Changes In Serum Electrolytes Research Articles

Effect of canagliflozin on serum electrolytes in patients with type 2 diabetes in relation to estimated glomerular filtration rate (eGFR)

Objective:Effects of canagliflozin, a sodium glucose co-transporter 2 inhibitor, on serum electrolytes were evaluated using pooled data from studies of patients with type 2 diabetes mellitus (T2DM).Research design and methods:Analyses were performed using two datasets, each including four placebo-controlled studies: Population 1 (N = 2215), patients with baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 (mean = 89.6 mL/min/1.73 m2) and Population 2 (N = 721), patients with baseline eGFR ≥45 and <60 mL/min/1.73 m2 (mean = 53.3 mL/min/1.73 m2).Clinical trial registration:ClinicalTrials.gov identifier: NCT01081834.ClinicalTrials.gov identifier: NCT01106625.ClinicalTrials.gov identifier: NCT01106677.ClinicalTrials.gov identifier: NCT01106690.ClinicalTrials.gov identifier: NCT01032629.ClinicalTrials.gov identifier: NCT01064414.ClinicalTrials.gov identifier: NCT01106651.Main outcome measures:Mean percent changes from baseline in serum electrolytes (potassium, sodium, magnesium, bicarbonate, phosphate, calcium) and outlier analyses were assessed in patients receiving canagliflozin 100 and 300 mg or placebo. Potassium changes were further evaluated based on baseline therapy with anti-hypertensive agents that interfere with potassium excretion (renin-angiotensin aldosterone system-acting agents and/or potassium-sparing diuretics).Results:Mean percent changes from baseline in potassium with canagliflozin 100 and 300 mg and placebo were 0.6%, 1.0%, and 0.5%, respectively (Week 26; Population 1); and 1.7%, 2.8%, and 0.7%, respectively (Week 18/26; Population 2). The proportion of patients who had potassium elevations meeting pre-defined outlier criteria (>5.4 mmol/L [5.4 mEq/L] and >15% increase from baseline) with canagliflozin 100 and 300 mg and placebo was 4.5%, 6.8%, and 4.7% (Population 1); and 5.2%, 9.1%, and 5.5% (Population 2). In both populations, potassium elevations were usually <6.5 mmol/L for patients treated with canagliflozin or placebo; elevations ≥6.5 mmol/L were rare but more frequent in patients taking anti-hypertensive agents that affect potassium excretion in both the canagliflozin and placebo groups. Small mean percent changes in sodium, bicarbonate, and calcium were seen across groups in both populations; small mean percent increases in magnesium and phosphate were seen with canagliflozin vs placebo, but without an increase in patients meeting outlier criteria. Adverse events related to changes in electrolytes were low across groups.Conclusions:In patients with T2DM, canagliflozin was generally associated with small mean percent changes in serum electrolytes. Infrequent episodes of potassium elevation occurred with canagliflozin 300 mg, but occurred more often in patients with reduced eGFR.

Effects of Hydrochlorothiazide on the Pharmacokinetics, Pharmacodynamics, and Tolerability of Canagliflozin, a Sodium Glucose Co-transporter 2 Inhibitor, in Healthy Participants

BackgroundMany patients with type 2 diabetes mellitus (T2DM) also have hypertension, which is commonly treated with thiazide diuretics, including hydrochlorothiazide (HCTZ). Canagliflozin, a sodium glucose cotransporter 2 inhibitor developed for the treatment of T2DM, lowers plasma glucose by inhibiting renal glucose reabsorption, thereby increasing urinary glucose excretion and mild osmotic diuresis. Because patients with T2DM are likely to receive concurrent canagliflozin and HCTZ, potential interactions were evaluated. ObjectiveThis study evaluated the effects of HCTZ on the pharmacokinetic and pharmacodynamic properties and tolerability of canagliflozin in healthy participants. MethodsThis Phase I, single-center, open-label, fixed-sequence, 2-period study was conducted in healthy participants. During period 1, participants received canagliflozin 300 mg once daily for 7 days, followed by a 14-day washout period. During period 2, participants received HCTZ 25 mg once daily for 28 days, followed by canagliflozin 300 mg + HCTZ 25 mg once daily for 7 days. Blood samples were taken before and several times after administration on day 7 of period 1 and on days 28 and 35 of period 2 for canagliflozin and HCTZ pharmacokinetic analyses using LC-MS/MS. Blood and urine samples were collected for up to 24 hours after canagliflozin administration on day 1 of period 1 and day 35 of period 2 for pharmacodynamic glucose assessment. Tolerability was also evaluated. ResultsThirty participants were enrolled (16 men, 14 women; all white; mean age, 43.7 years). Canagliflozin AUC during a dosing interval (T) at steady state (AUCτ,ss) and Cmax at steady state (Cmax,ss) were increased when canagliflozin was coadministered with HCTZ, with geometric mean ratios (90% CI) of 1.12 (1.08–1.17) and 1.15 (1.06–1.25), respectively. AUCτ,ss and Cmax,ss for HCTZ were similar with and without canagliflozin coadministration. The 24-hour mean renal threshold for glucose and mean plasma glucose were comparable for canagliflozin alone and coadministered with HCTZ. The change in 24-hour urine volume from baseline was −0.1 L with canagliflozin alone and 0.4 L with HCTZ alone and with canagliflozin + HCTZ. The overall incidence of adverse events (AEs) was higher with canagliflozin + HCTZ (69%) than with canagliflozin (47%) or HCTZ (50%) alone; most AEs were of mild severity. Overall, minimal changes in serum electrolytes (eg, sodium, potassium) were observed after coadministration of canagliflozin + HCTZ compared with individual treatments. ConclusionsAdding canagliflozin treatment to healthy participants on HCTZ treatment had no notable pharmacokinetic or pharmacodynamic effects; canagliflozin coadministered with HCTZ was generally well tolerated, with no unexpected tolerability concerns. ClinicalTrials.gov identifier: NCT01294631.

