Significant Electrolyte Changes Research Articles

P83 EFFICACY AND SAFETY OF LEVOSIMENDAN IN AN ISCHEMIC CARDIOGENIC SHOCK POPULATION: A 10–YEARS SINGLE CENTRE RETROSPECTIVE STUDY

Abstract Background Levosimendan is a Ca2+–sensitizer with inodilator action able to improve cardiac contractility without increse oxygen demand. In AHF setting clinical trial and registries showed an improvement in systemic haemodynamics without a decrease in in–hospital mortality. Purpose: evaluate safety and efficacy of Levosimendan in an ischemic CS population. Methods All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single–centre retrospective study. 39 patients received Levosimendan alone or in combination with other inotropic drugs. All patients had an invasive monitoring of arterial pressure and continuous ECG–monitoring. Patients with severe renal failure were excluded. An echocardiogram was performed before drug infusion and 3 days after. We collected data from haemodynamics and from ECG monitoring looking for arrhythmic events. Results We enrolled 167 patients with CS after AMI, 39 patients received Levosimendan and 10 of them required association with low–dosage noradrenaline. 32 received Levosimendan at dosage of 0,1 mcg/kg/min. The drug was started on average 4 days after hospitalization. Statistical analysis showed a significant change in left ventricular EF assessed by echocardiogram from 25% to 31% (P = 0.018, fig 1). We observed also an improvement of symptoms with an overall relief of dyspnea and fatigue clinically evaluated. The ECG monitoring showed ventricular arrhythmias (VA) in 11 patients (NSVT, SVT, VF) but the most frequent arrhythmia after Levosimendan was atrial fibrillation (AF) which was significantly associated with in–hospital mortality (OR = 1,82, p = 0,002), whereas VA did not. Moreover patients with new onset AF after Levosimendan showed a lower clinical and instrumental response to the drug. No significant changes in electrolytes (sodium and potassium) have been documented during arrhythmic events. Conclusion Levosimendan is useful in CS after AMI setting because has demonstrated to improve systemic hemodynamics parameters and symptomatology. Overall Levosimendan is safe with a low rate of ventricular arrhythmias that, in our sample, are not associated with in–hospital mortality. Moreover we observed also a significant increase in AF that was associated with in–hospital mortality, but further studies in larger populations could be advisable to describe the real incidence of AF after Levosimendan infusion and its prognostic role in CS patients.

Analysis of pH and electrolytes in blood and ruminal fluid, including kidney function tests, in sheep undergoing long-term surgical procedures

BackgroundThe physiology of sheep as small ruminants is remarkably different from monogastric animals especially regarding the forestomach system. Using sheep for surgical procedures during scientific research thereby presents an exceptional setting for the anaesthetist. Long-term anaesthesia generally demands deprivation of food to reduce the risk of bloat in sheep. This might influence the energy and electrolyte balance. In horses and companion animals, close monitoring of mean arterial blood pressure, capnography and blood gas analysis are common procedures during long-term surgery. However, few data are available on reference ranges for blood gas in sheep and these cover only short periods of anaesthesia. To the authors’ knowledge, there is no study available that includes the monitoring of electrolytes and pH in ruminal fluid and kidney function tests in sheep undergoing long term anaesthesia. Thereby, the aim of the present study was to gather data on blood parameters, and data on ruminal fluid and kidney function during long-term anaesthesia in sheep. Data were obtained from eight sheep undergoing the invasive surgical procedure of left pneumonectomy and auto-transplantation or isolated left lung perfusion. After a 19-h fasting period, the animals were administered xylazine and ketamine and then intubated and maintained in general anaesthesia under artificial ventilation using isoflurane in oxygen. Blood samples were evaluated during 9 h of anaesthesia; ruminal fluid and kidney function tests were evaluated during 7 h of anaesthesia.ResultsBlood parameters such as electrolytes and partial pressure of carbon dioxide revealed few changes, yet blood glucose decreased and beta-hydroxybutyric acid increased significantly. All animals showed an elevated arterial pH and bicarbonate concentration despite artificial ventilation. In ruminal fluid, the pH significantly decreased and no significant changes in electrolytes occurred. Kidney function tests revealed no significant changes in any of the animals. However, fractional excretion of water and phosphate was slightly increased. One animal showed severe complications due to hypokalaemia.ConclusionInvasive surgery under long-term anaesthesia in sheep is possible without great imbalances of arterial pH and electrolytes. Nevertheless, potassium concentrations should be monitored carefully, as a deficiency can lead to life-threatening complications. The operated sheep tended not to develop metabolic acidosis and the mean kidney function could be maintained within the physiological range throughout anaesthesia. However, slight elevations in renal fractional water and phosphate excretion could suggest an early tubular reabsorption dysfunction. In ruminal fluid, acidification occurred, though no significant changes were observed in l- and d-lactate levels or in electrolyte concentrations. To our knowledge, the role of the rumen in storing fluids and balancing electrolytes in the blood has not yet been documented during anaesthesia. However, the importance of the rumen for fluid equilibrium in sheep indicates the necessity for routine monitoring and further research.

