Serum Potassium Levels Research Articles

Drug Distribution and Penetration of Foam-Based Intraperitoneal Chemotherapy (FBIC).

For decades, intraperitoneal chemotherapy (IPC) was used as a liquid solution for the treatment of peritoneal metastasis. Due to its advantageous physical properties, foam-based intraperitoneal chemotherapy (FBIC) was recently proposed as a treatment for peritoneal metastasis. For the first time, this study intends to examine the feasibility, expansion, drug distribution, and penetration of FBIC in vivo. Three swine received contrast-enhanced FBIC doxorubicin delivered using a bicarbonate carrier system. During the procedure, intraoperative blood analyses and periumbilical diameter, as well as foam distribution, penetration, and expansion of the FBIC were analyzed. The swine received an abdominal CT scan to evaluate the contrast distribution. Furthermore, a hematoxylin-eosin (HE) staining of peritoneal samples was performed, and fluorescence microscopy was conducted. FBIC was performed without complications. The periumbilical diameter peaked after 5 min and then decreased. Blood analyses showed changes in blood parameters, with a reduction in the pH levels of serum calcium and potassium. CT scan detected contrast-enhanced FBIC throughout the abdominal cavity. Fluorescence microscopy confirmed that all areas were exposed to doxorubicin and no pathologies were detected in the HE histology. Our preliminary results are quite encouraging and indicate that FBIC is a feasible approach. However, in order to discuss possible clinical applications, further studies are required to investigate the pharmacologic, pharmacodynamic, and physical properties of FBIC.

Efficacy and safety of finerenone in chronic kidney disease and type 2 diabetes patients: a systematic review and meta-analysis.

The incidence of morbidity and mortality in patients with type 2 diabetes mellitus is substantially correlated with cardiovascular disease and chronic kidney disease. The current guidelines recommend the use of renin-angiotensin system blockers, but recent studies probed into the effects of finerenone to mitigate the risk of cardiorenal events. This meta-analysis was performed to demonstrate the effects of finerenone on cardiorenal events, comprising cardiovascular mortality, heart failure, change in estimated glomerular filtration rate, and serum potassium levels. After screening with our eligibility criteria, 350 articles were identified with an initial literature search on multiple databases, including PubMed, Science Direct, and Cochrane Central. Seven randomized controlled trials with a total of 15462 patients (n=8487 in the finerenone group; n=6975 in the control group) were included. Patients receiving finerenone were at a reduced risk for cardiovascular mortality [HR: 0.84 (0.74, 0.95)], heart failure [OR: 0.79 (0.68, 0.92)], decrease in estimated glomerular filtration rate by 40% [OR: 0.82 (0.74, 0.91)] and by 57% [OR: 0.70 (0.59, 0.82)]; and a higher incidence of moderate hyperkalemia [OR: 2.25 (1.78, 2.84)]. Finerenone, owing to its better mineralocorticoid affinity, and a much lower risk of adverse effects, promises to be a much better alternative than other renin-angiotensin system blockers available for the treatment of chronic kidney disease patients with type 2 diabetes. Further trials should be conducted to provide more definitive evidence to assess the safety and efficacy of finerenone compared to spironolactone and eplerenone.

Segmental low-density area on contrast-enhanced CT is a possible clue to diagnosing branch artery fibromuscular dysplasia.

Fibromuscular dysplasia can cause renovascular hypertension. Since fibromuscular dysplasia may be underdiagnosed, precise diagnosis and management are crucial, especially for young women. A 20-year-old woman with hypertension and hypokalemia was referred to our hospital for further evaluation of secondary hypertension. At the previous hospital, her blood pressure was 160/110 mmHg and the serum potassium level was 2.9 mEq/L. The equilibrium phase on contrast-enhanced computed tomography revealed a low-density area in the upper median portion of the right kidney. On admission to our hospital, her blood pressure was 141/96 mmHg under 5 mg of amlodipine. Laboratory tests revealed plasma renin activity of 11.3 ng/mL/h and plasma aldosterone concentration of 117.1 pg/mL. Renal venous sampling of active renin concentration showed a right-to-left renin ratio of 3.13, confirming a significant increase in renin secretion from the right kidney. Selective reno-angiography detected focal stenosis with adjacent aneurysmal dilation and tortuosity in the proximal branch of the right renal artery. She was diagnosed with branch artery fibromuscular dysplasia and successfully treated with percutaneous transluminal angioplasty. After the treatment, she was free from hypertension and hypokalemia without any medications. Since branch artery fibromuscular dysplasia is sometimes difficult to diagnose, contrast-enhanced computed tomography can be a promising diagnostic tool as shown in this case. Concerning treatment, our patient was treated with percutaneous transluminal angioplasty, which should be considered for women of reproductive age because recommended antihypertensive medications can be teratogenic even in the first trimester of pregnancy. Although branch artery fibromuscular dysplasia (FMD) is sometimes difficult to diagnose, it should be considered in patients with high-renin, high-aldosterone hypertension. Branch artery FMD can present with a low-density area of the kidney on contrast-enhanced computed tomography, as shown in this case. Percutaneous transluminal angioplasty (PTA) can be an appropriate treatment for branch artery FMD, especially in young female patients. PTA may immediately improve hypertension and hypokalemia without the need for medications.

