Hyperkalemia Research Articles

Abstract 4117180: Hyperkalemia-Related Hospitalization Associated with Short-Term vs. Long-Term Outpatient SZC Therapy Among RAASi Users: The GALVANIZE Outcome study

Introduction: Patients receiving renin-angiotensin-aldosterone system inhibitors (RAASi) are at increased risk of developing hyperkalemia (HK). Sodium zirconium cyclosilicate (SZC) is used to treat HK, but the impact of duration of SZC on healthcare resource utilization (HRU) in RAASi users is unknown. The GALVANIZE Outcome study compared HK-related HRU among RAASi users between long-term and short-term SZC users. Methods: Adults with ≥1 outpatient prescription for SZC (index date) and ≥1 RAASi prescription spanning the index date were identified from a large US insurance claims database (7/2018-12/2022) and were stratified based on duration of SZC use. Long-term SZC users (>90 days) and short-term SZC users (≤30 days) were exactly and propensity score matched on key baseline characteristics. Rates of HK-related hospitalizations or emergency department (ED) visits, HK-related ED visits, and HK-related hospitalizations were compared during follow-up from index to the earliest of 6 months post-index, end of data availability, other potassium binder use, or re-initiation of SZC post-discontinuation. Results: Among 1,586 matched pairs, the mean age was 65.5 years, 41.0% of patients were female, and most patients had any stage chronic kidney disease (91.9%), hypertension (90.8%), and diabetes (73.4%). Also, 30.0% of patients had heart failure. The most used RAASi therapies at index were angiotensin-converting enzyme inhibitors (57.3%) and angiotensin-receptor blockers (56.3%). Patients with long-term SZC use had a 44% lower rate of HK-related hospitalizations or ED visits, a 41% lower rate of HK-related hospitalizations and a 52% lower rate of HK-related ED visits than patients with short-term SZC use during follow-up (all p<0.01; Figure 1). Conclusions: Among patients with RAASi and SZC therapy use, long-term SZC use was associated with significantly lower rates of HK-related HRU compared to matched patients with short-term SZC use. Funding: AstraZeneca

Abstract 4130314: High sodium, low potassium diet is associated with incident cardiovascular disease among US Hispanic/Latino adults: results from the Hispanic Community Health Study/Study of Latinos.

Background: Diets high in sodium and low in potassium are associated with increased blood pressure level but associations with cardiovascular disease (CVD) remain controversial. Few studies have evaluated this relationship among Hispanic/Latino adults. Objective: To assess whether dietary sodium and potassium are associated with incident CVD among diverse US Hispanics/Latino adults. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a cohort of 16,415 self-identifying Hispanic/Latino adults aged 18-74 four US urban communities in 2008-2011 (visit 1; V1). V1 included a comprehensive examination with in-person measurement of health information and interviewer administered questionnaires. Dietary sodium (mg/day) and potassium (mg/day) intakes were assessed from the average of two 24-hour dietary recall surveys administered by bilingual registered dietitians. CVD events occurring from V1 through 2019 were adjudicated by an expert panel of clinicians. We used Poisson regression to determine the association (incidence rate ratio, IRR) between sodium, potassium, and the sodium-to-potassium ratio, with CVD, using time to CVD as an offset. Models accounted for HCHS/SOL complex survey design and were adjusted for demographic, including Hispanic/Latino background, socioeconomic, and behavioral factors along with energy consumption, body mass index, cholesterol, and family history of CVD. Results: Among 15,291 participants without self-reported CVD at V1, mean age was 40 years, with 53% female. Mean daily intakes of sodium and potassium were 3,040 mg/day and 2,422 mg/day, respectively. Molar ratio of sodium to potassium was 1.33. Over 9.7 years of follow-up, there were 311 CVD events (2.0 events per 1,000 person years, 95% CI: 1.6, 2.5). In adjusted models, nutrients were associated with increased risk of CVD: by 17% for each 1g/day increment of sodium (IRR: 1.17, 95% CI: 1.03, 1.33); by 29% for each 1g/day decrement of potassium (IRR: 1.29, 95% CI: 1.01, 1.64); and by 112% for each 0.5 molar increment of sodium to potassium ratio (IRR: 2.12, 95% CI: 1.13, 4.11). Conclusions: In a large diverse sample of Hispanic/Latino adults, high dietary sodium and low dietary potassium were independently associated with an increased risk of CVD. Results underscore the importance of intensifying public health interventions to improve nutrient quality, by reducing dietary sodium and increasing dietary potassium consumption as a means of preventing CVD.

