Higher Serum Sodium Levels Research Articles

Relationship between sodium level and in-hospital mortality in traumatic brain injury patients of MIMIC IV database.

An association between prognosis and high sodium levels in Traumatic Brain Injury (TBI) patients in Intensive Care Units (ICUs) has been noted, but limited research exists on the ideal sodium level in these patients or the impact on early mortality, using the MIMIC-IV database. A retrospective survey was conducted on TBI patients from the MIMIC-IV database. Patients were divided into two categories based on their highest serum sodium level within 24 h of admission exceeding 145 mmol/L: those with hypernatremia, and those with moderate-to-low sodium levels. Collected covariates encompasses demographic, clinical, laboratory, and intervention variables. A multivariate logistic regression model was implemented to forecast in-hospital mortality. The study included 1749 TBI patients, with 209 (11.5%) experiencing in-hospital deaths. A non-linear test exposed an L-shaped correlation between sodium level and in-hospital mortality, with mortality rates increasing after a turning point at 144.1 mmol/L. Compared to the moderate-to-low group's 9.3% mortality rate, the hypernatremia group had a significantly higher mortality rate of 25.3% (crude odds ratio = 3.32, 95% confidence interval: 2.37 ~ 4.64, p < 0.001). After adjusting for all covariates, the hypernatremia group continued to show a significant correlation with higher mortality risk (adjusted odds ratio = 2.19, 95% confidence interval: 1.38 ~ 3.47, p = 0.001). This trend remained consistent regardless of the analyses stratification. The study reveals an L-shaped relationship between sodium levels and in-hospital deaths, with a pivotal point at 144.1 mmol/L. TBI patients displaying hypernatremia were independently linked to higher in-hospital mortality, underlining the need for further studies into targeted management of sodium levels in these patients.

Plasma aldosterone concentration / plasma renin activity ratio in patients with essential hypertension before treatment

Abstract Background The renin–angiotensin–aldosterone-sodium system, an important player in maintaining blood pressure, is influenced by antihypertensive drugs. However, the analysis of the renin-aldosterone-sodium system in hypertensive patients without adrenal adenoma without antihypertensive drugs is not still enough. Purpose We analyzed plasma aldosterone level, renin activity, serum potassium level, and serum sodium level in hypertensive patients without adrenal adenoma before treatment. Methods We measured plasma aldosterone concentration (PAC; pg/mL), plasma renin activity (PRA; ng/mL/h), serum potassium and sodium levels (mEq/L) in 456 consecutive new hypertensive patients untreated with antihypertensive drugs. We sampled all blood after 30 minutes bedrest. We excluded 28 cases with blood pressures less than 135/85 mmHg at rest, 4 patients with adrenal adenoma, and 3 patients with renovascular hypertension. We analyzed 421 patients with essential hypertension before treatment (232 males, mean age 56.5±12.8 years, and 189 females, mean age 61.0±13.5 years). Results There was a significant positive correlation between PRA and PAC (ρ=0.2445, p&amp;lt;0.001). There was a significant positive correlation between PAC/PRA ratio and serum sodium levels (ρ=0.1604, p=0.0027); however, no correlation was observed between PAC/PRA ratio and serum potassium levels. There were significant negative correlations between PRA and serum sodium levels (ρ=-0.1925, p&amp;lt;0.001). However, there was no correlation between PAC and serum sodium levels. On univariate analyses, a high PAC/PRA ratio (&amp;gt;200) was significantly associated with female (p&amp;lt;0.001), high serum sodium level (p=0.003), and low pulse rate (p=0.02). Multiple logistic analyses revealed that the most predictive independent factor for high PAC/PRA was female (p&amp;lt;0.001). On analyses of gender differences, the incidence rates of high PAC/PRA (&amp;gt;200) were 33.9% in females and 16.4% in males. There was a significant positive correlation between PRA and PAC in both genders (males: ρ=0.2731, p&amp;lt;0.001; females: ρ=0.1976, p=0.0064). In females, there was a significant positive correlation between PAC/PRA and serum sodium levels (ρ=0.2221, p=0.0043); however, there were no significant correlations between PAC/PRA and serum sodium levels in males. In females, there was a significant negative correlation between PRA and serum sodium levels (ρ=-0.2668, p&amp;lt;0.001); however, there were no significant correlations between PRA and serum sodium levels in males. Serum sodium levels were significantly higher in females than in males (p=0.02). Conclusion We revealed gender differences in the renin-aldosterone-sodium system in patients with essential hypertension before treatment.