FC 094THREE VERSUS TWICE-WEEKLY HEMODIALYSIS SESSIONS: A COMMUNITY EXPERIENCE

Abstract Background and Aims We investigated the feasibilty of converting stable end stage renal disease (ESRD) patients from three to twice weekly hemodialysis (HD) sessions based on published criteria. Method ESRD patients on three times weekly (3xwkly) HD sessions for at least 3 months duration were screened for eligibility for conversion to twice weekly (2xwkly) maintenace HD schedule in a university-affiliated community dialysis program. Eligibility criteria were: residual renal function > 3ml/min; urine output >500mL/day; intradialytic weight gain <2.5kg; hemoglobin >8gm/dL; manageable phosphorus and potasium levels. Clinical parameters on 3xwkly vs. 2xwkly HD sessions were then performed in the eligible patients. Results 7/71 (9.8%) of the patients met criteria for conversion to 2xwkly HD sessions. Baseline patient characteristics are shown in Table 1. Major indication for HD initiation was symptomatic progression of disease. Less than 50% of patients had a functioning arteriovenous fistula at initiation of HD. In the current cohort, residual renal function > 3mL/min was maintainedfor >200 days after initiation of HD. There were no significant changes in electrolytes, hemoglobin, nutrition staus or adequacy of dialysis. PTH levels were not significantly different: 3xwkly, 625.7 + 546.2pg/mL vs. 2xwkly, 399 + 344.2pg/mL; p=0.374). Karnofsky Performance Status Scale improved post conversion but did not achieve statistical significance (3xwkly, 57.1 vs. 2xwkly, 70; p=0.316). There were no hospital admissions since conversion to 2xwkly schedule during the study period. Conclusion In a community-based dialysis program, 10% of total HD patients qualified for conversion from 3xwkly to 2xwkly maintenance HD without significant changes to their laboratory or clinical performance measures. These observations stimulate discussion regarding increased application of incremental dialysis initiation strategies to preserve residual renal function, increase dialysis-free days and alleviate transportation and care provider-related burden to patients and families.

S0545 Impact of Colonoscopy Bowel Preparation and Intra-Procedural Volume of Colonic Irrigation (VOCI) on Serum Electrolytes

INTRODUCTION: A safe and effective bowel preparation (BP) is key to the performance of high-quality colonoscopy. Colonic irrigation is often used to clear stool and improve mucosal visualization. Procedures involving high volume water irrigation in other organs (e.g. TURP syndrome) have been associated with complications due to fluid shifts and electrolyte imbalance (nausea, emesis, hypotension, altered consciousness, mortality rate 0.2-0.8%). The effect of BP and volume of colonic irrigation (VOCI) on serum electrolytes requires further investigation. METHODS: An institutionally approved quality improvement prospective cohort study was undertaken at a large VA Medical Center. Veterans scheduled for outpatient colonoscopy between 03/2019 and 03/2020 were included. Data collected included demographics, baseline electrolyte levels (within prior 6 months), BP type, volume of clear liquid diet consumed (CLD) prior to colonoscopy, procedure details including VOCI, and complications. Serum chemistry panels were obtained from the intravenous catheter placed for sedation. After 8 weeks, data for 110 patients (pilot cohort) were analyzed. To confirm findings of significant electrolyte changes, observed rates of change and missing data were used to determine a validation cohort (n = 89). A +/-10% change in serum electrolyte level AND outside the normal range was considered significant. RESULTS: There was little variation among demographics and colonoscopy characteristic between the two cohorts (Table 1). Significantly more veterans had serum electrolyte abnormalities pre-colonoscopy compared to baseline in both cohorts (56.4% vs. 32.1% in pilot cohort, P < 0.001 and 53.9% vs. 28.9% in validation cohort, P < 0.001,Figure 1), with hypokalemia being the most common (12-16%). Rates of significant electrolyte changes (> 10%) were similar between cohorts with hypokalemia and hypocalcemia being the most common. Changes in Cr, Ca, and Phos were more pronounced in the validation cohort (Table 2). CONCLUSION: Significant pre-procedure serum electrolyte changes occurred following BP, especially hypokalemia. Post-procedure hypokalemia and, the increased incidences of post-colonoscopy hypocalcemia and hypophosphatemia in the validation cohort (cohort with higher average VOCI) suggest that VOCI is associated with electrolyte shifts. Further studies are required to assess the clinical impact of these electrolyte shifts and measures to avoid them.Figure 1.: Number of Unique Patients with Abnormal Labs at Given Times.Table 1Table 2

Prospective Multicenter Experience With Cooled Radiofrequency Ablation Using High Impedance Irrigant to Target Deep Myocardial Substrate Refractory to Standard Ablation.