Haematological, Biochemical And Serum Electrolyte Changes In Non-Pregnant Boer Does Inoculated With Corynebacterium Pseudotuberculosis Via Various Routes

Caseous lymphadenitis is a chronic disease characterized by internal and external abscesses and is caused by Corynebacterium pseudotuberculosis.Thisstudy is designed to measure the hematological, biochemicaland serum electrolyte changes in experimental non-pregnant doesinoculated with Corynebacterium pseudotuberculosis via variousroutes. Little is known about the changes in these parameters through different routes of infection.A total of 20 healthy does (n=20) were divided into 4 groups (intradermal, intranasal, oral and control) of 5 goats each. The three groups were inoculated with 107cfu/1ml of live Corynebacterium pseudotuberculosis, while control is kept unexposed. Following infection, blood samples were collected from the jugular vein for hematological, biochemical and serum electrolyteanalysis. A significantdecrease was observed in RBC count (p<0.05) in the intradermal group, whilenochangesobserved in PCV, Hb, MCV and MCHC parameters. Significant increasein WBC were observed in intradermal, intranasal and oral groups (p<0.05). Slight increase (p<0.05) in monocyte count was observed in intranasal group. A significant reduction (p<0.05) in lymphocytic count was observed for the intranasally inoculated group (p<0.05) and a slight increase (p<0.05) in neutrophil was observed in intranasal and intradermal groups. Biochemically,creatinine and albumin levels increases inintranasal group(p<0.05) and GGT levels were elevated in all the three infected groups (p<0.05).However,there were no significant changes in AST, T.Protein and APT. Serumelectrolyte, revealed a decrease in Calcium (Ca+) concentration in intradermal group with concentration of 2.22mmol/L,intranasal 2.23mmol/L group (p<0.05), and no changes were observed in potassium (K+) and sodium (Na+). The study, therefore, observed increase in WBCs, neutrophils, monocytes, creatinine, GGT, albumin levels and decrease in RBCs, lymphocytes and calcium concentrations on different route of infections.

Study of serum sodium and potassium in acute myocardial infarction.

Acute myocardial infarction (AMI) is one of the leading causes of morbidity and mortality across the world. Serum electrolytes changes in AMI have not been studied extensively and there is paucity of information in the literature in this regard. Scanty information is available in the literature about prognostic value of serum electrolytes in ischaemic heart disease. Hence this study was undertaken to study any changes in the serum electrolytes with special reference to serum sodium and potassium in cases of AMI and study the correlation of serum sodium and potassium in the severity and outcome of AMI. Hundred people were included in study divided equally in study and control groups. Study group comprised confirmed diagnosis of recent onset of AMI. The blood samples of both the groups were analysed for Serum electrolytes (Na+, K+) by flame-photometry (Bio-Lab Diagnostic kit). There was statistically significant decrease in sodium and potassium levels in across all age groups & in both sexes of study group compared to control group. Significant high level of sodium was observed in AMI patients who are smokers and AMI patients with Diabetes whereas the level was low in AMI patients with hypertension. Potassium levels were low in AMI patients with Diabetes whereas the change was insignificant in association with smoking and hypertension. Decrease in sodium level was due to hypoxia and ischaemia, which increase the permeability of sarcolemma to sodium whereas decrease in potassium level was influenced by the catecholamine levels which are elevated in early acute myocardial infarction.