Association between serum sodium levels within 24 h of admission and all-cause mortality in critically ill patients with non-traumatic subarachnoid hemorrhage: a retrospective analysis of the MIMIC-IV database.

The study aimed to evaluate the relationship between serum sodium and mortality in critically ill patients with non-traumatic subarachnoid hemorrhage. This is a retrospective investigation of critically ill non-traumatic patients with subarachnoid hemorrhage (SAH) utilizing the MIMIC-IV database. We collected the serum sodium levels at admission and determined the all-cause death rates for the ICU and hospital. We employed a multivariate Cox proportional hazard regression model and Kaplan-Meier survival curve analysis to ascertain the relationship between serum sodium and all-cause mortality. In order to evaluate the consistency of correlations, interaction and subgroup analyses were also conducted. A total of 864 patients with non-traumatic SAH were included in this study. All-cause mortality in the ICU and hospital was 32.6% (282/864) and 19.2% (166/864), respectively. Sodium levels at ICU admission showed a statistically significant J-shaped non-linear relationship with ICU and hospital mortality (non-linear P-value < 0.05, total P-value < 0.001) with an inflection point of ~141 mmol/L, suggesting that mortality was higher than normal serum sodium levels in hypernatremic patients. Multivariate analysis after adjusting for potential confounders showed that high serum sodium levels (≥145 mmol/L) were associated with an increased risk of all-cause mortality in the ICU and hospital compared with normal serum sodium levels (135-145 mmol/L), [hazard ratio (HR) = 1.47, 95% CI: 1.07-2.01, P = 0.017] and (HR = 2.26, 95% CI:1.54-3.32, P < 0.001). Similarly, Kaplan-Meier (K-M) survival curves showed lower survival in patients with high serum sodium levels. Stratified analysis further showed that the association between higher serum sodium levels and hospital all-cause mortality was stronger in patients aged < 60 years with a hospital stay of <7 days. High serum sodium levels upon ICU admission are related to higher ICU and hospital all-cause mortality in patients with non-traumatic SAH. A new reference is offered for control strategies to correct serum sodium levels.

Association between serum sodium and 28-day mortality in sepsis patients: A secondary data analysis from three large critical illness cohorts.

The present study was designed to explore the association between serum sodium and mortality in patients with sepsis by using a large sample, multicenter MIMIC-IV database. We extracted the data of 34 925 sepsis patients from the retrospective cohort mimicIV database. After adjusting the confounders, we explored the independent effects of serum sodium on 28-day mortality. A nonlinear relationship existed between serum sodium and 28-day mortality, of which a negative association was found between serum sodium and 28-day mortality (odds ratio: 0.95, 95% CI: 0.94, 0.96, p = 0.0001) when serum sodium was in 102 mmol/L to 138 mmol/L, but a positive correlation appeared when sodium climbed to the range of 140-179 mmol/L (odds ratio: 1.04, 95% CI: 1.03-1.06, p = 0.0001). Both lower and higher serum sodium levels are associated with an increased risk of death in sepsis patients.

Natriuretic Response to Acetazolamide in Patients With Acute Heart Failure and Volume Overload

BackgroundAcetazolamide facilitates decongestion in acute decompensated heart failure (ADHF). ObjectivesThis study sought to investigate the effect of acetazolamide on natriuresis in ADHF and its relationship with outcomes. MethodsPatients from the ADVOR (Acetazolamide in Decompensated Heart Failure with Volume Overload) trial with complete data on urine output and urine sodium concentration (UNa) were analyzed. Predictors of natriuresis and its relationship with the main trial endpoints were evaluated. ResultsThis analysis included 462 of 519 patients (89%) from the ADVOR trial. During 2 days after randomization, UNa was 92 ± 25 mmol/L on average, and total natriuresis was 425 ± 234 mmol. Allocation to acetazolamide strongly and independently predicted natriuresis with a 16 mmol/L (19%) increase in UNa and 115 mmol (32%) greater total natriuresis. Higher systolic blood pressure, better renal function, higher serum sodium levels, and male sex also independently predicted both a higher UNa and greater total natriuresis. A stronger natriuretic response was associated with faster and more complete relief of signs of volume overload, and this effect was already significant on the first morning of assessment (P = 0.022). A significant interaction was observed between the effect of allocation to acetazolamide and UNa on decongestion (P = 0.007). Stronger natriuresis with better decongestion translated into a shorter hospital stay (P < 0.001). After multivariable adjustments, every 10 mmol/L UNa increase was independently associated with a lower risk of all-cause death or heart failure readmission (HR: 0.92; 95% CI: 0.85-0.99). ConclusionsIncreased natriuresis is strongly related to successful decongestion with acetazolamide in ADHF. UNa may be an attractive measure of effective decongestion for future trials. (Acetazolamide in Decompensated Heart Failure with Volume Overload [ADVOR]; NCT03505788)

Relationship between serum sodium levels and all-cause mortality in congestive heart failure patients: A retrospective cohort study based on the Mimic-III database.