Sustainable Cropping Sequences to Improve Soil Fertility and Microbiological Properties

Different cropping systems and nutrient management techniques impact the microbiological characteristics of soil and nutrient availability for plants. This study assessed four cropping systems—rice–wheat, cotton–wheat, pearl millet–wheat, and pearl millet–mustard in Hisar district, Haryana, using 80 soil samples (20 from each system) collected in April 2022 after the Rabi crop harvest. The cotton–wheat system had the highest accessible nitrogen (N) at 155.9 kg ha−1, while both the cotton–wheat (59.3 kg ha−1) and rice–wheat (54.0 kg ha−1) systems had higher available sulfur (S) levels compared to pearl millet–wheat (41.2 kg ha−1). Pearl millet–wheat also showed 12.4% higher potassium (K) levels than rice–wheat. The rice–wheat system exhibited the highest phosphorus (P) concentration at 54.3 kg ha−1 and greater DTPA-extractable micronutrients. Soils from the rice–wheat system had higher DTPA-extractable micronutrients (Zn, Fe, Mn, Cu) and superior microbial biomass nitrogen (MBN, 54.7 mg kg−1), urease (37.9 µg NH4+-N g−1 h−1), and alkaline phosphatase activity (APA, 269.7 µg PNP g−1 h−1) compared to other systems. Canonical discriminant functions explained 88.1% of the variability among cropping systems, while principal component analysis identified available P, DTPA-extractable Zn, and Cu as key soil quality indicators, accounting for 66.9% of the variance. These insights can inform policymakers on promoting effective cropping systems and sustainable soil health in northwestern India.

Patients with crush syndrome and kidney disease: lessons learned from the earthquake in Kahramanmaraş, Türkiye

This study investigated in-hospital outcomes and related factors in patients diagnosed with postearthquake crush syndrome after the earthquakes in Kahramanmaraş, Türkiye. One thousand twenty-four adult patients diagnosed with crush syndrome were analyzed. Data on demographic characteristics, clinical presentation, laboratory values, treatments, and outcomes were collected. A total of 9.8% of patients died during their hospital stay. Nonsurvivors were generally older, more likely to have preexisting chronic kidney disease, and faced more severe injuries and complications, including hypotension-shock, arrhythmias, elevated markers of renal dysfunction, and higher rates of acute kidney injury (AKI) and compartment syndrome. In addition, intensive care unit needs were higher. Multivariate analysis confirmed that age, injury severity, shock, high potassium, uric acid, and lactate levels on admission, development of AKI, compartment syndrome, and intensive care unit admission were significant predictors of mortality. Better disaster preparedness and improved health care infrastructure could be potential explanations for improved in-hospital mortality in the current era, as compared to previous earthquakes.

Effect of sulfur and potassium foliar applications on wheat grain protein quality

ContextThe effects of sulfur and potassium fertilizers on wheat yield and quality have been well studied, but most of them are used as basal fertilizers. However, the root system is senescent at the later stages of wheat growth and cannot absorb sufficient sulfur and potassium fertilizers plant needed. It is still unclear whether sulfur and potassium foliar applications at the later stages can affect wheat yield and quality. ObjectiveThis experiment was conducted to investigate the changes of sulfur and potassium accumulation and transport, protein synthesis and flour processing quality after foliar application of sulfur and potassium fertilizers, transport and the relating physiological mechanisms. MethodsIn 2020–2021 and 2021–2022, a three-factor split plot experiment was carried out in the middle and lower reaches of Yangtze River, with wheat variety, concentration of sulfur fertilizer and potassium fertilizer served as main factor, subfactor and sub-subfactor respectively. ResultsIn the study from 2020 to 2022, the albumin protein content of both varieties decreased in the nutrient spraying treatment, particularly in the high potassium level. However, there was no significant effect on the globulin content. Moreover, the gliadin protein content decreased in the sulfur spraying treatment alone, but significantly increased the wheat gluten content, and thereby the total protein content. We also found significant genotypic differences in the composition and content of high molecular weight wheat glutenin subunits (HMW-GS) between the two varieties. The foliar spraying of sulfur and potassium fertilizers significantly increased the content of subunits 1 and 8 in Yangmai (YM15) and subunits 7 and 12 in Yangmai (YM16), and the effect of mixed spraying was better than single-nutrient spraying, especially the amount of 0.2 % sulfur and 0.3 % potassium fertilizer treatment. ConclusionsThe superimposed effect of sulfur and potassium effectively increased the total protein content by promoting the accumulation of sulfur in transit to the seeds, increasing the substrate supply level, and enhancing enzyme activity. Although sulfur and potassium combination can improve the grain protein quality and flour processing quality, too high spraying concentrations can decrease the flour processing quality. ImplicationsSpraying the appropriate amount of 0.2 % sulfur and 0.3 % potassium fertilizer can serve as an optimization measure for high-quality and efficient production of different types of wheat varieties.