Serum and urine electrolyte changes following ligation of a left segmental renal artery in dogs

Background and Aim: Ligation of renal artery has been reported to cause acute reduction of nephron population resulting in altered Na + and K + excretion pattern. However, no study has reported electrolyte balance following the ligation of a branch of left renal artery. Methods: Segmental ligation of left renal arterial branch was performed in 18 dogs. Changes in the excretion pattern of Na + and K + and the urine flow rate by the remnant kidney have been observed. Serum and urine samples were collected before and after the ligation at 30-minute intervals for a period of two hours, and Na + and K + concentrations were determined along with the flow rate of urine. Results: A considerable reduction in the urinary excretion rate of Na + and K + was observed in 30 minutes after the ligation. Subsequently, a gradual rise in the rate of excretion of Na + and K + towards pre-ligation values was observed by the end of 120 minutes. Statistically significant increase in K + concentration in urine was observed at the end of two hours ( P = 0.023). The serum analysis for both the electrolytes in all experiments showed no significant changes in concentrations. Conclusion: Findings of the present study suggest that ligation of an artery segment in the kidney though affects acute changes in K + , it does not affect the overall homeostasis of either water or electrolytes. The maintenance of homeostasis might be achieved through the improvement of function by the remnant kidney.

Effect of oestrous cycle on serum electrolytes and liver enzymes in Red Sokoto goats

This study was carried out to determine changes in serum electrolytes and liver enzymes during the oestrous cycle in Red Sokoto goats. Eleven (11) apparently healthy Red Sokoto goats were synchronized with a single injection of 7.5 mg of PGF2α. The goats were bled via jugular venipuncture in oestrus or late oestrus, metoestrus/early dioestrus, mid-dioestrus and late dioestrus/proestrus. Mean serum sodium, potassium and chloride levels non-significantly fluctuated during the oestrous cycle. Calcium levels in oestrus or late oestrus were higher (P < 0.05) than in late diestrus/pro-oestrus. There was a positive correlation between oestradiol and calcium concentrations (r = 0.771; P < 0.05). Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations non-significantly fluctuated during the oestrous cycle. Progesterone and AST concentrations were correlated (r = 0.925; P < 0.05) during the oestrous cycle. In conclusion, some serum electrolytes and liver enzymes fluctuated and correlated with ovarian steroids in different phases of the oestrous cycle. The information generated may be useful as physiologic reference values for reproductive herd health management. Key words: Red Sokoto goats, oestrous cycle, electrolytes, liver enzymes.

Safety, Tolerability, and Efficacy of a Low-volume Picosulfate/Magnesium Citrate Bowel Preparation in Patients ≥65 Years

Purpose: Patients ≥65 years may be more susceptible to adverse reactions with the administration of a bowel preparation before colonoscopy. We assessed the safety and tolerability of sodium picosulfate and magnesium citrate (P/MC; PREPOPIKTM), a nonphosphate, low-volume, dual-action, natural orange-flavored bowel preparation, among patients ≥65 years using data from two previous phase 3, randomized, multicenter, assessor-blinded studies. Methods: The previous two studies investigated the efficacy, safety, and tolerability of Split-dose (SEE CLEAR I) or Day Before (SEE CLEAR II) administration of P/MC compared with conventional day before dosing of 2 L polyethylene glycol-3350 solution and two 5-mg bisacodyl tablets (2L PEG+bis; HALFLYTELY®) among adults preparing for colonoscopy. This post hoc analysis assessed safety (adverse events [AEs] and laboratory values), tolerability (patient-reported questionnaire), and efficacy (Aronchick and Ottawa scores) of P/MC among patients who were <65 years and patients ≥65 years. Results: Across both studies, P/MC was administered to 111 patients aged ≥65 years and 487 patients aged <65 years. The overall incidence of treatment-emergent AEs was similar among P/MC patients who were ≥65 years (73%) and those who were <65 years (71%). The most common AEs for both studies included nausea (1.8% and 3.1%), headache (0.9% and 2.5%), and vomiting (0.9% and 1.0%), and were reported at slightly lower rates among patients ≥65 years than those <65 years, respectively. Changes in mean serum bilirubin and magnesium levels were transient, returned to baseline levels within 24 hours of colonoscopy, and remained within normal ranges throughout the course of both studies, regardless of patient age. There were no marked changes in other serum electrolytes including sodium and potassium. When comparing patients who received P/MC with those who received 2L PEG+bis, more patients ≥65 years who received either Split-dose P/MC (86% vs 31%; P<.0001) or day before PMC (90% vs 38%; P<.0001) rated their bowel preparation as very easy/easy to consume than did patients ≥65 years who received 2L PEG+bis. More than 80% of patients ≥65 years who received either dosing regimen of P/MC rated the taste as excellent/good, compared with only 31% of patients ≥65 years who rated the taste of 2L PEG+bis as excellent/good. Based on Aronchick and Ottawa scores, both dosing regimens of P/MC were equally effective at bowel cleansing in patients ≥65 years and patients <65 years. Conclusion: Split-dose and day before P/MC was safe, tolerable, and efficacious in patients ≥65 years and <65 years who were enrolled in the two SEE CLEAR studies. Disclosure: This study was supported by funding from Ferring Pharmaceuticals Inc, Parsippany, New Jersey. Disclosure - Dr. Grandhi has received grant/research support, participated in speakers' bureaus, and/or acted as a consultant for Takeda. Dr. Katz has received grant/research support, participated in speakers' bureaus, and/or acted as a consultant for Intec Pharma, Ironwood, Novartis Consumer, and Takeda. Dr. Krause has received grant/research support, participated in speakers' bureaus, and/or acted as a consultant for Ferring Pharmaceuticals, Forest Research Institute, and Ironwood. Dr. Joseph is an employee of Ferring Pharmaceuticals, Inc.