The relationship between serum sodium levels and mortality in congestive heart failure (CHF) patients has not been well-studied previously. The non-linear correlation between serum sodium levels and mortality in patients with heart failure is currently controversial, and the relationship between different serum sodium levels and mortality is disputed. The goal of this study is to look into the relationship between serum sodium levels and all-cause mortality in people with CHF after controlling for other factors. The publicly accessible Mimic III database was the source of data for our study. We use the ICU Admission Scoring System to collect demographic data, laboratory findings, comorbidities, vital signs, and scoring information for each patient. Cox proportional risk analysis, smooth curve fitting, and the Kaplan-Meier survival curve were used to assess the relationship between baseline sodium levels and all-cause mortality in CHF patients. The segmentation regression model discovered a turning point value of serum sodium levels (137.5 mmol/L) between serum sodium levels and all-cause mortality. According to the results of the fully adjusted Cox proportional hazard model, lower serum sodium levels (<137.5 mmol/L) were associated with an increased risk of 30, 90, 365-day, and 4-year all-cause deaths. The HRs and 95th confidence intervals were 0.96 (0.94, 0.99), 0.96 (0.94, 0.99), 0.96 (0.94, 0.98), and 0.96 (0.95, 0.98), respectively; the higher serum sodium levels (≥137.5 mmol/L) were related to an associated multiplied risk of 30, 90, 365-day, and 4-year all-cause deaths; the HRs and 95th confidence intervals were 1.02 (1.00, 1.05), 1.02 (1.00, 1.04), 1.02 (1.00, 1.03), and 1.02 (1.00, 1.03), respectively. Serum sodium levels were u-shaped about all-cause mortality. In individuals with CHF, serum sodium levels are linked to an elevated risk of short-, medium-, and long-term all-cause mortality.

OR27-6 Effects of the SGLT2-Inhibitor Empagliflozin in Patients With Chronic Syndrome of Inadequate Antidiuresis (SIAD) - Results of a Double-Blind, Randomized, Placebo-Controlled, Crossover Trial

Abstract Introduction Hyponatremia is the most common electrolyte disorder and the syndrome of inappropriate antidiuresis (SIAD) is one of its main causes. However, treatment options for chronic SIAD-induced hyponatremia are inadequate. This is problematic because hyponatremia has been associated with neurocognitive deficits, although there is little data on its reversibility.We previously showed that the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin is a promising short-term treatment option for hospitalized patients with SIAD-induced hyponatremia, promoting osmotic diuresis via urinary glucose excretion. However, there are no data on long-term treatment in outpatients nor its effect on neurocognitive function. Material and Methods In this double-blind, randomized, placebo-controlled, crossover trial we compared 4-week treatment with empagliflozin 25mg/day to placebo in addition to fluid restriction of ≤1.5L/24h in outpatients with chronic SIAD-induced hyponatremia (serum sodium &amp;lt;135mmol/L). At baseline and after both treatment cycles, patients underwent neurocognitive testing (Montreal Cognitive Assessment (MoCA) test). There was a 2-week wash-out period between the two treatment cycles, and a follow-up visit was scheduled 30 days after completion of the treatment phase.The primary endpoint was the difference in serum sodium levels (mmol/L) after 4 weeks of treatment with empagliflozin or placebo, calculated using a linear mixed-effects model. Results 14 patients, 50% female, with a median (IQR) age of 72 years (65-77) completed the trial.Median (IQR) serum sodium level at baseline was 131mmol/L (130-132). Under treatment with empagliflozin, median (IQR) serum sodium level increased to 134mmol/L (132-136), while no notable change was seen under placebo (130mmol/L (128-132)). This resulted in a 4.1 mmol/L (95% CI 1.7-6.5) higher serum sodium level after 4 weeks of empagliflozin treatment compared to placebo (p=0.004). This effect was independent of severity of SIAD.In addition, treatment with empagliflozin led to improved neurocognitive function, as shown by an increase of 1.2 points (SE 0.5) in the MoCA test (p=0.042).Treatment with empagliflozin was generally well tolerated, no serious adverse events occurred during the observation period. Conclusion This trial shows that the SGLT-2 inhibitor empagliflozin is a promising new treatment option for outpatients with chronic SIAD-induced hyponatremia. Furthermore, hyponatremia treatment led to an improvement of neurocognitive function. Presentation: Tuesday, June 14, 2022 11:00 a.m. - 11:15 a.m.