Adrenal Insufficiency in Patients with COVID-19

Background: SARS-CoV-2, which emerged in China and spread globally, has been associated with adrenal insufficiency in numerous COVID-19 patients. The clinical evidence regarding adrenal involvement in COVID-19 patients is currently limited, primarily consisting of case reports and small patient series. Objectives: This study aimed to assess the variations in serum cortisol levels and evaluate the response of hospitalized COVID-19 patients to the adrenocorticotropic hormone (ACTH) test. Methods: This study was performed on patients with COVID-19 admitted to Valiasr Hospital, Birjand, Iran, in 2021. Sixty patients with COVID-19 were included in this study by simple random sampling. Patients' venous blood (5 mL) was collected in an EDTA anticoagulant tube. Blood samples were placed in a cool place, then 250 μg intramuscular cosyntropin was injected, and blood samples were taken again 60 minutes later. According to the kit protocol, cortisol levels were measured by a quantitative luminescence kit (Saluggia, Italy). Results: The study involved 60 participants, of which 32 were male (53.3%) and 28 were female (46.7%). The Mean participants' age was 63.1 ± 20.93. The median baseline cortisol serum levels were 28.075 µg /dL for men and 21.820 µg /dL for women. There was no significant difference between base cortisol serum levels (P-value = 0.248). After measuring the baseline cortisol levels in the studied patients, 21.7 % suffered from adrenal Insufficiency, 40 % were suspected of adrenal insufficiency and required cosyntropin injections, and 38.3 % did not have adrenal Insufficiency. Following the administration of cosyntropin injections, it was found that 33.3% of participants had adrenal insufficiency, while the remaining 66.7% did not exhibit any signs of adrenal insufficiency. Vital signs demonstrated that patients with adrenal insufficiency had notably lower mean systolic and diastolic blood pressures, and a statistically significant correlation was observed when comparing these two groups (P-value < 0.001 and P-value = 0.001, respectively). In assessing sodium and potassium serum levels between the two groups, individuals with adrenal insufficiency demonstrated lower average sodium levels (P-value < 0.001). At the same time, no noteworthy divergence was found in potassium levels between the groups (P-value = 0.587).Furthermore, no considerable discrepancy emerged in the in-hospital mortality rate during the patients' follow-up period (P-value = 0.322). Conclusions: As Adrenal insufficiency is life-threatening, early adrenal axis testing for COVID-19 patients with clinical suspicion of adrenal insufficiency should be carried out.

Evaluating renin and aldosterone levels in children with organic acidemia-therapeutic experience with fludrocortisone.

Hyporeninemic hypoaldosteronism has been reported in only a few cases with methylmalonic acidemia (MMA) and has been attributed to the renal involvement. This study aims to investigate renin-aldosterone levels along with the renal functions of the patients with organic acidemia.This is a cross-sectional study conducted in patients with MMA, propionic acidemia (PA), and isovaleric acidemia (IVA). Serum renin, aldosterone, sodium, and potassium levels were measured, and glomerular filtration rates (GFR) were calculated. Comparisons were made between the MMA and non-MMA (PA+IVA) groups.Thirty-two patients (MMA:PA:IVA = 14:13:5) were included. The median GFR was significantly lower in the MMA group than in the non-MMA group (p < 0.001). MMA patients had the highest incidence of kidney damage (71.4%), followed by PA patients (23%), while none of the IVA patients had reduced GFR. GFR positively correlated with renin levels (p = 0.015, r = 0.433). Although renin levels were significantly lower in the MMA group than the non-MMA group (p = 0.026), no significant difference in aldosterone levels was found between the two groups. Hyporeninemic hypoaldosteronism was found in 3 patients with MMA who had different stages of kidney damage, and fludrocortisone was initiated, which normalized serum sodium and potassium levels. Conclusions: This study, which has the largest number of patients among the studies investigating the renin-angiotensin system in organic acidemias to date, has demonstrated that hyporeninemic hypoaldosteronism is not a rare entity in the etiology of hyperkalemia in patients with MMA, and the use of fludrocortisone is an effective treatment of choice in selected cases. What is Known: • Hyperkalemia may be observed in cases of methylmalonic acidemia due to renal involvement and can be particularly prominent during metabolic decompensation. • Hyporeninemic hypoaldosteronism has been reported to be associated with hyperkalemia in only a few cases of methylmalonic acidemia. What is New: • Hyporeninemic hypoaldosteronism was found in one-fifth of cases with methylmalonic acidemia. • Fludrocortisone therapy leads to the normalization of serum sodium and potassium levels.

