Plasma Potassium Levels Research Articles

Effects of sublethal exposure to new pesticides lufenuron and flonicamid on common carp, Cyprinus carpio, hydromineral balance to further saltwater exposure

The effects of 21 days exposure to lufenuron and flonicamid were investigated on common carp responses to saltwater exposure. Fish were assigned in three groups: control (21 days in freshwater), lufenuron (exposed for 21 days) and flonicamid (exposed for 21 days). After 21 days, all fish were subjected to 15 g/l saltwater for further 4 days. Plasma glucose, cortisol, sodium, potassium, chloride, calcium and phosphorus levels were monitored 0, 24, 72 and 120 h after saltwater exposure. Type of pesticides and time of salt water exposure had interaction on plasma glucose and cortisol levels. These two stress indicators were increased significantly in all groups after saltwater exposure. The cortisol elevation continued until 72 h after salinity challenge and then decreased significantly after 120 h salinity exposure in all treatments. Plasma glucose level showed fluctuation during saltwater exposure. It was increased after 24 h saltwater exposure, then decreased after 72 h and again it was increased after 120 h salinity challenge. Increased plasma sodium showed significant elevation along with elongation of saltwater exposure. Pesticide exposure significantly affected plasma chloride levels as the flonicamid group had significantly lower chloride compared to the control and lufenuron groups. Plasma chloride showed significant elevation along with elongation of saltwater exposure. Pesticide and time of salinity challenge had interaction on plasma calcium levels as 24 h after salinity challenge calcium level of pesticide groups increased significantly. Along with elongation of saltwater exposure, calcium level of pesticides treatments decreased but it higher than the pre salinity challenge. Plasma phosphorus level increased 24 h after saltwater exposure and decreased along with elongation of saltwater exposure. In conclusion, lufenuron and flonicamid induce stress and alter gill function and blood ionic homeostasis during saltwater exposure.

Effectiveness of Thermal Ablation for Aldosterone-Producing Adrenal Adenoma: A Systematic Review and Meta-Analysis of Clinical and Biochemical Parameters.

To assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma. A systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated. A total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (-29.06 mm Hg; 95% confidence interval [CI],-33.93 to-24.19), DBP (-16.03 mm Hg; 95% CI,-18.33 to-13.73), and the number of antihypertensive medications used (-1.43; 95% CI,-1.97 to-0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration. Thermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results.

Combination of oxymatrine and diammonium glycyrrhizinate significantly mitigates mice allergic contact dermatitis induced by dinitrofluorobenzene.

This study investigated the safety and effect of oxymatrine (OMT) and/or diammonium glycyrrhizinate (DG) on allergic contact dermatitis (ACD) induced by 1-fluoro-2,4-dinitrofluorobenzene (DNFB) in ICR mice. Mice were topically smeared with vehicle (control) or DNFB on their ear and skin to induce ACD. The mice were randomized and injected with saline as the model, treated intraperitoneally with dexamethasone (DEX), 45 or 90 mg·kg−1 OMT and/or DG daily beginning one day post the first smearing for two weeks. The body weights, the severity of ear and skin inflammation, the levels of serum IgE, IL-4, and IFNγ, creatinine and urea as well as plasma sodium and potassium in individual mice were measured. In comparison with the control group, the model group did not change the body weights, but developed severe skin and ear inflammation with increased ear thickness, accompanied by many inflammatory infiltrates in the lesions and high levels of serum IgE, IL-4, and IFNγ. Combination of OMT and DG prevented the OMT- or DG-altered body weights in mice. While treatment with either OMT or DG moderately reduced the skin and ear inflammation, their thickness and inflammatory infiltrates, combination of OMT and DG further significantly increased their anti-inflammatory effects in mice. A similar pattern of inhibitory effect on the levels of serum IgE, IL-4, and IFNγ was observed in the different groups of mice. Combination of OMT and DG also prevented the OMT-, DG-, or DEX-altered plasma sodium or potassium levels in mice. Therefore, combination of OMT and DG significantly increased anti-inflammatory effects on ACD induced by DNFB in mice and attenuated DG- or OMT-related adverse effects. Impact statement Diammonium glycyrrhizinate (DG) and oxymatrine (OMT) have similar anti-inflammatory, anti-allergic, anti-tumor, immunomodulatory, and other pharmacological properties. Our previous study has shown that when DG and OMT are combined, DG can attenuate both high-dose (347.44 mg·kg−1) and regular-dose (90 mg·kg−1) OMT-induced mortality and adverse effects (such as body weight loss and hyponatremia). Furthermore, OMT can similarly attenuate the adverse effects (such as body weight gain, hypernatremia, and hypokalemia) induced by regular dose (90 mg·kg−1) of DG. Accordingly, we tested whether combination of OMT and DG would increase anti-inflammatory activities and reduce their adverse effect in a mouse model of allergic contact dermatitis (ACD) induced by 1-fluoro-2,4-dinitrofluorobenzene (DNFB). Our findings indicated that combination of OMT and DG significantly increased anti-inflammatory effects on ACD induced by DNFB in ICR mice and attenuated adverse effects of DG or OMT alone.