Prospective evaluation of irrigation fluid absorption during pure transurethral bipolar plasma vaporisation of the prostate using expired‐breath ethanol measurements

To investigate if absorption of irrigation fluid occurs during bipolar plasma vaporisation (BPV) of the prostate. To examine the clinical predictors of increased risk of fluid absorption and to assess if changes in serum electrolytes, venous pH, haemoglobin or haematocrit are able to detect intra-operative fluid absorption. Over a 15-month period, 55 consecutive patients undergoing BPV of the prostate were investigated. The volume of intra-operative fluid absorption was measured using expired-breath ethanol measurements. Intra-operative irrigation was performed with isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min during the operation and the volume of irrigation fluid absorption was calculated from these concentrations. Data on clinical (age, prostate volume, smoking status) and surgical variables (operation time, irrigation volume, appearance of capsular perforation) as well as intra-operative changes in serum electrolytes, venous pH, haemoglobin and haematocrit were recorded. The median (range) age of the patients was 67 (48-87) years and the median (range) prostate volume was 41 (17-111) mL. Nine patients (16%) showed a positive ethanol breath test during the procedure. The median (range) calculated fluid absorption in these patients was 346 (138-2166) mL. Three patients had a fluid absorption >500 mL. One patient with absorption of >2 L showed clinical symptoms (dyspnoea and agitation) during the operation under spinal anaesthesia. In the group of patients with fluid absorption, capsular perforation or injury to larger vessels was more often detectable. In the group of patients with fluid absorption, only venous pH showed a significant change during the operation (from median 7.41 to median 7.34, P = 0.02). The pH decrease was significantly greater in the fluid absorption group than in the group of patients without fluid absorption (0.09 vs. 0.02, P = 0.005). We have demonstrated that significant intra-operative fluid absorption can occur during BPV of the prostate. Care must be taken if using this procedure in patients with significant cardiovascular comorbidities. Respecting the anatomical borders of the prostate seems to play a relevant role in preventing fluid absorption during the procedure. Venous pH could be used to detect potentially dangerous fluid absorption if intra-operative monitoring with breath ethanol measurements is not available.

2006 IRRIGATION FLUID ABSORPTION DURING 120W HIGH-POWER GREENLIGHT LASER VAPORIZATION OF THE PROSTATE: RESULTS FROM A PROSPECTIVE INVESTIGATION USING EXPIRED BREATH ETHANOL MEASUREMENTS

INTRODUCTION AND OBJECTIVES: Greenlight laser vaporisation (LV) of the prostate has been shown to be a safe procedure even for high-risk patients with lower urinary tract symptoms caused by prostate enlargement. Intra-operative fluid absorption was not detectable during LV using the first generation 80W greenlight laser. For the more powerful 120W greenlight laser, a different spectrum of adverse events, including a higher rate of capsular perforations and more bleeding complications, has been reported. The aim of the present investigation was to assess if fluid absorption occurs during LV using the more powerful 120W laser. METHODS: A total of 50 consecutive patients was investigated during 120W greenlight LV of the prostate. Intra-operative irrigation was performed using isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min throughout the procedure with a conventional alcometer. The volume of fluid absorption was calculated from the results of these measurements. Intraoperative changes of haemoglobin, haematocrit, venous pH and serum electrolytes were also recorded. RESULTS: The median patients’ age was 69 y (range: 49-84) and the median prostate volume 41 mL (23-118). 25 patients (50%) were operated under thrombocyte aggregation inhibition and 8 (16 %) under anti-coagulation therapy. The median operation time was 70 min (30-170), the median irrigation volume 18 L (8-45) and the median applied laser energy 230 kJ (65-400). 22 patients (44 %) had a positive ethanol breath test. The median amount of fluid absorption in these patients was 1249 mL (138-3452). The surgeons reported intra-operative events in form of opened venous sinuses (n 2), capsular perforation (n 3) or a deep bladder neck incision (n 5) In 10 of these patients (45%). In the group of patients with a positive ethanol test, a significant decrease of the haemoglobin, haematocrit and venous pH and a significant increase of the serum chloride were detectable. CONCLUSIONS: Intra-operative fluid absorption was detectable in 44% of the patients undergoing 120W greenlight LV of the prostate. Absorption of isotonic saline does not result in a classical TUR-syndrome. However, care must be taken in cardiovascular highrisk patients because absorption of up to 3.5 liters of saline can result in serious complications in these patients. Intra-operative monitoring with venous pH or serum chloride might help to detect potentially dangerous fluid absorption if ethanol breath ethanol measurements are not performed.

