Sodium Levels Research Articles

Investigating the effects of formulation variables on the disintegration of spray dried amorphous solid dispersion tablets

Amorphous solid dispersion (ASD) tablets based on hydrophilic polymer carriers may encounter disintegration challenges. In this work, the effect of different formulation composition variables on the ASD tablet disintegration performance was systematically studied. GDC-0334: copovidone (PVPVA) 60: 40 ASD prepared by spray drying was selected as the model ASD system. The effects of ASD loading, filler type and ratio, disintegrant type and level were then investigated using tablets made by direct compression process. Tablet disintegration time increased with the increase of ASD loading, especially when ASD loading exceeded 50 %. At the same tablet solid fraction, when lactose was used as the soluble filler, faster tablet disintegration time was observed compared to the tablets with mannitol as the soluble filler. Among the three tested disintegrants, croscarmellose sodium performed the best in facilitating the ASD tablet disintegration, followed by sodium starch glycolate, and crospovidone was the poorest. When croscarmellose sodium was used as the disintegrant, 5 % level was sufficient to enable ASD tablet disintegration at 60 % ASD loading and further increase of croscarmellose sodium level to 8 % did not provide additional benefit. Water uptake experiments were performed on selected tablets and the results demonstrated a positive correlation with tablet disintegration time, indicating water penetration is a major contributing step for the disintegration of our ASD tablets. Overall, this work provides a rationale for excipient selection and insights into building a platform formulation approach for developing immediate-release ASD tablets.

The Safety and Efficacy of Hypertonic Saline in Achieving Primary Fascial Closure Following Damage Control Laparotomy: A Systematic Review and Meta-Analysis.

Effective fluid management is critical in patients undergoing damage control laparotomy (DCL) for trauma and sepsis. Hypertonic saline (HTS) has been proposed as an alternative to isotonic fluids to enhance primary fascial closure rates and optimize fluid balance. This systematic review and meta-analysis aimsto evaluate the efficacy and safety of HTS compared to isotonic fluids in patients undergoing DCL. A comprehensive literature search was conducted across multiple databases up to the 14thof June 2024, identifying studies that compared HTS to isotonic fluids in adult patients undergoing DCL for trauma or sepsis. Eligible studies included randomized controlled trials and observational studies reporting outcomes such as early primary fascial closure (EPFC) rates, time to fascial closure, fluid requirements, electrolyte imbalances, renal function, and mortality. Data extraction and quality assessment were performed independently by two reviewers, and pooled analyses were conducted using fixed-effectmodels where appropriate. Four studies encompassing 375 patients met the inclusion criteria, with 100 patients receiving HTS and 275 receiving isotonic fluids. HTS administration was associated with a significantly higher EPFC rate compared to isotonic fluids (odds ratio (OR): 0.314; 95% confidence interval (CI): 0.142-0.696; p=0.004). The mean time to fascial closure was also significantly reduced in the HTS group by approximately eight hours (mean difference (MD): 8.007 hours; 95% CI: 5.558-10.596; p<0.001). Patients receiving HTS required significantly less total fluid over 48 hours (MD: 1.055 liters; 95% CI: 0.713-1.398; p<0.001). While HTS use led to higher peak sodium levels (MD: -4.318 mEq/L; 95% CI: -4.702 to -3.934; p<0.001), there were no significant differences in peak creatinine levels, need for inpatient renal replacement therapy, or 28-day mortality between the groups. HTS appears to be effective in improving EPFC rates and reducing both time to closure and overall fluid requirements in patients undergoing DCL for trauma and sepsis. Although associated with higher serum sodium levels, HTS did not increase the risk of renal dysfunction or mortality. These findings suggest that HTS is a safe and efficacious alternative to isotonic fluids in the management of critically ill patients requiring DCL. Further large-scale, randomized controlled trials are warranted to confirm these results and inform clinical guidelines.