Use of Human Albumin Administration for the Prevention and Treatment of Hyponatremia in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis.

Background. Hyponatremia is a common complication of liver cirrhosis and aggravates patients’ outcomes. It may be corrected by human albumin (HA) infusion. Herein, we have conducted a systematic review and meta-analysis to evaluate the efficacy of intravenous HA administration for the prevention and treatment of hyponatremia in liver cirrhosis. Methods. Literature was searched in the PubMed, EMBASE, and Cochrane Library databases. If possible, a meta-analysis would be conducted. Incidence of hyponatremia, rate of resolution of hyponatremia, and serum sodium level were compared between cirrhotic patients who received and did not receive HA infusion. Odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. The quality of evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results. Initially, 3231 papers were identified. Among them, 30 studies, including 25 randomized controlled trials (RCTs) and 5 cohort studies, were eligible. Among cirrhotic patients without hyponatremia, the HA infusion group had significantly lower incidence of hyponatremia (OR = 0.55, 95%CI = 0.38–0.80, p = 0.001) and higher serum sodium level (MD = 0.95, 95%CI = 0.47–1.43, p = 0.0001) as compared to the control group. Among cirrhotic patients with hyponatremia, the HA infusion group had a significantly higher rate of resolution of hyponatremia (OR = 1.50, 95%CI = 1.17–1.92, p = 0.001) as compared to the control group. Generally, the quality of available evidence is low. Conclusions. Based on the current evidence, HA may be considered for preventing the development of hyponatremia in liver cirrhosis, especially in those undergoing LVP, and treating hyponatremia. Well-designed studies are required to clarify the effects of HA infusion on hyponatremia in liver cirrhosis.

Pretreatment Low Serum Sodium as a Prognostic Factor for Patients with Esophageal Cancer Treated with Radiotherapy or Chemoradiotherapy.

Low serum sodium levels have been associated with poor prognoses for several cancers. However, the prognostic value of low serum sodium levels in esophageal carcinoma (EC) has not been well elucidated. We examined the prognostic value of low baseline serum sodium levels before radiotherapy or chemoradiotherapy for EC patients. A retrospective analysis of data from EC patients who received radiotherapy or chemoradiotherapy at a single cancer center was performed. Patients were divided into low serum sodium level (≤140.0 mmol/L) or high serum sodium level (>140.0 mmol/L) groups according to the median pretreatment serum sodium level. The Kaplan–Meier model and Cox proportional hazards model were used for survival analyses. The 5-year progression-free survival (PFS) and overall survival (OS) rates in the whole group were 16.9% and 21.8%, respectively. The PFS and OS rates of patients in the low serum sodium levels group were significantly lower than those in the high serum sodium levels group (p < 0.001). A similar association between PFS/OS and sodium levels was observed in the treatment subgroups. The univariate analysis showed that low serum sodium levels, Karnofsky performance status (KPS), clinical N stage, tumor site, clinical stage, and treatment mode were the influencing factors of OS. Multivariate analyses indicated that low baseline serum sodium levels were an independent prognostic marker of poor PFS (HR, 1.744; 95% CI, 1.248-2.437; p = 0.001) and OS (hazard ratio (HR), 2.125; 95% confidence interval (CI), 1.555-2.904; p < 0.001). Pretreatment levels of low serum sodium could be a new and helpful serum biomarker of the prognosis of EC patients receiving radiotherapy or chemoradiotherapy.

Impact of Female Sex on the Susceptibility to Hypernatremia Among Older Community-Dwelling Individuals in Japan.

