Hyponatremia Research Articles

Evaluation of the growth-inducing efficacy of various Bacillus species on the salt-stressed tomato (Lycopersicon esculentum Mill.).

Plants are affected by salt stress in a variety of ways, including water deficiency, ion toxicity, nutrient imbalance, and oxidative stress, all of which can cause cellular damage or plant death. Halotolerant plant growth-promoting rhizobacteria (PGPR) could be a viable alternative for tomato plants growing in arid and semi-arid environments. The aim of this research was to isolate halotolerant plant growth promoting Bacillus sp. to promote tomato (Lycopersicon esculentum Mill.) growth and salt stress resistance. 107 PGPR strains were isolated from the rhizospheres of 'Kesudo' (Butea monosperma Lam.), 'Kawaria' (Cassia tora L.), and 'Arjun' (Terminalia arjuna Roxb.) plants to test their plant growth promoting abilities, including indole-3-acetic acid, phosphate solubilization, siderophore production, and ACC deaminase activity. Five bacterial strains (Bacillus pumilus (NCT4), Bacillus firmus (NCT1), Bacillus licheniformis (LCT4), Bacillus cereus (LAT3), and Bacillus safensis (LBM4)) were chosen for 16S rRNA on the basis of PGPR traits. Compared to PGPR untreated plants, tomato plants developed from PGPR-treated seeds had considerably increased germination percentage, seedling growth, plant height, dry weight, and leaf area. As comparison to PGPR non-inoculated plants, salt-stressed tomato plants treated with PGPR strains had higher levels of total soluble sugar, proline, and chlorophyll as well as higher levels of SOD, CAT, APX, and GR activity. PGPR-inoculated salt-stressed tomato plants had lower MDA, sodium, and chloride levels than non-inoculated plants. In addition, magnesium, calcium, potassium, phosphorus, and iron levels were higher in PGPR treated plants when subjected to salt stress. These results indicate that halotolerant PGPR strains can increase tomato productivity and tolerance to salt stress by removing salt stress's negative effects on plant growth.

Dual organic-structure directing agents in the synthesis of high-silica MOR Zeolite: Cooperation or competition?

Constructing a high-silica framework of a given zeolite topology via a conventional hydrothermal synthetic strategy is still an open question. In this work, In this contribution, we report the high-silica MOR zeolite (Si/Al ratio: ∼30) was fabricated by a dual OSDA combination strategy at a fixed alkalinity (OH−/SiO2) ratio of around 0.4. Additionally, we found that bulky TEA+ cation and smaller neutral heterocycle molecules severed as the pore-filling agent and cooperatively squeeze the occupation of sodium cation resulting in the low sodium content of high-silica MOR zeolite. However, such cooperative behavior can be easily spoiled by the high alkalinity ratio above 0.5. With the increment of the alkalinity ratio, the sodium cations can retake the occupied sites and facilitate the MOR framework with a relatively low Si/Al ratio. As unveiled by the powder X-ray diffraction crystallography and combined spectroscopy strategies, the nature of different dual OSDA combinations occluded in the high-silica MOR zeolite with deduced aluminum enriched T sites provide the reference for the forthcoming target design of zeotype catalysts.

Renal transplant hastalarında idrar sodyum atılımının metabolik sendrom, hipertansiyon ve greft fonksiyonu ile ilişkisinin değerlendirilmesi

Aim: To evaluate the relationship between high sodium intake determined by spot urinary sodium excretion with metabolic syndrome, hypertension, and graft function in renal transplant (RT) recipients.
 Materials and methods: 152 RT recipients were enrolled. The demographic characteristics, office blood pressure (BP) values, height, weight, body mass index, waist and hip measurements, immunesuppressive drugs, other medications and biochemical parameters of the patients were recorded. Spot urinary sodium and spot urinary protein excretions were measured in the first morning urine in all the RT recipients. The patients were grouped as low sodium excretion (≤57) and high sodium excretion (≥58) based on the median value of 57 in spot urinary sodium.
 Results: In the low sodium group; creatinine values were found to be significantly lower (p

Impact of Grass Pea Sweet Miso Incorporation in Vegan Emulsions: Rheological, Nutritional and Bioactive Properties