The Effect of Mocaf Flour and Yellow Pumpkin Flour (Cucurbita Moschata) Proportion on the Acceptability and Physicochemical Quality of Wet MI

Overcoming dependence on wheat flour as raw material, researchers want to develop a wet noodle product by using mocaf flour to substitute wheat flour and adding pumpkin flour to increase the nutritional value of wet noodles, namely potassium minerals as an alternative main food that can help lower blood pressure in hypertension sufferers.To determine the effect of the proportion of mocaf flour and pumpkin flour on the physicochemical quality of wet noodles. This type of research uses an experimental study design with a Completely Randomized Design (CRD). The comparison of the proportions of mocaf flour and pumpkin flour is P0 (100g : 0g), P1 (95g : 5g), P2 (90g :10g), P3 (85 g :15g), P4 (80g :20g). Physical quality and chemical quality test data were analyzed using the Independent T-test. The research results show that the percent water absorption capacity; percent elongation; potassium levels; and sodium levels, namely P0 (58.5% ; 19.8% ; 16.5mg/100 g; 5.64 mg/100g), P2 (70.3% ; 8.8% ; 55.95 mg/100g ; 5.55 mg/100g). The best treatment P2 does not meet the adult RDA percentage and cannot be classified as high in potassium. Wet noodle products cannot yet be used as an alternative to foods high in potassium for preventing hypertension.

Management of Stage-4 HIV with Cerebral Toxoplasmosis Coinfection and SIADH Complication

HIV/AIDS stage 4 is the stage where the HIV/AIDS patients have low immunity protection against infections, which can led to coinfections and complications. This case report presented an evaluation of the diagnosis and treatment of an HIV/AIDS stage 4 patient with cerebral toxoplasmosis coinfection and SIADH complications. A man (47 years, 35 kg), married with two children, complaining of weakness, nausea, vomiting, weight loss, and low appetite. Sodium level were measured, showing a 117 mg/dL level that continued to decrease throughout the patient's treatment. Five days later, the patient lost his consciousness with a GCS score of 224, indicating severe brain injury, and was diagnosed with cerebral toxoplasmosis based on the result of head CT-SCAN with contrast. On day 6, the patient was tested positive for HIV and diagnosed with stage 4 with an absolute CD4 count of 4 cells/μl. Therapy was provided by giving pyrimethamine-clindamycin therapy for cerebral toxoplasmosis, followed by Tenofovir, Lamivudine, and Evafirenz as antiretroviral therapy. Treatment for hyponatremia was done by administration of 3% NaCl and tolvaptan. The patient started experiencing an improvement in consciousness after the 10th day of medication, and sodium levels fluctuated throughout the treatments. Patient was discharged after 15 days with clinical improvements.

Integrating mineral elements and metabolite features to distinguish Lotus seeds from different geographic origins

The characteristics of lotus seeds (LS) are influenced by variety and environment. However, it remains unknown the difference of metabolites and elements of LS from different origins. In this study, an accurate quantification method (97–107 %) for 20 mineral elements in LS was developed, and a metabolomic method was established to identify a total of 323 metabolites in LS. Mineral composition analysis revealed significant variations in the mineral element contents among LS samples from seven geographical regions. LS were rich in potassium (14,710 mg/kg), manganese (67.19 mg/kg), with a low level of sodium (210 mg/kg). A total of 10 mineral elements and 117 metabolites (p < 0.05 and VIP > 1) were identified as the potential geographical markers of LS by integration analysis. The linear discriminant analysis model showed high prediction accuracy. This study provides strong experimental evidence to maintain the authenticity and quality of LS in the food industry.

STUDY OF SERUM SODIUM LEVELS AND ITS CLINICAL SIGNIFICANCE IN DECOMPENSATED CHRONIC LIVER DISEASE PATIENTS ADMITTED IN A TERTIARY CARE CENTRE OF NORTH EASTERN STATE, TRIPURA

Introduction: Chronic Liver Disease is a major source of death and morbidity globally. Hyponatremia is one of the most common electrolyte abnormalities in chronic liver disease patients. Various studies have established a correlation between serum sodium levels and survival in these patients. Hyponatremia is a marker of severity in CLD patients and studies have shown its relationship with MELD score and Child Pugh score. The complications of DCLD and mortality also increases with hyponatremia. The aim of this study was to study the serum sodium levels in patients with DCLD and to establish its significance. Materials And Methods: Data was collected from 100 patients admitted in medical wards. Patients were divided into 3 groups based on serum sodium levels and the relevant parameters analyzed among the groups. OBSERVATIONS: Among 100 patients, 45 had serum sodium levels ≥136 mEq/L, while 32 had serum sodium levels between 131 and 135 mEq/L and 23 patients had serum sodium level ≤130. No patients had serum sodium levels greater than 145. Serum sodium levels were associated strongly with the severity of liver disease as assessed by Child Pugh and MELD scores. Serum sodium ≤130 indicated the existence of Hepatic Encephalopathy, Hepatorenal Syndrome and Spontaneous Bacterial Peritonitis. Patients with serum sodium less than 130 mEq/L had increased frequency of complications than those with ≥136 mEq/L. Patient with serum sodium levels ≤130 had increased mortality. Conclusion: Hyponatremia is more common in DCLD and low serum sodium levels are associated with increased frequency of complications such as hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis and GI bleeding. Lower serum sodium levels were associated with increased MELD and Child Pugh score and mortality indicating the inverse relationship between serum sodium levels and severity of the disease.