PurposeOlder individuals are at high risk for hypernatremia. However, actual data on serum sodium levels and differences between the sexes remain unclear in the older Japanese population. This study aimed to describe the data regarding serum sodium level and hypernatremia prevalence and to investigate whether female sex is associated with an increased risk of hypernatremia.Patients and MethodsWe retrospectively analyzed the data of adults aged ≥65 years without severely reduced kidney function who underwent an annual health checkup in 2019. Serum sodium levels were investigated as the outcome and corrected for glucose, if necessary. Clinical characteristics were compared between women and men.ResultsIn the 903 participants consisting of 273 women and 630 men who were enrolled in this study, the overall prevalence of hypernatremia, defined as a serum sodium level ≥145 mmol/L, was 12.5%. Female participants showed significantly more frequent hypernatremia than male participants (17.6% vs 10.3%, p = 0.003) and higher serum sodium levels (median [interquartile range]; 143.0 [142.0, 144.0] vs 142.4 [141.5, 144.0], p <0.001). Serum creatinine (sCr), but not estimated glomerular filtration rate (eGFR), was correlated with serum sodium levels (rs = −0.108, p = 0.001). In the binary logistic regression analysis, female sex was significantly associated with hypernatremia (odds ratio, 1.89; 95% confidence interval, 1.23–2.89; p = 0.004) even after adjusting for age, alcohol use, antihypertensive agent use, body mass index, and winter season. The association between female sex was reduced and no longer significant after adjusting for sCr, although the association remained unchanged after adjustment for eGFR.ConclusionOne-eighth of the older community dwellers in Japan exhibits hypernatremia after an overnight fast, and female sex is a significant risk factor. Since sCr is a surrogate of muscle mass, smaller muscle mass possibly mediates the association between female sex and hypernatremia.

Relationship between Hyponatremia and Peripheral Neuropathy in Patients with Diabetes.

Objectives Hyponatremia is a common complication of diabetes. However, the relationship between serum sodium level and diabetic peripheral neuropathy (DPN) is unknown. This study was aimed at investigating the relationship between low serum sodium level and DPN in Chinese patients with type 2 diabetes mellitus. Methods A retrospective study was performed on 1928 patients with type 2 diabetes between 2010 and 2018. The multivariate test was used to analyze the relationship between the serum sodium level and the nerve conduction function. A restricted cubic spline was used to flexibly model and visualize the relationship between the serum sodium level and DPN, followed by logistic regression with adjustment. Results As the serum sodium level increased, the prevalence of DPN had a reverse J-curve distribution with the serum sodium levels (69.6%, 53.7%, 49.6%, 43.9%, and 49.7%; P = 0.001). Significant differences existed between the serum sodium level and the motor nerve conduction velocity, sensory nerve conduction velocity, part of compound muscle action potential, and sensory nerve action potential of the participants. Compared with hyponatremia, the higher serum sodium level was a relative lower risk factor for DPN after adjusting for several potential confounders (OR = 0.430, 95%CI = 0.220–0.841; OR = 0.386, 95%CI = 0.198–0.755; OR = 0.297, 95%CI = 0.152–0.580; OR = 0.376, 95%CI = 0.190–0.743; all P < 0.05). Compared with low-normal serum sodium groups, the high-normal serum sodium level was also a risk factor for DPN (OR = 0.690, 95%CI = 0.526–0.905, P = 0.007). This relationship was particularly apparent in male participants, those aged <65 years, those with a duration of diabetes of <10 years, and those with a urinary albumin − to − creatinine ratio (UACR) < 30 mg/g. Conclusions Low serum sodium levels were independently associated with DPN, even within the normal range of the serum sodium. We should pay more attention to avoid the low serum sodium level in patients with type 2 diabetes mellitus.

Symptom management to alleviate thirst and dry mouth in critically ill patients: A randomised controlled trial

BackgroundCritically ill patients often experience coexisting symptoms. Thirst, in particular, appears to be an important symptom, having the highest prevalence, intensity, and induction of distress, and is significantly correlated with other symptoms. However, thirst and dry mouth are not usually assessed or treated. ObjectivesThe aim of the study was to demonstrate the effectiveness of an intervention bundle to relieve thirst and dry mouth. MethodsThe present study was a randomised controlled trial in which critically ill patients were allocated to an experimental or control group. The intervention bundles, including vitamin C sprays, peppermint water mouthwash, and a lip moisturiser, were provided to the experimental group for 3 days, whereas patients in the control group were exposed to the placebo interventions, including saline sprays, 40 °C water mouthwash, and wetting the lips with water. ResultsA total of 61 patients were recruited to the study; 65.6% (n = 41) were men, and the average age was 64.2 ± 16.8 years. The average decrease in thirst intensity and oral mucosa situation scores after the interventions was larger in the experimental group patients relative to controls (1.27 and 0.36 vs. 0.19 and 0.1 points, respectively; p < 0.05). Being male, scoring highly on the Acute Physiology and Chronic Health Evaluation II scale, not receiving diuretics, and having higher serum sodium levels were potential predictors of thirst and oral dryness. ConclusionsThe interventional bundle used in this study was shown to be a promising approach that can relieve thirst intensity and dry mouth, which are pervasively distressful to critically ill patients. Clinical Trial Registration NumbersThe study was registered on the www.Chictr.org.cn under the identification number ChiCTR1900022873.