The safety of in-hospital initiation of SGLT2 inhibitor with MRA therapy in patients hospitalized for heart failure with a reduced left ventricular ejection fraction and chronic kidney disease

Abstract Deferring in-hospital initiation of guideline-recommended medications in HFrEF has a few chances they will be initiated ambulatory, especially in the case of coexisting HFrEF and chronic kidney disease (CKD). The aim was to investigate the safety of in-hospital initiation of SGLT2i with MRA therapy for patients hospitalized for HFrEF and CKD 3. Methods 88 patients with HFrEF (on top of standard therapy ACE-I/ARB, B-blockers) and CKD (baseline eGFR between 30 and 60 ml/min) were included in the study. The potassium (K), creatinine (C), uric acid (UA) levels were estimated at baseline and week 12. After biochemical evaluation, patients started on spironolactone (SP) treatment with a median dose of 20 mg daily (titrated) and dapagliflozin (D) with a dose of 10 mg daily (D+SP). Blood pressure (BP), K, and renal function (RF) were checked at weeks 1 (in-hospital), 2, 4, 6, 8, 12 (ambulatory), and more frequently as necessary. Results After the start of therapy D+SP mean eGFR decreased significantly at week 1 from 51.14±9.18 to 46.26±7.91 ml/min/1.73m2 (P<.0001) and at week 2 to 44.18±6.51 ml/min/1.73m2 (-2.08±1.2; P<.001). At week 4 mean eGFR decreased to 42.73±6.86 ml/min/1.73m2 (-1.45±1.1; P<.05). So, a significant decrease in eGFR was observed only during the first month with no significant decrease at 6 and 12 weeks after the start of therapy. Six patients (8%) experienced a significant decline in RF resulting in temporary withdrawal of SP. At week 2 mean K level increased significantly from 4.56±0.63 to 5.07±0.57 mmol/L (P<.001). At weeks 4, 6, 8 K levels remain stable. At week 12 mean K level decreased significantly compared with week 2 (to 4.92±0.57 mmol/L, P<.05). The incidences of severe hyperkalemia (HK) (K+≥6.0mmol/L) were in three patients < 2 %, and moderate HK (K 5.5–5.9 mmol/L) occurred in ten patients (11 %). Patients who experienced inpatient hyperkalemia had a significantly lower eGFR than patients without episodes of HK (38.70 vs. 55.21 mL/min/1.73 m2; P<.0001). Episodes of HK were predicted by baseline K≥5.0 mmol/L and eGFR≤40 ml/min/1.73m2. Additionally, there was a significant improvement in blood UA (-1,53±0.49 mg/dL, P<.01). By multivariate analysis older age, diabetes, low diastolic BP (<60 mm Hg), eGFR≤40 ml/min/1.73m2 at baseline were associated with decreased RF (0.378, P<.01; 0.632, P<.001; 0.771, P<.0001; 0.397, P<.01; respectively), whereas episodes of HK were predicted by baseline K≥5.0 mmol/L and eGFR≤40 ml/min/1.73m2 (0.785, P<.0001; 0.542, P<.001; respectively). Conclusion Initiation of SGLT2i with MRA in patients hospitalized for HFrEF and CKD 3 was mainly safe although it caused an early drop in eGFR. Importantly, a fall in eGFR was observed during the first month. Concern about the reduction in eGFR should be in older diabetic patients with eGFR≤40 and low diastolic blood pressure. Although hyperkalemia was common, the occurrence of it was predicted by baseline potassium level and eGFR.

Up-titration of Guideline Directed Medical Therapy (GDMT) and the occurrence of side effects in Heart Failure with reduced Ejection Fraction (HFrEF)

