Higher Blood Urea Nitrogen Concentrations Research Articles

Homeopathic Products as a Complementary Dietary Additive for Pigs in their Growing and Finishing Phases.

Homeopathic products (HP) have been proposed for the prevention of disease and as a complementary dietary additive in pig farming, with resulting improved performance and quality of life of the animals and with benefits for food safety. The aim of this study was to assess the addition of HP to pig feed and its effects on growth performance, dietary protein utilization, nutrient digestibility, meat quality, and economic feasibility. A total of 80 male pigs, body weight 32.8±2.3kg, were allocated in a randomized design, with two treatments of 10 replications and four animals per experimental unit. Treatments were composed of a control diet (CD) or CD+HP (Finalvitaplus+Figotonus, 1.1kg/ton feed of each product). The outcome measures used were growth performance (body weight gain) and feed efficiency (body weight gain per unit of feed consumed), efficiency of dietary protein utilization (blood urea nitrogen), nutrient digestibility (apparent digestibility coefficient and apparent nutrient digestibility), meat quality (including pH, temperature, color, liquid loss by cooking and thawing, intramuscular fat and meat tenderness), and economic feasibility (cost of the diets). There was no effect (p >0.05) of treatments on growth performance of the pigs, though the group that received HP showed an 8.93% greater feed efficiency than the control group (p=0.077). The animals in the control group had a 14.37% higher blood urea nitrogen concentration in the finishing I phase (70-100kg body weight) compared with those fed HP (p=0.028), indicating lower protein utilization in the controls. There was comparative improvement in digestibility coefficient and in nutrient digestibility in pigs fed HP in the growing-finishing phase (p <0.05). There was no differential effect of treatments on meat quality or economic feasibility (p >0.05). The addition of HP to the diet of growing-finishing pigs produced some improvement in their dietary protein utilization, nutrient digestibility and feed efficiency, though it did not affect their growth performance, meat quality or economic feasibility.

Risk factors for rebleeding in patients with obscure gastrointestinal bleeding from southern China.

BackgroundTo identify the risk factors associated with rebleeding in obscure gastrointestinal bleeding (OGIB) patients from southern China.MethodsThis retrospective study involved 229 patients who underwent small bowel endoscopy in our hospital between 1 January 2018 and 1 December 2020. The clinical characteristics and risk factors related to rebleeding were retrospectively evaluated.ResultsRebleeding patients were significantly older than non-rebleeding patients (53.0 ± 15.9 vs. 46.2 ± 17.8 years), had lower hemoglobin concentrations (89.2 ± 28.1 vs. 126.2 ± 25.1 g/L), and higher blood urea nitrogen concentrations (5.4 ± 2.6 vs. 4.5 ± 2.2 µmol/L), respectively. A higher percentage of rebleeding patients had diabetes mellitus (13.9% vs. 2.9%) and overt bleeding (70.4% vs. 38.6%), and required blood transfusions (43.1% vs. 8.0%), compared with non-rebleeding patients, respectively. Multivariate logistic analysis indicated that drinking alcohol (odds ratio (OR): 9.27; 95% confidence interval (CI) = 1.35–63.78), anemia (OR: 17.38; 95% CI = 5.48–55.10), and blood transfusion (OR: 3.76; 95% CI = 1.04–13.56) increased the risk of rebleeding in OGIB patients.ConclusionOur data suggested that OGIB patients who drink alcohol, have anemia, and require blood transfusion have an increased risk of rebleeding.

Effects of long-term feeding of Achyranthes japonica Nakai extract as a supplement to diets with different protein levels diets on the growth performance and meat quality characteristics of growing-fattening pigs