Attention to Detail.

Attention to Detail.

Prevalence of distal renal tubular acidosis in patients with calcium phosphate stones.

Distal renal tubular acidosis (DRTA) is a metabolic disorder that associates urolithiasis and urinary pH > 6. The prevalence of DRTA in patients with calcium phosphate stones is not well known. The objective is to determine the prevalence of DRTA in patients with calcium phosphate stones and urinary pH above 6 based on the furosemide test. A total of 54 patients with calcium phosphate stones and urinary pH above 6.0 were submitted to the furosemide test. The association of DRTA with age, sex, type of stone, stone recurrence, stone bilaterality, 24-h urine biochemistry, and adverse effects of the furosemide test were examined. The furosemide test indicated that 19 of 54 patients (35.2%) had DRTA. The sex ratio was similar in the two groups (p < 0.776). The DRTA group was significantly younger (p < 0.001), and had a higher prevalence of bilateral stones (p < 0.001), a higher prevalence of recurrent stones (p < 0.04), a lower plasma potassium level (p < 0.001), a higher urinary Ca level (p ≤ 0.05), and a lower urinary citrate level (p < 0.001). None of the patients reported adverse effects from the furosemide test. There was a high prevalence of DTRA in patients with urinary pH above 6 and calcium phosphate stones. Young age, bilateral stones, stone recurrence, hypercalciuria, hypocitraturia, and plasma hypokalemia were associated with DRTA. None of the patients reported adverse effects of the furosemide test.

Digenetic inheritance of SLC12A3 and CLCNKB genes in a Chinese girl with Gitelman syndrome

BackgroundGitelman syndrome (GS) is an autosomal recessive disorder and mild variant of classic Bartter syndrome. The latter is caused by defects in the genes CLCNKB and/or CLCNKA (chloride voltage-gated channel Ka and Kb). Patients with GS usually have loss-of-function mutations in SLC12A3. No patient has been reported with compound heterozygous mutations in these genes. We report a girl with GS with a paternally inherited heterozygous mutation in SLC12A3, and maternally inherited heterozygous variants in both CLCNKB and CLCNKA.Case presentationIn this report, we reported a female patient (8 y and 10 mo) who had growth retardation (111.8 cm, − 1.62 standard deviation height for age) and normal blood pressure, with persistent hypokalemia, hypomagnesemia, hypocalciuria, hypochloremic alkalosis, and elevated levels of plasma renin and aldosterone. Her younger brother, father, and paternal grandmother all had histories of mild low levels of plasma potassium (3.0–3.5 mmol/L), which were rectified by potassium-rich foods. The genomic DNA of the patient, younger brother, parents, and grandparents were screened for gene variations and pedigree analysis using trio whole exome sequencing (WES). The candidate variants were validated by Sanger sequencing. Protein-protein interaction analysis utilized the following databases: Biogrid, MINT, HPRD, STRING, IntAct, iRefIndex, and ppiTrim. The trio WES screening showed that the patient has paternally inherited SLC12A3 p.N359K, and maternally inherited CLCNKB p.L94I. The paternal grandmother and younger brother are both carriers of SLC12A3 p.N359K. According to the STRING database, SLC12A3 and CLCNKB proteins may interact or coexpress with proteins associated with GS.ConclusionsBased on clinical phenotypes, genetic evidence of the pedigree, and previous reported studies, this case of GS indicates a digenetic inheritance of SLC12A3 and CLCNKB that resulted in renal tubular dysfunction perhaps, due to a genetic double-hit mechanism. The putative pathogenicity of the CLCNKB p.L94I variant requires confirmation.