Effects of sacubitril/valsartan in patients with cancer therapy-related heart failure

To evaluate the effect of Sacubitril/Valsartan (S/V) on the functional status, systolic and diastolic function of the left ventricle (LV), tolerability of therapy and to determine predictors of its effectiveness in patients with cancer therapy-related heart failure (СTRHF). Forty patients 58 [46; 65.5] years of age with HF associated with anthracycline-containing cancer therapy were enrolled. Clinical examination, echocardiography, and assessment of potassium and creatinine levels were performed at baseline and after 6 months of S/V therapy. NYHA functional class (FC) improvement was observed in 22 (64.7%) patients. Radiation therapy (RT) decreased (OR 0.091; 95% CI 0.01-0.83; p=0.03) while baseline low LV EF increased (OR 9.0; 95% CI 1.78-45.33; p=0.008) the odds of FC improvement. LV EF increased from 37.3 [30; 42.5] % to 45 [38; 48] % (p<0.0001) and exceeded 50% in 7 (20.6%) patients. The odds of LV EF recovery increased when S/V therapy was initiated ≤1 year after anthracycline therapy (OR 10.67; 95% CI 1.57-72.67; p=0.0016) and decreased in patients with the history of RT (OR 0.14; 95% CI 0.02-0.89; p=0.0037) and in patients over 58 years (OR 0.07; 95% CI 0.01-0.68; p=0.022). LV diastolic function improvement included E/e' descent from 13.6 [10; 18.3] to 8.9 [6.9; 13.7] (p=0.0005), and decrease in diastolic dysfunction grade in 18 (45%) patients (p=0.0001). No significant change in serum potassium (4.45 [4.2; 4.8] versus 4.5 [4.3; 4.8]; p=0.5) and creatinine (75.4 [67.6; 85.1] versus 75.5 [68.2; 98.3]; p=0.08) levels were observed. S/V therapy is associated with improvement of EF, systolic and diastolic LV function, demonstrates a favorable tolerability profile in patients with СTRHF. Lack of RT and low baseline LV EF increased the odds of LV EF improvement; lack of RT, early (≤1 year) start of treatment after discontinuation of anthracycline therapy, and age <58 years increased the odds of LV EF recovery.

Management of Hyperkalemia in Patients with Chronic Kidney Disease Using Renin Angiotensin Aldosterone System Inhibitors.

Use of renin-angiotensin-aldosterone system (RAAS) inhibiting medications is critical in the prevention of cardiovascular disease and kidney function decline in patients with chronic kidney disease (CKD); however, these agents can lead to hyperkalemia, an electrolyte disorder associated with risk of arrythmia, conduction disorders, and increased overall mortality. Discontinuation, or reduction of dose, of RAAS inhibitor therapy in hyperkalemic patients with CKD can lead to loss of kidney and cardiovascular protection afforded by these medications. Given the high prevalence of hyperkalemia among patients with CKD utilizing RAAS inhibitors, clear management principles are critical to minimize risk and maximize benefit when facing this clinical dilemma. Strategies to mitigate hyperkalemia that do not interfere with optimal RAAS inhibitor therapy should be prioritized when managing potassium elevation in patients with CKD. These strategies include discontinuing non-RAAS inhibitor medications known to cause hyperkalemia, correction of metabolic acidosis, and maximization of medication therapies that lower serum potassium, including diuretics and sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Initiation of potassium exchange resins should also be considered to allow for sustained RAAS inhibitor utilization. An approach which employs multiple strategies concurrently is important to mitigate hyperkalemia and maintain long-term use of RAAS-inhibitors. Persistence of RAAS inhibitor use in patients with CKD is important to slow kidney function decline, delay onset of dialysis or the need for kidney transplant, and prevent adverse cardiovascular outcomes. When hyperkalemia develops among patients with CKD utilizing a RAAS inhibitor, a deliberate effort to reduce serum potassium levels using an approach that allows for continuation of maximally dosed RAAS inhibitor therapy is important. Patient education and engagement in the potassium management process is important for sustained success.

