Sodium Supplementation Research Articles

Oral Exposure to Sodium Chloride without Subsequent Consumption Does Not Alter Salt Taste Function in Adults: A Cross-Over Intervention Study

BackgroundReduction in dietary sodium increases salt taste sensitivity; however, non-oral sodium supplementation does not, suggesting that oral exposure is more important for modulating taste perception than consumption without tasting. ObjectiveUsing psychophysical methods, we assessed the effect of a two-week intervention involving oral exposure to a tastant without consumption on modulating taste function. MethodsIn a cross-over intervention study, n = 42 adults (age, mean ± SD: 29.7 ± 8.0 years) completed 4 intervention treatments requiring participants to rinse their mouths with 30 mL of a tastant, 3 times daily for 2 weeks. Treatments included oral exposure to 400 mM sodium chloride (NaCl), monosodium glutamate (MSG), monopotassium glutamate, and sucrose. Participants’ taste function for salty, umami, and sweet [detection threshold (DT), recognition threshold (RT), and suprathreshold (ST)], and the glutamate-sodium discrimination status was evaluated before and after the tastant treatments. Effects of the interventions on taste function were assessed by using linear mixed models including treatment, time, and treatment x time interactions as fixed effects; significance was set at P > 0.05. ResultsThere was no treatment × time interaction on DT and RT for all tastes assessed (P > 0.05). The only change in ST was following the NaCl intervention, participants’ salt ST decreased at the highest concentration (400 mM) compared with the pre-NaCl treatment taste assessment (mean difference (MD): −0.052 [95% CI: −0.093, −0.010] labeled magnitude scale, P = 0.016). Compared with the pre-MSG treatment taste assessment, participants improved their ability to perform the glutamate-sodium discrimination task after the MSG intervention (MD:1.64 [95% CI: 0.395, 2.878] correct discrimination tasks, P = 0.010). ConclusionSaltiness of an adult’s free-living diet is unlikely to influence salt taste function, as oral exposure without consumption to a salt concentration greater than normally found in food, only attenuated taste responses to highly salty stimuli. This provides preliminary evidence that regulating salt taste function may require a coordinated response between oral activation and consumption of sodium.

Feeding trial evaluation of supplemental sodium and calcium use by pigeons

AbstractThe Pacific Coast band‐tailed pigeon's (Patagioenas fasciata monilis) conspicuous and well documented use of supplemental minerals has allowed wildlife managers to conduct counts of pigeons at sites with minerals to index their abundance; but despite at least 9 associated peer‐reviewed research publications since 1998, the reason that band‐tailed pigeons use mineral sites and necessity of that use remains unknown. I conducted feeding trials with pigeons during summers of 2009 and 2010 to evaluate maintenance and reproductive performance associated with access to supplemental minerals: one with 24 pairs of wild‐caught band‐tailed pigeons, and one with 30 pairs of wild‐caught rock pigeons (Columba livia). Data indicate that red elderberry (Sambucus racemosa var. arborescens) and cascara (Rhamnus purshiana) berries (natural food items) are high energy food sources for band‐tailed pigeons, and that band‐tailed pigeons can thrive on these berries without access to supplemental sodium and calcium. However, access to supplemental sodium could offer band‐tailed pigeons advantages in body weight maintenance or gain when consuming a diet low in sodium and high in potassium. Band‐tailed pigeons did not nest in this study; thus, it remains unknown if there are benefits to reproductive performance from access to supplemental minerals. Rock pigeons with access to supplemental sodium fledged ≥33% more young than those pigeons without access to supplemental sodium, and this was primarily associated with the increased number of clutches and increased fledging rate. Also, fledgling mass was greater ( ± SE = 35.5 ± 7.9 g, 95% CI = 19.3–51.8) for rock pigeons with access to supplemental sodium at fledging in 2010, but the difference was not statistically significant in 2009 (5.9 ± 22.9, 95% CI = − 43.2–55.0) possibly because of the nutritionally limited diet that year. Access to supplemental sodium could offer band‐tailed pigeons advantages in fecundity and hatchling survival rates (recruitment) through increased efficiency in food conversion. Natural mineral sites used by band‐tailed pigeons should be conserved until additional information is available for evaluation. Also, comparison of counts of band‐tailed pigeons at mineral sites over time and among sites must be interpreted cautiously until the factors (e.g., diet, weather, accessibility, supplemental mineral concentration, etc.) that influence the proportion of the local band‐tailed pigeon population that uses mineral sites can be determined.