ECG after near-drowning mimicking acute coronary syndrome with left main coronary artery involvement.

We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea. When he was rescued, he complained of dyspnea and chest pain. An electrocardiogram (ECG) suggested acute coronary syndrome (ACS) affecting the left main coronary artery. Therefore, he was referred to our hospital for urgent coronary angiography. Arriving at our hospital, the patient was asymptomatic, but his blood pressure and saturation were normal. The ECG (Figure 1) showed normalization of previous anomalies. Besides, an echocardiogram showed nothing abnormal, and a blood sample was normal and served as a cardiac marker. Angiogram showed normal coronary arteries. After the procedure, the patient remained asymptomatic without an increase of cardiac enzymes, and he was discharged from the hospital after three days. Figure 1 First ECG, with the patient complaining of chest pain and dyspnea, showing ST depression in inferior and left precordial leads and elevation in V1 and VR (A). Second ECG, during the transfer to the hospital, showing minimal changes in ST segment (B). ... The initial response to immersion is apnea and aspiration of water, provoking a syndrome of respiratory failure and changes in serum electrolytes. This is frequently associated with hypothermia, which can lead to cardiac damages, mainly, conduction disturbance and ventricular arrhythmia.[1] A study[2] showed that the appearance of ECG changes in dogs subjected to experimental aspiration of fresh or sea water provoked bradycardia, tall T waves and ventricular fibrillation or ventricular asystole as the cause of death. Another study found[3] ECG changes in 37 patients who suffered from a near-drowning syndrome at the Dead Sea in addition to important changes in electrolyte levels, namely, hypercalcemia and hypermagnesemia. The most common findings were sinus tachycardia, prolongation of PR interval, widening of QRS complex and inversion of T waves. Nearly 35% of the 37 patients presented with ST segment depression. Besides, cases of Tako-Tsubo cardiomyopathy and corresponding ECG changes after near-drowning have also been reported.[4] Our case illustrates the importance of differential diagnosis in cases of near-drowning, since the associated symptoms can easily be mistaken with those of ACS. ECG changes could be confusing, leading to the mismanagement of the patient. In our case, clinical evolution and coronary angiogram of the patient were conducive to the correct diagnosis and treatment of the condition. In conclusion, the ECG findings of patients suffering from near-drowning may be similar to those of the patients affected by ACS with left coronary artery involvement. Hence, the patients should be managed with caution and a differential diagnosis should be made. An accurate medical history and additional examinations such as coronary angiogram are also necessary so as to make a final diagnosis and choose an appropriate treatment.

The Effect of Ramadan Fasting and Physical Activity on Body Composition, Serum Osmolarity Levels and Some Parameters of Electrolytes in Females

BackgroundSo far, there have been a few and incoherent results about the effects of physical activities. Fasting in Ramadan has an effect on the level of osmolarity and the concentration of serum electrolytes both in active and inactive females.ObjectivesThe aim of this study was to observe the changes of serum electrolytes and osmolarity levels according to regular exercise during fasting.Patients and MethodsTwenty two healthy females who were elected by convenience sampling method were divided into two groups: 1) fasting + exercise (FE; n = 11) and 2) fasting + non exercise (FNE; n = 15). The FE group participated in aerobic training for four sessions per week during the fasting. All measurements were done once before the first day, on the second week, on the fourth week and two weeks after fasting month and these measures were used to analyze test results.ResultsThe mean differences were as follows: significant weight loss, BMI, WHR, in two groups at the end of Ramadan (P < 0.05). The mean of weight, BMI, WHR, body fat, protein, mineral and total water showed no difference between groups (P > 0.05). Potassium, creatinine, urea and uric acid had been decreased significantly in both groups (P < 0.05). Variance between groups was significant only in variable urea (P < 0.05). Variations within group had been changed in FBS; sodium, phosphorus and osmolarity levels were not changed significantly.ConclusionsAccording to this result, regular exercise in case of fasting in Ramadan led to some changes in serum osmolarity index, electrolytes and water. Therefore, it is important for female athletes to consider applying a suitable nutritious diet and sufficient water consumption during Ramadan

Skin Metastasis of Cervical Cancer: About an Unusual Case

Congenital Chloride Diarrhoea (CCD) is a form of autosomal recessive disorder which is presented by persistent chloride rich watery diarrhea from birth. Diagnosis of CCD is simple but it needs early prediction and clinical and laboratory evaluation. It can be tentatively made from the typical history of polyhydramnios in antenatal period, prematurity, and watery diarrhea from the beginning and then confirmed by the high fecal concentration of Cl-. Serum electrolyte and pH changes are not reliable diagnostic criteria. Without early intervention most of the children will die in infancy, rest will achieve failure to thrive, and psychomotor developmental delay. .Although congenital chloride diarrhoea has been reported worldwide, but in Bangladesh, we have no reported cases. Here we have discussed two cases of CCD with their diagnostic and management outcome and also discuses about captopril and its effectiveness. Early diagnosis and treatment are essential for normal growth, development, and prevention of other severe complications of congenital chloride diarrhea.