Grass pea (Lathyrus sativus L.) is a pulse with historical importance in Portugal, but that was forgotten over time. Previous to this work, an innovative miso was developed to increase grass pea usage and consumption, using fermentation as a tool to extol this ingredient. Our work's goal was to develop a new vegan emulsion with added value, using grass pea sweet miso as a clean-label ingredient, aligned with the most recent consumer trends. For this, a multidisciplinary approach with microbiological, rheological and chemical methods was followed. Grass pea sweet miso characterization revealed a promising ingredient in comparison with soybean miso, namely for its low fat and sodium chloride content and higher content in antioxidant potential. Furthermore, in vitro antimicrobial activity assays showed potential as a preservation supporting agent. After grass pea sweet miso characterization, five formulations with 5-15% (w/w) of miso were tested, with a vegan emulsion similar to mayonnaise as standard. The most promising formulation, 7.5% (w/w) miso, presented adequate rheological properties, texture profile and fairly good stability, presenting a unimodal droplet size distribution and stable backscattering profile. The addition of 0.1% (w/w) psyllium husk, a fiber with great water-intake capacity, solved the undesirable release of exudate from the emulsion, as observed on the backscattering results. Furthermore, the final product presented a significantly higher content of phenolic compounds and antioxidant activity in comparison with the standard vegan emulsion.

Reclamation effects of distinct volumes and concentrations of CaCl2-amended brackish ice in different saline-sodic soils

The proper usage of marginal soil and water resources has major implications for the sustainability of agriculture, such as brackish water and saline-sodic soils. The saline soils can be ameliorated though melting process of calcium-containing brackish ice, however, the optimum concentration and volume of brackish ice (water) for the reclamation of different saline-sodic soils remain to be determined. In this study, 108 soil columns representing four Ice salinity levels (16, 26, 36, 46 mmolc L−1) and three Pore Volumes (2/3, 1.5, 2.5 PV) of calcium-amended brackish ice were tested to reveal the reclaiming effect on a range of saline-sodic soils. The linear mixed model (LMM), multiple regression equation, and principal coordinate analysis (PCoA) were applied to calculate the amelioration effect in terms of three factors: Ice volume, Ice salinity and Column depth. Our results showed that the soil salinity and sodicity generally decreased with increasing Ice volume and Ice salinity, and the saline-sodic soils with low exchangeable sodium percentages (i.e. ESP 20) were more sensitive to Ice salinity, with high salinity (26–46 mmolc L−1) and large volume (2.5 PV) of brackish ice reaching a better amelioration effect. The effect of Ice volume became more dominant in medium and high ESP soils (ESP 40 and ESP 70), whereas the high salinity combined with low volume of brackish ice would lead to worse soil properties, especially at the bottom layers. Meanwhile, the Column depth factor had a considerable effect on the soil chemical properties, with the variance explained ranging from 18.6% to 36.0%. These results provide theoretical guidance in the rational use of calcium-amended brackish ice and highlight the necessity to take layer effect into consideration for reclaiming saline-sodic soils.

A candidate locus in the renalase gene and susceptibility to blood pressure responses to the dietary salt.

High dietary salt confers a risk of elevating blood pressure (BP) and the development of hypertension. BP to salt intake may be determined in part by individual genetic predisposition. Identifying these genetic underpinnings will enhance our understanding of the biological mechanisms of BP regulation. This study aims to assess the genetic association with salt sensitivity of BP (SSBP) within two well-phenotyped multinational cohorts. A total of 720 white participants from the HyperPATH consortium program were selected and genotyped using a multiethnic genotyping array. Individuals consumed two study diets containing high (>200 mEq/day) and low (<10 mEq/day) sodium content, after which SSBP, aldosterone, and plasma renin activity (PRA) were assessed in a controlled inpatient research setting. A top signal (rs10887801; beta = 4.57, P = 5.03E - 07) at the renalase gene ( RNLS ) region was significantly associated with SSBP. We also identified seven single nucleotide variants with linkage disequilibrium to the top signal at this region that comprised a significant haplotype (TCTTAGTT, P = 0.00081). Homozygous carriers of the T-risk allele of the key single nucleotide variant had higher SSBP ( P ≤ 0.00001) and lower PRA ( P = 0.0076) compared with the nonrisk allele. We identified significant associations between genetic variants of the RNLS gene and BP responses to dietary salt intervention and PRA that suggest susceptibility to volume-driven hypertension. These findings may contribute to a better understanding of the genetic mechanisms underlying BP regulation, support the role of RNLS in the pathogenesis of SSBP, and identify individuals who may be at risk from excess dietary salt intake.