Reductions in dietary protein and the supplementation of diets with feed additives have become two practical strategies in swine production to reduce costs and promote pig growth and health. This study was conducted to evaluate the effects of long-term feeding of Achyranthes japonica Nakai extract (AJE) combined with different dietary protein levels on growth performance, nutrient digestibility, blood parameters, fecal microbiota, fecal noxious gas emissions, meat quality, and carcass grade in growing-fattening pigs. In total, 144 crossbred [Duroc × (Yorkshire × Landrace)] growing pigs with average initial body weight (BW) of 23.77 ± 1.65 kg were used in a 16-week feeding experiment. The pigs were randomly sorted into one of six dietary treatments in a 2 × 3 factorial arrangement with two levels of dietary protein—high crude protein (HCP) vs. low crude protein (LCP), each without (0 g/kg) or with two doses of AJE (0.5 g/kg and 1 g/kg) based on the BW and sex [four pigs per pen (two barrows and two gilts); six pens per treatment]. All samples were taken at the end of the growing (week 6) and fattening (week 16) phases. Growth performance indices were also assessed in the middle of the fattening phase (week 11). The addition of both dosage of AJE improved the average daily gain (ADG) throughout the experimental period. Similarly, the ADG was higher in pigs fed the HCP diet than in those fed the LCP diet during weeks 6 and 11 and throughout the experimental period. At weeks 6 and 16, positive effects on digestibility, blood profiles, fecal microbial population, fecal gas emission concentrations, and the water holding capacity of meat were observed in pigs fed AJE-supplemented diets. The pigs fed the HCP diet had higher nitrogen digestibility, blood total protein, serum growth hormone, and insulin-like growth factor-1 at both weeks 6 and 16. Furthermore, pigs fed the HCP diet had higher blood urea nitrogen concentrations and carcass weights at week 16, and lower fecal Escherichia coli counts at week 6. Additionally, lower concentrations of fecal ammonia and total mercaptans were observed at weeks 6 and 16, respectively. In summary, AJE and high dietary crude protein level improved growth performance, nutrient digestibility, blood parameters, fecal microbiota, fecal noxious gas emission, and meat quality but no interactive effects between protein level and AJE were observed.

First-trimester blood urea nitrogen and risk of gestational diabetes mellitus.

Prior studies indicated that urea increased insulin resistance and higher blood urea nitrogen (BUN) was associated with incident diabetes mellitus. However, it remains unclear whether BUN during the first trimester of pregnancy increases risk of gestational diabetes mellitus (GDM). We aimed to investigate the association between first‐trimester BUN and risk of incident GDM. We conducted a prospective, multicenter cohort study of pregnant women. A total of 13 448 eligible pregnant women with measured first‐trimester BUN levels were included in this analysis. Logistic regression analysis was used to estimate the relationship between BUN and GDM. Discrimination and reclassification for GDM by BUN were analysed. A total of 2973 (22.1%) women developed GDM. Compared with the lowest quartile of BUN, the third and fourth quartiles were associated with increased risk of GDM (adjusted odds ratios 1.21 [95% CI 1.07‐1.37] and 1.50 [95% CI 1.33‐1.69], respectively, P for trend <.001). The addition of BUN to conventional factor model improved discrimination (C statistic 0.2%, P = .003) and reclassification (net reclassification index 14.67%, P < .001; integrated discrimination improvement 0.12%, P < .001) for GDM. In conclusion, higher BUN concentrations during the first trimester of pregnancy were associated with increased risk of GDM, suggesting that BUN could be a potential predictor for GDM.

Effect of energy intake and L-carnitine on fattening performance, carcass traits, meat quality, blood metabolites, and gene expression of lamb

