Abnormal Potassium Research Articles

Analysis and nursing of critical value in digestive department

Objective To analyze the common critical value reports of digestive department, and explore the nursing management strategies of critical value. Methods We collect and analyze the critical value reports of digestive department from January to December 2015. Nursing method and management methods were concluded and analyzed. Results There were 479 cases of critical value reports in all. The items with higher incidence rate were: dysfunction of coagulation (54.28%), abnormal blood potassium (10.86%), abnormal white blood cell count (6.68%), abnormal blood glucose (5.22%) and low blood sodium (3.76%). According to the result of critical value reports, the reasons of the occurrence and the corresponding treatment and nursing were analyzed and summarized. Conclusions Through the analysis of common critical values in digestive department, corresponding medical and nursing plans and processes are formulated and the nursing management method are optimized. Nursing of critical value will develop well in the accumulation of experience and continuous improvement. Key words: Nursing; Critical value; Digestive department; Dysfunction of blood coagulation; Abnormal blood potassium

Interaction between synaptic inhibition and glial-potassium dynamics leads to diverse seizure transition modes in biophysical models of human focal seizures.

How focal seizures initiate and evolve in human neocortex remains a fundamental problem in neuroscience. Here, we use biophysical neuronal network models of neocortical patches to study how the interaction between inhibition and extracellular potassium ([K +]o) dynamics may contribute to different types of focal seizures. Three main types of propagated focal seizures observed in recent intracortical microelectrode recordings in humans were modelled: seizures characterized by sustained (∼30−60 Hz) gamma local field potential (LFP) oscillations; seizures where the onset in the propagated site consisted of LFP spikes that later evolved into rhythmic (∼2−3 Hz) spike-wave complexes (SWCs); and seizures where a brief stage of low-amplitude fast-oscillation (∼10−20 Hz) LFPs preceded the SWC activity. Our findings are fourfold: (1) The interaction between elevated [K +]o (due to abnormal potassium buffering by glial cells) and the strength of synaptic inhibition plays a predominant role in shaping these three types of seizures. (2) Strengthening of inhibition leads to the onset of sustained narrowband gamma seizures. (3) Transition into SWC seizures is obtained either by the weakening of inhibitory synapses, or by a transient strengthening followed by an inhibitory breakdown (e.g. GABA depletion). This reduction or breakdown of inhibition among fast-spiking (FS) inhibitory interneurons increases their spiking activity and leads them eventually into depolarization block. Ictal spike-wave discharges in the model are then sustained solely by pyramidal neurons. (4) FS cell dynamics are also critical for seizures where the evolution into SWC activity is preceded by low-amplitude fast oscillations. Different levels of elevated [K +]o were important for transitions into and maintenance of sustained gamma oscillations and SWC discharges. Overall, our modelling study predicts that the interaction between inhibitory interneurons and [K +]o glial buffering under abnormal conditions may explain different types of ictal transitions and dynamics during propagated seizures in human focal epilepsy.

Serum potassium and sodium levels after subarachnoid haemorrhage

Background: Many studies have demonstrated that subarachnoid haemorrhage (SAH) is associated with hyponatraemia but associations with potassium levels are less well studied. There is a clear physiological link between sodium and potassium and abnormal potassium levels that can lead to dangerous outcomes. The purpose of the present study is to define changes in levels of both these cations that occur in standardised salt management of SAH.Method: 114 records of patients admitted between 2 January 2011 and 27 December 2011 with SAH at a single institution were obtained retrospectively. Sodium and potassium values were recorded for 14 days post-SAH from the earliest electrolyte measurements of the day for each patient where available. Patients were identified from the Newcastle SAH database. Fluid management was standardised. Descriptive and non-parametric statistics were used.Results: The most common electrolyte imbalance was hypokalaemia. Patients were equally as likely to develop more severe hypokalaemia as they were to develop more severe hyponatraemia. Both imply that low potassium is of as much relevance as low sodium post-SAH. Individually there was no significant association between either sodium or potassium imbalance and WFNS grade.Conclusions: Low K + is common with current management of a SAH at the Royal Victoria Infirmary.

Short-term mortality risk of serum potassium levels in hypertension: a retrospective analysis of nationwide registry data.