Congenital Adrenal Hyperplasia with Poor Virilization at the Onset: A Case Report

Objective: Congenital adrenal hyperplasia (CAH) is a relatively rare disorder. This case report aims to highlight the diagnostic challenges faced by clinicians when typical characteristics of the disease are not fully evident. Case: The patient, a 2-month-old infant, presented at the emergency room with vomiting, diarrhea, dehydration, and lethargy. Physical examination revealed mild clitoral hypertrophy. Laboratory tests showed sodium levels at 121 mEq/L and potassium at 5.8 mEq/L, without hyperpigmentation or genital ambiguity. CAH was suspected. Due to resource constraints, 17-hydroxyprogesterone levels could not be measured. Treatment was initiated with oral prednisone (1 mg) and sodium chloride supplementation. One month later, after another hospital discontinued the treatment, the patient was readmitted with vomiting, dehydration, hyponatremia, and hyperkalemia, but still showed no significant clitoral enlargement or hyperpigmentation. The patient was stabilized and discharged after resuming treatment. Subsequent consultations revealed poor weight and height gain. At one year of age, the mother reported clitoral enlargement and morning erections. Treatment with fludrocortisone and oral hydrocortisone led to significant improvement. A genetic study confirmed a CYP21A2 gene mutation. Conclusion: This case underscores the diagnostic complexity of CAH in patients who do not initially exhibit typical virilization. It also emphasizes the importance of clinical suspicion and tailored treatment in resource-limited settings.

A recent ongoing effect: Hyponatremia in neurologically ill patients

Different variables altering the volume of extracellular fluid might result in hyponatremia, which is defined as a serum sodium content below 136 millimoles per liter. Depending on the volume status, it can be classified as hypovolemic, euvolemic, or hypervolemic. Hyponatremia is caused by a number of risk factors and drugs, such as diuretics, NSAIDs, and antidepressants. Hyponatremia is more common in patients with neurological conditions, especially those with head trauma, subarachnoid hemorrhage, or acute meningitis. Recent advancements in analysis for disorder of antidiuretic hormone syndrome (SIADH), a prevalent cause, include vasopressin-2 receptor antagonists. The intricate regulation of sodium and water balance by humoral, neurological, and renal mechanisms is a part of normal physiology. Hyponatremia may result from medications such as tramadol, sacubitril/valsartan, antidepressants, and anticonvulsants interfering with these mechanisms. Drug-induced hyponatremia is managed by stopping the offending agent, limiting fluid intake, and occasionally administering hypertonic saline. For chronic hyponatremia, the use of vaptans, like tolvaptan, in conjunction with urea therapy is growing. A risky complication of hyponatremia is osmotic demyelination syndrome, which can occur when the condition is treated too quickly. To avoid negative consequences, close observation and the right amount of fluids must be administered during treatment. To summarize, treating hyponatremia effectively entails determining the underlying causes, treating them, and making sure that serum sodium levels are carefully corrected to avoid consequences such as osmotic demyelination syndrome.