Congenital Chloride Diarrhoea: First Time Diagnosis in Bangladesh and its Management Difficulties

Congenital Chloride Diarrhoea (CCD) is a form of autosomal recessive disorder which is presented by persistent chloride rich watery diarrhea from birth. Diagnosis of CCD is simple but it needs early prediction and clinical and laboratory evaluation. It can be tentatively made from the typical history of polyhydramnios in antenatal period, prematurity, and watery diarrhea from the beginning and then confirmed by the high fecal concentration of Cl-. Serum electrolyte and pH changes are not reliable diagnostic criteria. Without early intervention most of the children will die in infancy, rest will achieve failure to thrive, and psychomotor developmental delay. .Although congenital chloride diarrhoea has been reported worldwide, but in Bangladesh, we have no reported cases. Here we have discussed two cases of CCD with their diagnostic and management outcome and also discuses about captopril and its effectiveness. Early diagnosis and treatment are essential for normal growth, development, and prevention of other severe complications of congenital chloride diarrhea.

Effects of Ashwagandha (Withania somnifera) Root Extract Against Gentamicin Induced Changes of Serum Electrolytes in Rats

Background: Regulation of electrolytes and body fluids are essential for maintaining the body homeostasis. Kidney plays an important role for these regulations. Higher doses of drugs, toxins, infectious agents, chemicals etc. can causes kidney damage and ultimately electrolytes disturbances can be occurred. Ashwagandha (Withania somnifera) is an herbal plant may have some role on serum electrolytes balance.Objective: To observe the effects of ashwagandha (Withania somnifera) root on serum electrolytes against gentamicin induced nephrotoxicity in Wistar albino rats.Methods: This experimental study was carried out in the Department of Physiology, Sir Salimullah Medical College SSMC), Dhaka from 1st July 2010 to 30th June 2011. A total number of 35 Wistar albino rats, age from 90 to 120 days, weighing between 150 to 200 grams were selected for the study. After acclimatization for 14 days, they were divided into control group and experimental group. Control group was again subdivided into baseline control, (10 rats) and gentamicin treated control group, (10 rats). Again, experimental group (gentamicin treated group after ashwagandha treatment) consisted of 15 rats. All groups of animals received basal diet for 22 consecutive days. In addition to this, gentamicin treated control group also received gentamicin subcutaneously (100mg /kg body weight/day) for the last eight (15th to 22nd day) consecutive days. Again, gentamicin treated group after ashwagandha treatment received ashwagandha root extract (500mg/kg body weight/day, orally) for 22 consecutive days and gentamicin subcutaneously (100mg/kg body weight /day) for last eight (15th to 22nd day) days. All the animals were sacrificed on 23rd day. Then blood samples were collected and kidney weight was measured. For assessment of kidney function, some serum electrolyte levels e,g. serum sodium, potassium and chloride ion levels were estimated by ion selective electrode (ISE) electrolyte auto analyzer method, by using Biolyte 2000 auto analyzer. However, body weight and kidney weight of the animals were measured to assess the nephrotoxicity in these groups of animals. All these tests were done in the laboratory of Department of Physiology and Biochemistry, SSMC. Statistical analysis was done by one way ANOVA and Bonferroni tests as applicable.Results: The serum sodium and chloride ion levels were almost similar in all the groups and the differences were not statistically significant. The mean serum levels of potassium ion were significantly (p&lt;0.001) lower in gentamicin treated group and (p&lt;0.05) in gentamicin treated group after ashwagandha treatment in comparison to that of baseline control group. But this level of gentamicin treated group after ashwagandha treatment was significantly (p&lt;0.01) higher than that of gentamicin treated group. Initial body weight was almost similar and no significant difference of this value was observed among the groups. Whereas, the final body weight was significantly (p&lt;0.001) lower in gentamicin treated control group and in gentamicin treated group after ashwagandha treatment than that of baseline control group. Again this level of gentamicin treated group after ashwagandha treatment was significantly (p&lt;0.05) higher in comparison to that of gentamicin treated control group. The kidney weight was significantly (p&lt;0.01) higher in gentamicin treated control group when compared to that of baseline control and gentamicin treated group after ashwagandha treatment. Whereas, kidney weight of gentamicin treated group after ashwagandha treatment and of baseline control group was almost similar and showed no statistically significant difference of this value between this two groups.Conclusion: Ashwagandha (Withania somnifera) root extract may have some role in maintaining some of the serum electrolyte levels within normal limit, which indicates its nephroprotective effects against gentamicin induced toxicity. DOI: http://dx.doi.org/10.3329/jbsp.v7i1.11157 J Bangladesh Soc Physiol. 2012, June; 7(1): 29-35