Abstract Background The ESC Guidelines recommend early, full-dose use of heart failure (HF) medications to enhance survival, but real-world application often faces delays and inconsistencies. Clinicians often fear side effects during up-titration to the recommended target dose (TD), i.e. hypotension, bradycardia, renal impairment, and hyperkalemia (HK). The dependency of side effects during dose escalation from the severity of HF remains unclear. Purpose This study aimed to evaluate the relationship between the occurrence of side effects during up-titration of HF medication and HF severity reflected by N-terminal pro B-type natriuretic peptide (NT-proBNP). Methods 425 patients with HFrEF and a complete data set of patient characteristics, medications and laboratory values at baseline (BL), 2 months (2M), and 6 months (6M) were included from our outpatient HF unit's prospective registry. Significant side effects were defined as: systolic blood pressure (SBP) <90mmHg, heart rate (HR) <50 beats per minute (bpm), potassium (K) >5.0mmol/l or K >5,5mmol/l and estimated glomerular filtration rate (eGFR) <30ml/min/1.73m2. Patients were categorized into three risk groups based on their NT-proBNP levels, i.e. low-risk with NT-proBNP <1000pg/ml, medium-risk with NT-proBNP 1000-2000pg/ml or high-risk with NT-proBNP >2000pg/ml. The occurrence of side effects was recorded and the development compared among the HF risk groups. Results Figure 1 shows up-titration of HF medication. Mean daily dosages of betablockers (BB), mineralocorticoid receptor antagonists (MRA) and renin-angiotensin-system inhibitors (RASi) increased significantly during follow-up (BL vs 2M and BL vs 6M, p<0.001 for all). The majority of patients received ≥50% of the recommended TDs at 6M (89% for BB, 83% for MRA, 88% for RASi and 91% for total mean TDs ≥50%), and the achieved daily dosages at 6M were largely comparable across the HF risk groups at 6M, except for RASi (p=0.030). Figure 2 depicts the side effects. Side effects developed almost exclusively at short-term within 2M except for lower SBP (Figure 2A). Newly developed side effects occurring after up-titration (2B) were even more rare and predominantly occurred within the highest NT-proBNP group. The occurrence of hypotension and bradycardia was infrequent and comparable within the HF risk groups. Renal dysfunction (at 6M p=0,041) and HK occurred predominantly in higher risk patients (HK at 2M p=0,001 and at 6M p<0,001). Conclusions Up-titration of HF medications is highly feasible, particularly in low- and medium-risk patients. Despite rare side effects such as hyperkalemia and renal impairment, up-titration remains unimpeded, especially in patients with NT-proBNP levels below 2000pg/ml. These findings emphasize the safety of up-titration in HF.

Physico-chemical and Mineral Composition of White Seeded Raisin Varieties (Vitis vinifera L.) Grown under Semi-arid Condition

Raisins (dried grapes) are preferred for their distinctive, delightful flavor, high nutritional content, and their potential to lower the risk of several serious and chronic conditions. The quality of raisins is crucial, as it has a direct impact on the health and well-being of those who consume them. The present study assessed the physiochemical composition, mineral content, and sensory parameters of white seeded raisins. The physiochemical parameters such as raisin weight, raisin recovery, pH, moisture, ash, carbohydrate, protein, and mineral content (potassium, phosphorus, calcium, magnesium, sodium, copper, iron, and zinc) were assessed. Result revealed that the grape variety Pandhari Sahebi showed higher raisin weight and protein content. Hussain Kadu recorded maximum moisture and carbohydrate content. Significantly, higher potassium and iron content was noted in Hussain Kadu. Based on the results, Hussain Kadu was preferred for raisin colour, texture and overall acceptability.

The effect of spironolactone versus eplerenone on blood pressure targets in resistant hypertension patients

Abstract Objective to evaluate different effects on blood pressure (BP) control in two treatment options spironolactone (SPIR) versus eplerenone (EPL) as an add-on therapy in resistant hypertensive (RAH) patients. Design and methods: We studied 208 patients with true RAH confirmed by the office and ambulatory BP monitoring (ABPM) despite the use of 3 antihypertensive medications including a calcium channel blocker, a blocker of the renin-angiotensin system, and a thiazide diuretic with maximally tolerated doses for at least 3 months. Patients were randomized into 2 groups throughout 12 weeks of once-daily treatment with SPIR (25–50 mg) or EPL (25-50 mg) in addition to their baseline triple-combination and then rotated with drugs. BP was measured in the office and by ABPM. Changes in laboratory tests were also studied. The predictive values of plasma aldosterone, active renin concentration (ARC), aldosterone-renin ratio (ARR), and serum potassium were analyzed to determine the antihypertensive response. Results There were no significant differences in the reduction of average office BP, average systolic 24-h, daytime, and nighttime BP by SPIR and EPL. SPIR reduced average diastolic 24-h BP by 7.3 mm Hg, diastolic daytime BP by 7.2 mm Hg, and diastolic nighttime BP by 7.5 mm Hg compared with a reduction of 5.6 mm Hg (P = 0.01), 5.6 mm Hg (P = 0.03) and 4.2 mm Hg (P = 0.0001) with EPL, respectively. Overall, 40.7 % RAH patients achieved targets of clinical BP and 24-h ABPM levels on SPIR and 33.3 % on EPL (Р = 0.002). After 12 weeks of treatment mean plasma potassium concentrations increased by 7.1 (P = 0.0001) on SPIR and by 5.0 % (Р = 0.0001) on EPL, but eGFR did not significantly change on the two drugs. Plasma aldosterone (β = 0.498, Р = 0.02) and ARC (β= -0.374, Р = 0.04) were predictors of the BP-lowering effect of SPIR and plasma aldosterone (β = 0.453, Р = 0.04) was a predictor of reduction BP for EPL in multivariate modeling. Breast pain or tenderness, changes in sex drive, and irregular menstrual cycles or spotting were more often by SPIR than by EPL (5.2 % vs 1.9 %, respectively, P = 0.04). Conclusions The greater antihypertensive effect of SPIR is related to aldosterone status, ARS level in resistant hypertension. EPL may be recommended for RAH patients who have high serum potassium levels that cannot tolerate spironolactone and for people with systolic resistant hypertension.