Postoperative, but Not Preoperative, MELD-3.0 Prognosticates 3-Month Procedural Success in Patients Undergoing Orthotopic Heart Transplantation

Background/Objectives: Multi-organ failure (MOF) often complicates advanced heart failure (HF), contributing to a poor prognosis. The Model of End-Stage Liver Disease 3.0 (MELD-3.0) scale incorporates liver and kidney function parameters. This study aims to evaluate the prognostic significance of the MELD-3.0 score in patients with advanced HF who have undergone heart transplantation (HTx). Methods: The MELD-3.0 score was computed using the average values of the international normalized ratio and bilirubin, creatinine, sodium, and albumin levels during a hospital stay following HTx. The average MELD-3.0 scores from the period of 1 month preceding HTx and 1 week after HTx were analyzed. The primary endpoint of the study was the 6-month total mortality, and the secondary endpoint was ICU hospitalization time after HTx. Results: The analysis included 106 patients undergoing HTx, with a median age of 53 years (44–63), 81% of whom were male. Within 6 months post-HTx, 17 patients (16%) died; those patients had a higher 1-week post-HTx MELD-3.0 score of 18.3 (14.5–22.7) in comparison to survivors, whose average score was 13.9 (9.5–16.4), p &lt; 0.01. There was no difference in MELD 3.0 score in the pre-HTx period: 16.6 (11.4–17.8) vs. 12.3 (8.6–17.1), p = 0.36. The post-HTx MELD-3.0 score independently predicted death: RR 1.17 (95% CI 1.05–1.30), p &lt; 0.01. A Receiver Operating Characteristic (ROC) determined the cut-off value of the MELD-3.0 score as 17.3 (AUC = 0.83; sensitivity—67%; specificity—86%). Survivors with scores above this value had a longer ICU hospitalization time: 7 (5.0–11.0) vs. 12 (8–20) days (p = 0.01). Conclusions: The post-HTx MELD-3.0 score serves as an independent predictor of an unfavorable prognosis in patients with advanced HF undergoing HTx. The evaluation of MELD-3.0 scores provides additional prognostic information in this population.

Relationship between Dietary Fat-Sodium and Hypertension in Prolanis at the Jarak Kulon Public Health Center

Hypertension is a disease that causes high pain. Consuming sodium and fatty acids every day can increase the risk of hypertension. The impact of high fatty acids affects the presence of cholesterol deposits in the blood, while the levels of fatty acids cause increased blood pressure. This study aimed to analyze the relationship between sodium fat and hypertension in the Chronic Disease Management Program (Prolanis) at the Jarak Kulon Public Health Center Jombang. The research design used was cross-sectional. The population of this study was all hypertensive patients who participated in Prolanis, as many as 50 people. The sampling technique used was total sampling. The independent variable is the fat-sodium diet, and the dependent variable is hypertension. The instrument for the fat-sodium diet uses a questionnaire, while the incident uses observation. Statistical tests use Spearman Ranks. Spearman ranked data analysis with a significance of 0.01 and obtained a value of 0.000. Because (&lt;α) means there is a relationship between the fat-sodium diet and hypertension. The test results also show that the relationship level of 0.695 is included in the strong category. Based on the research results, it is hoped that food content that is low in fat and low in sodium levels will help blood pressure to reach near-normal levels to avoid more severe complications.

EVALUATING SOIL AMENDMENT EFFECTS ON TOMATO YIELD AND FRUIT QUALITY

This study investigates the impact of various soil treatments on key yield components of tomato (Solanum lycopersicum) plants, including fruit diameter, length, number per plant, and weight. Eight treatments were evaluated: BK+, MgSO4, CaPh, EcoTea, Pig Manure, Cow Manure, Combined Inorganic Fertilizer, and a Control. Comprehensive statistical analyses revealed significant differences in yield parameters across treatments. CaPh, MgSO4, and the Combined Inorganic fertilizer enhanced fruit production. EcoTea promoted larger tomato lengths, while Pig Dung increased weights. Mineral composition analyses showed distinct treatment effects on sodium, potassium, calcium, magnesium, and zinc levels. Nutrient profiling indicated varied impacts on moisture, protein, ash, fiber, fat, and carbohydrate contents. Strong correlations were observed between mineral and nutrient pairs, highlighting potential synergies and antagonisms. This research provides valuable insights into optimizing soil management practices for improved tomato yield, quality, and nutritional value, contributing to sustainable agricultural development.