WNK4 kinase is a physiological intracellular chloride sensor

With-no-lysine (WNK) kinases regulate renal sodium-chloride cotransporter (NCC) to maintain body sodium and potassium homeostasis. Gain-of-function mutations of WNK1 and WNK4 in humans lead to a Mendelian hypertensive and hyperkalemic disease pseudohypoaldosteronism type II (PHAII). X-ray crystal structure and in vitro studies reveal chloride ion (Cl-) binds to a hydrophobic pocket within the kinase domain of WNKs to inhibit its activity. The mechanism is thought to be important for physiological regulation of NCC by extracellular potassium. To test the hypothesis that WNK4 senses the intracellular concentration of Cl- physiologically, we generated knockin mice carrying Cl--insensitive mutant WNK4. These mice displayed hypertension, hyperkalemia, hyperactive NCC, and other features fully recapitulating human and mouse models of PHAII caused by gain-of-function WNK4. Lowering plasma potassium levels by dietary potassium restriction increased NCC activity in wild-type, but not in knockin, mice. NCC activity in knockin mice can be further enhanced by the administration of norepinephrine, a known activator of NCC. Raising plasma potassium by oral gavage of potassium inactivated NCC within 1 hour in wild-type mice, but had no effect in knockin mice. The results provide compelling support for the notion that WNK4 is a bona fide physiological intracellular Cl- sensor and that Cl- regulation of WNK4 underlies the mechanism of regulation of NCC by extracellular potassium.

Biochemical alterations in plasma total bile acid, creatinine, sodium, potassium, chloride, and bicarbonate in rabbits overdosed with ibuprofen and supplemented with guava leaf (Psidium guajava) extracts

STUDY BACKGROUND: Ibuprofen is an analgesic and a nonsteroidal anti-inflammatory drug while Psidium guajava leaf has antioxidative, antimicrobial, anti-inflammatory, and analgesic activities. AIM AND OBJECTIVE: The aim of the study is to evaluate plasma total bile acids (TBAs), creatinine, and electrolytes in rabbits overdosed with ibuprofen and supplemented with guava leaf (P. guajava) extracts. JUSTIFICATION: There exists a little information on the change in the plasma levels of TBA and electrolytes in ibuprofen toxicity supplemented with guava leaf extract. MATERIALS AND METHODS: Fifteen rabbits (weight – 0.8–1.4 kg; age – 1.5 ± 0.4 years, n = 5/group) were grouped into control (a); rabbits administered 1600 mg/KgBW of ibuprofen (B1) before being fed with 400 mg/KgBW of guava leaf aqueous extract (B2) and rabbits administered 1600 mg/KgBW of ibuprofen administration (C1) before being fed with 400 mg/KgBW of guava leaf methanolic extract (C2). Plasma creatinine, sodium, potassium, chloride, and bicarbonate levels were determined using COBAS C111 chemistry autoanalyzer while TBA was determined by spectrophotometry. RESULTS: The results showed a significant increase in the plasma level of TBA, potassium, and creatinine in the rabbits following the administration of 1600 mg/KgBW of ibuprofen (P CONCLUSION: There was a significant increase in the plasma values of TBA, creatinine, and potassium following the administration of ibuprofen possibly due to ibuprofen toxicity which was significantly reduced upon the administration of 400 mg/KgBW of guava leaf extract.