This study sought to evaluate the efficacy and safety of using half-normal saline (HNS) as the cooling radiofrequency ablation (RFA) irrigant among patients who had failed prior, standard RFA. Effective control of ventricular arrhythmias that arise from mid-myocardium may be refractory to standard RFA. Recent data suggest that delivering fluid with decreased ionic concentration during open-irrigated RFA can produce deeper RFA lesions. A 12-center prospective analysis was performed of all ablations using HNS for the treatment of ventricular arrhythmias (premature ventricular complex [PVC]/ventricular tachycardia [VT]) refractory to standard ablation with normal saline irrigant. HNS RFA was used clinically to target 94 PVC/VTs refractory to standard ablation. Acute success was achieved in 78 of 94 (83%), with longer-term success occurring in 78 subjects after a mean follow-up of 6.1 ± 6.7 months (range, 3.0 to 25.2 months). Steam pops were observed among 12 (12.6%) patients. There were no significant changes in electrolytes measured before and after the use of HNS, and there were no complications related to HNS use. The use of HNS instead of normal saline irrigant during high-power delivery targeting deep myocardial substrate is safe and effective. PVC/VT sources previously unaffected by standard ablation may be successfully ablatedwith improved efficiency of radiofrequency delivery using HNS.

Furosemide stimulation of parathormone in humans: role of the calcium-sensing receptor and the renin-angiotensin system.

Interactions between sodium and calcium regulating systems are poorly characterized but clinically important. Parathyroid hormone (PTH) levels are increased shortly after furosemide treatment by an unknown mechanism, and this effect is blunted by the previous administration of a calcimimetic in animal studies. Here, we explored further the possible underlying mechanisms of this observation in a randomized crossover placebo-controlled study performed in 18 human males. Volunteers took either cinacalcet (60 mg) or placebo and received a 20 mg furosemide injection 3 h later. Plasma samples were collected at 15-min intervals and analyzed for intact PTH, calcium, sodium, potassium, magnesium, phosphate, plasma renin activity (PRA), and aldosterone up to 6 h after furosemide injection. Urinary electrolyte excretion was also monitored. Subjects under placebo presented a sharp increase in PTH levels after furosemide injection. In the presence of cinacalcet, PTH levels were suppressed and marginal increase of PTH was observed. No significant changes in electrolytes and urinary excretion were identified that could explain the furosemide-induced increase in PTH levels. PRA and aldosterone were stimulated by furosemide injection but were not affected by previous cinacalcet ingestion. Expression of NKCC1, but not NKCC2, was found in parathyroid tissue. In conclusion, our results indicate that furosemide acutely stimulates PTH secretion in the absence of any detectable electrolyte changes in healthy adults. A possible direct effect of furosemide on parathyroid gland needs further studies.

Effects of a plasma heating procedure for inactivating Ebola virus on common chemical pathology tests.

The recent declaration of Ebola virus disease as epidemic by the World Health Organization indicates urgency for affected countries and their laboratories to evaluate and provide treatment to patients potentially infected by the Ebola virus. A heat inactivation procedure involving treating specimens at 60°C for 60 minutes has been suggested for inactivation of the Ebola virus. This study aimed at evaluating the effect of plasma heating on common biochemical tests. Comparative experimental study. A regional chemical pathology laboratory in Hong Kong. Forty consecutive plasma specimens for general chemistry analytes on Beckman Coulter AU5822 and another 40 plasma specimens for troponin I analysis on Access 2 Immunoassay System were obtained, anonymised, and divided into two aliquots. One aliquot was analysed directly and the other was analysed after heating at 60°C for 60 minutes. A total of 20 chemical pathology tests were evaluated. Nine tests (sodium, potassium, chloride, urea, creatinine, total calcium, phosphate, total protein, and glucose) were not significantly affected by the heat inactivation procedure and remained clinically interpretable. Results for magnesium (15% mean increase), albumin (41% mean increase), bilirubin (8% mean decrease), amylase (27% mean decrease), and troponin I (76% mean decrease) were still interpretable using regression estimation with proportional bias. However, all enzymes studied except amylase (alanine transaminase, aspartate transaminase, alkaline phosphatase, gamma-glutamyltransferase, creatine kinase, and lactate dehydrogenase) were inactivated to a significant degree. Their Pearson r or Spearman rho values ranged from no significant correlation (P≥0.05) to 0.767, and most normality was rejected. Heat inactivation results in no significant change in electrolytes, glucose, and renal function tests, but causes a significant bias for many analytes. Recognition of the relationship between pre- and post-heat inactivation specimens allows clinical interpretation of affected values and contributes to patient care. For safety and diagnostic accuracy, we recommend use of a point-of-care device for blood gases, electrolytes, troponin, and liver and renal function tests within a class 2 or above biosafety cabinet with level 3 or above biosafety laboratory practice.