Effects of dietary incorporation of Radix rehmanniae praeparata polysaccharide on growth performance, digestive physiology, blood metabolites, meat quality, and tibia characteristics in broiler chickens

Radix rehmanniae preparata polysaccharide (RRPP) is recognized as the primary bioactive compound in Radix rehmanniae preparata and has been extensively utilized in traditional Chinese medicine and functional food due to its diverse biological activities. However, this study has yet to explore the application of RRPP as a feed additive in broilers. This study investigated the effects of dietary RRPP on growth performance, meat quality, and physiological responses of broiler chickens. Two hundred eighty-eight 1-day-old Cobb 500 male broilers were randomly assigned to the 4 experimental groups with 6 replications and 12 birds/replicate. The 4 groups were fed the basal diet supplemented with 4 concentrations of RRPP (0, 300, 600, and 900 mg/kg, respectively). All RRPP levels did not affect the growth performance of broilers during the starter period (1-21 d), while during the grower (22-35 d) and overall (1-35 d) periods, body weight gain, feed conversion ratio, and European production efficiency index were linearly improved (P < 0.05) by incorporating RRPP at 600 and 900 mg/kg. Carcass characteristics, relative weight and length of intestinal segments, and meat quality and tibia criteria were not affected by dietary incorporation of RRPP. Dietary RRPP led to a linear increase (P < 0.05) in serum alkaline phosphatase, potassium, calcium and sulfhydryl levels, while reducing concentrations of hydrogen peroxide, LDL, triglycerides and total cholesterol. The addition of RRPP decreased (P < 0.05) the pH of the ileum and cecum at 21 and 35 d of age while not changing in the remaining intestinal segments. Dietary RRPP at 600 and 900 mg/kg linearly and quadratically (P < 0.05) increased the tibia ash content in chicken at 21 and 35 d of age. In conclusion, dietary supplementation of RRPP improved broiler chicken's growth, gut physiology, and tibia ash content, particularly at 600 and 900 mg/kg.

CLINICAL STUDY TO EVALUATE THE NEPHROPROTECTIVE EFFECT OF ELADI CHURNA IN DIABETIC KIDNEY DISEASE.

Diabetic Kidney Disease is now a worldwide health crisis. It is a spectrum of different pathophysiologic processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate. Globally it is the 12th cause of death and 17th cause of disability. Clinically this condition can be correlated to Madumeha and Mutrakshaya. The present study focuses on the efficacy of the Poly herbo-mineral compound, Eladi Churna in the nephroprotective effect in DKD. Consent from all the selected patients was taken before the study. Ethical clearance was accredited by the Government Ayurvedic college and Hospital, Guwahati Assam and CTRI registration was done for the trial. The patients were given the trial drug 1gm twice daily after food with Tandulodak 25 ml and Swadangstradi kwath 25 ml as Anupana for 3 months. A marked improvement was found in eGFR, Serum Creatinine, Blood Urea and Urine Albumin levels. Satisfactory results were noted in chief complaints like urine output, oedema, nausea, vomiting and muscle cramps and Serum Uric acid level. No change was observed in Serum Sodium and Serum Potassium levels at the end of the course.

Changes in serum potassium with concomitant administration of renin-angiotensin system agents and potassium-sparing diuretics: U.S. cohort study using electronic health record data

BackgroundPotassium-sparing diuretics (KSDs) and renin-angiotensin system (RAS) agents (including angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin II receptor blockers [ARBs]) are commonly prescribed for the management of hypertension, cardiovascular diseases, and diabetic nephropathy. However, there is a concern of developing hyperkalemia when these drugs are concomitantly used. This study investigates the change in serum potassium during concomitant administration of RAS agents (ACEI or ARB) and KSD. MethodsThis is a retrospective observational study using the Cerner Health Facts database. Electronic health records from unique patient hospitalization encounters were used to compare change in the serum potassium among 5 different cohorts (ACEI, ARB, KSD, ACEI-KSD, and ARB-KSD) and a non-RAS non-KSD exposed one (acetaminophen [APAP] cohort). Descriptive data of the cohorts and the risk of increase in potassium serum were estimated by generalized linear regression. ResultsA total of 5816 patients’ unique encounters were analyzed. After admission, 5.2% (N = 303) had serum potassium greater than 5.5 mmol/L. Results showed a significant increase in serum potassium during concomitant use of KSD and RAS agents and when only using KSD compared with the control APAP group (all P < 0.05). Other significant predictors of increased serum potassium levels included male (P = 0.002), black race (P < 0.001), and individuals with low estimated glomerular filtration rate (P < 0.001). ConclusionsThis study found no evidence of hyperkalemia when combining KSD and other medications that may increase potassium levels, even when controlling for other potential factors that may affect serum potassium levels, for patients within institutional settings. Warnings concerning excessive potassium levels when a KSD is prescribed with a medication that may affect potassium should be limited to patients with pre-existing higher levels of potassium.