Actual diet and nutritional deficiencies status in children on peritoneal dialysis at the Vietnam National Hospital of Pediatrics.

Nutrition is essential for children with end-stage renal disease, especially for those suffering from peritoneal dialysis (PD). Although the number of PD children has increased annually at the Vietnam National Hospital of Pediatrics, studies about the diet and nutritional deficiencies status of PD children is still limited. The aim of this study was to describe the actual diet and status of nutritional deficiencies of PD patients. This cross-sectional study was conducted on 31 PD children aged 2-15 years old using the 24-h dietary recall and biochemical parameters in blood (albumin, hemoglobin, calcium, sodium, potassium, and chloride). The energy intake was lowest in children over 13-year-old with only 32.9% of dietary reference intakes (DRIs). Carbohydrate intake among 10-15-year-old children was 38.1% of DRIs. Daily consumption of sodium was 65.6% and 33%-35% of DRIs for children under and over three-year-old, respectively. In comparison with DRIs, daily consumption of magnesium, iron, and calcium of over 10-year-old children was lower than that of younger children. In terms of vitamins, B-group vitamins, Vitamin C achieved the recommended levels except Vitamin A (63.0%) and Vitamin D (20.0%). The prevalence of children with serum albumin concentration lower than the normal range was 45.2% and prevalence of anemia was 51.6%. The proportion of children with decreased plasma calcium, sodium, and potassium levels was 83.8%, 77.4%, and 12.9%, respectively. PD children's diet lacks energy, protein, lipid, carbohydrate, as well as micronutrients. The prevalence of nutritional deficiencies is remarkably high in PD children.

Clinical characterіstics and survival of hospitalized patients with chronic heart failure and reduced left ventricular ejection fraction depending on dynamics of nitrogen-releasing kidney function during period of overcoming clinical decompensation

The aim — to investigate the main clinical hemodynamic and laboratory characteristics in hospitalized patients with chronic heart failure (CHF), depending on the dynamics of the nitrogen‑releasing renal function during the period of overcoming decompensation and to determine the prognostic value of impaired renal function (IRF) in this category of patients.Materials and methods. The study involved 134 patients with CHF caused by ischemic heart disease or dilated cardiomyopathy, and a reduced (&lt; 40 %) left ventricular ejection fraction, heart failure of II B according to Strazhesko — Vasilenko criteria, III — IV functional class according to the criteria of the New York Heart Association (NYHA). They were hospitalized for circulatory decompensation. The median age was 59.5 (54; 68) years. All patients underwent general clinical examination, determined the level of creatinine, urea nitrogen, uric acid, interleukin‑6, plasma citrulline, N‑terminal fragment of the brain natriuretic peptide (NTproBNP) at admission and before discharge, glomerular filtration rate (GFR) using the equation CKD‑EPI. Patients received standard treatment. The patients were divided into two groups according to the level of increase in creatinine before discharge: the first one with RFW with an increase in creatinine level ≥ 17.7 mmol/l, the second one with no RFW.Results and discussion. 110 (82 %) patients showed no RFW after overcoming clinical decompensation; in 24 (18 %) patients, the creatinine level increased by 17.7 mmol/l or more, which corresponded to a decrease in GFR і 5 ml/(min 1.73 m2). At the stage of hospitalization, patients did not differ in age, frequency of comorbid pathology, main hemodynamic parameters, potassium plasma levels, glomerular filtration rate (GFR), urea nitrogen, uric acid, NTproBNP. After attaining the stable condition, lower blood pressure levels, higher levels of blood urea nitrogen, uric acid, interleukin‑6 and citrulline were observed in patients with impaired renal function. To overcome decompensation, these individuals took longer time, almost two times higher course and daily doses of loop and potassium‑preserving diuretics. Patients with impaired renal function had a statistically significantly worse prognosis regarding long‑term survival.Conclusions. Among patients with CHF and a reduced left ventricular ejection fraction (LVEF) hospitalized for circulatory decompensation, impaired renal function during treatment occurred in 18 % of cases. At the time of discharge, patients with impaired renal function compared with patients without one showed a significantly lower level of systolic blood pressure, a longer duration of decompensation overcoming, higher average daily doses of loop and potassium‑preserving diuretics, a higher content of uric acid, urea nitrogen, interleukin ‑6 and citrulline in plasma. Patients with decompensated CHF and impaired renal function had lower survival rate compared with patients without impaired renal function.