Relationship between lipid profiles and reduced handgrip strength (dynapenia) in hospitalized patients with cirrhosis.

Dynapenia embraces clinical significance and predictive value separated from skeletal muscle loss among cirrhosis. Moreover, alterations in lipid levels may impact muscle function. It has yet to elucidate the relationship between lipid profiles and muscle strength weakness. We sought to explore which lipid metabolism indicator could be useful to identify patients with dynapenia in daily practice. A retrospective observational cohort study enrolling 262 cirrhotic patients. Analysis of the receiver operating characteristic (ROC) curve was performed to determine the discriminatory cutoff for dynapenia. Multivariate logistic regression was conducted to assess the association between total cholesterol (TC) and dynapenia. Also, we established a model based on the classification and regression tree method. ROC implicated a cutoff of TC ≤ 3.37 mmol/L to identify dynapenia. Patients with TC ≤ 3.37 mmol/L showed significantly lower handgrip strength (HGS; 20.0 vs. 24.7 kg, P = 0.003), lower hemoglobin, lower platelet, lower white blood cell count, lower sodium and higher prothrombin-international normalized ratio. A positive correlation was found between TC and HGS values (r = 0.1860, P = 0.003). TC remained a significant association with dynapenia after controlling for variables including age, sex, BMI, and the presence of ascites. The decision tree incorporating TC, BMI, and age had a sensitivity of 71.4%, specificity of 64.9%, and an area under ROC of 0.681. TC ≤ 3.37 mmol/L was significantly associated with the presence of dynapenia. Assessing TC may be helpful for identifying dynapenic patients with cirrhosis in the health care or hospital setting.

Hyponatremia and lower normal serum sodium levels are associated with an increased risk of all-cause death in heart failure patients.

To explore the relationship between the serum sodium level on admission and all-cause mortality in HF patients. A single-center retrospective cohort study. Patients hospitalized with HF at the Heart Failure Center, FuwaiHospital, from November 2008 to November 2018 were enrolled. A total of 3649 patients were included, and the mean sodium level was 137.19 ± 4.36 mmol/L, with a range from 115.6 to 160.9 mmol/L. During a median follow-up of 1101 days, mortality occurred in 1413 (38.7%) hospital survivors. After adjustment for age, sex, and other potential confounders, patients with sodium levels <135 mmol/L (hazard ratio [HR]: 1.67; 95% confidence interval [CI]: 1.29-2.16) and 135-137 mmol/L (HR: 1.34; 95% CI: 1.01-1.78) had an increased risk of all-cause mortality compared to those with sodium levels of 139-141 mmol/L.

Aldosterone Synthase Inhibitors and Dietary Interventions: A Combined Novel Approach for Prevention and Treatment of Cardiovascular Disease.

Systemic hypertension (HTN) is the hallmark of cardiovascular disease and the forerunner of heart failure. These associations have been established over decades of research on essential HTN. Advancements in the treatment of patients diagnosed with HTN, consisting of alpha- or beta-adrenergic receptor blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, thiazide, or aldosterone receptor blockers known as anti-mineralocorticoids, in the presence or absence of low sodium salt diets, often fail to control blood pressure adequately to prevent morbidity and mortality. Low sodium diets have had limited success in controlling HTN because low sodium intake is associated with renin-angiotensin-aldosterone system upregulation. Therefore, upregulating aldosterone secretion, sodium, and water retention which, in turn, moves the blood pressure back toward the range of HTN dictated by the baroreceptor reset value, as a compensatory mechanism, especially in resistant HTN. These impediments to blood pressure control in HTN may have been effectively circumvented by the advent of a new class of drugs known as aldosterone synthase inhibitors, represented by baxdrostat.The mechanism of action of baxdrostat as an aldosterone synthase inhibitor demonstrates the inextricable linkage between sodium and blood pressure regulation. Theoretically, combining a low sodium diet with the activity of this aldosterone synthesis inhibitor should alleviate the adverse effect of renin-angiotensin-aldosterone system upregulation. Aldosterone synthesis inhibition should also decrease the oxidative stress and endothelial dysfunction associated with HTN, causing more endothelial nitric oxide synthesis, release, and vasorelaxation. To the best of our knowledge, this is the first systematic review to summarize evidence-based articles relevant to the use of a novel drug (aldosterone synthase inhibitor) in the treatment of HTN and cardiovascular disease. Making the current database of relevant information on baxdrostat and other aldosterone synthase inhibitors readily available will, no doubt, aid physicians and other medical practitioners in their decision-making about employing aldosterone synthase inhibitors in the treatment of patients.