Prevention of Hyponatremia After Transsphenoidal Surgery: A Systematic Review

Context: Pituitary adenomas are amongst the most common tumors with a low mortality rate compared to other intracranial malignancies. Delayed hyponatremia (DH) is a common finding after transsphenoidal resection (TSS), which is the basis for the management of these tumors. Although DH is one of the leading causes of readmission after TSS, no unified guidelines exist with regard to the prevention of this electrolyte disturbance. Objectives: This study aims to evaluate and compare existing preventive protocols for DH in order to identify and signify their common grounds. Methods: After a search in electronic databases, including PubMed (NCBI), Embase, Scopus, and Google Scholar with the keywords of “pituitary adenoma,” “hyponatremia,” “transsphenoid surgery”, “water electrolyte balance,” “patient readmission", six original articles were included in the study. Results: We found that a protocol that both identifies groups susceptible to DH (males, older individuals, and those with a lower BMI) and consists of fluid restriction, sodium supplementation, and regular serum sodium monitoring could be utilized to prevent DH in patients with pituitary adenomas after TSS. Conclusions: Further studies with a larger sample size must be conducted to compare existing protocols for preventing DH and also investigate post-surgery optimal fluid-restricted diets and corticosteroid therapy in these patients.

Hyponatremia after neuroendoscopic skull base tumor surgery: Clinical characteristics and nursing management.

The current study was conducted to explore the clinical characteristics of hyponatremia after neuroendoscopic skull base tumor resection, and to summarize the nursing experience and provide insight for nursing management. In total, we enrolled 181 patients who underwent neuroendoscopic resection of skull base tumors in the Department of Neurosurgery of our hospital from 2016 to 2021. The patients' general data and parameters, including blood sodium level, polyuria, and other symptoms in different periods after surgery, were retrospectively reviewed. Forty-four patients developed hyponatremia after Surgery. The total incidence of hyponatremia was 24.30%, including 38 cases of mild hyponatremia and 6 cases of moderate and severe hyponatremia. Most cases of moderate and severe hyponatremia occurred 6 days after surgery. The incidence of hyponatremia varied in different pathological types and periods in patients undergoing skull base tumors. After standardized sodium supplementation, water restriction, and urine volume control, hyponatremia was corrected in all patients, and no osmotic demyelination syndrome (ODS) and nursing-related events occurred. Secondary hyponatremia after neuroendoscopic resection of skull base tumors can occur in various time periods after surgery. Early monitoring of manifestations and standardized intervention are thus necessary for clinical nursing practice to timely correct hyponatremia and avoid demyelination.

Multiple System Atrophy with Syndrome of Inappropriate Antidiuretic Hormone

Multiple System Atrophy (MSA) is a rare neurodegenerative disease which mainly affects extrapyramidal system, cerebellum and autonomic nervous system as well as hypothalamus. Hypothalamic disturbances can lead to the Syndrome of Inappropriate Antidiuretic Hormone (SIADH) and resultant hyponatremia. MSA with SIADH is rarely reported. We reported a 71-year-old woman was admitted to our hospital because of fever for two months. She was diagnosed with probable multiple system atrophy based on poorly L-Dopa responsive parkinsonism, urinary incontinence and orthostatic hypotension. Hyponatremia, and the urine sodium and osmolality increased indicating that she had SIADH at the same time. Hyponatremia was corrected after water restriction and sodium supplementation. In this report, we describe the clinical characteristics and treatment in regard to MSA with SIADH.

Congenital chloride diarrhea presenting as dilated fetal bowel loops.

Congenital chloride diarrhea presenting as dilated fetal bowel loops.

Risk of pre-existing hyponatremia and mortality in patients with traumatic brain injury across age groups

Traumatic brain injurySodiumClinical outcomes.

Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

BackgroundHyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH.MethodsWe prospectively identified consecutive...