Effect of heat stress on crossbred dairy cattle in tropical Nepal: Impact on blood parameters

Chitwan district of Nepal has been known as the dairy kingdom of the country considering its strategic location andpotential to easily provision inputs and produce as well as market quality milk across the country. However, theclimate especially during summer has been a challenge to farmers that potentially compromise the daily milk yieldof cows. Therefore, sixteen crossbred dairy cattle were placed in a RCBD fashion to assess the impacts of cold waterbathing in ameliorating effect of heat stress on their performance and body physiology. Routine assessment of themicroclimate within the experimental shed and blood parameters was made. The results from the experimentinferred that frequency of bathing (none, once, twice or thrice a day) did not have any significant impact onHaemoglobin, Haematocrit, Sodium, Potassium, Chloride and Bicarbonate levels in the blood plasma(p&gt;0.05). Inaddition, the animals did not exhibit any signs of physiological distress clinically either. A detailed study scopingtemperature humidity index and over a number of other milk and blood parameters are to be tested across a numberof other available breeds too in order for the researchers to come to a meaningful strategy to beat the heat stress.

Serological, pathological, and scintigraphic assessment of Hemiscorpius lepturus effects on renal dysfunction in rats.

Objective(s): Hemiscorpius lepturus is one of the dangerous scorpions of Iran leading to acute kidney injury (AKI) especially in infants. The purpose of this animal study was to compare the serological, pathological and scintigraphic data to quickly predict the occurrence of this disorder.Materials and Methods: In two groups of animals, each contained five rats, H. lepturus venom (1200 µg/Kg) were injected intravenously via the tail vein. At three hours and one week later, 99m Tc-DMSA (3 mCi) was intravenously injected and renal scintigraphy was performed after an hour. Moreover, plasma levels of creatinine, sodium, potassium, and blood urea nitrogen (BUN) were measured. At the end of the study, renal tissues were excised and prepared to perform pathological evaluation after Hematoxylin and Eosin staining.Results:All serological indices were remained unchanged compared to control. A large number of glomerular fibrin thrombi with entrapped red blood cells and simplified tubular epithelium in dilated and ectatic tubules were observed in high power field (×100) four hours after envenomation, which reduced significantly one week later. In our scintigraphic study, there was a statistically significant difference (P<0.05) in kidney count rate per pixels (CRPP) in both acute and chronic phases compared to the sham group that received normal saline (0.84±0.05 and 1.36±0.07 versus 1.7±0.05).Conclusion:The results of this preliminary animal study suggest renal scintigraphy is a non-invasive method to predict the occurrence of the AKI in H. lepturus envenomation. It leads the way for more investigation to counteract the renal failure induced by this venom.

Storage related haematological and biochemical changes in Plasmodium falciparum infected and sickle cell trait donor blood