Diuretics and renin–angiotensin–aldosterone system inhibitors are central in the treatment of hypertension, but may cause serum potassium abnormalities. We examined mortality in relation to serum potassium in hypertensive patients. From Danish National Registries, we identified 44 799 hypertensive patients, aged 30 years or older, who had a serum potassium measurement within 90 days from diagnosis between 1995 and 2012. All-cause mortality was analysed according to seven predefined potassium levels: <3.5 (hypokalaemia), 3.5–3.7, 3.8–4.0, 4.1–4.4, 4.5–4.7, 4.8–5.0, and >5.0 mmol/L (hyperkalaemia). Outcome was 90-day mortality, estimated with multivariable Cox proportional hazard model, with the potassium interval of 4.1–4.4 mmol/L as reference. During 90-day follow-up, mortalities in the seven strata were 4.5, 2.7, 1.8, 1.5, 1.7, 2.7, and 3.6%, respectively. Adjusted risk for death was statistically significant for patients with hypokalaemia [hazard ratio (HR): 2.80, 95% confidence interval (95% CI): 2.17–3.62], and hyperkalaemia (HR: 1.70, 95% CI: 1.36–2.13). Notably, normal potassium levels were also associated with increased mortality: K: 3.5–3.7 mmol/L (HR: 1.70, 95% CI: 1.36–2.13), K: 3.8–4.0 mmol/L (HR: 1.21, 95% CI: 1.00–1.47), and K: 4.8–5.0 mmol/L (HR: 1.48, 95% CI: 1.15–1.92). Thus, mortality in relation to the seven potassium ranges was U-shaped, with the lowest mortality in the interval of 4.1–4.4 mmol/L. Potassium levels outside the interval of 4.1–4.7 mmol/L were associated with increased mortality risk in patients with hypertension.

Appropriate baseline laboratory testing following ACEI or ARB initiation by Medicare FFS beneficiaries.

Laboratory testing to identify contraindications and adverse drug reactions is important for safety of patients initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Rates and predictors of appropriate testing among Medicare fee-for-service beneficiaries are unknown. The study's purpose was to examine baseline laboratory testing rates, identify predictors of suboptimal testing, and assess the prevalence of abnormal creatinine and potassium among beneficiaries initiating ACE inhibitors or ARBs. Retrospective cohort of 101 376 fee-for-service beneficiaries from 10 eastern US states in 1 July to 30 November 2011. Appropriate monitoring for serum creatinine or serum potassium was defined as evidence of an outpatient claim within 180 days before or 14 days after the index prescription fill date. Thirty-eight percent of beneficiaries were men, 78% were White race, 26% had prevalent heart failure, and 89% had prevalent hypertension. Rates of appropriate baseline laboratory testing were 82.7% for potassium, 83.2% for creatinine, and 82.6% for both potassium and creatinine 180 days prior to initiation. In logistic regression, men (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.11, 1.19), African-Americans (OR = 1.26, 95%CI: 1.20, 1.32), and beneficiaries with Alzheimer's disease and related disorders (OR = 1.22, 95%CI: 1.15, 1.28) or stroke (OR = 1.34, 95%CI: 1.26, 1.43) were more likely to experience suboptimal testing. At baseline, hyperkalemia was relatively uncommon (5.8%), and elevated creatinine values were rare (1.4%). Appropriate monitoring could be improved for African-American beneficiaries and beneficiaries with a history of stroke or Alzheimer's disease and related disorders initiating ACE inhibitors or ARBs. Copyright © 2016 John Wiley & Sons, Ltd.

Electrolyte composition of retro-oil fluid and silicone oil-related visual loss.

Up to one-third of patients with intra-ocular silicone oil (SO) tamponade for complex macula-on retinal detachment may experience an unexplained visual loss during or after SO tamponade. Although the underlying mechanism is unknown, previous studies suggested that accumulation of retinal potassium could be involved. Hence, this study tested the hypothesis that intra-ocular potassium levels are elevated during SO tamponade. A prospective cohort study was carried out from 13 October 2013 through 5 March 2015. Potassium, sodium, magnesium, chloride, calcium, lactate dehydrogenase (LDH) and glucose levels were measured in retro-oil fluid and paired serum from 16 patients undergoing oil removal, including two patients with SO-related visual loss (SORVL). Vitreous humour and paired serum from 27 patients with macular hole (n=19) or floaters (n=8) served as controls. Median potassium levels in retro-oil fluid and vitreous humour were similar. Magnesium and chloride levels were lower in retro-oil fluid compared with vitreous humour (p<0.01) and LDH levels were elevated in retro-oil fluid (p<0.0001). One of the two patients with SORVL revealed abnormal high potassium and magnesium levels. The other patient had normal levels. Potassium levels are not increased in retro-oil fluid during SO tamponade, making the 'potassium accumulation' hypothesis unlikely. The disturbance in magnesium concentration during SO tamponade warrants further investigation.