Development of a Passive Reactor Shutdown Device to Prevent Core Disruptive Accidents in Fast Reactors: A Study on Device Specifications

Abstract A new subassembly type passive reactor shutdown device is proposed to expand the diversity and robustness of core disruptive accident prevention measures for sodium-cooled fast reactors (SFRs). The device contains pins with a fuel material that is in a solid state during normal operation but melts and fluidizes during an unprotected loss of flow (ULOF) or unprotected transient overpower (UTOP) accident. By rapidly transferring the liquefied device fuel into the lower plenum region of the pins via gravitation alone, the device passively provides high negative reactivity to the core. This study evaluated the nuclear and thermal properties of the device subassembly with metallic fuel to determine the device specifications for proper device operation during ULOF and UTOP accidents. The results of the transient analysis of the ULOF initiating phase in a 750-MWel-class mixed-oxide-fueled SFR core confirmed that a conventional homogeneous core maintains stable cooling of the core before coolant boiling in the driver fuel subassemblies. In contrast, the negative reactivity required to terminate the event by device operation was slightly higher in the low sodium void reactivity core than in the conventional homogeneous core.

Long-term outcomes in heart failure with preserved ejection fraction: Predictors of cardiac and non-cardiac mortality.

Heart failure (HF) with preserved ejection fraction (HFpEF) is associated with cardiovascular (CV) and non-CV events, but long-term risk is poorly studied. We assessed incidence and predictors of the long-term CV and non-CV events. Patients presenting with acute HF, EF≥45%, and N-terminal pro-brain natriuretic peptide>300ng/L were enrolled in the Karolinska-Rennes study in 2007-11 and were reassessed after 4-8weeks in a stable state. Long-term follow-up was conducted in 2018. The Fine-Gray sub-distribution hazard regression was used to detect predictors of CV and non-CV deaths, investigated separately from baseline acute presentation (demographic data only) and from the 4-8week outpatient visit (including echocardiographic data). Of 539 patients enrolled [median age 78 (interquartile range: 72-84) years; 52% female], 397 patients were available for the long-term follow-up. Over a median follow-up time from acute presentation of 5.4 (2.1-7.9) years, 269 (68%) patients died, 128 (47%) from CV and 120 (45%) from non-CV causes. Incidence rates per 1000 patient-years were 62 [95% confidence interval (CI) 52-74] for CV and 58 (95% CI 48-69) for non-CV death. Higher age and coronary artery disease (CAD) were independent predictors of CV death, and anaemia, stroke, kidney disease, and lower body mass index (BMI) and sodium concentrations of non-CV death. From the stable 4-8week visit, anaemia, CAD, and tricuspid regurgitation (>3.1m/s) were independent predictors of CV death, and higher age of non-CV death. In patients with acute decompensated HFpEF, over 5years of follow-up, nearly two-thirds of patients died, half from CV and the other half from non-CV causes. CAD and tricuspid regurgitation were associated with CV death. Stroke, kidney disease, lower BMI, and lower sodium were associated with non-CV death. Anaemia and higher age were associated with both outcomes. [Correction added on 24 March 2023, after first online publication: In the first sentence of the Conclusions, 'two-thirds' has been inserted before 'of patients died...' in this version.].

Inverse salt sensitivity in normotensive adults: role of demographic factors.