Independent and joint associations of urinary potassium excretion with cardiovascular death: a national population-based cohort study

Abstract Background Elevated potassium excretion is associated with lower blood pressure, as well as reduced risks of cardiovascular disease (CVD) death. However, the impact of varied sodium levels on this association remains a topic of debate, and the mediators of this association besides blood pressure remain uncertain. Purpose To examine the joint association of potassium and sodium with CVD mortality risk, and to identify potential mediating factors of this association. Methods Based on the ChinaHEART (China Health Evaluation And risk Reduction through nationwide Teamwork) project, participants aged 35-75 from 239 sites across all 31 provinces in the mainland of China were recruited from November 2014 to December 2022. We collected spot urine samples from participants and estimated 24-hour sodium and potassium excretion using the Kawasaki formula. Death records were captured through data linkage with the National Mortality Surveillance System and Vital Registration. Multiple regressions were used to analyze the association between potassium excretion and CVD death, as well as to examine the addictive interaction of potassium and sodium. Results This study included 270,991 participants with a mean age of 55.8±9.8 years, and 60.5% of them were female. The mean potassium excretion was 54.36±12.58 mmol/d , which was higher in males and people living in the north. Findings revealed a positive correlation between low urinary potassium levels and CVD death , and the lowest adjusted hazard rate for CVD mortality was 0.65 (95% CI: 0.58-0.73) in the group with the highest potassium excretion (i.e. ≥64.27 mmol/d) compared with the reference group (<43.79 mmol/d), after adjusting for sociodemographic characteristics, medical histories, and lifestyles. Age modified the association between potassium excretion and risk of CVD death (P for interaction=0.031). In addition to systolic blood pressure (16.6%), heart rate (2.2%) also served as the significant mediator between urinary potassium excretion and CVD death. The relative excess risk of interaction (RERI) of lower potassium excretion and lower sodium was significantly positive (RERI=0.22, 95% CI: 0.02-0.42), which implied the synergy effect. Conclusion Potassium intake in the Chinese population is evidently lower than the guideline recommendations, and increasing potassium intake, especially in the population aged <65 years, may reduce the risk and burden of cardiovascular and other diseases. Moreover, when sodium intake is insufficient, supplementation with both sodium and potassium salt can achieve greater health benefits.Graphic abstract

Dietary potassium intake and its interaction with sodium intake on risk of developing cardiovascular disease in persons with type 2 diabetes: The Japan Diabetes Complication and its Prevention Prospective study (JDCP study 12).

Many guidelines recommend increases in potassium intake. However, the relationship of dietary potassium intake with incident cardiovascular disease (CVD) has not been examined in those with type 2 diabetes (T2DM), including sodium acting antagonistically with potassium. We investigated these relationships in Japanese patients with T2DM. The investigation was part of the JDCP study, a nationwide prospective study begun in 2007. Analysed were 1477 persons with T2DM, 40-75 years of age, who completed a brief-type, self-administered Diet History Questionnaire at baseline. Primary outcome was a CVD event during the follow-up median 7 years (3.9-8.1 years). Hazard ratios (HRs) for CVD were estimated by Cox regression adjusted for confounders of daily potassium intake categorized by tertiles. Tertiles of sodium intake were also analysed. Mean daily potassium intake in tertiles was 1877, 2627 and 3532 mg, respectively, and significant associations were not shown between potassium intake and incidence of CVD. When HRs for CVD were stratified for potassium intake in tertiles (reference group, bottom tertile) and sodium intake (reference group, bottom tertile), potassium intake in the bottom tertile and sodium intake in the second and top tertiles were associated with significantly elevated HR for CVD (2.79 [1.02-7.63] and 3.92 [1.30-11.79], respectively). Low potassium intake in conjunction with high sodium intake was significantly associated with increased incident CVD in persons with T2DM. However, CVD incidence was not related to high potassium intake, regardless of sodium intake.