Dyselectrolytaemia in Acute Stroke Patients, A Study of Hundred Cases in Holy Family Red Crescent Medical College Hospital

Introduction: Stroke is a growing public health concern in low- and middle-income countries. There are many studies on stroke, its associated conditions, and its effect on stroke patients’ outcomes, but few studies on dyselectrolytaemia in stroke patients have been done in our country. This study aimed to highlight the pattern and correlation of dyselectrolytaemia in acute stroke patients of a tertiary care hospital. Methods: This cross-sectional study was conducted in the Department of Medicine, Holy Family Red Crescent Medical College Hospital, from January, 2016 to June, 2016. A total of 100 patients with stroke were selected as study subjects as per inclusion and exclusion criteria. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 20.0 for Windows. The mean values were calculated for continuous variables. The quantitative observations were indicated by frequencies and percentages. The chi-square test with Yates correction was used to analyze the categorical variables. Student t-test was used for continuous variables. P values &lt;0.05 were considered statistically significant. Result: In this study, 31 (31.0%) patients had dyselectrolytaemia. This study shows serum electrolytes of the study patients, it was observed that 17(17.0%) patients had hyponatremia: serum sodium level (&lt;135 mmol/I), 13(13.0%) patients had hypokalaemia serum potassium (&lt;3.5 mmol/l), 16(16.0%) patients had hypochloraemia serum Chloride level (&lt;96 mmol/l) and 11(11.0%) patients had low bicarbonate level (&lt; 24 mmol/I). Conclusion: This study highlights the prevalence of dyselectrolytaemia in acute stroke patients. Among the 100 patients studied, 17% experienced hyponatremia, 13% had hypokalaemia, 16% exhibited hypochloraemia, and 11% had low bicarbonate levels. These findings highlight the importance of routine electrolyte monitoring and prompt management in acute stroke care to prevent complications and improve patient outcomes.

Evaluation of Serum Electrolytes among Geriatric and Non-Geriatric Men in Osisoma, ABA, Nigeria

Background: Ageing is a progressive development associated with a decline in the physiological functions, which increases susceptibility to organ dysfunction (especially the kidney) in geriatrics. This facilitates the risk of electrolyte imbalance, as the kidneys play a crucial role in maintaining these electrolyte concentration. Aim: This was a cross-sectional study designed to evaluate serum sodium ( ), potassium ( ), chloride ( ), and bicarbonate ( ) levels, and understand their prevalence among apparently healthy geriatric and non-geriatric men residing in Osisoma, Aba. Methodology: A total of 100 apparently healthy participants were enrolled for this study, comprising of 50 geriatric men aged 65 years and above, and 50 non-geriatric men aged 20-30 years. From both groups, serum samples were used for the analyses of sodium ( ), potassium ( ), chloride ( ), and bicarbonate ( ) using Spectrophotometer. The data obtained was analyzed statistically using Statistical Package for Social Science (SPSS version 25), student’s t-test, one way analysis of variance (ANOVA), pearson correlation coefficient and P values less than 0.05 were considered statistically significant. Results: The mean values of sodium (136.6+3.9mmol/L), potassium (3.9+0.5mmol/L), chloride (100.2+3.9mmol/L) and bicarbonate (24.4+4.3 mmol/L) levels in geriatric subjects showed no statistical significant difference (P &gt; 0.05) when compared to the mean values of sodium (136.9+2.3 mmol/L), potassium (3.9+0.4 mmol/L), chloride (100.8+2.8 mmol/L) and bicarbonate (24.9+3.9 mmol/L) in non-geriatric subjects. The study also revealed a significant difference (P = 0.001) in the mean value of bicarbonate (24.8+4.3 mmol/L; 25.8+1.9mmol/L, and 18.1 +3.3 mmol/L) among geriatric subjects, when compared based on age range using ANOVA. There was a significant negative correlation between the ages and bicarbonate levels (r = -0.4, P = 0.008), a non-significant positive correlation between ages and sodium levels (r = 0.1, P = 0.498), and chloride levels (r = 0.2, P = 0.125), and a non-significant negative correlation between the ages and potassium levels (r = -0.1, P = 0.691) in geriatric subjects. Conclusion: The result from this study showed no significant alteration of serum electrolytes between geriatric and non-geriatric subjects, and a significant alteration of bicarbonate levels among the geriatric subjects. This present study has shown that ageing without any comorbidities has lesser effect on serum electrolytes.