Salt sensitivity and inverse salt sensitivity [ISS; a reduction in blood pressure (BP) on a high sodium diet] are each associated with increased incidence of hypertension. The purpose of this analysis was to determine the prevalence of ISS in normotensive adults and whether ISS is associated with any demographic characteristic(s). Healthy normotensive, nonobese adults [ n = 84; 43 women; age = 37 ± 13 years; baseline mean arterial pressure (MAP) = 89 ± 8 mmHg] participated in a controlled feeding study, consuming 7-day low-sodium (20 mmol sodium/day) and high-sodium (300 mmol sodium/day) diets. Twenty-four-hour ambulatory BP was assessed on the last day of each diet. ISS was defined as a reduction in 24-h MAP more than 5 mmHg, salt sensitivity as an increase in MAP more than 5 mmHg and salt resistance as a change in MAP between -5 and 5 mmHg from low sodium to high sodium. Using this cutoff, 10.7% were ISS, 76.2% salt resistant, and 13.1% salt sensitive. Prevalence of ISS was similar between sexes and age groups ( P > 0.05). However, ISS was more prevalent in those with normal BMI (15.8% ISS) compared with those with overweight BMI (0% ISS; P < 0.01). Interestingly, classification of participants using a salt sensitivity index (ΔMAP/Δ urinary sodium excretion) categorized 21.4% as ISS, 48.8% salt resistant, and 29.8% salt sensitive. Overall, we found that the prevalence of ISS was 10.7% (5 mmHg cutoff) or 21.4% (salt sensitivity index), and that ISS was associated with lower BMI. These results highlight the importance of future work to understand the mechanisms of ISS and to standardize salt sensitivity assessment.

Global mean potassium intake: a systematic review and Bayesian meta-analysis

PurposeIncreasing potassium intake, especially in populations with low potassium intake and high sodium intake, has emerged as an important population-level intervention to reduce cardiovascular events. Current guideline recommendations, such as those made by the World Health Organisation, recommend a potassium intake of > 3.5 g/day. We sought to determine summary estimates for mean potassium intake and sodium/potassium (Na/K) ratio in different regions of the world.MethodsWe performed a systematic review and meta-analysis. We identified 104 studies, that included 98 nationally representative surveys and 6 multi-national studies. To account for missingness and incomparability of data, a Bayesian hierarchical imputation model was applied to estimating summary estimates of mean dietary potassium intake (primary outcome) and sodium/potassium ratio.ResultsOverall, 104 studies from 52 countries were included (n = 1,640,664). Mean global potassium intake was 2.25 g/day (57 mmol/day) (95% credible interval (CI) 2.05–2.44 g/day), with highest intakes in Eastern and Western Europe (mean intake 3.53g/day, 95% CI 3.05–4.01 g/day and 3.29 g/day, 95% CI 3.13–3.47 g/day, respectively) and lowest intakes in East Asia (mean intake 1.89 g/day; 95% CI 1.55–2.25 g/day). Approximately 31% (95% CI, 30–41%) of global population included have an estimated potassium intake > 2.5 g/day, with 14% (95% CI 11–17%) above 3.5 g/day.ConclusionGlobal mean potassium intake (2.25 g/day) falls below current guideline recommended intake level of > 3.5 g/day, with only 14% (95% CI 11–17%) of the global population achieving guideline-target mean intake. There was considerable regional variation, with lowest mean potassium intake reported in Asia, and highest intake in Eastern and Western Europe.

Overcorrection and undercorrection with fixed dosing of bolus hypertonic saline for symptomatic hyponatremia

Current guidelines recommend treating symptomatic hyponatremia with rapid bolus-wise infusion of fixed volumes of hypertonic saline regardless of body weight. We hypothesize that this approach is associated with overcorrection and undercorrection in patients with low and high body weight. Single-center, retrospective cohort study. Data were collected on patients treated with ≥1 bolus 100 or 150 mL 3% NaCl for symptomatic hyponatremia between 2017 and 2021. Outcomes were overcorrection (plasma sodium rise > 10 mmol/L/24 h, > 18 mmol/L/48 h, or relowering therapy) and undercorrection (plasma sodium rise < 5 mmol/L/24 h). Low body weight and high body weight were defined according to the lowest (≤60 kg) and highest (≥80 kg) quartiles. Hypertonic saline was administered to 180 patients and caused plasma sodium to rise from 120 mmol/L to 126.4 mmol/L (24 h) and 130.4 mmol/L (48 h). Overcorrection occurred in 32 patients (18%) and was independently associated with lower body weight, weight ≤ 60 kg, lower baseline plasma sodium, volume depletion, hypokalemia, and less boluses. In patients without rapidly reversible causes of hyponatremia, overcorrection still occurred more often in patients ≤ 60 kg. Undercorrection occurred in 52 patients (29%) and was not associated with body weight or weight ≥ 80 kg but was associated with weight ≥ 100 kg and lean body weight in patients with obesity. Our real-world data suggest that fixed dosing of bolus hypertonic saline may expose patients with low and high body weight to more overcorrection and undercorrection, respectively. Prospective studies are needed to develop and validate individualized dosing models.