Effects of sodium and magnesium supplement on lipid production and wastewater treatment by Rhodosporidium toruloides

Effects of sodium and magnesium supplement on biolipid production simultaneously with wastewater treatment by Rhodosporidium toruloides were investigated using synthetic wastewater with the composition similar to the mixture of real distillery and domestic wastewater. When Mg2+ was supplemented as MgCl2 at 200 mg/L, both lipid production and wastewater treatment were enhanced. The biomass and lipid production increased from 6.48 ± 0.69 and 0.96 ± 0.13 g/L to 7.78 ± 0.58 and 1.35 ± 0.02 g/L, respectively. The removal efficiencies for chemical oxygen demand (COD) and total phosphorus (TP) also increased from 72.09 ± 3.32 and 19.57 ± 2.51% to 79.20 ± 1.13 and 23.19 ± 3.07%, respectively. These increases were considered mainly due to the important role of Mg2+ in lipid synthesis, phosphate transfer, and carbohydrate metabolism. In comparison to Mg2+, the effect of Na+ depended on the supplement form. When 200 mg/L Na+ were provided as NaCl, maximum lipid production was 2.66 ± 0.11 g/L while only 1.98 ± 0.63 g/L when Na + provided as Na2SO4. For a better lipid production, the optimal concentrations of both Mg2+ and Na+ were considered around 200 mg/L. Both sodium and magnesium supplement did not show any obvious negative impact on biodiesel quality. The estimated values of important parameters of biodiesel with sodium or magnesium supplement met ASTM D6751 standard.

Effect of nutritional supplementation on mortality in peritoneal dialysis patients: A meta-analysis.

Malnutrition is a common clinical problem in peritoneal dialysis (PD) patients and is a predictor of mortality. This work analyzes the effect of nutritional supplementation for PD patients on all-cause and cardiovascular disease (CVD)-related deaths by meta-analysis. A study about nutritional interventions for PD patients on all-cause or CVD-related mortality is included. Eight studies were included. The results showed that nutritional intervention can reduce all-cause mortality in PD patients (HR, 0.71; 95% confidence interval (CI), 0.64-0.79; p < 0.01). In CVD-related mortality, the results also showed that nutritional interventions significantly reduce CVD-related mortality (HR, 0.75; 95% CI, 0.64-0.87; p < 0.01). In exploratory analysis, vitamin D, folic acid, and high-plant-protein ratio intake have relative advantages. Appropriate nutritional supplementation to PD patients can effectively reduce all-cause and CVD- related mortality in clinical practice, especially for vitamin D, folic acid, sodium supplements, and a high proportion of plant protein.

Hypernatremia is associated with poor long-term neurological outcomes in out-of-hospital cardiac arrest survivors

BackgroundBrain oedema after cardiac arrest is strongly associated with poor neurological outcomes. Excessive sodium supplementation may increase serum osmolarity and facilitate brain oedema development in cardiac arrest survivors. We aimed to investigate the association of serum sodium levels with long-term neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. MethodsThis retrospective observational study used a multicentre prospective cohort registry of OHCA survivors collected between December 2013 and February 2018. We analyzed the association of serum sodium levels at the return of spontaneous circulation (ROSC) (Sodium 0H) and at 24 h after ROSC (Sodium 24H) with 1-year neurological outcomes in OHCA survivors. Patients with 1-year cerebral performance categories (CPC) 1 and 2 were included in the good outcome group while those with CPC 3, 4, and 5 were included in the poor outcome group. ResultsAmong 277 patients, 84 (30.3%) and 193 (69.7%) were in the good and poor outcome groups, respectively. Compared with the good outcome group, the poor outcome group showed significantly higher Sodium 24H levels (140 mEq/L vs. 137.4 mEq/L, p < 0.001). Increased serum sodium levels per 1 mEq/L increased the risk of poor 1-year CPC by 13% (adjusted odds ratio = 1.13; 95% CI, 1.04⎼1.23; p = 0.004). ConclusionsRelatively high Sodium 24H levels showed a strong and independent association with poor long-term neurological outcomes in OHCA survivors. These findings may be applied in therapeutic strategies for improving neurological outcomes in OHCA survivors.

Vaptans for oedematous and hyponatraemic disorders in childhood: A systematic literature review.