Selected clinical, biochemical, and electrolyte alterations in anesthetized captive tigers (Panthera tigris) and lions (Panthera leo).

A prospective study to assess changes in selected plasma biochemistry and electrolyte values, plasma insulin and aldosterone concentrations, and electrocardiography (ECG) was performed on eight female captive tigers (Panthera tigris) and three lions (Panthera leo) undergoing general anesthesia for elective laparoscopic ovariectomy. Each animal was sedated with medetomidine (18-25 microg/kg) and midazolam (0.06-0.1 mg/kg) intramuscularly, and anesthesia was induced with ketamine (1.9-3.5 mg/kg) intramuscularly and maintained with isoflurane. Venous blood samples were collected and analyzed for plasma biochemistry parameters and insulin and aldosterone concentrations. An ECG was recorded at the time of each blood sample collection. Mean plasma potassium, glucose, phosphorus, and aldosterone concentrations increased during anesthesia (P < or = 0.05). One tiger developed hyperkalemia (6.5 mmol/L) 2.5 hr after anesthetic induction. Plasma insulin concentrations were initially below the low end of the domestic cat reference interval (72-583 pmol/L), but mean insulin concentration increased (P < or = 0.05) over time compared with the baseline values. Three tigers and two lions had ECG changes that were representative of myocardial hypoxemia. Based on these results, continuous monitoring of clinical and biochemical alterations during general anesthesia in large nondomestic felids is warranted, and consideration should be given to reversal of medetomidine in these animals should significant changes in electrolytes or ECG occur.

Hemodynamic Effects of 6% Hydroxyethyl Starch Infusion in Sevoflurane-Anesthetized Thoroughbred Horses

To determine hemodynamic effects of hydroxyethyl starch (HES) infusion during anesthesia in horses, incremental doses of 6% HES were administered to 6 healthy Thoroughbred horses. Anesthesia was induced with xylazine, guaifenesin and thiopental and maintained with sevoflurane at 2.8% of end-tidal concentration in all horses. The horses were positioned in right lateral recumbency and administered 3 intravenous dose of 6% HES (5 ml/kg) over 15 min with 15-min intervals in addition to constant infusion of lactated Ringer's solution at 10 ml/kg/hr. Hemodynamic parameters were measured before and every 15 min until 90 min after the administration of 6% HES. There was no significant change in heart rate and arterial blood pressures throughout the experiment. The HES administration produced significant increases in mean right atrial pressure, stroke volume, cardiac output (CO) and decrease in systemic vascular resistance (SVR) in a dose-dependent manner. There was no significant change in electrolytes (Na(+), K(+), Cl(-)) throughout the experiment, however, packed cell volume, hemoglobin concentration, and total protein and albumin concentrations decreased in a dose-dependent manner following the HES administration. In conclusion, the HES administration provides a dose-dependent increase in CO, but has no impact upon arterial blood pressures due to a simultaneous decrease in SVR.

Split-Dosed MiraLAX/Gatorade Is an Effective, Safe, and Tolerable Option for Bowel Preparation in Low-Risk Patients: A Randomized Controlled Study

MiraLAX with Gatorade is a low-volume bowel preparation regimen that has been used widely in community practice and is anecdotally better tolerated than Golytely. Despite its widespread use, there are little data on the efficacy and tolerability of this solution and no safety data in the literature. The primary aim of this study was to compare the efficacy, safety, and tolerability of single-dosed and split-dosed regimens of MiraLAX/Gatorade with Golytely for bowel preparation before colonoscopy. Adults presenting for outpatient colonoscopy were screened for enrollment into this single-blinded randomized controlled trial. Patients with severe cardiac or renal disease and patients with electrolyte abnormalities were excluded. Subjects were randomized into four groups: 4 l Golytely single-dosed (Go-Si), 4 l Golytely split-dosed (Go-Sp), 238 g MiraLAX in 64 oz of Gatorade single-dosed (Mlax-Si), and MiraLAX/Gatorade split-dosed (Mlax-Sp) groups. Laboratory data including complete blood count, comprehensive metabolic panel, and osmolality were collected before the day of bowel preparation and just before the start of colonoscopy. Subjects completed a survey assessing taste and tolerability of the solution. Colonoscopies were recorded using video recording software and de-identified. Colonoscopy videos were evaluated for efficacy of cleansing by two blinded endoscopists. Two validated bowel preparation scales were used to assess bowel cleansing: the Boston Bowel Preparation Scale (BBPS; 0-9 best) and Ottawa Scale (0-14 worst). A total of 222 patients were evaluated in this study (86.2% male, mean age 59.4). Of these, 57 subjects were randomized to the Go-Si group, 51 to Go-Sp group, 60 to Mlax-Si group, and 54 to Mlax-Sp group. There was no significant difference in age, gender, or timing of colonoscopy between the groups (P>0.05). Mean BBPS scores were: Go-Si=6.07, Go-Sp=8.33, Mlax-Si=6.62, and Mlax-Sp=8.01. Mean Ottawa score for the groups were: Go-Si group=6.77, Go-Sp=4.12, Mlax-Si=6.25, and Mlax-Sp=4.8. Go-Sp resulted in significantly better cleansing than Go-Si (P<0.01). Mlax-Sp resulted in significantly better cleansing than Mlax-Si (P<0.01). There was no significant difference in BBPS between Go-Sp and Mlax-Sp. There were no clinically significant electrolyte changes from baseline in any subject in any group after bowel prep (P>0.05). Subjects rated the taste and overall experience of Mlax/Gatorade preparation better than Golytely (P<0.01). In all, 96.8% of Mlax/Gatorade subjects were willing to repeat the same preparation vs. 75% for Golytely subjects (P<0.01). Split-dosed MiraLAX/Gatorade was an effective, safe, and tolerable option for bowel preparation before colonoscopy in the low-risk patients in this study. MiraLAX/Gatorade appears to be more tolerable than Golytely as a bowel cleansing regimen and was the preferred agent by the patients in this study.