• LPL and FASN were increased in adipose tissues with energy intake increasing, while LIPE and SCD were decreased. • L-carnitine supplementation did not improve growth performance and mutton quality. • L-carnitine could be used as a potential feed additive to inhibit fat accumulation in sheep. A 70-day feeding experiment was conducted on Tan sheep ( Ovis ) to study the effects of energy intake (low, medium, or high) and/or L -carnitine supplementation (0 or 200 ppm) on fattening performance, carcass traits, meat quality, and expression of lipid metabolism associated genes. A 2 × 3 factorial arrangement was designed, 144 lambs (14.21 ± 0.30 kg) were randomly divided into six groups of four replicates (six lambs per replicate). At the end of feeding experiment, 24 lambs were slaughtered and sampled to analyze indexes. The results showed that live body weight (LBW), average daily gains (ADG), tail fat weight, GR values, and carcass weight increased with increasing energy intake. Increased energy intake significantly increased cooked meat percentage, shear force, and the content of crude protein (CP), ash, and crude fat (EE) in muscle. L -carnitine supplementation significantly reduced tail fat weight, GR values, and the content of CP and EE in muscle, while cooked meat percentage and water loss rate significantly increased. However, L -carnitine supplementation did not affect the LBW and ADG indexes. The effects of L -carnitine or energy intake did not significantly affect amino acid compositions of the longissimus dorsi (LD) muscle. High-energy intake resulted in higher blood urea nitrogen concentrations; in contrast, no significant effects of energy intake were observed on total cholesterol (TC), triglyceride (TG), and glucose (GLU) concentrations. In addition, L -carnitine supplementation in the high-energy group reduced GLU serum concentrations, but did not affect the concentrations of TC and TG. The investigation of gene expression showed that lipoprotein lipase and fatty acid synthase were significantly increased in the liver, tail fat, and subcutaneous fat with energy intake, while lipase E (hormone sensitive type) and stearoyl-CoA desaturase gene expression were significantly decreased. Furthermore, the effects of L -carnitine supplementation on gene expression were opposite to those of energy intake. Significant interaction was found between energy intake and L -carnitine supplementation for EE content in muscle, blood biochemical index, and amino acid compositions in the LD muscle. In conclusion, high-energy diets promote animal growth and production performance, while accelerating fat deposition. L -carnitine supplementation had slightly effect on the improvement of performance and lamb quality, while effectively counteracting the negative influence of high-energy intake, particularly inhibiting fat accumulation.

Reproductive efficiency and serum progesterone concentration on dairy cattle based on blood urea nitrogen (BUN) concentrations

The objective of this study was to identify the levels of Blood Urea Nitrogen (BUN) and its relation to the reproductive efficiency and serum progesterone concentration in lactating Holstein Friesian dairy cattle. Data were obtained by stratified random sampling from population to get 18 dairy cows, which divided into three groups. The first, second, and third groups each with milk yield of less than 17, between 17-21, and over 21 liters/day, and with calving interval of less than 365, between 365-450 and more than 450 days. Blood was collected from the coccygeal vein at the time of insemination (D0), 7 day (D+7) and 22 days (D+22) after insemination. BUN and progesterone concentration were measured. Data analysis showed no significant difference (P>0.05) on the observed parameters. Data regrouping based on BUN concentration showed that the mean of services per conception (S/C) was lower and conception rate (CR) was higher (P<0.05) in dairy cattle having BUN<18 than those of with BUN>18 mg/dL. The mean of progesterone concentration at D+22 was higher (P<0.05) than those at D0 and D+7 in pregnant dairy cows and with BUN<18 mg/dL, as well as those at D+22 in non-pregnant dairy cows with BUN>18 and BUN<18 mg/dL. This study concluded that high BUN concentration affect the reproductive efficiency of dairy cows by decreasing CR and increasing progesterone serum concentration.

Protein supplementation of human milk for promoting growth in preterm infants.