Pneumonia Caused by Severe Acute Respiratory Syndrome Coronavirus 2 and Influenza Virus: A Multicenter Comparative Study.

BackgroundDetailed differences in clinical information between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia (CP), which is the main phenotype of SARS-CoV-2 disease, and influenza pneumonia (IP) are still unclear.MethodsA prospective, multicenter cohort study was conducted by including patients with CP who were hospitalized between January and June 2020 and a retrospective cohort of patients with IP hospitalized from 2009 to 2020. We compared the clinical presentations and studied the prognostic factors of CP and IP.ResultsCompared with the IP group (n = 66), in the multivariate analysis, the CP group (n = 362) had a lower percentage of patients with underlying asthma or chronic obstructive pulmonary disease (P < .01), lower neutrophil-to-lymphocyte ratio (P < .01), lower systolic blood pressure (P < .01), higher diastolic blood pressure (P < .01), lower aspartate aminotransferase level (P < .05), higher serum sodium level (P < .05), and more frequent multilobar infiltrates (P < .05). The diagnostic scoring system based on these findings showed excellent differentiation between CP and IP (area under the receiver operating characteristic curve, 0.889). Moreover, the prognostic predictors were different between CP and IP.ConclusionsComprehensive differences between CP and IP were revealed, highlighting the need for early differentiation between these 2 pneumonias in clinical settings.

Clinical, Imaging, and Lab Correlates of Severe COVID-19 Leukoencephalopathy.

Patients infected with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) can develop a spectrum of neurological disorders, including a leukoencephalopathy of variable severity. Our aim was to characterize imaging, lab, and clinical correlates of severe coronavirus disease 2019 (COVID-19) leukoencephalopathy, which may provide insight into the SARS-CoV-2 pathophysiology. Twenty-seven consecutive patients positive for SARS-CoV-2 who had brain MR imaging following intensive care unit admission were included. Seven (7/27, 26%) developed an unusual pattern of "leukoencephalopathy with reduced diffusivity" on diffusion-weighted MR imaging. The remaining patients did not exhibit this pattern. Clinical and laboratory indices, as well as neuroimaging findings, were compared between groups. The reduced-diffusivity group had a significantly higher body mass index (36 versus 28 kg/m2, P < .01). Patients with reduced diffusivity trended toward more frequent acute renal failure (7/7, 100% versus 9/20, 45%; P = .06) and lower estimated glomerular filtration rate values (49 versus 85 mL/min; P = .06) at the time of MRI. Patients with reduced diffusivity also showed lesser mean values of the lowest hemoglobin levels (8.1 versus 10.2 g/dL, P < .05) and higher serum sodium levels (147 versus 139 mmol/L, P = .04) within 24 hours before MR imaging. The reduced-diffusivity group showed a striking and highly reproducible distribution of confluent, predominantly symmetric, supratentorial, and middle cerebellar peduncular white matter lesions (P < .001). Our findings highlight notable correlations between severe COVID-19 leukoencephalopathy with reduced diffusivity and obesity, acute renal failure, mild hypernatremia, anemia, and an unusual brain MR imaging white matter lesion distribution pattern. Together, these observations may shed light on possible SARS-CoV-2 pathophysiologic mechanisms associated with leukoencephalopathy, including borderzone ischemic changes, electrolyte transport disturbances, and silent hypoxia in the setting of the known cytokine storm syndrome that accompanies severe COVID-19.

Serum lipid and electrolyte profiles of Wistar rats fed with Vernonia amygdalina supplemented Vigna subterranea (Bambara groundnut) pudding

Objective: This study investigated the effects of Vernonia amygdalina supplementation on Vigna subterrenea (bambara groundnut) pudding on serum lipid profile and electrolyte levels in Wistar rats. Materials and Methods: Twenty five weanling rats were randomly selected into 5 groups of 5 rats each. Group 1 received normal rat pellet. Groups 2 and 3 received 10% and 5% (w/w) non supplemented bambara pudding, respectively. Groups 4 and 5 were fed with 10% and 5% (w/w) Vernonia supplemented bambara pudding, respectively, for 21 days. The animals were sacrificed using anaesthesia at the end of the experiment and blood sample collected for serum lipid profile and serum electrolyte determinations using standard methods. Results: There was a significant increase (p&lt;0.05) in total cholesterol level in groups 2 (1.64 ± 0.01 mmol/L) and 4 (1.66 ± 0.01 mmol/L) compared to normal control (1.31 ± 0.02 mmol/L). Triacylglycerol level increased significantly in groups 2, 3, and 4 compared to normal control. The high density lipoprotein cholesterol (HDL-c) and Serum sodium level were significantly increased (p &lt; 0.05) in group 2 and 4 respectively compared to the normal control. Potassium, chloride, bicarbonate and calcium levels showed significant increases in group 2 relative to normal control. Phosphate level decreased significantly in group 2 (1.37 ± 0.03 mmol/L), 3 (1.43 ± 0.03 mmol/L) and 5 (1.37 ± 0.03 mmol/L) when compared to normal control (1.75 ± 0.03 mmol/L) respectively. Conclusion: Consumption of bambara groundnut pudding supplemented with Vernonia leaves increases HDL-c level as well as supply appreciable amounts of electrolytes in the body.

