus repletion are necessary to further study the therapeutic impact of electrolyte supplementation on ICANS incidence and severity.

Alcoholic ketoacidosis evaluated with a point-of-care capillary beta-hydroxybutyrate measurement device.

The diagnosis of alcoholic ketoacidosis (AKA) has traditionally been made based only on clinical history and the presence of severe metabolic acidosis with a high anion gap (AG); however, the concentration of beta-hydroxybutyrate (BOHB), a pivotal ketone body in AKA, is not evaluated in most cases. The aim of this study was to clarify the clinical spectrum of AKA in terms of the severity of ketoacidosis by using a point-of-care capillary BOHB measurement device. This retrospective case series was conducted at a Japanese private teaching hospital. Patients with suspected AKA, based on their clinical history, who underwent BOHB measurement using a point-of-care capillary measurement device in the emergency department, were included. Data on their clinical presentations, blood tests, and treatments were collected, described, and compared between patients with a BOHB concentration higher than 3.0mmol/L (H-BOHB) and those with a concentration less than 3.0mmol/L (L-BOHB). A total of 83 patients were included in this study. Sixty-eight patients were categorized as having H-BOHB and 15 as having L-BOHB. Nausea (71%), vomiting (71%), tachycardia (76%), and tachypnea (46%) were commonly observed at presentation. Hyponatremia (46%), hypokalemia (34%), hypomagnesemia (42%), and hyperphosphatemia (41%) were frequent electrolyte abnormalities upon presentation. Rehydration with balanced crystalloids and glucose-containing intravenous fluids, electrolyte supplementation, and thiamine replacement were the major treatments. The mean length of stay in the ICU and hospital were 4.4 and 7.0 days, respectively, with low overall mortality (1%). The H-BOHB and L-BOHB groups did not differ in terms of clinical data. Seventy percent of patients with L-BOHB had severe metabolic acidosis with a high AG due to hyperlactatemia (mean lactate concentration: 8.5mmol/L). We described the clinical features of AKA measured by using a point-of-care capillary BOHB measurement device. Although certain patients diagnosed with AKA based only on their clinical history had predominant lactic acidosis with minor elevations in BOHB concentration, the BOHB concentration had no effect on the clinical spectrum of AKA in this study.

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.

The effects of feeding sodium chloride pellets on the gastric mucosa, acid-base, and mineral status in exercising horses.

Electrolyte supplementation may be a risk factor for gastric mucosal lesions, but relevant evidence is limited in horses. Investigate the effects of PO sodium chloride (NaCl) supplementation on the gastric mucosa of exercising horses. We hypothesized that NaCl supplementation would neither cause nor exacerbate existing gastric mucosal damage. Fifteen 3-year-old healthy Warmblood stallions from a stud farm. Placebo-controlled study with a crossover design. Horses were fed either a NaCl pellet at a dosage adequate to replace the electrolyte losses in 10 L sweat or a placebo for 19 days with a washout period of 14 days between treatments. The gastric mucosa was evaluated by gastroscopy before and after treatment. Blood samples were collected for evaluation of acid-base status, packed cell volume (PCV), and total protein, creatinine and blood urea nitrogen concentrations. Urine was collected, and urine specific gravity, electrolyte, creatinine, and urea concentrations were measured. The initial prevalence of gastric mucosal lesions was 85%. Sodium chloride pellets did not adversely affect the gastric mucosa and treatment did not significantly alter the hematologic and serum biochemical variables. Urine creatinine concentrations significantly decreased and urinary sodium concentrations significantly increased after supplementation with NaCl pellets. Water intake did not significantly differ between treatments. Daily NaCl pellet supplementation is a palatable and safe way to replace electrolyte losses from sweating in exercising horses and has no negative effects on the gastric mucosa.

Diagnostic Challenge of Gitelman Syndrome: A Rare but Significant Cause of Electrolyte Imbalance

Objective: This case study presents a young female patient diagnosed with symptomatic electrolyte disturbances, later confirmed as Gitelman syndrome (GS). It highlights the underlying pathophysiology and emphasizes the importance of its proper management. Background: GS is a rare genetic disorder affecting kidney electrolyte reabsorption, leading to symptoms like weakness, muscle cramps, fatigue, nausea, and vomiting. Diagnosis involves lab tests and genetic confirmation, with treatment comprising electrolyte supplementation and medications. Ongoing management is vital to prevent complications. Case presentation: A 23-year-old Caucasian female presented to the ED with sudden weakness in all extremities, thirst, and lightheadedness. Lab results showed hyperglycemia 166 (70-100 mg/dL), severe hypokalemia 1.1 (3.6-5.1 mmol/L), mild hypercalcemia 11 (8.9-10.4 mg/dL), and severe hypophosphatemia 0.6 (2.3-7.0 mg/dL). Incidentally, she had prior hypokalemia history from a motor accident hospitalization and managed it with KCl for a year but stopped when symptoms improved. She was treated with electrolyte replacement and discharged with oral potassium. Five days later, she returned with severe hypokalemia 1.3, mild hypercalcemia 10.7, and severe hypophosphatemia 0.6. A 24-hour urinary test showed distal convoluted tubulopathy indicative of GS. She was treated with replacement therapy and spironolactone, with instructions for ongoing supplementation and follow-up with a nephrologist. Discussion: GS is mostly caused by mutations in the SLC12A3 gene, affecting the kidneys’ sodium chloride cotransporter function, as confirmed in our patient. Conclusion: While GS has no cure, appropriate treatment with medication and dietary adjustments can enhance patients’ quality of life by maintaining electrolyte balance. Healthcare providers’ awareness is crucial for effective care and complication prevention.