Serum Potassium Profile and Associated Factors in Incident Peritoneal Dialysis Patients

Background/Aims: Abnormal potassium profiles are common in peritoneal dialysis (PD) patients. We studied the factors associated with serum potassium profiles in incident PD patients. Methods: Patients were enrolled from two hospital-facilitated PD centers from May 2013 to May 2016 and January 2009 to December 2015. A total of 319 incident PD patients were examined for factors associated with serum potassium profile. Average serum potassium levels were obtained for analysis during the first 3 months after PD initiation. Clinically factors and parameters associated with PD were assessed by logistic regression. Results: There were 168 men and 151 women (mean age, 50.8 years). Blood urea nitrogen (BUN), creatinine (Cr), and intact parathyroid hormone levels were significantly increased in patients in the higher serum potassium group. There were no significant risk factors for hypokalemia, including sex, age, diabetes, blood examination parameters, medication use, or PD-related parameters by multivariate logistic regression analysis. BUN (adjusted odds ratio [OR] 1.02, 95% CI 1.01-1.03, p = 0.001) and Cr (adjusted OR 1.08, 95% CI 1.01-1.16, p = 0.029) levels were significant risk factors for hyperkalemia by multivariate logistic regression analysis. Conclusion: Hyperkalemia and blood BUN and Cr levels were significantly associated in incident PD patients.

Uncompacted Myelin Lamellae and Nodal Ion Channel Disruption in POEMS Syndrome.

To elucidate the significance of uncompacted myelin lamellae (UML) and ion channel disruption at the nodes of Ranvier in the polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome, we evaluated sural nerve biopsy specimens from 33 patients with POEMS syndrome and from 7 control patients. Uncompacted myelin lamellae distribution was assessed by electron microscopy and immunofluorescence microscopy. In the POEMS patient biopsies, UML were seen more frequently in small versus large myelinated fibers. Paranodes and Schmidt-Lanterman incisures, where normal physiologic UM is located, were frequently associated with UM. Widening of the nodes of Ranvier (i.e. segmental demyelination) was not associated with UML. There was axonal hollowing with neurofilament condensation at Schmidt-Lanterman incisures with abnormal UML, suggesting axonal damage at those sites in the POEMS patient biopsies. Myelin sheath irregularity was conspicuous in large myelinated fibers and was associated with abnormally widened bizarrely shaped Schmidt-Lanterman incisures. Indirect immunofluorescent studies revealed abnormalities of sodium (pan sodium) and potassium (KCNQ2) channels, even at nonwidened nodes of Ranvier. Thus, UML was not apparently associated with segmental demyelination but seemed to be associated with axonal damage. These observations suggest that nodal ion channel disruption may be associated with functional deficits in POEMS syndrome patient nerves.

Uncompacted Myelin Lamellae and Nodal Ion Channel Disruption in POEMS Syndrome

To elucidate the significance of uncompacted myelin lamellae (UML) and ion channel disruption at the nodes of Ranvier in the polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome, we evaluated sural nerve biopsy specimens from 33 patients with POEMS syndrome and from 7 control patients. Uncompacted myelin lamellae distribution was assessed by electron microscopy and immunofluorescence microscopy. In the POEMS patient biopsies, UML were seen more frequently in small versus large myelinated fibers. Paranodes and Schmidt-Lanterman incisures, where normal physiologic UM is located, were frequently associated with UM. Widening of the nodes of Ranvier (i.e. segmental demyelination) was not associated with UML. There was axonal hollowing with neurofilament condensation at Schmidt-Lanterman incisures with abnormal UML, suggesting axonal damage at those sites in the POEMS patient biopsies. Myelin sheath irregularity was conspicuous in large myelinated fibers and was associated with abnormally widened bizarrely shaped Schmidt-Lanterman incisures. Indirect immunofluorescent studies revealed abnormalities of sodium (pan sodium) and potassium (KCNQ2) channels, even at nonwidened nodes of Ranvier. Thus, UML was not apparently associated with segmental demyelination but seemed to be associated with axonal damage. These observations suggest that nodal ion channel disruption may be associated with functional deficits in POEMS syndrome patient nerves.