Serum Electrolytes Changes in Healthy Dogs Submitted to Dobutamine Stress Test

Serum Electrolytes Changes in Healthy Dogs Submitted to Dobutamine Stress Test

Science behind cisplatin-induced nephrotoxicity in humans: A clinical study

ObjectiveTo investigate the relationship between serum electrolyte changes and cisplatin induced nephrotoxicity. MethodsWe collected data from 18 patients undergoing cisplatin chemotherapy including serum electrolytes, creatinine, blood urea nitrogen (BUN) and urine potassium, sodium and pH levels before and after the cisplatin chemotherapy. All the patients had cancer and were treated with 40–50 mg/day cisplatin. Renal injury was assessed by measuring serum electrolytes, creatinine, BUN levels and urine potassium, sodium and pH levels. ResultsThe five cycles of cisplatin based chemotherapy resulted in hypomagnesia (P=0.029), hypocalcaemia (P=0.001*), hypophosphatemia (P=0.003*), hypokalemia (P=0.001*) and increased serum creatinine (P=0.001*) and BUN (P=0.292*) levels. In urine analysis, decrease in potassium (P=0.024*) was found, except potassium there was no significant changes in sodium and urine pH. ConclusionsThe present study demonstrates that, acute nephrotoxicity was observed in patients with different types of cancers undergoing cisplatin based chemotherapy due to electrolyte disturbances, when no corrective measures were initiated.

Changes in Serum Electrolytes, Urea, and Creatinine in Aloe Vera-treated Rats

This study was carried out to investigate the effect of Aloe vera extract (AvE) on serum electrolytes, urea, and creatinine as indices of renal function in Sprague-Dawley rats. Twelve male Sprague-Dawley rats weighing between 80 and 130 g were used. Rats were divided into two groups: The control and the test groups (n=6). The test group received 1 ml of AvE daily for 28 days. Both the groups fed on standard rat chow and water ad libitum. The results showed a decrease in serum levels of sodium, and potassium, but an increase in the serum levels of bicarbonate, urea, and creatinine in the test group. The changes seen were, however, statistically insignificant, except for the serum levels of sodium and creatinine (P<0.05). It is thus concluded that AvE impairs renal handling of electrolytes with consequent hyponatremia and hypercreatinemia. However, this might be of therapeutic value in conditions associated with hypernatremia.

2021 PROSPECTIVE EVALUATION OF IRRIGANT ABSORPTION DURING PURE TRANSURETHRAL BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE BY EXPIRED BREATH ETHANOL MEASUREMENTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology II1 Apr 20122021 PROSPECTIVE EVALUATION OF IRRIGANT ABSORPTION DURING PURE TRANSURETHRAL BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE BY EXPIRED BREATH ETHANOL MEASUREMENTS Christian Daniel Fankhauser, Lukas John Hefermehl, Benedikt Kranzbühler, Oliver Gross, Marian Severin Wettstein, Nico Grossmann, Janine Corinne Capol, Matthias Zimmermann, Tullio Sulser, Alexander Müller, and Thomas Hermanns Christian Daniel FankhauserChristian Daniel Fankhauser Zürich, Switzerland More articles by this author , Lukas John HefermehlLukas John Hefermehl Zürich, Switzerland More articles by this author , Benedikt KranzbühlerBenedikt Kranzbühler Zürich, Switzerland More articles by this author , Oliver GrossOliver Gross Zürich, Switzerland More articles by this author , Marian Severin WettsteinMarian Severin Wettstein Zürich, Switzerland More articles by this author , Nico GrossmannNico Grossmann Zürich, Switzerland More articles by this author , Janine Corinne CapolJanine Corinne Capol Zürich, Switzerland More articles by this author , Matthias ZimmermannMatthias Zimmermann Zürich, Switzerland More articles by this author , Tullio SulserTullio Sulser Zürich, Switzerland More articles by this author , Alexander MüllerAlexander Müller Zürich, Switzerland More articles by this author , and Thomas HermannsThomas Hermanns Zürich, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2184AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral bipolar plasma vaporisation (BPV) has been introduced as a minimal invasive alternative for conventional transurethral resection of the prostate (TURP). Especially high-risk patients may profit from irrigation with isotonic saline and from the excellent haemostatic properties of the so-called “mushroom electrode”. Those characteristics allow for a nearly bloodless operation and prevent the development of a TUR syndrome. However, it is unknown if irrigant absorption per se is prevented during BPV. METHODS A total of 55 consecutive patients were prospectively investigated between 07/2010 and 09/2011 during routine pure BPV using the TURIS HF system (Olympus GmbH, D). Intraoperative irrigation was performed with isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min during the operation using an AlcoQuant 602 alcometer (r-Technik GmbH, D). The volume of irrigant absorbtion was then calculated from these concentrations using an established nomogram. Additionally, intraoperative changes in serum electrolyte and heamoglobin concentrations were recorded. RESULTS The median patients' age was 67 y (48-88 y) and median prostate volume was 41.4 ml (21-89 ml). The median operation time was 70 min (30-140 min) and median irrigation volume 21 l (3-39 l). A total of 9 patients (16.4%) showed a positive ethanol breath test during BPV. The median calculated fluid absorption in those patients was 230 ml (range: 50-2000 ml). Significant changes in electrolyte or haemoglobin concentrations were not detectable. Only one patient with an irrigant absorption of 2 l showed clinical symptoms in form of mild dyspnoea and agitation. The surgeons reported capsular perforation, opening of large prostatic sinuses or a deep bladder neck incision in all patients with detectable fluid absorption. CONCLUSIONS Significant fluid absorption occurs during BPV of the prostate despite the excellent haemostatic properties of the “mushroom electrode”. Isotonic saline irrigation prevents the development of a dreaded TUR-syndrome with serious serum electrolyte changes. However, absorption of large isotonic volumes can also be dangerous especially for patients with e.g. cardiac insufficiency. It is important to know that fluid absorption cannot be monitored by intraoperative electrolyte measurements. Respecting the anatomical boundaries of the prostate seems to play a major role in preventing fluid absorption during BPV. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e815-e816 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Daniel Fankhauser Zürich, Switzerland More articles by this author Lukas John Hefermehl Zürich, Switzerland More articles by this author Benedikt Kranzbühler Zürich, Switzerland More articles by this author Oliver Gross Zürich, Switzerland More articles by this author Marian Severin Wettstein Zürich, Switzerland More articles by this author Nico Grossmann Zürich, Switzerland More articles by this author Janine Corinne Capol Zürich, Switzerland More articles by this author Matthias Zimmermann Zürich, Switzerland More articles by this author Tullio Sulser Zürich, Switzerland More articles by this author Alexander Müller Zürich, Switzerland More articles by this author Thomas Hermanns Zürich, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ringer’s lactate vs normal saline for children with acute diarrhea and severe dehydration: A double blind randomized controlled trial