Effects of esaxerenone on blood pressure, urinary albumin excretion, serum levels of NT-proBNP, and quality of life in patients with primary aldosteronism.

Primary aldosteronism (PA) is typically managed with mineralocorticoid receptor antagonists (MRAs) barring adrenalectomy. The efficacy of esaxerenone, a nonsteroidal MRA, were explored in patients with PA. Various parameters such as the urinary albumin to creatinine ratio (UACR) and serum levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were evaluated in 25 PA patients before and 3 and 6 months after esaxerenone treatment. Systolic and diastolic blood pressure (BP), and the estimated glomerular filtration rate decreased after treatment, while serum levels of potassium and active renin increased. Significant reductions were observed in UACR 3 and 6 months after treatment. A significant decrease in NT-proBNP was evident at 6 months but not 3 months after treatment. Correlation analysis indicated that the reductions in BP and UACR at 3 months were independent of estimated daily salt intake. Furthermore, the effect of esaxerenone treatment on lowering UACR and NT-proBNP levels was independent of BP reduction. Responders whose systolic BP decreased 6 months after esaxerenone treatment by more than 10 mmHg compared to pretreatment had higher pretreatment NT-proBNP and similar UACR before and after treatment when compared with nonresponders. Esaxerenone improved mental, physical, and social quality of life (QOL) 6 months after treatment compared to healthy controls and increased over time. No patients discontinued treatment due to severe hyperkalemia or renal dysfunction. In conclusion, esaxerenone is a safe and effective MRA for PA treatment, offering significant benefits in terms of hypertension, albuminuria, NT-proBNP levels, and QOL improvement. Esaxerenone effectively lowers BP, UACR, and serum levels of NT-proBNP independent of dietary salt intake in mild PA patients. ARC active renin concentration, DBP diastolic blood pressure, MR mineralocorticoid receptor, MRA mineralocorticoid receptor antagonist, NT-proBNP N-terminal pro-brain natriuretic peptide, PA primary aldosteronism, QOL quality of life,SBP systolic blood pressure,SF-36Medical Outcomes Study 36-Item Short-Form Health Survey,UACR urinary albumin to creatinine ratio.

Oral treatment of hypokalemia with potassium chloride and propylene glycol in cows

Hypokalemia is a fatal metabolic, pathological and induced disorder of Potassium, manifested by low serum levels generally encountered in lactating animals and during thermal-stress. Currently Potassium is given in normal saline intravenously and very slowly. This method is costly, risky and laborious. To study the effect of oral administration of 12 g of elemental Potassium and 200 ml of Propylene glycol orally in hypokalemic cows. After estimating the serum level of potassium with Serum, analyzer, the effect of Nutri-Pot (A) containing 12 g of Potassium in 50-gram pouch and Nutri-Pot (B) containing 200 ml Propylene Glycol in 28 clinically hypokalemic cows was studied. Both A &amp; B were mixed with 200 ml of drinking water and were slowly drenched and the second dose is repeated after 12 hours. Out of 28 cows, 26 were recovered fully and returned to normal condition and milk production. Combined drenching of Potassium and Propylene glycol was only the safest, most effective and economical method than administration through a balling gun and gelatin boluses or by ororuminal intubation. Or parenteral administration.