Pretreatment Depressive Status Associated with Poor Nutrition and Prognosis in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

The prevalence of pretreatment depression in breast cancer patients and its impact on nutrition and prognosis during neoadjuvant chemotherapy remain unknown. One hundred twenty-one patients with previously untreated breast cancer undergoing neoadjuvant chemotherapy (NAC) were enrolled. Patients completed the Self-rating Depressive symptoms Scale (SDS) before treatment and were divided into two groups (non-depressive group and depressive group). The nutrition risk screening-2002 (NRS-2002), and nutritional and prognostic indicators, including neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI), were collected at baseline (pretreatment) and post-treatment. One- and two-year progression-free survival (PFS) in both groups were also calculated. We found that 38.84% patients experienced pretreatment depressive symptoms. Patients in the depressive group had higher nutritional risk and lower body mass index, potassium, sodium, total cholesterol, total protein, and fasting blood glucose levels than those in pretreatment non-depressive group after NAC (all p < 0.05). And higher NLR (p = 0.039) and lower PNI level (p = 0.0021) after NAC were found in patients with pretreatment depressive status. Multivariable Cox analysis showed pretreatment depressive status (HR: 1.893; 95% CI: 1.047-3.426; p = 0.034) were a significant predictor of PFS. This study provides evidence for early identification of pretreatment depression in patients receiving NAC, which would certainly favor nutrition and survival outcome.

Valproate-induced severe symptomatic hyponatremia in a patient with schizoaffective disorder: a case study and literature review

IntroductionThe syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a serious condition associated with persistently high ADH with water retention despite sufficient vascular volume. Sodium valproate (VPA), an antiepileptic indicated to treat bipolar disorder, blocks sodium (Na) and calcium ions. Few studies have examined the association between VPA and SIADH.ObjectivesThis abstract has two interrelated objectives: (1) to describe a VPA-associated SIADH case study we encountered in our clinical setting; and (2) to review literature for other VPA-associated SIADH cases to illuminate associations and possible risk factors.MethodsAfter recording a case from clinical experiences, we completed a literature review of other cases of hyponatremia associated with VPA.We reviewed resulting artticles from searches in PubMed and in the aggregate Dartmouth Biomedical Library indices with no date or language parameters. We then searched those articles’ bibliographies.ResultsMs. A is a 63-year-old woman with schizoaffective disorder, bipolar type, hospitalized for the resurgence of visual hallucinations (VH) of “monsters” asking her to hurt herself and others. She had been adherent to VPA (500mg twice daily) and non-adherent to prescribed Olanzapine (25mg). On Day 1 (D1), her labs were concerning for serum Na 119mEq/L (n=135-145), serum osmolality (SOsm) 264mEq/L (n=275-295), and inappropriately high urine osmolality 111mOsm/kg (n &lt;100 mosmol/kg in hyponatremia) and urine Na 34mEq/L (n &lt;20 mosmol/kg in hypovolemic hyponatremia). Her VPA level was 73.6 mcg/mL.She was restarted on her home psychiatric medications for VH, and her hyponatremia responded to water restriction, with serum osmolality at 292mEq/L by D4 (see Figure). She was admitted to the inpatient psychiatric unit for concerns of persistent VH. On D13, her SOsm worsened to 267mEq/L and VPA was discontinued at that time. On D19, SOsm improved to 283mEq/L. Her VH responded well to discontinuing VPA and adding Risperidone (titrated to 6mg) and on D22 she was discharged home. Given the chronological sequence of her newly developed VH, the patient’s hallucinations were likely multifactorial, with contribution from hyponatremic encephalopathy-related psychosis.Our literature review found ten articles reporting thirteen other cases of VPA-associated SIADH (see Table). Our patient shared demographics with most previously reported cases: being older in age and having polytherapy and a low baseline Na. None of the previous case reports showed specific drug interactions to be particularly likely causes of hyponatremia.Image:Image 2:ConclusionsAlthough VPA-associated SIADH is a rare phenomenon, caution is warranted when evaluating patients with VPA use presenting acutely with psychosis and hyponatremia. These symptoms could be the manifestation of hyponatremic encephalopathy-related psychosis.Disclosure of InterestNone Declared

Water quality assessment and reuse potential of groundwater combined saline solution for irrigation