Abstract 4843: Furosemide-induced Diuresis With Matched Replacement of Intravascular Volume Compared to Standard Hydration for Contrast-induced Nephropathy Prevention: The Mythos Trial

Hypothesis. We investigated the effect of a new preventive strategy strategy for contrast-induced nephropathy (CIN) based on a dedicated device (RenalGuard; PLC Medical System Inc., USA). The system is capable of delivering i.v. saline solution to a patient in an amount matched to the volume of urine produced after an i.v. bolus of furosemide. The aim of the study was to evaluate if furosemide-induced high-volume diuresis with concurrent maintenance of intravascular volume may prevent CIN. Methods . To date, 63 chronic kidney disease (CKD) patients (eGFR&lt;60 ml/min/1.73 m 2 ) undergoing percutaneous coronary interventions (PCI) were enrolled in the MYTHOS trial. They were randomized to matched hydration (RenalGuard group, n=30) or to i.v. isotonic saline hydration (control group; n=33) at a rate of 1 ml/kg/hour for 12 hours before and after PCI. Matched fluid replacement was started approximately 90 minutes pre-PCI, maintained during catheterization, and for up to 4 hours afterwards. Patients were given an initial i.v. bolus of 250 ml of normal saline over 30 minutes and then an i.v. bolus of furosemide (0.5 mg/kg). The RenalGuard measures the patient’s urine volume and then automatically adjusts the infusion pump rate to precisely replace the measured urine output in real time. When a &gt;300 ml/hour urine output rate was obtained, patients underwent PCI. CIN was defined as a ≥0.5 mg/dl or ≥25% rise in serum creatinine over baseline. Results . Overall, the mean eGFR was 40±9 ml/min/1.73 m 2 . The mean contrast volume was 190±92 ml in RenalGuard group and 212±118 ml in controls (P=0.4). In RenalGuard group, urine output ranged from 319 to 1788 ml/hr (mean 830±322 ml/hr). There were no serious device-or therapy-related complications, including clinically significant electrolyte changes (asymptomatic ipokalemia was corrected in 1 case). CIN occurred in no patient (0%) of the RenalGuard group and in 5 (15%) controls (P=0.03). Two controls (6%) required temporary renal replacement therapy. Conclusions. These preliminary results indicate that furosemide-induced high urine output with maintenance of intravascular volume through matched hydration can be safely obtained with the RenalGuard system and may reduce the risk of CIN in CKD patients undergoing PCI.

Impairment of Renal Function and Electrolyte Balance in Rabbit Hemoorhagic Disease

Rabbit hemorrhagic disease virus (RHDV) induced viral fulminant hepatitis in adult rabbits. We investigated the damage of renal function and electrolyte balance in experimentally infected rabbit by measuring the related serum parameters to elucidate the pathogenesis of RHDV as an index for medical treatment. Nineteen New Zealand White rabbits, ten females and nine males, were each intramuscularly inoculated with 0.5 ml 50% rabbit lethal dose (RLD(50)) rabbit hemorrhagic disease virus. Blood samples were collected at 0 hr post inoculation (HPI) and every 6 hr from 18 HPI repeatedly through 66 HPI. After virus inoculation, serum blood urea nitrogen (BUN), creatinine (CREA) and sodium (Na(+)) were elevated to a highly significant level (p<0.0001), whereas serum potassium (K(+)) was moderately elevated to a significant level (p<0.05). Hypoglycemia developed highly significantly (p<0.0001). Serum chloride ion (Cl(-)) was the only parameter which did not change significantly (p=0.077). No significant sexual difference was observed among these parameters. Renal insufficiency progressed from 36 hr, as indicated by the increases in BUN and CREA; significant changes in electrolytes resulting in the increased osmolality of extracellular fluid that induced flow disturbance which consequently destroy the homeostasis in cells. Therefore, the later impairments in renal function and electrolyte balance might be an important threat for rabbits which might have survived from acute fulminant hepatitis in RHD.