Preterm infants require high protein intake to achieve adequate growth and development. Although breast milk feeding has many benefits for this population, the protein content is highly variable, and inadequate to support rapid infant growth. This is a 2018 update of a Cochrane Review first published in 1999. To determine whether protein-supplemented human milk compared with unsupplemented human milk, fed to preterm infants, improves growth, body composition, cardio-metabolic, and neurodevelopmental outcomes, without significant adverse effects. We used the standard search strategy of Cochrane Neonatal to search CENTRAL, MEDLINE via PubMed, Embase, and CINAHL (February 2018). We also searched clinical trials databases, conference proceedings and the reference lists of retrieved articles for randomised controlled trials (RCT) and quasi-randomised trials. Published and unpublished RCTs were eligible if they used random or quasi-random methods to allocate hospitalised preterm infants who were being fed human milk, to additional protein supplementation or no supplementation. Two review authors independently abstracted data, assessed risk of bias and the quality of evidence at the outcome level, using GRADE methodology. We performed meta-analyses, using risk ratio (RR) for dichotomous data, and mean difference (MD) for continuous data, with their respective 95% confidence intervals (CIs). We used a fixed-effect model and had planned to explore potential causes of heterogeneity via subgroup or sensitivity analyses. We included six RCTs, involving 204 preterm infants. Low-quality evidence showed that protein supplementation of human milk increased in-hospital rates of growth in weight (MD 3.82 g/kg/day, 95% CI 2.94 to 4.7; five RCTs, 101 infants; I² = 73%), length (MD 0.12 cm/wk, 95% CI 0.07 to 0.17; four RCTs, 68 infants; I² = 89%), and head circumference (MD 0.06 cm/wk, 95% CI 0.01 to 0.12; four RCTs, 68 infants; I² = 84%). There was no evidence of a clear difference in rate of growth of skin fold thickness between the supplemented and unsupplemented groups (triceps MD 0.06 mm/wk, 95% CI -0.09 to 0.21; one RCT, 20 infants; or subscapular MD 0.00 mm/wk, 95% CI -0.17 to 0.17; one RCT, 20 infants). Protein supplementation led to longer hospital stays (MD 18.5 days, 95% CI 4.39 to 32.61; one RCT, 20 infants; very low-quality evidence), and higher blood urea nitrogen concentrations compared to the unsupplemented group (MD 0.95 mmol/L, 95% CI 0.81 to 1.09; four RCTs, 81 infants; I² = 56%). Very low-quality evidence did not show that protein supplementation clearly increased the risk of feeding intolerance (RR 2.70, 95% CI 0.13 to 58.24; one RCT, 17 infants), or necrotizing enterocolitis (RR 1.11, 95% CI 0.07 to 17.12; one RCT, 76 infants), or clearly altered serum albumin concentrations (MD 2.5 g/L, 95% CI -5.66 to 10.66; one RCT, 11 infants), compared with the unsupplemented groups. No data were available about the effects of protein supplementation on long-term growth, body mass index, body composition, neurodevelopmental, or cardio-metabolic outcomes. Low-quality evidence showed that protein supplementation of human milk, fed to preterm infants, increased short-term growth. However, the small sample sizes, low precision, and very low-quality evidence regarding duration of hospital stay, feeding intolerance, and necrotising enterocolitis precluded any conclusions about these outcomes. There were no data on outcomes after hospital discharge. Our findings may not be generalisable to low-resource settings, as none of the included studies were conducted in these settings.Since protein supplementation of human milk is now usually done as a component of multi-nutrient fortifiers, future studies should compare different amounts of protein in multi-component fortifiers, and be designed to determine the effects on duration of hospital stay and safety, as well as on long-term growth, body composition, cardio-metabolic, and neurodevelopmental outcomes.

Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU

PurposeBlood urea nitrogen (BUN) was reported to be associated with mortality in heart failure patients. We aimed to evaluate admission BUN concentration in a heterogeneous critically ill patient collective admitted to an intensive care unit (ICU) for prognostic relevance.MethodsA total of 4176 medical patients (67±13 years) admitted to a German ICU between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. Association of admission BUN and both intra-hospital and long-term mortality were investigated by Cox regression. An optimal cut-off was calculated by means of the Youden-Index.ResultsPatients with higher admission BUN concentration were older, clinically sicker and had more pronounced laboratory signs of multi-organ failure including kidney failure. Admission BUN was associated with adverse long-term mortality (HR 1.013; 95%CI 1.012–1.014; p<0.001). An optimal cut-off was calculated at 28 mg/dL which was associated with adverse outcome even after correction for APACHE2 (HR 1.89; 95%CI 1.59–2.26; p<0.001), SAPS2 (HR 1.85; 95%CI 1.55–2.21; p<0.001) and several parameters including creatinine in an integrative model (HR 3.34; 95%CI 2.89–3.86; p<0.001). We matched 614 patients with admission BUN >28 mg/dL to case-controls ≤ 28mg/dL corrected for APACHE2 scores: BUN above 28 mg/dL remained associated with adverse outcome in a paired analysis with the difference being 5.85% (95%CI 1.23–10.47%; p = 0.02).ConclusionsHigh BUN concentration at admission was robustly associated with adverse outcome in critically ill patients admitted to an ICU, even after correction for co-founders including renal failure. BUN might constitute an independent, easily available and important parameter for risk stratification in the critically ill.