Prediction of postoperative hypokalemia in patients with oral cancer undergoing en bloc cancer resection: a retrospective cohort study

BackgroundThe factors associated with postoperative hypokalemia in patients with oral cancer remain unclear. We determined the preoperative factors associated with postoperative hypokalemia in patients with oral cancer following en bloc cancer resection and established a nomogram for postoperative hypokalemia prediction.MethodsData from 381 patients with oral cancer who underwent en bloc cancer resection were retrospectively analyzed. Univariate and multivariate analyses were performed to identify the risk factors for postoperative hypokalemia. We used receiver operating characteristic (ROC) curves to quantify the factors’ effectiveness. A nomogram was created to show each predictor’s relative weight and the likelihood of postoperative hypokalemia development. The multinomial regression model’s effectiveness was also evaluated.ResultsPreoperative factors, including sex, preoperative serum potassium level, and preoperative platelet-to-lymphocyte ratio (PLR), were significantly associated with postoperative hypokalemia. Based on the ROC curve, the preoperative serum potassium and PLR cut-off levels were 3.98 mmol/L and 117, respectively. Further multivariate analysis indicated that female sex, preoperative serum potassium level < 3.98 mmol/L, and preoperative PLR ≥ 117 were independently associated with postoperative hypokalemia. We constructed a predictive nomogram with all these factors for the risk of postoperative hypokalemia with good discrimination and internal validation.ConclusionsThe predictive nomogram for postoperative hypokalemia risk constructed with these factors had good discrimination and internal validation. The developed nomogram will add value to these independent risk factors that can be identified at admission in order to predict postoperative hypokalemia.

Constipation as a Drug-Related Adverse Effect in Patients with Hyperkalemia: Sodium Zirconium Cyclosilicate versus Conventional Potassium Binders.

(1) Background: Constipation is one of the most serious adverse effects of potassium-lowering agents and decreases patients' quality of life. Sodium zirconium cyclosilicate (SZC) is a recently innovated potassium binder intended for patients with hyperkalemia. The impact of SZC on the worsening of constipation, as compared with conventional potassium binders, remains unknown. (2) Methods: Patients with hyperkalemia who continued SZC for over 3 months between July 2020 and May 2022 were included in this retrospective study. Patients who received other conventional potassium binders during the same period were included as a control group. Trends in the doses of anti-constipation agents during the 3-month therapeutic period were compared between the two groups as a surrogate for worsening constipation. (3) Results: A total of 50 patients (median age 74 years, 31 male) were included, consisting of 22 patients with SZC and 28 patients with other conventional potassium binders. All patients had hyperkalemia and chronic kidney disease at baseline. During the 3-month therapeutic period, serum potassium levels decreased significantly in both groups (p < 0.05 for both). The number of anti-constipation remained unchanged in the SZC group but tended to increase in the control group (p = 0.56 and p = 0.090, respectively). The total dose change in all anti-constipations was significantly lower in the SZC group than in the control group (p = 0.037). (4) Conclusions: Conventional potassium binders have a tendency to worsen constipation, whereas SZC may have the potential to improve hyperkalemia without worsening constipation. SZC may be recommended, particularly in elderly patients with ongoing or high-risk constipation.

Electrolyte profile in COVID-19 patients: insights into outcomes

BackgroundSome evidence has provided that electrolyte disorders may be present upon presentation of patients with COVID-19 infection. We investigated serum sodium, potassium, calcium, magnesium, and phosphorus levels in large numbers of critically ill COVID-19 patients to identify its possible prognostic value in these patients.MethodsThis retrospective study included patients confirmed with COVID-19 infection admitted to critical care units of Zagazig University Hospital all over 1 year, from May 1, 2020, to April 30, 2021. We analyzed the data for possible correlations between serum electrolytes and patients’ outcomes.ResultsAmong 600 patients included in the study with a mean age of 51.33 ± 16.5 years, 44.16% were mechanically ventilated, and 30.66% died during hospital admission. Serum sodium, potassium, phosphorus, magnesium, and calcium were 141.96 ± 5.4, 4.33 ± 0.66, 3.76 ± 1.26, 2.21 ± 0.52, and 8.55 ± 0.85 respectively, at admission to the ICU. Unfavorable admission course and mortality were significantly associated with high normal serum sodium, potassium, and phosphorus levels and a low normal calcium level.ConclusionAlthough mean serum sodium, potassium, calcium, magnesium, and phosphorus were within normal levels in patients with COVID-19 at presentation, serum sodium, potassium, and phosphorus were significantly higher in those with poor outcomes, whereas calcium was significantly lower in those with poor outcomes.