A Randomized, Multicenter Study Comparing the Safety and Efficacy of Sodium Phosphate Tablets With 2L Polyethylene Glycol Solution Plus Bisacodyl Tablets for Colon Cleansing

The safety and efficacy of NaP tablets have not been compared with 2L PEG lavage solution. A multicenter, investigator-blinded study was conducted to compare the colon-cleansing efficacy of a new NaP tablet formulation with that of 2L PEG solution plus bisacodyl tablets in adults undergoing colonoscopy. A total of 481 patients were randomized to receive either 32 tablets (48 g) of NaP or 2L PEG solution plus 4 (20 mg) bisacodyl tablets. Quality of colon cleansing was assessed using a 4-point scale (1 = excellent, 2 = good, 3 = fair, and 4 = inadequate), and the primary efficacy end point was mean overall colon-cleansing score. Safety assessments included recording of adverse events and changes in biochemical tests and vital signs. A total of 411 patients were included in the efficacy analysis. The mean overall and ascending colon-cleansing scores for NaP tablets were significantly better than PEG plus bisacodyl (overall 1.5 vs 1.8, ascending 1.4 vs 1.8, P < 0.0001 for both). Patients treated with NaP tablets experienced significantly fewer adverse events (66%vs 82%, P= 0.0003) and gastrointestinal symptoms (64%vs 79%, P= 0.0001) compared with patients receiving PEG plus bisacodyl. Patients receiving NaP tablets were significantly less likely to experience abdominal distention, abdominal pain, and vomiting than patients receiving PEG plus bisacodyl (P < 0.0012). Transient fluctuations in laboratory parameters were observed in both treatment groups; however, the fluctuations were more common and of greater magnitude in the NaP group particularly in phosphorous, sodium, and potassium. The colon-cleansing efficacy of the new 32-tablet NaP dosing regimen in this study was found to be significantly better than the 2L PEG solution plus bisacodyl tablets regimen. The 32-tablet NaP dosing regimen was associated with fewer adverse events. As expected electrolyte shifts were more common and of greater magnitude in the NaP group compared with the PEG plus bisacodyl group; however, both treatment groups demonstrated significant changes in electrolytes and creatinine.

New maintenance fluid guidelines for children: is 0.9% sodium chloride with 5% glucose a good choice?

New maintenance fluid guidelines for children: is 0.9% sodium chloride with 5% glucose a good choice?

Dose response of PEG 3350 for the treatment of childhood fecal impaction

Objective: To investigate the efficacy and safety of polyethylene glycol (PEG) 3350 in the treatment of childhood fecal impaction. Methods: This was a prospective, double-blind, parallel, randomized study of 4 doses of PEG 3350; 0.25 g/kg per day, 0.5 g/kg per day, 1 g/kg per day, 1.5 g/kg per day, given for 3 days in children with constipation for >3 months and evidence of fecal impaction. Results: Forty patients completed the study (27 boys, median age 7.5, range 3.3-13.1 years). Disimpaction occurred in 75% of children, with a significant difference between the two higher doses and the lower doses (95% vs 55%, P <.005). All groups had an increased number of bowel movements during the 5-day study versus baseline, respectively: 6.5 versus 1.1 (P <.005), 8.0 versus 1.3 (P <.005), 10.9 versus 1.7 (P <.005), and 12.3 versus 1.4 (P <.005). Adverse effects included nausea (5%), vomiting (5%), bloating (18%), cramping (5%), and diarrhea (13%). Diarrhea and bloating were more prevalent (P <.02) in the higher-dose than in the lower-dose group. No clinically significant changes in electrolytes were noted. Conclusions: The 3-day administration of PEG 3350 is safe and effective in the treatment of childhood fecal impaction at doses of 1 and 1.5 g/kg per day. (J Pediatr 2002;141:410-4)

Fluid and salt supplementation effect on body hydration and electrolyte homeostasis during bed rest and ambulation