Transient water-electrolyte disturbance after hemispherotomy in young infants with epileptic encephalopathy.

This study aimed to elucidate the clinical features of water-electrolyte disturbance (WED) as a sequela of hemispherotomy. We performed a retrospective chart review to identify the clinical features of diabetes insipidus (DI) as a complication in < 12-month-old patients who underwent hemispherectomy or hemispherotomy for severe epilepsy between 2007 and 2018. Central DI was diagnosed if a patient developed polyuria (urine output > 5mL/kg/h), abnormally high serum osmolality (> 300mOsm/kg), high serum sodium level (> 150mEq/L), either abnormally low urine specific gravity (< 1.005) or low urine osmolality (< 300mOsm/kg) or both, and effective control of polyuria with arginine vasopressin (AVP). The clinical course of post-hemispherotomy WED, complications other than WED, and seizure outcomes were analyzed. The review identified that 3 of 23 infants developed WED. All patients developed polyuria within 2days after surgery, with high serum osmolality and hypotonic urine; AVP was effective in treating these symptoms. The clinical course was compatible with central DI. Two patients subsequently developed hyponatremia in a biphasic or triphasic manner. All patients had multiple seizures that were probably related to WED. Two patients developed asymptomatic cerebral sinovenous thrombosis, possibly because of the surgical procedure and dehydration; anticoagulant treatment was provided. All patients were treated for WED for up to 2months and had no residual pituitary dysfunction. Systemic complications other than intracranial ones can occur in patients who have undergone hemispherotomy. Perioperative systemic management of young infants undergoing this procedure should include careful water and electrolyte balance monitoring.

Impact of CYP3A5 genotype on tolvaptan pharmacokinetics and their relationships with endogenous markers of CYP3A activity and serum sodium level in heart failure patients.

Tolvaptan efficacy for heart failure has a large interindividual variation. This study aimed to evaluate the influence of CYP3A5 and ABCB1 genotypes on tolvaptan pharmacokinetics and their relationships with plasma markers of CYP3A activity and laboratory test values in heart failure patients. Fifty-eight heart failure patients receiving oral tolvaptan for volume overload were enrolled. Blood samples for determination of pre-dose plasma concentrations of tolvaptan and its metabolites were collected. CYP3A5 and ABCB1 genotypes, plasma 4β-hydroxycholesterol/total cholesterol ratio (4β-OHC/TC) and 25-hydroxyvitamin D (25-OHD), and serum laboratory test values were evaluated. The CYP3A5*3/*3 genotype was associated with a higher plasma concentration of tolvaptan but not with its metabolic ratios. The ABCB1 3435C>T, 2677G>T/A and 1236C>T polymorphisms affected neither tolvaptan pharmacokinetics nor its metabolism. Plasma 4β-OHC/TC and 25-OHD concentration were not correlated with plasma tolvaptan concentration. In a stratified analysis based on CYP3A5 genotype, plasma 4β-OHC/TC had a negative correlation with plasma tolvaptan concentration in the patients with the CYP3A5*1 allele, while the plasma concentration of 25-OHD did not. The CYP3A5*3/*3 genotype was associated with a higher serum sodium level in the patients with volume overload. The plasma concentration of 25-OHD had a positive correlation with the serum total bilirubin level. In conclusion, CYP3A5*3 but not ABCB1 genotypes elevated tolvaptan plasma exposure in heart failure patients. CYP3A5-deficient patients treated with tolvaptan had a higher serum sodium level. The CYP3A5 genotype altered the relationship between plasma tolvaptan and 4β-OHC.