СПИРОНОЛАКТОН В СОСТАВЕ АНТИГИПЕРТЕНЗИВНОЙ ТЕРАПИИ ПЕРВОЙ ЛИНИИ: ВЛИЯНИЕ НА СОСУДИСТОЕ РЕМОДЕЛИРОВАНИЕ

Introduction. Previously, clinical studies have proven a pronounced antihypertensive effect of spironolactone in patients with true resistant hypertension. The effectiveness of spironolactone as part of first-line therapy, as well as the effect on vascular wall remodeling, has not been studied. Target. To study the effect of spiroconolactone as part of the first line of therapy when added to telmisartan on indicators of vascular wall stiffness in patients with hypertension at high/very high cardiovascular risk. Materials and methods 32 patients (54 (45; 59) years old) were randomly divided into two groups: in the main group receiving spironolactone at a dose of 25 mg in addition to telmisartan (ARB/spironolactone) and in the group receiving hydrochlorothiazide/ARB combination (control). group). Inclusion criteria: age of patients (30-65 years), hypertension at high/very high cardiovascular risk without antihypertensive therapy, no contraindications to prescribed drugs. At baseline and 6 months later, all patients underwent clinical (office) blood pressure (BP) measurements, ABPM, endothelium-dependent vasodilation (EDVD), vascular remodeling indicators: central blood pressure (CAP), augmentation index, pulse wave velocity (PWV). In patients in the ARB/spironolactone group, serum potassium levels were assessed at baseline and after 4 weeks of treatment. Results. In both groups, a significant decrease in clinical and average daily blood pressure was revealed, as well as a decrease in the augmentation index and CAP. PWV in the carotid-radial segment (CWCR) did not significantly decrease in both groups, while PWV in the carotid-femoral area (CWCF) decreased in the ARB/spironolactone group from 9.8 (9.0; 10.6) m/s to 8.6 (8.0; 10.2) m/s (p = 0.0007). The dynamics of SPWcr was 0.9 (1.3;-0.5) m/s in the ARB/HCT group. In all patients, blood potassium was within reference values. Conclusions. Spironolactone as part of first-line therapy, when added to ARBs in patients with hypertension at high/very high cardiovascular risk, led to a significant decrease in clinical and mean daily blood pressure, as well as a decrease in PWCF.

Moderate Hyperkalemia Regulates Autophagy to Reduce Cerebral Ischemia-Reperfusion Injury in a CA/CPR Rat Model.

Cerebral ischemia-reperfusion injury (CIRI) can cause irreversible brain damage and autophagy has been implicated in the pathophysiology. Increasing serum potassium (K+) levels reduces CIRI, but the relationship between its protective mechanism and autophagy is unclear. In this study, we aimed to find the optimal degree of raising serum (K+) and to investigate the relationship between high (K+) and autophagy and the underlying mechanisms in a cardiac arrest/cardiopulmonary resuscitation (CA/CPR) rat model. Sprague Dawley (SD) rats were divided into four groups: S group, N group, P group, and Q group. The rats S group and N group were administered saline. The rats P group and Q group were administered 640 mg/kg of potassium chloride (KCl) continuously pumped at 4 mL/h (21.3 mg/(kg·min) and divided according to the electrocardiogram (ECG) changes during the administration of KCl. After 24-h of resuscitation, neural damage was assessed by measuring neurological deficit score (NDS), oxidative stress markers, and pathological staining of the cerebral cortex. The level of autophagy and the expression of mTOR-ULK1-Beclin1 pathway-related proteins were evaluated using transmission electron microscopy (TEM), immunostaining, and western blotting. Our results revealed that high (K+) improved NDS and decreased the oxidative stress markers. The autophagosomes, autolysosomes, and lysosomes were decreased following treatment KCl. Furthermore, the levels of micro-tubule-associated protein 1 light chain 3 (LC3) Ⅱ/Ⅰ, Unc-51-like kinase 1 (ULK1), and Beclin1 were decreased, whereas mTOR expression was increased in the cortex. The results demonstrated that moderate hyperkalemia could alleviate autophagy after CIRI via regulating the mTOR-ULK1-Beclin1 pathway.

Effect of Fluoxetine and Escitalopram on Heart Rate Variability (HRV) and Serum Potassium Level in Patients of Depression and Anxiety Disorders