Bed rest (BR) induces significant urinary and blood electrolyte changes, but little is known about the effect of fluid and salt supplements (FSS) on catabolism, hydration and electrolytes. The aim was to measure the effect of FSS on catabolism, body hydration and electrolytes during BR. Studies were done during 7 days of a pre-bed rest period and during 30 days of a rigorous bed rest period. Thirty male athletes aged, 24.6±7.6 years were chosen as subjects. They were divided into three groups: unsupplemented ambulatory control subjects (UACS), unsupplemented bed rested subjects (UBRS) and supplemented bed rested subjects (SBRS). The UBRS and SBRS groups were kept under a rigorous bed rest regime for 30 days. The SBRS daily took 30 ml water per kg body weight and 0.1 sodium chloride per kg body weight. Plasma sodium (Na), potassium (K), calcium (Ca) and magnesium (Mg) levels, urinary Na, K, Ca and Mg excretion, plasma osmolality, plasma protein level, whole blood hemoglobin (Hb) and hematocrit (Hct) level increased significantly ( p≤0.05), while plasma volume (PV), body weight, body fat, peak oxygen uptake, food and fluid intake decreased significantly ( p≤0.05) in the UBRS group when compared with the SBRS and UACS groups. In contrast, plasma and urinary electrolytes, osmolality, protein level, whole blood Hct and Hb level decreased significantly ( p≤0.05), while PV, fluid intake, body weight and peak oxygen uptake increased significantly ( p≤0.05) in the SBRS group when compared with the UBRS group. The measured parameters did not change significantly in the UACS group when compared with their baseline control values. The data indicate that FSS stabilizes electrolytes and body hydration during BR, while BR alone induces significant changes in electrolytes and body hydration. We conclude that FSS may be used to prevent catabolism and normalize body hydration status and electrolyte values during BR.

Urinary and serum electrolyte changes in athletes during periodic and continuous hypokinetic and ambulatory conditions.

Hypokinesia (HK) (diminished movement) induces significant electrolyte changes, but little is known about the effect of periodic hypokinesia (PHK) on minerals. The aim of this study was to measure the effect of PHK and continuous hypokinesia (CHK) on urinary and serum electrolytes. Studies were done during a 30-d period of prehypokinesia (HK) and during 364 d of PHK and CHK periods. Thirty male athletes aged 24.6 +/- 7.7 yr were chosen as subjects. They were equally divided into three groups: unrestricted ambulatory control subjects (UACS), continuously hypokinetic subjects (CHKS), and periodically hypokinetic subjects (PHKS). The UACS group experienced no changes in the daily activities and regular training and they were maintained under an average running distance of 11.7 km/d. The CHKS group was limited to an average walking distance of 0.7 km/d; and the PHKS group was limited to an average walking distance of 0.7 and running distance of 11.7 km/d for 5 d and 2 d/wk, respectively, for a period of 364 d. Urinary and serum phosphate (P), calcium (Ca), sodium (Na) and potassium (K), serum intact parathyroid hormone (iPTH), calcitonin (CT), plasma renin activity (PRA) and aldosterone (PA) levels, food and water intakes, and physical characteristics were measured. Urinary P, Ca, Na, and K loss, serum Ca, P, Na, and K, and PRA and PA values increased significantly (p < or = 0.01), whereas serum iPTH and CT levels decreased significantly (p < or = 0.01) in the PHKS and CHKS groups when compared with the UACS group. However, significant (p < or = 0.01) differences were observed between PHKS and CHKS groups regarding urinary and serum electrolytes, serum and plasma hormones. Food and water intakes, body weight, body fat, and peak oxygen uptake decreased significantly (p < or = 0.01) in the CHKS group when compared with PHKS and UACS groups. Food and fluid intakes, body fat, and body weight increased significantly (p < or = 0.01), whereas peak oxygen uptake remained significantly (p < or = 0.01) higher in the PHKS group when compared with the CHKS group. Serum and urinary minerals, serum hormones, food and fluid intakes, and physical characteristics did not change significantly (p > 0.01) in the UACS group when compared with their baseline control values. It was shown that both PHK and CHK induce significant serum and urinary electrolyte changes. However, urinary and serum electrolyte changes were significantly (p < or = 0.01) greater during PHK than CHK. It was concluded that the greater the stability of muscular activity, the smaller the serum and urinary electrolyte changes during prolonged HK.

Electrolyte changes in plasma and urine of athletes during acute and rigorous bed rest and ambulatory conditions.

Rigorous bed rest (RBR) induces significant electrolyte changes, but little it is not known about the effect of acute bed rest (ABR) (i.e., abrupt confinement to a RBR). The aim of this study was to measure urinary and plasma electrolyte changes during ABR and RBR conditions. The studies were done during 3 d of a pre-bed-rest (BR) period and during 7 d of an ABR and RBR period. Thirty male trained athletes aged, 24.4 +/- 6.6 yr were chosen as subjects. They were divided equally into three groups: unrestricted ambulatory control subjects (UACS), acute-bed-rested subjects (ABRS), and rigorous-bed-rested subjects (RBRS). The UACS group experienced no changes in professional training and daily activities. The ABRS were submitted abruptly to a RBR regimen and without having any prior knowledge of the exact date and time when they would be subjected to an RBR regimen. The RBRS were subjected to an RBR regime on a predetermined date and time known to them from the beginning of the study. Sodium (Na), potassium (K), magnesium (Mg), calcium (Ca), and phosphate (P) in plasma and urine, plasma renin activity (PRA) and plasma aldosterone (PA), physical characteristics, peak oxygen uptake, and food and water intakes were measured. Urinary Na, K, Ca, Mg, and P excretion and plasma Na, K, Mg, Ca, and P concentration, PRA, and PA concentration increased significantly (p < or = 0.01), whereas body weight, peak oxygen uptake, and food and water intakes decreased significantly in the ABRS and RBRS groups when compared with the UACS group. However, urinary and plasma Na, K, Mg, P, and Ca, PRA, and PA values increased much faster and were much greater in the ABRS group than in the RBRS group. Plasma and urinary Na, K, Ca, Mg, and P, PRA and PA levels, food and water intakes, body weight, and peak oxygen uptake did not change significantly in the UACS group when compared with its baseline control values. It was shown that RBR and ABR conditions induce significant increases in urinary and plasma electrolytes; however, urinary and plasma electrolyte changes appeared much faster and were much greater in the ABRS group than the RBRS group. It was concluded that the more abruptly motor activity is ended, the faster and the greater the urinary and plasma electrolyte change.