Dyselectrolytemia and Leucocytosis in Traumatic Brain Injury Patients

Traumatic brain injuries are common. These constitute an important cause of morbidity and mortality in people of all age groups. Electrolyte disturbance and leucocytosis are commonly seen in patients with traumatic brain injuries. This study was done to find out the frequency of electrolyte disturbances and leucocytosis in patients with traumatic brain injuries. This was a descriptive study of all patients who were brought to the emergency room of Manipal Teaching Hospital. Demographic parameters, cause of injury, CT scan findings, severity of injury were noted in a proforma. Serum sodium and potassium level and total count was measured in blood samples taken from all patients in the emergency. There were 85 patients included in the study. Abnormal sodium level was found in 36.5% and abnormal potassium level was found in 10.6%. Similarly almost two thirds of patients had leucocytosis. Electrolyte disturbances should be measured and meticulously treated in patients with traumatic brain injuries.

The clinical relevance of plasma potassium abnormalities on admission in trauma patients: a retrospective observational study.

BackgroundAbnormalities in potassium levels can lead to several clinical difficulties in trauma patients admitted to the ICU. However, the significance of potassium abnormalities soon after admission in trauma patients has not yet been clearly delineated. The objective of this study was to describe the plasma potassium abnormalities in trauma patients on admission and to examine the clinical outcomes associated with these abnormalities.MethodsWe performed a retrospective observational study of plasma potassium levels in trauma patients admitted to the Fukuyama City Hospital between January 1, 2010 and December 31, 2013. Five hundred twenty consecutive trauma patients were included and categorized into six groups according to their plasma potassium level on admission (<3.0, 3.0–<3.5, 3.5–<4.0, 4.0–<4.5, 4.5–<5.0, and ≥5.0 mEq/L). After adjusting for covariates, including age, gender, the Revised Trauma Score, and the Injury Severity Score, logistic regression analysis was used to examine the association between plasma potassium levels and outcomes, including life-saving interventions and in-hospital mortality.ResultsTwo hundred twenty-seven patients (43.7 %) presented with hypokalemia (<3.5 mEq/L), while seven patients (1.3 %) presented with hyperkalemia (≥5.0 mEq/L). Patients in the lowest potassium group (<3.0 mEq/L, n = 36 [6.9 %]) were significantly associated with craniotomy (adjusted odds ratio 5.25 [95 % confidence interval 2.06–13.40]; p < 0.001) and showed an increased trend toward in-hospital mortality. In the second lowest potassium group (3.0–< 3.5 mEq/L, n = 191 [36.7 %]), the adjusted odds ratio for craniotomy was significantly higher (2.03 [95 % confidence interval 1.01–4.07]; p = 0.048) compared to the reference group.ConclusionsTrauma patients presenting with hypokalemia (<3.5 mEq/L) on admission may be associated with severe head trauma requiring life-saving craniotomy.

Raising the standard for clinical care of patients with Ebola virus disease

Raising the standard for clinical care of patients with Ebola virus disease

Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction.

AimsDiuretic treatment is often needed in acute heart failure following myocardial infarction (MI) and carries a risk of abnormal potassium levels. We examined the relation between different levels of potassium and mortality.Methods and resultsFrom Danish national registries we identified 2596 patients treated with loop diuretics after their first MI episode where potassium measurement was available within 3 months. All-cause mortality was examined according to seven predefined potassium levels: hypokalaemia <3.5 mmol/L, low normal potassium 3.5–3.8 mmol/L, normal potassium 3.9–4.2 mmol/L, normal potassium 4.3–4.5 mmol/L, high normal potassium 4.6–5.0 mmol/L, mild hyperkalaemia 5.1–5.5 mmol/L, and severe hyperkalaemia: >5.5 mmol/L. Follow-up was 90 days and using normal potassium 3.9–4.2 mmol/L as a reference, we estimated the risk of death with a multivariable-adjusted Cox proportional hazard model. After 90 days, the mortality rates in the seven potassium intervals were 15.7, 13.6, 7.3, 8.1, 10.6, 15.5, and 38.3%, respectively. Multivariable-adjusted risk for death was statistically significant for patients with hypokalaemia [hazard ratio (HR): 1.91, confidence interval (95%CI): 1.14–3.19], and mild and severe hyperkalaemia (HR: 2, CI: 1.25–3.18 and HR: 5.6, CI: 3.38–9.29, respectively). Low and high normal potassium were also associated with increased mortality (HR: 1.84, CI: 1.23–2.76 and HR: 1.55, CI: 1.09–2.22, respectively).ConclusionPotassium levels outside the interval 3.9–4.5 mmol/L were associated with a substantial risk of death in patients requiring diuretic treatment after an MI.