Nutrient Composition and Antioxidant Potential of Rambutan (Nephelium lappaceum L) Peel

The present study was conducted to assess the nutri-chemical composition and antioxidant potential of rambutan fruit (Nephelium lappaceum L) peel. Red rambutan fruit peel was used in fresh as well as dried form for the study. The nutri-chemical profiling revealed, fresh peel had 24g/100g of carbohydrate, 2.5g/100g of protein, 0.17g/100 g of fat and 0.89g/100g starch. However, dried peel had 55.45g/100g carbohydrate, 5.25g/100 protein, 10.2g/100g fat and 1.00g/100g starch. Crude fiber content of the fresh and dried peel was 0.77g/100g and 0.068g/100g respectively. Moreover, the fresh peel had higher moisture (73%) content than dried peel (4.2%). Vitamin C being heat liable, was found higher in fresh peel (9.31mg/100g). Sodium and potassium levels was found higher in dried peel powder as 1.55mg/100g and 9.4mg/100g respectively. Phytochemical composition of rambutan peel revealed that total polyphenol was higher in dried peel (580mg/100g) when compared to fresh (310 mg/100 g), meanwhile saponin, tannin and terpenoid was found higher in fresh peel as 47mg/100g, 390mg/100g and 5.101mg/100g respectively. Flavonoid content was dominant in dried peel (20.51mg/100g) than that of fresh peel (9.6mg/100 g). The radical-scavenging activity was expressed as IC50, which reported dried peel (43.79μg/100 mL) had strong antioxidant potential than fresh peel (184.39μg/100mL). However, it is concluded that rambutan peel is a potent source of nutrients, bioactive compounds and antioxidants which in turn has immense therapeutic benefits. Furthermore, valorisation of agri-food wastes and by- products can enhance food security and promote sustainable development.

HPMC Extended-Release Multi-Composite Matrix for Co-delivery of Oxcarbamazepine and Vitamin D.

Background: Carbamazepine (CBZ) is considered as first-line treatment for epilepsy. The literature has signified a history of non-uniform drug performance and clinical failures. However, many studies suggested that Oxcarbazepine (OXC), a structural analog of CBZ, may have an equivalent antiepileptic effect. OXC follows a different metabolic pathway other than CBZ. However, both share the same mechanism of action by blocking voltage-gated sodium channels. Objectives: This study aimed to form hydroxypropyl methylcellulose (HPMC) extended-release tablets containing OXC combined with vitamin D. Methods: These formulated tablets were tested for their dissolution rate, tablet hardness, friability, thickness and pharmacokinetic parameters (Cmax and Cmin). Blood sodium levels were additionally investigated to ensure the absence of hyponatremia; the main side effect of long-term use of CBZ and some of its derivatives. Results: The use of HPMC inhibited the formation of dihydrate OXC form thus offering a significant extended-release profile. OXC also showed a highlighted capability to attain high bioavailability. Microcrystalline cellulose (MCC) was also added to tablets formed to inhibit polymorphic transformation. Tablets containing OXC co-delivered with vitamin D ensured significantly decreased susceptibility to hyponatremia, and an extended-release profile was evident. Lower amounts of OXC were loaded in formed tablets containing vitamin D owing to the synergistic effect between vitamin D and antiepileptic drugs. Conclusion: Conclusively, employing these newly HPMC-constructed tablets of OXC co-delivered with vitamin D appeared to be a promising option for the effective management of epilepsy with least side effects.

Correlation of Serum Electrolyte Imbalances With Diabetic Duration and Medication Use: A Cross-Sectional Comparative Study.

Certain anti-diabetic medications may exacerbate electrolyte imbalances, potentially complicating glycemic control in diabetic patients. The present study aimed to correlate the serum electrolyte imbalances such as Na+, K+, Ca+2, Cl-, and Mg+2 with the duration of disease, glycemic control, and medication regimens. In this cross-sectional study, 31 patients with type 2 diabetes mellitus (T2DM) and 30 healthy controls, with mean ages of 52.06 and 48.5 years, respectively, were recruited based on eligibility criteria. Data on demographic information, medication history, and duration of diabetes were collected. Fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1C), and serum electrolytes were measured. The data were statistically analyzed. The mean differences in serum electrolytes between T2DM patients and non-diabetic participants were compared using the Mann-Whitney U test, and correlation analysis was performed. A p-value of <0.05 was considered statistically significant. Around 9.6% of participants had diabetes duration of less than one year, while the majority (45%) fell within the 1-5-year duration range. Most diabetic patients (61.2%) exhibited poor glycemic control. Statistically significant differences were observed between the mean FBS, PPBS, and HbA1C levels of T2DM (150, 249, and 8.82, respectively) and control group (95, 114, and 5.52, respectively). Analysis of serum electrolytes showedstatistically significant differences with regard toNa+, K+, andCl-between the diabetic and control groups. Mean sodium and chloride levels were lower and potassium levels were higher in diabetic patients compared to the control group. Negative correlations were observed between sodium and chloride levels and duration of diabetes and HbA1C levels. The study reveals significant electrolyte imbalances in patients with T2DM, characterized by reduced sodium and chloride levels and elevated potassium levels compared to healthy controls. These alterations are closely associated with poor glycemic control and longer disease duration, emphasizing the importance of regular electrolyte monitoring in T2DM management to mitigate potential complications.