Cerebrovascular CO2 reactivity during isoflurane-nitrous oxide anesthesia in patients with chronic renal failure.

We assessed the cerebrovascular CO2 reactivity (CO2R) in chronic renal failure (CRF) patients without diabetes mellitus (DM), uncontrolled hypertension, peripheral vascular disease, or neurological disease under isoflurane-nitrous oxide anesthesia. Forty-nine patients undergoing surgery, including 36 CRF patients (30 receiving dialysis and six pre-dialysis patients) and 13 patients without CRF (controls). Middle cerebral artery flow velocity (VMCA) was measured by transcranial Doppler ultrasonography at an end-tidal CO2 of 35 to 45mmHg. CO2R was calculated as an absolute value (change in VMCA per mmHg PaCO2) and a relative value (absolute CO2R/baseline VMCA×100). Factors associated with CO2R were evaluated simultaneously. Despite no significant differences in the absolute and relative values of CO2R between the CRF (mean 2.5cm/s/mmHg; median 5.0%/mmHg) and control (2.4cm/s/mmHg; 5.0%/mmHg) groups, blood urea nitrogen (BUN) concentrations in the CRF group correlated inversely with both absolute and relative CO2R. BUN concentration was higher (mean 72 versus 53mg/dl, p=0.006) and relative CO2R was lower (mean 2.6 versus 5.7%/mmHg, p=0.011) in patients with pre-dialysis CRF (n=6) versus CRF patients receiving dialysis (n=30). CO2R in CRF patients was not significantly different from that in controls. However, in CRF patients with high BUN concentrations, CO2R might be impaired, leading to reduced cerebrovascular reserve capacity. Because DM is a major cause of CRF and we excluded DM patients, our results might not be applicable to patients with DM-induced CRF.

Chronic Kidney Disease After Acute Kidney Injury Requiring Continuous Renal Replacement Therapy and Its Impact on Long-Term Outcomes: A Multicenter Retrospective Cohort Study in Korea.

Severe acute kidney injury requiring continuous renal replacement therapy is associated with a high risk of early mortality. Our objectives were to identify a cohort of early survivors and to follow their renal progress and long-term mortality. Multicenter, observational, retrospective cohort study. ICUs in tertiary academic hospitals in Korea. From 2009 to 2013, we identified 1,764 severe acute kidney injury patients who were started on continuous renal replacement therapy at four hospitals. Of these, we identified 331 survivors for whom we could identify renal function at baseline and at 3 months. None. The 331 patients were separated into two groups based on their renal function at 3 months after the start of continuous renal replacement therapy. Those who displayed significant deterioration in renal function compared to baseline, defined as greater than or equal to 50% increase in serum creatinine or greater than or equal to 35% decrease in the estimated glomerular filtration rate, or those who continued to receive renal replacement therapy were designated as a "3-month chronic kidney disease progression" group. Those with a return to baseline, less than 50% increase in serum creatinine or less than 35% decrease in the estimated glomerular filtration rate, were designated as a "3-month chronic kidney disease nonprogression" group. The acute kidney injury patients requiring continuous renal replacement therapy showed a higher risk of progression to end-stage renal disease compared to that of stage 3 chronic kidney disease patients who did not undergo an acute kidney injury episode, even if the acute kidney injury was recovered at 3 months after continuous renal replacement therapy initiation. Furthermore, "3-month chronic kidney disease progression" was associated with a high risk of progression to end-stage renal disease and long-term mortality over a median follow-up period of 12.7 (3.8-33.2) and 20.4 (7.5-39.7) months, respectively. Older age, higher baseline serum creatinine levels, and higher blood urea nitrogen concentrations at continuous renal replacement therapy initiation, and lower 24-hour urine output after continuous renal replacement therapy initiation are associated with an increased risk of "3-month chronic kidney disease progression." Renal functional assessment at 3 months after continuous renal replacement therapy initiation can be useful in predicting progression to end-stage renal disease and long-term mortality. Furthermore, continuous close monitoring and management of acute kidney injury patients requiring continuous renal replacement therapy are required, even in those with recovered renal function.