Biochar affects soil properties over 1 m depth in an alkaline soil of north China Plain

Biochar has been shown to enhance soil quality and agricultural yields. Previous studies about biochar's effect on soil properties mainly concentrated on the top 30 cm layer but less on the subsoils. Given the subsoil's active role in climate change mitigation and its significance for nutrient cycling and crop productivity, understanding biochar's effects at depth is crucial. This study explored the responses of soil organic carbon (SOC), total nitrogen, available potassium, available phosphorus, pH, and electrical conductivity to different doses of biochar addition (0, 10, 20, and 30 Mg/ha) over the 1 m depth of alkaline soil. Additionally, the impact of biochar on soil microbial community was assessed in the top 20 cm. Results demonstrated that biochar addition can increase SOC and improve soil properties in deep soil horizons. Specifically, a 30 Mg/ha biochar addition increased SOC by 1.2–10.1 Mg C/ha in the 10–40 cm layer and by 3 Mg C/ha in the 60–80 cm depth over two years. Additionally, biochar addition at this rate increased total nitrogen by 0.2–0.3 g N/kg in the 10–40 cm depth and elevated available potassium across the 1 m profile, with a maximum increment of 313 mg/kg in the surface 10 cm and a minimum of 97 mg/kg in the 40–60 cm depth. While biochar application did not increase available phosphorus, it resulted in a minor decrease in soil pH (<0.7 units) and a slight increase in electrical conductivity. Moreover, biochar addition did not significantly alter the soil microbial community. Our findings underscore the importance of considering subsoils when evaluating biochar's impact on soil properties. We suggest that subsoils should be considered when estimating the potential of cropland management for increasing soil carbon sequestration and improving soil conditions.

The Pathology and Blood Biochemistry of Juvenile Lates calcarifer on Diets Contaminated With Mycotoxins, Histamines and Rancid Fats-A Case Study.

Mycotoxins, originating from contaminated raw materials or suboptimal feed storage, are a growing concern in tropical aquaculture. Common fungi such as Aspergillus spp. and Fusarium spp. produce mycotoxins including aflatoxin, fumonisin, deoxynivalenol and zearalenone. High doses or prolonged exposure (weeks) to low doses of these mycotoxins (< 20 μg/kg) can depress growth, immunity, and cause mortality. This study investigated poor growth and low survival in juvenile Asian seabass, Lates calcarifer fed two different diets (FM40 and ABS3) for 5 weeks. Analysis of these diets revealed high peroxide values, multiple mycotoxins and high histamine levels. Fish fed the FM40 diet, which was contaminated with aflatoxin B1 (13.2 μg/kg), aflatoxin B2 (1.9 μg/kg), deoxynivalenol (29.5 μg/kg), alternariol (2.2 μg/kg), elevated peroxide value (45.91 mEq/kg), and histamine (129.51 mg/kg) developed mild bile duct hyperplasia, depressed total serum proteins (50.40 ± 10.06 g/L), markedly elevated blood potassium (8.2 ± 0.18 mmol/L), and heavy iron deposits in splenic melanomacrophage centres (Perl's stain) indicative of increased haemolysis. The presence of multiple cytotoxic mycotoxins in FM40 diet could explain the increased haemolysis and elevated blood potassium. In contrast, fish fed the ABS3 diet, which had high histamine levels (210.05 mg/kg), exhibited protein-losing nephropathy with multifocal fibrin plugs (Martius scarlet blue stain) indicating acute renal damage, and elevated blood calcium and phosphorus levels. Histamine is metabolised and excreted through the kidneys and known to induce renal arteriolar constriction, disrupt glomerular filtration barrier and increase permeability resulting in protein loss. This study shows that blood biochemistry and histopathology are useful diagnostic tools for assessing the impact of mycotoxins and histamines on fish health.

Transmembrane Serine Protease 2 and Proteolytic Activation of the Epithelial Sodium Channel in Mouse Kidney.

The renal epithelial sodium channel (ENaC) is essential for sodium balance and blood pressure control. ENaC undergoes complex proteolytic activation by not yet clearly identified tubular proteases. Here, we examined a potential role of transmembrane serine protease 2 (TMPRSS2). Murine ENaC and TMPRSS2 were (co-)expressed in Xenopus laevis oocytes. ENaC cleavage and function were studied in TMPRSS2-deficient murine cortical collecting duct (mCCDcl1) cells and TMPRSS2-knockout (Tmprss2-/-) mice. Short-circuit currents (ISC) were measured to assess ENaC-mediated transepithelial sodium transport of mCCDcl1 cells. The mCCDcl1 cell transcriptome was studied using RNA sequencing. The effect of low-sodium diet with or without high potassium were compared in Tmprss2-/- and wildtype mice using metabolic cages. ENaC-mediated whole-cell currents were recorded from microdissected tubules of Tmprss2-/- and wildtype mice. In oocytes, co-expression of murine TMPRSS2 and ENaC resulted in fully cleaved γ-ENaC and ∼2-fold stimulation of ENaC currents. High baseline expression of TMPRSS2 was detected in mCCDcl1 cells without a stimulatory effect of aldosterone on its function or transcription. TMPRSS2 knockout in mCCDcl1 cells compromised γ-ENaC cleavage and reduced baseline and aldosterone-stimulated ISC which could be rescued by chymotrypsin. A compensatory transcriptional upregulation of other proteases was not observed. Tmprss2-/- mice kept on standard diet exhibited no apparent phenotype, but renal γ-ENaC cleavage was altered. In response to a low-salt diet, particularly with high potassium intake, Tmprss2-/- mice increased plasma aldosterone significantly more than wildtype mice to achieve a similar reduction of renal sodium excretion. Importantly, the stimulatory effect of trypsin on renal tubular ENaC currents was much more pronounced in Tmprss2-/- mice than that in wildtype mice. This indicated the presence of incompletely cleaved and less active channels at the cell surface of TMPRSS2-deficient tubular epithelial cells. TMPRSS2 contributes to proteolytic ENaC activation in mouse kidney in vivo.