Serum, urinary and fecal phosphate changes in athletes during periodic and continuous restriction of muscular activity

Continuous hypokinesia (CHK) induces significant electrolyte changes, however, it is not known if periodic hypokinesia (PHK) induces smaller or greater electrolyte changes. Thus, the aim of this study was to measure phosphate (P) changes during PHK and CHK. Studies were done during 30 days pre HK period and during 364 days of PHK and CHK periods. Thirty male athletes were chosen as subjects. They were divided into three groups: unrestricted ambulatory control subjects (UACS), continuously hypokinetic subjects (CHKS) and periodically hypokinetic subjects (PHKS). The CHKS group was maintained under an average running distance of 0.7 km.day-1; while the PHKS group was maintained under an average running distance of 0.7 and 11.7 km.day-1 for five days and two days per week, respectively, and the UACS group was maintained under an average running distance of 11.7 km.day-1. Urinary, fecal and serum P, urinary and serum calcium (Ca) and magnesium (Mg), serum 1,25-dehydroxivitamin D (OH)2 D, intact parathyroid hormone (iPTH), urinary creatinine and physical characteristics and peak oxygen uptake were measured. Serum, urinary and fecal P, serum and urinary Ca and Mg, and urinary creatinine increased significantly (p≤ 0.01), while serum iPTH and 1,25 (OH)2 D decreased significantly (p≤ 0.01) in the CHKS and PHKS groups when compared with the UACS group. Body weight and peak oxygen uptake decreased significantly (p≤ 0.01) in the CHKS group, when compared with the UACS group while body weight increased and peak oxygen uptake decreased significantly (p≤ 0.01) in the PHKS group. The measured parameters changed much faster and much more in the PHKS group than in the CHKS group. The measured parameters did not change significantly in the UACS group when compared with the baseline control values. It was concluded that PHK and CHK induced significant fecal, urinary and serum P changes in endurance trained athletes; however, serum, fecal and urinary P changes appeared much faster and were much greater in the PHKS group than in the CHKS group. Thus prolonged PHK induces much greater P changes than CHK.

Plasma, urinary and fecal potassium changes in athletes during ambulatory, periodic, and continuous hypokinetic conditions

Objectives: Prolonged hypokinesia (HK) induces significant electrolyte changes, but little is known about the effect of prolonged periodic hypokinesia on plasma, urinary, and fecal K. The aim of this study was to measure potassium (K) changes during prolonged periodic (PHK) and continuous (CHK). Design and methods: Studies were done during the pre HK and HK periods. Thirty male athletes were chosen as subjects. They were divided equally into three groups: unrestricted ambulatory control subjects (UACS), continuously hypokinetic subjects (CHKS), and periodically hypokinetic subjects (PHKS). The CHKS group was kept on a running distance of 0.7 km/day, while the PHKS group kept on a running distance of 0.7 and 11.7 km/day for 5 days and 2 days per week, respectively. The UACS group was on a running distance of 11.7 km/day. Results: The following were measured: fecal K excretion; urinary K; sodium (Na) and chloride (Cl) excretion; plasma K; Na and Cl concentration; plasma renin activity (PRA) and plasma aldosterone (PA) concentration; physical characteristics; and peak oxygen uptake. Fecal K, urinary K, Na and Cl excretion, plasma K, Na and Cl concentration, and PRA and PA concentration, increased significantly (p ≤ 0.01) in the CHKS and PHKS groups when compared with the UACS group. Body weight and VO 2 peak decreased significantly ( p ≤ 0.01) in the CHKS group, while body weight increased and VO 2 peak decreased significantly ( p ≤ 0.01) in the PHKS group when compared with the UACS group. The measured parameters changed much more in the PHKS group than in the CHKS group. By contrast, the measured parameters did not change significantly in the UACS group when compared with the baseline control values. Conclusion: It was shown that prolonged PHK and CHK induce significant plasma and excretory K changes; however, plasma and excretory K changes were much greater in the PHKS group than in the CHKS group. It was concluded that the greater the stability of muscular activity, the smaller the plasma, urinary, and fecal K changes during prolonged HK.