Impact of preoperative uncontrollable hepatic hydrothorax and massive ascites in adult liver transplantation

Uncontrollable hepatic hydrothorax and massive ascites (H&MA) requiring preoperative drainage are sometimes encountered in liver transplantation (LT). We retrospectively analyzed the characteristics of such patients and the impact of H&MA on the postoperative course. We evaluated 237 adult patients who underwent LT in our institute between April 2006 and October 2010. Recipients with uncontrollable H&MA (group HA: n = 36) had more intraoperative bleeding, higher Child-Pugh scores, lower serum albumin concentrations and higher blood urea nitrogen concentrations than those without uncontrollable H&MA (group C: n = 201). They were also more likely to have preoperative hepatorenal syndrome and infections. The incidence of postoperative bacteremia was higher (55.6 vs. 46.7%, P = 0.008) and the 1- and 3-year survival rates were lower (1 year: 58.9 vs. 82.9%; 3 years: 58.9 vs. 77.7%; P = 0.003) in group HA than in group C. The multivariate proportional regression analyses revealed that uncontrollable H&MA and the Child-Pugh score were independent risk factors for the postoperative prognosis. Postoperative infection control may be an important means of improving the outcome for patients with uncontrollable H&MA undergoing LT, and clinicians should strive to perform surgery before H&MA becomes uncontrollable.

Protective effects of green tea polyphenol against cisplatin-induced nephrotoxicity in rats.

ObjectiveThis study is to compare the effects of green tea polyphenol (GTP) pre-treatment with those of GTP post-treatment on cisplatin (CP)-induced nephrotoxicity in rat.MethodsMale Sprague-Dawley rats were randomly divided into six groups. Animals in the control group received 0.9% saline (intraperitoneal); animals in the GTP group received 0.9% saline and GTP (0.2% GTP as their sole source of drinking water); the CP group received only CP (7 mg/kg, intraperitoneal); the CP+preGTP group received GTP from two days before CP to four days after CP and the CP+postGTP group received GTP for four days after CP. CP-induced renal toxicity was evaluated by plasma creatinine and blood urea nitrogen (BUN) concentrations; kidney tissue γ-glutamyl transpeptidase (GGT) and alkaline phosphatase (AP) activities and histopathological examinations.ResultsHigh serume creatinine and BUN concentrations were observed in CP treated rats. The GGT and AP activites were lower in kidney of CP treated rats compared to control rats. In addition, treatment with CP resulted in development of a marked tubular necrosis, and tubular dilation in kidney of rats. Pretreatment with GTP resulted in markedly reduced elevation of serum creatinine and BUN amounts and changes of GGT and AP activity in kidney induced by CP. CP-induced histopathological changes, including tubular necrosis and dilation, were ameliorated in GTP pre-treated rats, compared to CP alone or GTP post-treated rats.ConclusionThese results demonstrate that GTP might have some protective effect against CP-induced nephrotoxicity in rat, and GTP pre-treatment was more effective than GTP post-treatment on reduction of CP-induced renal dysfunction.

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

Background: Anemia in patients with early diabetes mellitus nephrosclerosis (DMN) is more severe than in patients with kidney disease of other origins, and the mechanism for this remains unclear. In this study, we carried out a retrospective study in order to identify the factors associated with anemia in patients with DMN. Methods: To elucidate the factors that influence the severity of anemia in patients with DMN, we carried out a retrospective follow-up study of 124 biopsy-proven DMN cases [mean (SE) age, 55.3 (1.2) years; range, 18–78 years; male/female, 80/44]. First, a cluster analysis was performed using red blood cell counts and hemoglobin (Hb) and hematocrit levels. We then divided the clusters with regard to renal prognosis and survival and carried out simple and multifactorial analysis of clinical data, including the body mass index, age, systolic blood pressure (BP), diastolic BP, duration after the diagnosis of diabetes mellitus, serum albumin levels, blood urea nitrogen (BUN) concentrations, serum creatinine concentrations, the estimated glomerular filtration rate (eGFR) validated in the Japanese population, iron levels, total cholesterol levels, triglyceride levels, fasting blood sugar levels, HbA1c levels, urinary protein secretion, and pathohistological parameters. Results: The factors that were significantly associated with the cluster group that showed severe anemia were sex (p = 0.0162), hypoalbuminemia (p < 0.0001), high BUN concentrations (p = 0.0020), low eGFR (p = 0.0104), and Kimmelstiel–Wilson nodules (p = 0.0022). In addition, hypoalbuminemia (p = 0.0277), high BUN concentrations (p = 0.0338), and a low eGFR (p = 0.0417) were significantly associated with this group in a multifactorial analysis. Conclusion: Our data strongly suggest that hypoalbuminemia is associated with severe anemia in DMN patients.