Background The present study was conducted to generate data regarding the effect of fluoxetine as an anti-depressant and escitalopram as an antianxiety agent on heart rate variability (HRV). There is a scarcity of data regarding the correlation between selective serotonin reuptake inhibitors (SSRIs) and serum potassium levels. Purpose To find out the effect of SSRIs on HRV, and whether it is either dependent or independent of serum potassium level. Materials and Methods In this prospective, open-label, observational study, 70 participants were enrolled and divided into two groups, the fluoxetine group ( n = 35) and the escitalopram group ( n = 35) suffering from depression and anxiety, respectively. Parameters, like HRV, serum potassium level, heart rate, respiratory rate, and blood pressure, were measured baseline and after the first, second, and third months of treatment. HRV was calculated by root mean square deviation of successive differences between adjacent RR intervals (RMSSD). ECG (electrocardiogram) was recorded by Physio Pac Digital Polygraph software. All values were expressed as mean ± SD, and statistical analysis was done by using the repeated measure analysis of variance (ANOVA) test with Greenhouse–Geisser correction, post hoc analysis with Bonferroni correction, and SPSS 20.0 software. Results Among a total of 70 participants, post hoc tests using the Bonferroni correction showed a statistically significant difference between the HRV of the pretreatment group and after the second, and third month of fluoxetine therapy ( p &lt; 0.05). In the escitalopram group, the Bonferroni correction showed a significant difference between the HRV of the pretreatment and third-month value ( p &lt; 0.05). Repeated measure ANOVA with Greenhouse–Geisser correction showed no statistical significance of serum potassium at different time points ( p &gt; 0.05). There were also no significant changes in heart rate, respiratory rate, and blood pressure at different points of time in both groups. Pearson’s correlation coefficient test for a relationship between HRV and serum potassium was negative at different time points. Conclusion Fluoxetine significantly increased HRV from the pretreatment value to the second and third months of treatment, whereas in the escitalopram group of participants, the third-month value of HRV was increased compared to the first month. The effect of SSRIs on HRV was independent of serum potassium levels at different time points suggesting that the effect of SSRIs on HRV was independent of serum potassium level.

Medical Costs in Patients with Hyperkalemia on Long-Term Sodium Zirconium Cyclosilicate Therapy: The RECOGNIZE II Study.

Hyperkalemia, defined as abnormally high serum potassium levels of ≥5.1 mmol/L, is associated with increased medical costs. This real-world study evaluated the impact of long-term sodium zirconium cyclosilicate (SZC) therapy on medical costs in patients with hyperkalemia. This retrospective, comparative study used claims data from IQVIA PharMetrics® Plus. Patients aged ≥18 years with hyperkalemia who had outpatient SZC fills (>3-month supply over 6 months) between July 2019 and December 2021 and continuous insurance coverage 6 months before and 6 months after the first SZC fill were included. These patients (SZC cohort) were 1:1 exact- and propensity score-matched on baseline variables with patients with hyperkalemia who did not receive SZC (non-SZC cohort). The primary endpoint was hyperkalemia-related medical costs to payers over 6 months. Each cohort included 661 matched patients. Mean per-patient hyperkalemia-related medical costs were reduced by 49.5% ($3728.47) for the SZC versus non-SZC cohort ($3798.04 vs $7526.51; P<0.001), whereas mean all-cause medical costs were reduced by 21.0% ($5492.20; $20,722.23 vs $26,214.43; P<0.01). A 39.8% ($3621.03) increase in all-cause pharmacy costs ($12,727.20 vs $9106.17; P<0.01) was offset by the medical cost savings. This study demonstrated that long-term (>3 months) outpatient treatment with SZC was associated with medical cost savings compared with no SZC therapy.

Comparison of treatment of hypokalemia with oral administration of potassium chloride vial or oral tablets

Introduction: Treatment of mild to moderate hypokalemia is a high potassium-containing diet and oral pharmaceutical potassium products. However, several medical centers in Iran use injectable dosage forms orally, which is not a confirmed method by reliable guidelines. Objectives: This study investigated the advantages and side effects of oral tablets versus injection vials of potassium chloride orally. Patients and Methods: This descriptive-analytical cross-sectional study was performed from March 2022 to June 2022. Thirty patients received tablets ("potassium chloride tablet" group), and thirty patients received injection vials ("potassium chloride vials orally" group) of potassium chloride orally. The variables, including age, gender, clinical side effects, and serum level of potassium, were regularly recorded. Results: The mean duration of serum potassium normalization was 42.00 hours for the "potassium chloride tablet" group and 84.57 hours for the "potassium chloride vials orally" group. The mean total potassium intake was 127.20 mEq/L in the "potassium chloride tablet" group and 280.03 mEq/L for the "potassium chloride vials orally" group. No significant difference was observed in gastrointestinal complications, including esophagitis, bloating, stomach ache, and nausea. None of the patients have required endoscopy due to esophagitis. Conclusion: Our result suggested that prescribing oral potassium chloride tablets has superior benefits over injection vials. However, more detailed research is needed to reveal the other aspects of this problem. Study Registration: This study was retrospectively registered in Research Registry UIN (UIN: reviewregistry1668).