The aim of this study was to systematically review the use of vaptans (nonpeptide vasopressin receptor antagonists) in children. Through a database search (Web of Science, the National Library of Medicine, Excerpta Medica), we identified case series and case reports and extracted clinical and laboratory data. Twenty-six articles, published since 2008, reported on 226 patients. Among 115 children with hyponatraemic (n = 63) and oedematous disorders (n = 52), a 48 hour course of tolvaptan with an initial dose of 0.38 ± 0.27 mg/kg was administered in 106 cases, while intravenous conivaptan was reported in nine cases. An increase (P < .02) in urine output was shown in both oedematous (from 3.2 ± 2.0 to 5.3 ± 6.7mL/kg/day) and hyponatraemic (from 3.0 ± 1.5 to 4.4 ± 2.3mL/kg/day) patients. In these latter, sodium increased from 125 ± 6 to 133 ± 6mmol/L (P < .0001). The increase in sodium level correlated with its basal value, but not with the administered vaptan dose. Among 111 children undergoing cardiac surgery, after tolvaptan 0.21 ± 0.01 mg/kg/day, mostly combined with conventional diuretics, an increase in diuresis by 41 ± 4% was seen within 24 hours (P < .0001). Similarly, a single add-on dose of tolvaptan 0.45 mg/kg allowed a reduced additional intravenous furosemide administration (0.26 ± 0.23 vs 0.62 ± 0.48 mg/kg, P < .005). Side effects were rarely reported, and included excessive thirst and xerostomia in seven, skin rash in one and elevated aminotransferases in one patient(s). Vaptans appear to be safe for oedematous and hyponatraemic disorders also in children. Although they increase diuresis and natraemia, no superiority to traditional diuretics and sodium supplements has been demonstrated. Reported side effects are rare and non-serious.

Low Sodium Supply in Early Life Causes Growth Restriction and Programs Long‐Term Changes in Energy Homeostasis

Preterm birth is a risk factor for the development of a multitude of diseases later in life. Preterm infants are also at risk for growth failure following parturition, which further compounds the adverse effects of preterm birth. Previous studies have shown that prematurely born human infants’ kidneys are inefficient at retaining sodium, therefore putting these infants at high risk of sodium depletion. We have developed a “post‐wean” dietary manipulation to model early‐life sodium depletion. In this model, mice are fed variations of soy‐free 2920x diet (Teklad); low‐sodium (0.04% Na, n=6), or high/normal‐sodium (0.30% Na, n=8), from weaning at week three of life, until week six of life. At six weeks of age, all mice are switched back to the “standard” 2920x diet (0.15% Na). Food and water intake behaviors, physical activity, energy expenditure, and body composition of the mice were serially analyzed using a multiplexed phenotyping system (Promethion, Sable Systems International) and time‐domain nuclear magnetic resonance (NMR; Bruker LF110). Mice supplied low‐Na between 3‐6 weeks of age exhibited delayed growth during weeks 3‐6, then rapid “catch‐up growth” following return to “normal” diet in week 6, and similar growth kinetics to the high‐Na group thereafter (diet x age interaction p&lt;0.01). The delay in body mass expansion in the low‐Na group was due to a decrease in fat‐free mass (diet x age interaction p&lt;0.01). Mice fed low‐Na diet exhibited reduced food intake (diet p&lt;0.01), due to slower eating speed (diet p&lt;0.01) and meal size (diet p=0.01). The reduced food intake relative to body composition was sustained through 18 weeks of age (diet x age interaction p=0.93). Water intake was also increased in mice treated with low‐Na diet both during diet intervention and through 18 weeks of age (diet p&lt;0.01), due to an increased number of drinking bouts (diet p&lt;0.01) of comparable size (diet p=0.46). Total aerobic energy expenditure was increased in mice fed the low‐Na diet, even after correction for body composition (diet p&lt;0.01). Mice treated with low‐Na diet in early life also exhibited an increase in energy expenditure that was maintained through 18 weeks of age (diet x age p&gt;0.99), even after correction for body composition and for differences in food intake. Finally, mice treated with low‐Na diet demonstrate a reduction in calories that are unaccounted for by these methods (diet p&lt;0.01, diet x age interaction p=0.68). In conclusion, post‐wean sodium depletion causes growth failure and changes in body composition that parallel premature human infant growth failure. Profoundly, this relatively simple 3‐week diet switch causes changes in intake behaviors and energy expenditure that are then “programmed” for at least another 12 weeks after switch back to a “normal” diet. These findings support our working hypothesis that early‐life sodium supply impacts energy homeostasis and growth kinetics and prompts reconsideration of current guidelines concerning sodium supplementation to prematurely born and low‐birthweight infants.