BackgroundIn sub-Saharan Africa where sickle cell trait (SCT) and malaria is prevalent, significant proportions of blood donors may be affected by one or more of these abnormalities. The haemato-biochemical properties of SCT and asymptomatic malaria in donor blood have not been evaluated. This study evaluated the haemato-biochemical impact of SCT and asymptomatic malaria infections in citrate-phosphate-dextrose-adenine (CPDA-1) stored donor blood units.MethodsFifty-milliliters of sterile CPDA-1 anti-coagulated blood were drained into the sample pouch attached to the main blood bag. Ten units each of sickle cell/malaria negative, sickle cell and malaria positive blood were analyzed. Baseline and weekly haematological profiling and week 1, 3 and 5 concentrations of plasma haemoglobin, % haemolysis, sodium, potassium and chloride and lactate dehydrogenase (LDH) were assayed. Differences between baseline and weekly data were determined using one-way analysis of variance (ANOVA) and Kruskal-Wallis test, whereas differences between baseline parameters and week 1–3 data pairs were determined using paired t-test. P-value < 0.05 was considered statistically significant.ResultsStorage of SCT and malaria infected blood affected all haematological cell lines. In the SCT donors, red blood cells (RBC) (4.75 × 1012/L ± 1.43baseline to 3.49 × 1012/L ± 1.09week-5), haemoglobin (14.45 g/dl ± 1.63baseline to 11.43 g/dl ± 1.69week-5) and haematocrit (39.96% ± 3.18baseline to 33.22% ± 4.12week-5) were reduced. In the asymptomatic malaria group, reductions were observed in RBC (5.00 × 1012/L ± 0.75baseline to 3.72 × 1012/L ± 0.71week-5), haemoglobin (14.73 g/dl ± 1.67baseline to 11.53 g/dl ± 1.62week-5), haematocrit (42.72% ± 5.16baseline to 33.38% ± 5.80week-5), mean cell haemoglobin concentration (35.48 g/dl ± 1.84baseline to 35.01 g/dl ± 0.64week-5) and red cell distribution width coefficient of variation (14.81% ± 1.54baseline to 16.26% ± 1.37week-5). Biochemically, whereas plasma LDH levels significantly increased in asymptomatic malaria blood donors (319% increase at week 5 compared to baseline), SCT blood donors had the most significant increase in plasma potassium levels at week 5 (382% increase). Sodium ions significantly reduced in SCT/malaria negative and sickle cell trait blood at an average rate of 0.21 mmol/L per day. Moreover, elevations in lymphocytes-to-eosinophils and lymphocytes-to-neutrophils ratios were associated with SCT and malaria positive blood whilst elevation lymphocytes-to-basophils ratio was exclusive to malaria positive blood.ConclusionSevere storage lesions were significant in SCT or malaria positive donor blood units. Proper clinical evaluation must be done in prospective blood donors to ensure deferral of such donors.

Assessment of plasma sodium and potassium levels in sudanese patients with hypothyroidism

Assessment of plasma sodium and potassium levels in sudanese patients with hypothyroidism

Assessment of postoperative renal function after adrenalectomy in patients with primary aldosteronism.

To investigate kidney function change during adrenalectomy in patients with primary aldosteronism and assess predictors of kidney function decline. The present study included 90 patients who underwent adrenalectomy for primary aldosteronism between 2004 and 2017. Kidney function was evaluated 1month after surgery. Predictors associated with a ≥10% decline in the estimated glomerular filtration rate were investigated. Kidney parenchymal volume was compared before and after surgery in 10 patients using volumetric studies. The mean estimated glomerular filtration rate decline in the total cohort at 1month after surgery was 13.3% (before: 72.9mL/min/1.73m2 , after: 64.9mL/min/1.73m2 , P<0.0001). The mean serum plasma aldosterone concentration (before: 373pg/mL vs after: 78pg/mL, P<0.0001) and potassium level (before: 3.7mEq/L vs after: 3.9mEq/L, P=0.0001) were also significantly different after surgery. Age (odds ratio 6.37, P=0.0006), preoperative plasma aldosterone concentration (odds ratio 3.12, P=0.0209) and preoperative serum potassium level (odds ratio 2.87, P=0.0010) were independent predictors of a ≥10% decline in estimated glomerular filtration rate. Volumetric studies in 10 patients showed that mean postoperative parenchymal volume was significantly decreased compared with the preoperative volume (263cc vs 312cc, P=0.0003), with decreases in estimated glomerular filtration rate from 63 to 56mL/min/1.73m2 (P=0.0146). Kidney function deterioration after adrenalectomy can be detected in patients with primary aldosteronism. Age, preoperative plasma aldosterone concentration and preoperative potassium level are significant predictors of a decrease in the estimated glomerular filtration rate. Normal parenchymal volume decreases in line with renal functional deterioration.

Regulation of Aldosterone Secretion.