Management of Diabetic Ketoacidosis in Children and Adolescents: Figure.

* Based on some research evidence, DKA is a significant contributor to morbidity and mortality in children who have type 1 diabetes, and cerebral edema is responsible for most of the deaths during DKA in children. (Dunger, 2004). * Based on strong research evidence, treatment of DKA requires replacement of water and electrolytes and correction of the insulin deficiency. (Dunger, 2004). * Based on some research data and consensus opinion, after providing initial volume expansion (if needed), fluid resuscitation of children who have DKA should be calculated to rehydrate evenly over at least 48 hours. Initial fluid resuscitation should be with an isotonic solution; subsequent fluid management should be with a solution that has a tonicity of at least 0.45% saline. (Dunger, 2004). * Based on strong research evidence, insulin treatment for DKA should begin at a dose of 0.1 units/kg per hour and generally should remain at or above this level until the ketoacidosis is resolved. (Dunger, 2004). * Based on some research evidence, risk factors for the development of cerebral edema during treatment of DKA include the severity of acidosis, greater hypocapnia (after adjusting for the degree of acidosis), higher blood urea nitrogen concentration at presentation, and treatment with bicarbonate. (Dunger, 2004; Glaser, 2002).

Timing of Initiation of Dialysis in Critically Ill Patients with Acute Kidney Injury

Among critically ill patients, acute kidney injury (AKI) is a relatively common complication that is associated with an increased risk for death and other complications. To date, no treatment has been developed to prevent or attenuate established AKI. Dialysis often is required, but the optimal timing of initiation of dialysis is unknown. Data from the Program to Improve Care in Acute Renal Disease (PICARD), a multicenter observational study of AKI, were analyzed. Among 243 patients who did not have chronic kidney disease and who required dialysis for severe AKI, we examined the risk for death within 60 d from the diagnosis of AKI by the blood urea nitrogen (BUN) concentration at the start of dialysis (BUN < or = 76 mg/dl in the low degree of azotemia group [n = 122] versus BUN > 76 mg/dl in the high degree of azotemia group [n = 121]). Standard Kaplan-Meier product limit estimates, proportional hazards (Cox) regression methods, and a propensity score approach were used to account for selection effects. Crude survival rates were slightly lower for patients who started dialysis at higher BUN concentrations, despite a lesser burden of organ system failure. Adjusted for age, hepatic failure, sepsis, thrombocytopenia, and serum creatinine and stratified by site and initial dialysis modality, the relative risk for death that was associated with initiation of dialysis at a higher BUN was 1.85 (95% confidence interval 1.16 to 2.96). Further adjustment for the propensity score did not materially alter the association (relative risk 1.97; 95% confidence interval 1.21 to 3.20). Among critically ill patients with AKI, initiation of dialysis at higher BUN concentrations was associated with an increased risk for death. Although the results could reflect residual confounding by severity of illness, they provide a rationale for prospective testing of alternative dialysis initiation strategies in critically ill patients with severe AKI.

Serum biochemical values in fallow deer ( Dama dama L.) from different habitats in Croatia

Serum biochemical values were determined in blood samples collected from 48 shot fallow deer from the Brijuni islands and 45 sedated fallow deer (Dama dama L.) from hunting grounds in the continental part of Croatia. The parameters were compared with regard to age, sex and habitat. Statistically significant differences were found for serum total protein concentration, alkaline phosphatase, aspartate aminotransferase and alanine aminotransferase activity between young and adult island deer, as well as for total protein, triacylglyceride, cholesterol concentration and alkaline phosphatase activity between young and adult continental deer. In young animals, island males had higher albumin concentrations, while continental males had higher alkaline phosphatase values than females. In adult animals, island males had a higher blood urea nitrogen concentration, while continental males had higher albumin and cholesterol concentrations, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and creatine kinase activities. In this group, males exhibited lower bilirubin and triacylglyceride concentrations than females. Our results indicate that besides age, sex and sampling method, nutritional and environmental factors should be considered when evaluating serum biochemical parameters of fallow deer

Effects of level of energy intake and energy demand on growth hormone, insulin, and metabolites in Targhee and Suffolk ewes.