Acute Kidney Injury After Pediatric Liver Transplantation

BackgroundThe aim of the present study is to assess acute kidney injury (AKI) incidence according to the pRIFLE and AKIN criteria and to evaluate the risk factors for early developing AKI in postoperative intensive care unit after pediatric liver transplantation (LT). MaterialsAfter exclusion of retransplantations, 7 cadaveric and 44 living donors, totaling 51 pediatric LT patients that were performed between 2005 and 2017, were reviewed retrospectively. AKI was defined according to both pediatric RIFLE (Risk for renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal disease) and Acute Kidney Injury Network (AKIN) criteria. Documented data were compared between AKI and non-AKI patients. ResultsAKI incidences were 17.6% by AKIN and 37.8% by pRIFLE criteria. AKIN-defined AKI group had statistically lower serum albumin level, higher serum sodium level, higher furosemide dose, and higher rate of red blood cell (RBC) transfusion than the non-AKI group (P = .02, P = .02, P = .01 and P = .04, respectively). AKI patients had significantly prolonged mechanical ventilation (P = .01) and hospital LOS (P = .02). The pRIFLE-defined AKI group had significantly lower serum albumin level, higher blood urea nitrogen (BUN) level, and higher ascites drained and also showed higher requirement for RBC and 20% human albumin transfusions than the non-AKI group (P = .02, P = .04, P: =.007, P = .02 and P = .05, respectively). ConclusionWe evaluated that hypoalbuminemia, high requirement for RBC and 20% human albumin transfusions, high serum sodium, high furosemide use, and high flow of ascites are risk factors for AKI and high BUN levels can be predictive for AKI in pediatric LT patients. The effect of AKI on outcome variables were prolonged mechanical ventilation and hospital LOS.

Serum Sodium and Pulse Pressure in SPRINT.

High dietary sodium intake may induce a small, yet physiologically relevant rise in serum sodium concentration, which associates with increased systolic blood pressure. Cellular data suggest that this association is mediated by increased endothelial cell stiffness. We hypothesized that higher serum sodium levels were associated with greater arterial stiffness in participants in the Systolic Blood Pressure Intervention Trial (SPRINT). Multivariable linear regression was used to examine the association between baseline serum sodium level and (i) pulse pressure (PP; n = 8,813; a surrogate measure of arterial stiffness) and (ii) carotid-femoral pulse wave velocity (CFPWV; n = 591 in an ancillary study to SPRINT). Baseline mean ± SD age was 68 ± 9 years and serum sodium level was 140 ± 2 mmol/L. In the PP analysis, higher serum sodium was associated with increased baseline PP in the fully adjusted model (tertile 3 [≥141 mmol] vs. tertile 2 [139-140 mmol]; β = 0.87, 95% CI = 0.32 to 1.43). Results were similar in those with and without chronic kidney disease. In the ancillary study, higher baseline serum sodium was not associated with increased baseline CFPWV in the fully adjusted model (β = 0.35, 95% CI = -0.14 to 0.84). Among adults at high risk for cardiovascular events but free from diabetes, higher serum sodium was independently associated with baseline arterial stiffness in SPRINT, as measured by PP, but not by CFPWV. These results suggest that high serum sodium may be a marker of risk for increased PP, a surrogate index of arterial stiffness.

Association of macrophage migration inhibitory factor - 173 G/C polymorphism with dilated cardiomyopathy in children

Objective The objective of this study was to detect the relation between macrophage migration inhibitory factor (MIF) −173 G/C gene polymorphism and dilated cardiomyopathy (DCM) in children. Background DCM is the most common cardiomyopathy. Myocardial inflammation is one of the commonest mechanisms in cardiomyopathy. MIF plays an important role in the control of innate immune responses and promotes proinflammatory biological activities; hence, MIF gene polymorphisms may predispose affected hosts to severe inflammatory or infectious disease. Patients and methods This study was conducted on 50 patients, 30 patients with DCM and 20 age-matched and sex-matched healthy controls. All patients were subjected to history taking, clinical examination, echocardiography, and laboratory measurement of serum sodium and uric acid. Patients and controls were subjected to PCR-restriction fragment length polymorphism to determine MIF 173 G/C polymorphism. Results Our study revealed a significant statistical difference in the distribution of the genotypes and allele frequencies between patients and controls. Studying the relation between different genotypes and echocardiographic parameters (ejection fraction, fractional shortening, left ventricular end-diastolic diameter and left ventricular end-systolic diameter) revealed a highly significant difference between different genotypes among patients. With regard to laboratory characteristics, there was a significantly higher serum sodium level in the CC genotype, while the uric acid level showed no significant difference between different genotypes among patients. Conclusion In our study, we conclude that the CC genotype of MIF gene may be a risk factor for cardiomyopathic patients and that the C allele is associated with severe clinical condition.