Secretion of the major mineralocorticoid aldosterone from the adrenal cortex is a tightly-regulated process enabling this hormone to regulate sodium homeostasis and thereby contribute to blood pressure control. The circulating level of aldosterone is the result of various regulatory mechanisms, the most significant being those controlled by the renin-angiotensin system and plasma potassium levels. The importance of maintaining tight control over aldosterone secretion is demonstrated by cases of dysregulation, which can result in severe hypertension and significantly increased cardiovascular risk. In this article we summarize current knowledge of the major regulatory mechanisms, focusing particularly on the systems operating within the adrenocortical zona glomerulosa cells; we also describe some of the other factors that influence aldosterone production to a lesser but still significant extent. Finally, we discuss the influence of common genetic polymorphisms on aldosterone secretion in large sections of the population and also the emerging role of microRNA as significant regulators of this system.

Metabolic syndrome and its components as risk factors for prolonged corrected QT interval in apparently healthy Korean men and women

Metabolic syndrome (MetS) is clinically important because of its association with increased risk of sudden cardiac death, as well as cardiovascular disease-related mortality. Data between MetS and prolonged corrected QT (QTc) intervals, a useful predictor of sudden cardiac death, are limited in apparently healthy adults. This study determined the association between MetS and QTc interval in apparently healthy Korean men and women. We examined the association between MetS and QTc interval in 2157 Korean adults (1317 men and 840 women) in a health examination program but excluded participants with a history of ischemic heart disease, stroke, cardiac arrhythmia, cancer, thyroid, respiratory, renal, hepatobiliary, or rheumatologic disease. The QTc interval was calculated using Bazett's formula (QTc=QT/√RR). Multivariate-adjusted mean QTc values by the number of MetS components were calculated after sex stratification and compared using analysis of covariance test. The overall prevalence of MetS was 30.5% in men and 19.8% in women. The QTc interval positively correlated with age, body mass index, blood pressure, fasting plasma glucose, triglycerides, and potassium level in both men and women and negatively correlated with calcium and potassium levels and smoking status in men. The multivariate-adjusted mean QTc value increased proportionally with increasing number of MetS components (P values<0.001 for both men and women). We confirmed the arrhythmogenic potential of MetS in apparently healthy Korean men and women. These findings suggest that careful monitoring of electrocardiography is necessary to evaluate possible arrhythmic risk in individuals with MetS.

Refeeding syndrome in adults receiving total parenteral nutrition: An audit of practice at a tertiary UK centre

The key to preventing refeeding syndrome (RS) is identifying and appropriately managing patients at risk. We evaluated our clinical management of RS risk in patients starting total parenteral nutrition (TPN). Patients commencing TPN at University College London Hospital between January and July 2015 were prospectively followed-up for 7-days. Eighty patients were risk assessed for RS and categorized into risk groups. High and low risk RS groups were compared focussing on the onset of biochemical features of RS (hypophosphatemia, hypokalaemia and hypomagnesemia) and initial clinical assessment. Statistical analysis was conducted using t-tests and Mann-Whitney U tests. Sixty patients (75%) were identified as high-risk for RS and received lower initial calories (12.8kcal/kg/day, p<0.05). All high-risk patients received a high potency vitamin preparation compared to 35% in the low risk group (p<0.05). Daily phosphate, magnesium and potassium plasma levels were monitored for seven days in 25%, 30% and 53.8% of patients, respectively. Hypophosphatemia developed in 30% and hypomagnesaemia and hypokalaemia in 27.5% of all patients. Approximately 84% of patients had one or more electrolyte abnormalities, which occurred more frequently in high-risk RS patients (p<0.05). Low risk patients developed mild hypophosphatemia at a much lower percentage than high-risk RS (20% vs 33.3%, respectively). A significant proportion of patients commencing TPN developed biochemical features of RS (but no more serious complications) despite nutritional assessment, treatment, and follow up in accordance with national recommendations. High vs low risk RS patients were more likely to have electrolyte abnormalities after receiving TPN regardless of preventative measures. Additional research is required to further optimise the initial nutritional approach to prevent RS in high-risk patients.