Gold Mineralization at the Syenite-Hosted Anwangshan Gold Deposit, Western Qinling Orogen, Central China

The Anwangshan gold deposit is located in the northwestern part of the Fengtai Basin, Western Qinling Orogen (WQO). The gold ore is hosted within quartz syenite and its contact zone. The U–Pb weighted mean age of the quartz syenite is 231 ± 1.8 Ma. It is characterized by high potassium (K2O = 10.13%, K2O/Na2O &gt; 1) and high magnesium (Mg# = 55.31 to 72.78) content, enriched in large ion lithophile elements (Th, U, and Ba) and light rare earth elements (LREE), with a typical “TNT” (Ti, Nb, and Ta) deficiency. The geochemical features and Hf isotope compositions (εHf(t) = −6.68 to +2.25) suggest that the quartz syenite would form from partial melting of an enriched lithospheric mantle under an extensional setting. Three generations of gold mineralization have been identified, including the quartz–sericite–pyrite (Py1) stage I, the quartz–pyrite (Py2)–polymetallic sulfide–early calcite stage II, and the epidote–late calcite stage III. In situ sulfur isotope analysis of pyrite shows that Py1 (δ34S = −1.1 to +3.8‰) possesses mantle sulfur characteristics. However, Py2 has totally different δ34S (+5.1 to +6.7‰), which lies between the typical orogenic gold deposits in the WQO (δ34S = +8 to +12‰) and mantle sulfur. This suggests a mixed source of metamorphosed sediments and magmatic sulfur during stage II gold mineralization. The fluid inclusions in auriferous quartz have three different types, including the liquid-rich phase type, pure (gas or liquid)-phase type, and daughter-minerals-bearing phase type. Multiple-stage fluid inclusions indicate that the ore fluids are medium-temperature (concentrated at 220 to 270 °C), medium-salinity (7.85 to 13.80% NaCleq) CO2–H2O–NaCl systems. The salinity is quite different from typical orogenic gold deposits in WQO and worldwide, and this is more likely to be a mixture of magmatic and metamorphic fluids as well. In summary, the quartz syenite should have not only a spatio-temporal but also a genetical relationship with the Anwangshan gold deposit. It could provide most of the gold and ore fluids at the first stage, with metamorphic fluids and/or gold joining in during the later stages.

Effect of preservation on changes in the volume of corneal endothelial cells in an environment with a high concentration of potassium

The experimental study of preservation length on the effect of high potassium concentration in the medium on the volume of human corneal endothelial cells was done. The results of the study of individual samples of fragments of donor material and the values calculated using joined data after hypothermic preservation for 4 and 10 days are presented. The increase of the time when cornea samples are kept in preservation medium (Eusol-C) at 4℃ led to a decrease in the average value (M ± SEM) of cell swelling indicator (N) in a potassium medium from 1.055 ±0.001; n = 982 to 1.014±0.001; n = 338; after 4 and 10 days, respectively. Student’s-t test for independent samples showed a high degree of significance for the difference between these values (p = 2E-76). Identification of the proportion of cells capable to swell in a medium with a high content of potassium ions (N 1), reflecting the electrogenic activity in these cells, showed a decrease of this indicator in the studied groups with increasing duration of preservation (94.3% and 56.8% after 4 and 10 days, respectively). Based on the results of the study, it is suggested that the values of endothelial cells swelling in a potassium environment can serve as indicators of the cells’ ability to restore electrogenic transport. It is concluded that the study of cell swelling in a medium with a high content of potassium ions can provide information for predicting the functionality of the graft.

Skin rash related to the use of wood ash in wound healing, about a case

Abstarct Introduction: The ash of wood plants is part of the ancestral remedies because of its physical and chemical properties. It has detergent, fertilizing, and antiseptic properties, which justifies its many uses. Case report: We report the case of a woman aged 50 years who presented with a generalized rash all over the body with painful macules a burning sensation and a fever. Symptoms appeared after taking wood ash from plants, for three days. The reason for use was the healing of Zona's wound that she contracted and treated before admission. The patient’s general condition was preserved, and the drug treatment allowed a quick healing. Conclusion: Wood ash from plants with a high potassium hydroxyl content may be an irritant and partly explain the reaction observed. Traditional treatments should be used with great care to avoid adverse effects.