Sterile water and regional citrate anticoagulation: A simple CRRT strategy for safe correction of severe hyponatraemia.

Hyponatraemia is a prevalent electrolyte disturbance observed in critically ill patients. The rapid correction of low plasma sodium levels by continuous renal replacement therapy (CRRT) carries the risk of developing osmotic demyelination syndrome (ODS), which can be prevented by implementing an individualized CRRT method. This study aims to introduce a CRRT protocol for the safe and gradual correction of severe hyponatraemia. This retrospective case series study was conducted in an intensive care unit (ICU). All four patients with severe hyponatraemia (<125 mmol/L) and renal failure between October 1, 2022, and September 30, 2023, were treated by CRRT with sterile water and regional citrate anticoagulation (RCA). Data on patient demographics, laboratory biochemical parameters, urine outputs and CRRT-related adverse events were collected. Laboratory parameters and urine outputs were compared by paired t-tests before and after CRRT. After CRRT, sodium levels were significantly increased (112.7 ± 6.7 vs. 141.9 ± 2.8 mmol/L, p = .005). Abnormal urine outputs, potassium, creatinine and bicarbonate were corrected (p for all <.05). Safe and gradual correction of hyponatraemia and internal environmental dysregulation was achieved in all patients without any complications related to CRRT, particularly ODS. It is a novel and simple strategy to correct severe hyponatraemia effectively while ensuring the safety of patients that can be easily implemented by experienced nurse staff. The sterile water-based protocol for postfilter dilution is safe to correct severe hyponatraemia with RCA and can be easily performed by experienced critical care nurses according to the precalculated formula. CRRT-trained, experienced ICU nurses are competent to initiate and adjust sterile water infusion discretely to prevent overcorrection of hyponatraemia.

Abstract C068: Primary adrenocortical insufficiency as a presenting symptom of acute myeloid leukemia

Abstract Introduction: Primary Adrenal Insufficiency (PAI), also known as Addison's disease, is a rare endocrinopathy resulting from the destruction or dysfunction of the adrenal cortex. It has an estimated increasing prevalence between 100 and 140 cases/million and an incidence of 4 cases per million/year. On the other hand, Acute Myeloid Leukemia (AML) is the most common leukemia among adults and accounts for about 80% of all cases. Even though our case is exceptionally rare, it highlights the coexistence of both conditions in the same patient and that PAI can be the presenting symptom of AML. Case Report: A 52-year-old female with a history of lower extremity cellulitis presented for evaluation after experiencing fever, chills, fatigue, night sweats, nausea, and dysphagia. On arrival, she had pharyngeal erythema with cervical lymphadenopathy. Her white blood cell count was 33,000. A CT chest revealed bilateral neck adenopathy and an enlarged left hilar lymph node. Bone marrow flow cytometry results were consistent with AML, CD33 positive with 68% blasts. Induction chemotherapy with gemtuzumab ozogamicin and dexamethasone IV was initiated. Meanwhile, she developed acute abdominal pain. A CT abdomen/pelvis revealed bilateral adrenal symmetric thickening, indicating adrenal dysfunction, a new finding compared to prior imaging. Endocrinology was consulted. Physical examination revealed hyperpigmented palmar creases, fatigue, and nausea, raising suspicion of adrenal insufficiency. Laboratory work showed sodium 134, basal ACTH 10, and morning cortisol levels less than 1 mcg/dl. An ACTH stimulation test confirmed PAI, with ACTH increasing from 26 to 47, cortisol from 9.2 to 11.7, aldosterone from 2 to 15, and high plasma renin activity 2.64. She continued on steroid therapy with monitoring of blood pressure and sodium levels for two weeks. She was eventually discharged with a medication plan and follow-up appointments with endocrinology and hematology/oncology. Discussion: The coexistence of PAI and AML in the same patient is rare. Obscure clinical presentations complicated the diagnosis. Symptoms like fatigue, weakness, and nausea are common in AML patients, but hyperpigmentation of the palmar creases is not. We recommend evaluating adrenal function in acute leukemia patients to avoid adrenal insufficiency crises. If adrenal insufficiency was considered later, early steroid discontinuation could have provoked an adrenal crisis. Monitoring should continue to determine if the concern is permanent or transient. Conclusion: High suspicion and early evaluation of adrenal function in all acute leukemia patients should be considered to avoid adrenal insufficiency as a later complication. Due to the rarity of the disease and non-specific early symptoms, PAI is frequently not considered, leading to delayed diagnosis and increased risk for adrenal crisis. Successful long-term therapy relies on adequate patient education, frequent assessment of basal and stimulated cortisol levels, testing of HPA axis integrity, and various imaging techniques. Citation Format: Maria Toustsoglou, Aliya M. Khan, Mehmet Hepgur, John McDonald, Rubens Sievert. Primary adrenocortical insufficiency as a presenting symptom of acute myeloid leukemia [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C068.