WITHDRAWAL OF ANGIOTENSIN ANTAGONISTS IN ELDERLY CHRONIC KIDNEY DISEASE PATIENTS

Objective: Hypertension guidelines worldwide recommend first-line treatment with Angiotensin Convertor Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARBs) in almost all groups of patients. Nevertheless, some population as elderly or CKD patients at high risk to develop renal complications may benefit from avoidance of these commonly used drugs. Design and method: We reviewed our registry of out-hospital patients who had to suspend ACEI or ARBs treatment selecting those without kidney loss, known renal artery stenosis, active neoplasms or drug withdrawal in a condition of Acute Kidney Injury and we performed 12 months follow up. Finally, 36 resulting patients completed the one year period and data of basal, three months and 12-month visits have been compared. A case-control study examining the glomerular filtration rate (GFR), first-day urine albuminuria, blood pressure control and plasmatic potassium has been performed. Results: Baseline characteristics: 17 males and 19 females both with an average age of 78.3 (SD 7.7) years, Charlson's comorbidity index of 6.8 (SD 2), 14 treated previously with ACEI and 22 with ARBs. Comparison of average blood pressure, GFR, proteinuria and potassium levels showed: 1. There were no significant variations in blood pressure at 3 and 12 months. 2. GFR increased at 3 and 12 months from 31.9 (SD 9.4) to 39.6 (SD 14.9) and 43.1 (SD 17.3) ml/min/1.73m2 [p < 0.001] 3. Plasma potassium level decreased at 3 and 12 months from 5.1 (SD 0.6) to 4.7 (SD 0.5) and 4.6 (SD 0.5) mg/dl respectively [p < 0.001] 4. First-day urine albuminuria increased significantly at the 12-month visit in the overall group(from 127.4 (SD 301.8) to 233 (SD 557) mg/g, p < 0.05). Nevertheless, no significant change was observed in the group of 27 patients without significant previous proteinuria (from 13.9 (SD 16.8) to 21.5 (SD 24.8), p = 0.1 NS). Conclusions: Elderly patients with prolonged hypertension are at risk to develop slowly progressive kidney failure associated with the use of ACEI and ARBs, especially if renal atrophy is present. These patients without previous proteinuria would benefit from the first-line use of antihypertensive drugs without suppressive effect over the renin-angiotensin system.

Errors of Classification With Potassium Blood Testing: The Variability and Repeatability of Critical Clinical Tests

ObjectiveTo understand the performance of a currently used clinical blood test with regard to the frequency and size of variation of the results. Patients and MethodsFrom November 29, 2012, through November 29, 2013, patients were recruited at 65 sites as part of a previously reported clinical trial (ClinicalTrials.gov Identifier: NCT01737697). Eligible outpatients who had been fasting for at least 8 hours underwent venous phlebotomy at baseline, 30 minutes, and 60 minutes to measure plasma potassium levels in whole blood using a point-of-care device (i-STAT, Abbott Laboratories). We analyzed the results to assess their variability and frequency of pseudohyperkalemia and pseudonormokalemia. ResultsA total of 1170 patients were included in this study. Absolute differences between pairs of measurements from different time points ranged from 0 to 2.5 mmol/L, with a mean difference of 0.26 mmol/L. The mean percentage differences were approximately 5% with an SD of 5%. Approximately 12% of differences between repeated fasting potassium blood test results were above 0.5 mmol/L (33% of the normal range), and 20% of patients (234) had at least one difference greater than 0.5 mmol/L. In 44.0% of the patients with a hyperkalemic average value (true hyperkalemia) (302 of 686), at least one blood test result was in the normal range (pseudonormokalemia), and in 30.2% of the patients with a normal average value (146 of 484), at least one blood test result was elevated (pseudohyperkalemia). ConclusionExpected variability and errors exist with potassium blood tests, even when conditions are optimized. Pseudohyperkalemia and pseudonormokalemia are common, indicating a need for thoughtful clinical interpretation of unexpected test results.