Is postoperative delirium a relevant outcome?

potentially confounding neurological dysfunctions. In their study with 100 postoperative patients without a known risk factor of POD, the incidence of POD diagnosed using CAM was 28 %. Their result suggested that the incidence of POD was common in patients after major surgery even without known risk factors. Major surgery might evoke a strong stress response. Recent studies provided the hypothesis that it may introduce postoperative delirium or cognitive dysfunction [9, 10]. As the authors have pointed out, prior studies have commonly been conducted in postoperative patients with known risk factors; their study is relevant and novel. Another finding was a significant association of the use of thiopental with the risk of POD compared with propofol. Thiopental, a barbiturate class of drug, has effects on the gamma-aminobutyric acid (GABA) receptor [11] and propofol is also considered to act through potentiation of GABA receptor activity. Although their finding on thiopental may be skewed by the bias of patient characteristics and conditions which may cause anesthesiologists to choose thiopental rather than propofol, the potential action of thiopental on non-GABA-ergic ligand-gated ion channels, including the neuronal nicotinic acetylcholine receptor channels, may contribute to its association [12]. Although there are potential hypotheses for the etiology and pathophysiology of POD including cholinergic inhabitation, serotonin deficiency, dopamine activation [13], GABA activity [14], and melatonin activity [15], they are not fully understood [16]. This is one of the reasons why there are still just a few strategies for preventing POD [17]; the use of dexmedetomidine in post-cardiac surgery patients [18], multicomponent interventions, and antipsychotics. In this regard, further study should be warranted to develop a detailed understanding and preventive strategy for these postoperative complications. Delirium is characterized by the acute onset of mental status or a fluctuating course and inattention and disorganized thinking or an altered level of consciousness [1], which is common in critically ill patients [2]. Recently, the diagnosis of delirium is recommended by using the Confusion Assessment Method for the intensive care unit (CAM-ICU) [3]. Postoperative delirium (POD) was defined as so because it occurs postoperatively. Although operation, anesthetics, and analgesics can contribute to POD, it is not just associated with emergence from anesthesia, but often occurs between postoperative days 1 and 3. Although POD is commonly recovered from within a short period of time [4], patients with POD are more likely to die or develop dementia and require institutionalization [5]. A number of risk factors are reported for POD, including older age, preoperative cognitive or functional impairment, decreased postoperative hemoglobin, markedly abnormal sodium potassium and glucose, the presence of alcohol abuse, noncardiac thoracic surgery, aortic aneurysm surgery, history of delirium, preoperative use of narcotics, low postoperative oxygen saturation, history of cerebrovascular disease, and untreated pain [6, 7]. In a recent prospective observational study conducted by Saporito and Sturini [8], they excluded patients with any known preexisting predisposing factor for POD; types of surgery, preoperative dementia, sensory deficits, requirement of psychotropic drugs, and alcoholism etc., and other

Abstract W P335: The Impact of Electrolyte Abnormalities in Primary Intracerebral Hemorrhage

Background and Purpose: Electrolyte abnormalities are common in patients with hemorrhagic stroke. In subarachnoid hemorrhage for instance, hyponatremia is common and is independently associated with adverse outcomes. For patients with primary ICH, however, there is limited about electrolyte abnormalities. This study aims to examine the relationship between electrolyte abnormalities and outcomes in ICH patients. Methods: We retrospectively reviewed consecutive ICH patients in a single center stroke registry between 2008-2013. Patient demographics, clinical information including stroke severity (NIHSS) and ICH score, laboratory values and neuroimaging were collected. Admission electrolyte abnormalities for serum sodium, potassium and chloride were defined as any value outside the hospital’s reference range. Outcomes of interest included hematoma expansion, discharge mRS, length of stay (LOS) and poor discharge disposition (i.e., not to home or inpatient rehabilitation). Results: A total of 384 patients were included in this analysis. Serum sodium was abnormal in 47 patients (12.2%), potassium was abnormal in 46 patients (11.9%) and chloride was abnormal in 76 patients (19.8%). Hyponatremia was the most common sodium abnormality (46/47, 98%). Potassium and chloride abnormities were not associated with worse outcomes. Serum sodium abnormalities were associated with longer length of stay (11 vs 5 days, p=0.002), higher discharge mRS (5 vs 4, p=0.04) and poor disposition (60% vs 43%, p=0.03). There was no association with hematoma expansion. Although not significant for all hemorrhage severities, in patients with an ICH score ≤2, abnormal sodium was associated with a discharge mRS 4-6 (OR 2.49, 95% CI 1.16-5.39, p=0.02) and poor disposition (OR 2.55, 95% CI 1.29-5.02, p=0.01). Conclusions: Electrolyte abnormalities were not uncommon in our sample of ICH patients and hyponatremia was a frequent cause of abnormal serum sodium. Although potassium and chloride abnormalities were not associated with poor outcomes, serum sodium abnormalities were associated with worse functional outcomes, particularly in patients with milder hemorrhage severity. Further research is needed to determine if sodium correction can improve these outcomes.