WHO recommends Ringers lactate (RL) and Normal Saline (NS) for rapid intravenous rehydration in childhood diarrhea and severe dehydration. We compared these two fluids for improvement in pH over baseline during rapid intravenous rehydration in children with acute diarrhea. Double-blind randomized controlled trial Pediatric emergency facilities at a tertiary-care referral hospital. Children with acute diarrhea and severe dehydration received either RL (RL-group) or NS (NS-group), 100 mL/kg over three or six hours. Children were reassessed after three or six hours. Rapid rehydration was repeated if severe dehydration persisted. Blood gas was done at baseline and repeated after signs of severe dehydration disappeared. Primary outcome was change in pH from baseline. Secondary outcomes included changes in serum electrolytes, bicarbonate levels, and base-deficit from baseline; mortality, duration of hospital stay, and fluids requirement. Twenty two children, 11 each were randomized to the two study groups. At primary end point (disappearance of signs of severe dehydration), the improvement in pH from baseline was not significant in RL-group [from 7.17 (0.11) to 7.28 (0.09)] as compared to NS-group [7.09 (0.11) to 7.21 (0.09)], P=0.17 (after adjusting for baseline serum Na/ Cl). Among this limited sample size, children in RL group required less fluids [median 310 vs 530 mL/kg, P=0.01] and had shorter median hospital stay [38 vs 51 hours, P=0.03]. There was no difference in improvement in pH over baseline between RL and NS among children with acute diarrhea and severe dehydration.

A43 The Effect of Plasmalyte-148 compared to 0.9% Saline on Serum Sodium and Chloride Concentrations in Patients with Severe Head Injury

Background and Goal: In neurocritical care intravenous fluid solutions with a higher sodium content are preferred as the consequences of hyponatraemia in head-injured patients can be devastating. Following the introduction of a balanced crystalloid solution (Plasmalyte – 148) to our unit, we undertook a retrospective survey to assess the effect on our patient's biochemical parameters, compared to 0.9% saline (155 mmol l−1 sodium chloride) infusions. Materials and Methods: Five patients with severe head injury who received Plasmalyte-148 maintenance infusions were identified, and their venous biochemistry reviewed. Five similar patients who had received 0.9% saline were compared as a control group. Repeated-measures ANOVA was used to test for statistically significant differences in serial concentrations of sodium (Na) & chloride (Cl). Results: All 10 patients were male. The mean age in the Plasmalyte-148 group was 38 (26–47) years, and mean length of stay was 5 (3–8) days. The mean age in the 0.9% saline group was 48 (23–81) years, and mean length of stay 4 (3–5) days. The changes in serum electrolytes are shown in Fig. 1.Discussion: Both serum sodium & chloride concentrations increased significantly in the 0.9% saline group, but not the Plamalyte-148 group; the clinical relevance of this is however questionable. Reassuringly, serum Na-Cl did not decrease in the Plasmalyte-148 group, suggesting that serum osmolality is at least maintained. Our small survey does not show that serum sodium or chloride concentrations are drastically altered over the 3 days studied.