Abstract This study aims to evaluate the water quality and reuse potential of groundwater combined with a saline solution for irrigation. The brine dilution process was done by adding groundwater by determining the total dissolved salts (TDS) value according to the irrigation criteria and then by calculating the amount of groundwater to be added using the law of concentrations to obtain the water mixture, as the TDS value decreased from 4922 and 3810 mg/l to 2587 and 2200 mg/l, respectively. The assessment aimed to determine the suitability of the water for irrigation, and the quality indices used were sodium adsorption ratio, magnesium hazard ratio percentage, sodium percentage, residual sodium carbonate, permeability index, Kelly index, and irrigation water quality index. The results indicated that the water after mixing is suitable for irrigation. The USSL diagram was used to evaluate the post-mixing water at two stations, Touggourt and El-Oued, and the results showed that the post-mixing water at Touggourt falls in the C4–S1 group (extremely high salinity with low sodium), and the post-mixing water at El-Oued falls in the C4–S2 group (very high salinity with medium sodium).

Reducing dietary sodium of dairy cows fed a low-roughages diet affect intake and feed efficiency, but not yield.

Wastewater from dairy farms has become a major environmental and economical concern. Sodium residue in treated and untreated wastewater from dairy farms used for irrigation can lead to soil and groundwater salinization, with the risk of soil degradation. We examined the effect of reducing sodium fed to mid to late lactating cows from 0.61% (high sodium [HS]) to 0.45% (low sodium [LS]) of dry matter on dry matter intake (DMI), milk and milk-component yields, eating behavior, apparent total track digestibility, feed efficiency, and sodium excretion into the environment. We randomly assigned 28 multiparous high-yielding ( > 35kg milk/d) cows to 1 of 2 treatment groups (LS or HS) in a crossover design, with 7d of adaptation and 28d of data collection. Reducing sodium in the diet reduced sodium intake from 171 to 123g/d while lowering sodium excreted in the manure by 22%. Energy corrected milk (ECM) yield (37.4kg/d) and sodium excretion in the milk (33.7g/d) were similar for both groups. The DMI of LS cows was lower than that of HS cows (27.3 vs. 28kg/d) and consequently, feed efficiency of the LS cows was higher (1.40 vs. 1.35 ECM/DMI). Eating rate, meal and visit frequency, and eating time were similar for both treatments; meal and visit duration were longer for the HS cows, and meal and visit sizes tended to be larger. Digestibility of DM and amylase-treated neutral detergent fiber remained similar. Based on the results of this study, and discussed considerations, we recommend lowering the dietary sodium content for mid to late lactating cows in commercial herds to 0.52% of DM, in order to reduce sodium excretion to the environment via urine.

Role of Routine Markers in the Diagnosis of Patients with Chronic Kidney Disease

Background Acute kidney injury (AKI) and chronic kidney disease CKD cause different GFR declines (AKI). A gradual, irreversible decline in GFR is a CKD symptom. Diseases impair the kidneys’ ability to concentrate or dilute tubular filtrate, eliminate nitrogenous waste, and maintain acid-base balance. Acute kidney failure (AKF) is a sudden, reversible renal function loss requiring RRT. Chronic kid- ney disease has a 13.4% global prevalence and 1.2 million annual deaths.The Aim Serum creatinine, urea, potassium, chloride, calcium, sodium, and serum uric acid in CKD patients and healthy controls, and how these indicators vary with CKD development.Determination of some trace elements such as copper, zinc, and iron in the sera of patients.Materials and Methods The study included (30 healthy participants) and (60) patients with CKD (control). The participants in this study were people who traveled to Basrah Teaching Hospital aged 25 to 65. From Octo- ber 2020 to February 2021, specialized physicians examined each participant in this study at Basrah Teaching Hospital. Serum potassium, sodium, chloride, calcium, phosphorus, urea, uric acid, and serum creatinine were measured using kits.Results The current study results have shown a signif- icant increase (P < 0.01) in the following biomarkers in CKD patients: serum creatinine, urea, phosphorus, chlo- ride, uric acid, and Cystatin-C. The results also showed a significant decrease in levels following biomarkers in CKD patients: serum calcium and sodium.Conclusion Chronic renal disease raises serum creati- nine, urea, potassium, chloride, and uric acid. Chronic renal disease patients had lower calcium and sodium levels.

Letter in reply: aletter to the editor commenting on the recent publication by AY Avidan and CA Kushida.

Letter in reply: aletter to the editor commenting on the recent publication by AY Avidan and CA Kushida.