Changes in Serum Potassium Levels During Hospitalization in Patients With Worsening Heart Failure and Reduced Ejection Fraction (from the EVEREST Trial)

Both hyperkalemia and hypokalemia may be related to heart failure (HF) therapy and are associated with adverse outcomes. Abnormalities in serum potassium levels in hospitalized patients with HF and reduced ejection fraction (EF) have not been previously investigated. A post hoc analysis was performed in 1,907 hospitalized patients with worsening HF and reduced EF in the placebo arm of the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST) trial. Serum potassium was measured at randomization and at discharge or day 7. The co-primary end points were all-cause mortality (ACM) and cardiovascular mortality or the first HF hospitalization (CVM + HFH). The association between inhospital change in potassium levels and time to outcomes was evaluated using multivariate Cox regression models. Study participants had a mean age of 65.6 ± 12.0 years and were on optimal guideline-directed medical therapies, including β blockers (77%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (85%), and aldosterone antagonists (55%). Baseline potassium concentration was 4.3 ± 0.6 mEq/l, and hyperkalemia or hypokalemia was seen in 6.5% of the participants. On average, serum potassium level increased by 0.21 ± 0.66 mEq/l, p <0.0001, during hospitalization. Inhospital potassium change was not associated with either the primary or the secondary end point over a median follow-up of 9.9 months. In conclusion, in patients with reduced EF hospitalized for worsening HF, serum potassium abnormalities are common at baseline (within 48 hours of admission) and potassium levels increase during hospitalization, despite aggressive diuretic therapy. However, they are not associated with all-cause or CVM or HFH. Inhospital changes in potassium may limit the implementation of evidence-based therapies such as mineralocorticoid receptor antagonists.

Potassium Abnormalities in Current Clinical Practice: Frequency, Causes, Severity and Management

Objective: We aimed to investigate the prevalence and etiology of potassium abnormalities (hypokalemia and hyperkalemia) and management approaches for hospitalized patients. Subjects and Methods: Over a 4-month period, all hospitalized patients at Hacettepe University Medical Faculty Hospitals who underwent at least one measurement of serum potassium during hospitalization were included. Data on serum levels of electrolytes, demographic characteristics, cause(s) of hospitalization, medications, etiology of potassium abnormality and treatment approaches were obtained from the hospital records. Results: Of the 9,045 hospitalized patients, 1,265 (14.0%) had a serum potassium abnormality; 604 (6.7%) patients had hypokalemia and 661 (7.30%) had hyperkalemia. In the hypokalemic patients, the most important reasons were gastrointestinal losses in 555 (91.8%) patients and renal losses in 252 (41.7%) patients. The most frequent treatment strategies were correcting the underlying cause and replacing the potassium deficit. Of the 604 hypokalemic patients, 319 (52.8%) were normokalemic at hospital discharge. The most common reason for hyperkalemia was treatment with renin-angiotensin-aldosterone system blockers in 228 (34.4%) patients, followed by renal failure in 191 (28.8%). Two hundred and ninety-eight (45.0%) patients were followed without any specific treatment. Of the 661 hyperkalemic patients, 324 (49.0%) were normokalemic at hospital discharge. Conclusion: This study showed a high prevalence of potassium imbalance among hospitalized patients. Although most of the potassium abnormalities were mild/moderate, approximately half of the patients treated for hypokalemia or hyperkalemia were discharged from the hospital with ongoing dyskalemia.