Yearling ewes (n = 32) were used in a 2x2x2 factorial experiment to determine effects of breed (Targhee vs. Suffolk), energy intake (1x vs. 3x NEm requirements, and physiological status (nonpregnant, nonlactating vs. lactating) on serum GH, insulin, NEFA, glucose, and blood urea nitrogen (BUN) concentrations. Blood collections were made in two periods that began 21 and 32 d after ewes lambed. Lactating ewes had more GH peaks (P<.10), higher (P<.01) mean GH concentration, and greater (P<.01) area under the GH curve (AUC) than nonlactating ewes. The AUC was greater (P<.01) in ewes fed 1x NEm than in ewes fed 3x NEm. Energy intake had no effect on serum GH before feeding (P>.23) when evaluated within physiological statuses. After feeding, GH concentrations were greater (P<.10) for ewes fed 1x NEm than for those fed 3x NEm. Insulin and glucose did not differ (P>.23) between energy intake levels. Insulin and glucose were greater (P<.001) in nonlactating than in lactating ewes when evaluated within breed. Lactating and Targhee ewes fed 1x NEm had greater (P<.001) NEFA concentration than nonlactating and Targhee ewes fed 3x NEm, respectively. Ewes fed 3x NEm and Targhee ewes had greater (P<.005) BUN concentrations than ewes fed 1x NEm and Suffolk ewes, respectively. Physiological status seems to play a more important role in the regulation of GH than does energy intake. Higher BUN concentrations in Targhee than in Suffolk ewes demonstrates one metabolic event that distinguishes a breed's adaptation to the environment in which it originated.

Metallothionein (MT)-Null Mice Are Sensitive to Cisplatin-Induced Hepatotoxicity

cis-Diamminedichloroplatinum (cisplatin) is an important anticancer drug used to treat solid tumors. The nephrotoxicity of cisplatin is recognized as the most important dose-limiting factor, but high doses of cisplatin also produce hepatotoxicity. However, little is known about cisplatin-induced liver injury and the role of metallothionein, a cysteine-rich, metal-binding protein, in modulating its hepatotoxicity. This study was designed to examine cisplatin hepatotoxicity in control and metallothionein-I/II knock-out (MT-null) mice. Animals were given a single injection of cisplatin (50–200 μmol/kg ip), and liver injury was evaluated 3–16 h later. Cisplatin produced dose- and time-dependent liver injury, as evidenced by increased serum activity of alanine aminotransferase (ALT), as well as by histopathology. Apoptosis, rather than necrosis, predominates in cisplatin-induced liver injury, as indicated by increased numbers of apoptotic cells (hematoxylin and eosin staining),in situapoptotic DNA detection, and DNA fragmentation on agarose gel electrophoresis. MT-null mice were more sensitive than controls to cisplatin-induced hepatotoxicity. Cisplatin (200 μmol/kg) was lethal to 12% of control mice, but 60% of MT-null mice died within 16 h. At the dose of 150 μmol/kg, serum ALT activities were increased 2-fold in control mice compared to 6.5-fold in MT-null mice. Apoptotic lesions were more pronounced in MT-null than in control mice. MT-null mice were also more susceptible than controls to cisplatin-induced nephrotoxicity, as evidenced by having higher blood urea nitrogen concentrations. Furthermore, cultured MT-null hepatocytes were more sensitive than control cells to the cytotoxicity of cisplatin (50–200 μM), as indicated by lactate dehydrogenase leakage into the medium. These results demonstrate that (1) high doses of cisplatin produce hepatotoxicity, with apoptosis as the major lesion, and (2) MT protects against cisplatin-induced liver injury.