Manual flagging failed to identify pseudohyperkalemia in acute myeloid leukemia: case report

BackgroundPseudohyperkalemia is well known in acute or chronic lymphocytic leukemia, but it is very rare in acute myeloid leukemia (AML). The lab flagging system for leukocytosis to prevent pseudohyperkalemia may not work.Case presentationA 55 year-old white man with AML was sent to emergency department for transfusion due to severe anemia. Blood test showed severe leukocytosis and elevated potassium. Repeated blood test showed his potassium was even higher. Anti-hyperkalemic medical treatment was given. He was then diagnosed with pseudohyperkalema.InvestigationI was repeatedly reassured that the lab’s manual flagging system for leukocytosis was the key in reaching the correct diagnosis. My persistent inquiries, however, revealed that the flagging system was not functioning in the care of this patient. It was clinicians’ suspicion of pseudohyperkalema that led to the correct diagnosis, although the clinicians’ recommendation of obtaining a heparinized plasma for test did not play a role because all blood samples were already heparinized. The cause of pseudohyperkalemia was pneumatic tube transport. After this incident, our laboratory is investigating the options of using the Laboratory Information System to automatically flag the results and Clinical Laboratory Scientists to make the chemistry team more aware of potentially erroneous potassium results due to pseudohyperkalemia.ConclusionsPseudohyperkalemia associated with leukocytosis still occurs. This is the first case of pneumatic tube transport causing pseudohyperkalemia associated with AML. When significant leukocytosis, thrombocytosis, hyperproteinemia, or hyperlipidemia is present, whole blood should be utilized for potassium measurements and walked to the lab instead of sent by pneumatic tube transport. Even in a lab with a manual flagging system, there is still room to improve by implementing an automatic flagging system.

Risk factors of early death in heat stroke and the challenges of emergency care in Hungary - a case series study

Background and aimThe increasing frequency of heat waves worldwide is a major challenge for emergency care providers worldwide. The aim of this study was to analyze the clinical features, treatment options, and early outcomes of heat stroke patients presenting to a large academic emergency department (ED) in Hungary and to provide guidance in management for other emergency professionals.MethodsPatients presenting to the ED between June 1, 2024, and July 31, 2024, with a body temperature above 40 °C were analyzed in a retrospective cohort study. Data collection included demographic, clinical and laboratory parameters. Predictors of mortality were analyzed with Mann-Whitney U test.ResultsEight patients were included in our analysis. Three patients died in the ED (37.5%). Patients who died had significantly lower pH (7.07 vs. 7.4, p = 0.036), higher potassium (7.3 vs. 3.2 mmol/L, p = 0.036), higher calcium (1.19 vs. 0.97 mmol/L, p = 0.036), higher lactate (10.9 vs. 3.5 mmol/L, p = 0.036) and higher PaCO2 (57.2 vs. 28 mmHg, p = 0.036) at admission compared to those who did not die.ConclusionsThe risk of heat stroke due to climate change-induced heat stress and the consequent thermoregulatory disruption may now be significant in temperate climate zones where it was not previously present. Standardization of differential diagnostic and therapeutic procedures could reduce mortality. pH, potassium, lactate and calcium levels may play an important role in predicting the outcome of heat stroke.

The Nutritional, Mineral, and Nutraceutical Quality Is Differentially Affected by the Mango Cultivar

The main mango cultivars produced in the southern Pacific region of Mexico are Ataulfo, Manila, Haden, and Criollo. However, mineral, nutritional, and nutraceutical composition studies are limited. This study aimed to evaluate the effect of cultivars on the nutritional, mineral, and nutraceutical qualities of mango produced in Mexico. The cultivar significantly affected (p ≤ 0.05) the fruit composition across these indices. Criollo had the highest potassium, magnesium, sodium, and zinc concentrations, while Haden showed the highest calcium content. Manila had the highest iron content, contributing 0.76% of the recommended daily intake. Ataulfo and Haden were statistically similar in manganese content, both higher than Criollo, with Ataulfo reaching the maximum copper concentration. Ataulfo also had the highest sugar content, while Criollo had the most dietary fiber (3.1%), double that of Ataulfo and Haden. Haden had the lowest dry matter (14.8%) and lowest protein content (0.46%), with Manila showing the lowest ash content. The cultivars also differed in nutraceutical composition: Ataulfo was highest in total phenols, DPPH, and vitamin A; Haden in carotenoids and flavonoids; and Criollo in vitamin C. Cultivar selection induces changes in mango nutritional composition.