Renal involvement and its detection in sickle cell disease children

Background: Sickle cell disease is common in this part of India. Study tries to find extent of renal involvement, risk factors and screening tests in sickle cell disease. Methods: Convenient Prospective, cross sectional, observational study among known sickle cell anemia (homo and heterozygous) children and Fifty controls. Demographic and clinical findings were recorded. Renal function tests including serum sodium and potassium, eGFR were studied. Presence of microalbuminuria was checked and renal Doppler study was performed. Results: Total 110 homozygous (SS type), 55 heterozygous (AS type) and 50 normal children were recruited. Majority belonged to low socioeconomic state with male preponderance. More patients in crisis had high Urea (23%) and Creatinine (43%) than in steady state (high urea 3.38%, high creatinine 15%). In AS type children also high urea (3.6%) and creatinine (11%) was found. A subgroup in SS and AS type had lower than normal urea and creatinine. Sodium and potassium abnormality also was found in both groups. eGFR was high below 5 years and then came down. All parameters worsened with age. Renal Doppler was better indicator of renal damage than microalbuminuria. Conclusions: Renal involvement is common in sickle cell anemia. Increasing age, male sex and homozygous state were risk factors. Renal Doppler and micro-albuminuria are good screening tests. Renal Doppler was marginally superior.

Thyroid Disorders and Biological parameters in chronic kidney disease patients having psychiatric illness

Background: Chronic Kidney Disease (CKD) is a public health problem that tends to take dimensions of epidemic and has serious impact on quality of patients life. Thyroid function disorders are common in patients with chronic kidney disease. Aim: The aim of the present study was to explore the conditions of Thyroid Disorders and Biological parameters in chronic kidney disease patients having psychiatric morbidity undergoing haemodialysis. Materials and Methods: Prospective study included 130 participants undergoing haemodialysis with Psychiatric morbidity. Exclusion criteria were: previous thyroid disorders, systemic illnesses, critically ill patients. Blood samples were taken for standard laboratory analysis, total and free thyroid hormone levels. Results: On comparing patients with and without psychiatric illness and their potassium values, there was a significant association (p< 0.05) between abnormal potassium values and psychiatric illness. There was a significant association (p< 0.05) between psychiatric illness and total bilirubin values. The thyroid profile, there was a significant association (p< 0.05) between abnormal FT3, FT4 values and psychiatric illness. Conclusions: Our study showed that functional thyroid gland disorders are more common among patients having psychiatric morbidity undergoing haemodialysis compared with healthy subjects and reveal their link with time on dialysis.

AT-15 * A PHASE II STUDY OF ANTINEOPLASTONS A10 AND AS2-1 IN PATIENTS WITH BRAINSTEM GLIOMAS FINAL REPORT (PROTOCOL BT-11)

PURPOSE: To evaluate the efficacy and safety of antineoplastons A10 and AS2-1 (ANP) in patients with brainstem glioma (BSG). METHODS: In the intent to treat (ITT) population forty patients (median age 11.2 years) were enrolled, and all were included in safety analysis, but only 39 patients were evaluated for efficacy. ANP was administered intravenously daily. Efficacy analyses were conducted in all BSG patients and in two subgroups: recurrent pediatric diffuse intrinsic pontine glioma (RPDIPG) and non-DIPG (NDIPG). RESULTS: In BSG, complete responses (CR) were observed in 13% of patients, partial responses (PR) 10%, and stable disease (SD) 20.5%. Overall survival (OS) at 1, 2, 5, 10 and 15 years was 38.5%, 28%, 23%, 20%, and 17% correspondingly. Six patients are presently alive 7.6 years to over 18 years. In the RPDIPG group, CR was 6%, PR 23.5%, and SD 17.5%. One year OS was 29%, 2 years 12%, and 5, 10 and 15 years 6%. In the NDIPG group, there were 36% CR and 27% SD. OS at 1, 2, 5, 10, and 15 years was 82%, 73%, 73%, 62%, and 50% correspondingly. Grade 3 and higher sodium and potassium abnormalities occurred in 15%, fatigue and somnolence in 12.5%, skin allergy and urinary incontinence occurred in 2.5% (all toxicities in ITT). No chronic adverse events occurred. Responding patients experienced improved quality of life. CONCLUSION: The results suggest that ANP shows efficacy and acceptable tolerability profile in patients with BSG, RPDIPG, and NDIPG.