The efficacy and safety of isotonic and hypotonic fluids in intravenous maintenance fluid therapy in term newborns: national multicenter observational "neofluid" study.

The objective of this study was to evaluate the efficacy and safety of isotonic and hypotonic intravenous fluids in maintenance fluid therapy for term infants. This was a multi-centre, prospective, observational study conducted in 21 participating centres from December 30, 2020, to June 30, 2023. The study included term newborns requiring parenteral fluid therapy for maintenance (NCT04781361). The fluid treatment was divided into two groups based on the concentration of sodium in the parenteral fluid, designated as hypotonic (NaCl <130 mmol/L) and isotonic (NaCl = 130-154 mmol/L). The primary outcomes were the change in mean plasma sodium (pNa) levels per hour (∆pNa mmol/L/h), the incidence of hyponatremia (pNa <135 mmol/L) and hypernatremia (pNa >145 mmol/L), and the occurrence of clinically significant changes in sodium levels (∆pNa >0.5 mmol/L/h). A total of 420 patients from 21 centers were included. The ∆pNa was negative in the hypotonic fluid group and positive in the isotonic fluid group, with a significant difference between the groups [respectively -0.07 ± 0.03 (95% CI: -0.13 to -0.02); 0.04 ± 0.03 (95%CI: -0.02 to 0.09), p = 0.04]. There was no difference between the groups in terms of the development of hypernatremia or a clinically meaningful pNa increase. The hypotonic fluid group had a higher incidence of hyponatremia and a clinically meaningful sodium decrease compared to the isotonic fluid group [7.9% vs. 1.2% (OR:6.5, p:0.03)] and [12.2% vs.4.2% (OR:2.9, p = 0.03)]. Contrary to current understanding, this large-scale study is the first to demonstrate that the use of hypotonic fluids in maintenance fluid therapy for newborns poses a risk of hyponatremia development, whereas isotonic fluid therapy appears safe.

Combating Soil Salinity in Sugarcane Farming: Integrated Approaches and Bio-saline Agriculture Innovations

Sugarcane, a vital commercial crop globally, faces significant challenges due to soil salinity, particularly in India where regions such as Gujarat, Uttar Pradesh, Maharashtra, West Bengal, and Rajasthan are notably affected. Salinity impairs sugarcane growth through reduced water uptake, ion toxicity, nutrient imbalance, stunted growth and soil structure degradation. To combat these issues, various strategies have been proposed, including improving drainage, leaching, selecting salt-tolerant varieties, optimizing irrigation, and using soil amendments. Bio-saline agriculture, incorporating plant growth-promoting rhizobacteria (PGPR) and salt-tolerant plants, offers an innovative approach by enhancing soil fertility and crop resilience under saline conditions. Additionally, research indicates that long-term irrigation practices can exacerbate soil salinity, altering key soil parameters such as pH, electrical conductivity and sodium levels. Studies on spent wash application show variable impacts on sugarcane yield and quality, with optimal results observed at moderate application rates. Effective management of soil salinity through these combined approaches can mitigate adverse effects and improve sugarcane productivity and sustainability.