133 Effects of Benzoic Acid and Sodium Benzoate Supplementation on Growth Performance of Nursery Pigs

Abstract This study was to investigate the effects of dietary supplementation of benzoic acid and sodium benzoate on growth performance of nursery pigs. A total of 432 pigs (6.9 ± 0.9 kg BW) were assigned to 8 treatments (6 pigs/pen, n = 9) in a randomized complete block design with initial BW as a block and fed for 41 d in 3 phases (7/17/17 d, respectively). Treatments were 1) basal diet (BD), 2) BD + antibiotic, 3) BD + 0.30% sodium benzoate, 4) BD + 0.40% sodium benzoate, 5) BD + 0.60% sodium benzoate, 6) BD + 0.25% benzoic acid, 7) BD + 0.35% benzoic acid, and 8) BD + 0.50% benzoic acid. Diets contained nutrients meeting the requirement. Growth performance and fecal score were measured for each phase. Pigs representing each pen were euthanized to collect stomach and intestinal digesta to measure pH, and urine to measure pH and hippuric acid content. Data were analyzed using contrasts in Proc MIXED and slope ratio in Proc GLM of SAS. Increasing supplemental sodium benzoate showed a quadratic response (P &amp;lt; 0.05, max at 339 g/d) on ADG and linear increase (P &amp;lt; 0.05, 514 to 578 g/d) in ADFI. Increasing supplemental benzoic acid tended to have a quadratic response on ADG (P = 0.094, max at 323 g/d), but no difference in ADFI. Urine pH linearly decreased (P &amp;lt; 0.05, 7.5 to 5.7) with increasing supplemental benzoic acid, but was not affected by supplemental sodium benzoate. Increasing both supplemental sodium benzoate and benzoic acid linearly increased (P &amp;lt; 0.05) hippuric acid content in urine (3.0 to 10.4 and 3.0 to 9.2 g/L, respectively). With the slope-ratio assay using ADG and urine hippuric acid as dependent variables and benzoic acid intake as an independent variable, the estimates of bioavailability of benzoic acids were not different between sources. In conclusion, supplementation of sodium benzoate and benzoic acid increased growth performance without differences in efficacy between the sources.

A review of risk factors and prevention strategies for exercise associated hyponatremia.

Exercise-associated hyponatremia (EAH) is defined as a serum sodium concentration under 135mmol·L-1 during or within 24h of exercise. Increasing interest in endurance events has led to a higher number of athletes presenting with this potentially life-threatening condition. EAH is largely caused by the overconsumption of hypotonic fluids leading to weight gain during exercise. The primary risk factors include the inappropriate secretion of arginine vasopressin, longer exercise duration, smaller body mass, and to smaller extent ingestion of non-steroidal anti-inflammatory drugs. Accurate tracking of fluid intake and losses to prevent weight gain during exercise, sodium supplementation, and heat acclimatization may help attenuate declines in serum sodium concentration during exercise.

Giant cystic hypothalamic hamartoma in an infant associated with persistent syndrome of inappropriate antidiuretic hormone secretion

A giant hypothalamic hamartoma (GHH) is a rare congenital malformation only reported in a few cases in the literature and is often associated with precocious puberty, gelastic seizures, or less commonly, Pallister-Hall syndrome. Persistent syndrome of inappropriate antidiuretic hormone secretion (SIADH) is very rare in infancy, and most patients with GHH do not develop persistent SIADH, usually only transient electrolyte disturbances postoperatively. Previous cases of GHH have not been associated with persistent derangements in antidiuretic hormone levels. A 7-month-old male infant presented to our hospital with a history of an intracranial cystic lesion diagnosed at 23weeks gestational age (GA), later impressed as a solid-cystic mass at 37weeks GA by ultrasound prenatally. Postnatal MRI after birth showed a large mass with a dorsal cyst occupying the hypothalamus, causing hydrocephalus and brainstem compression. The patient started to have subtle seizures on the seventh day after birth and eventually developed dacrystic seizures. Hyponatremia with persistent SIADH was observed at 3months of age before surgery. He received long-term oral sodium supplementation, polytherapy of anti-epileptic medications, ventriculocystostomy for progressive enlargement of the cystic cavity, and later surgical treatment for disconnection and partial resection which confirmed a histological diagnosis of hypothalamic hamartoma. In this case study, we present a novel association of GHH with persistent SIADH and a rare presentation of a cystic component at the dorsal part of the tumor. Clinicians should be aware of this potential endocrine derangement and provide emergent treatment.

Micronutrient Intakes and Health Outcomes in Preterm Infants.

Deficiency or excess of specific micronutrients is common in preterm infants and can have many effects on health outcomes, ranging from life-threatening electrolyte disturbances to long-term effects on growth, brain development, bone health, and the risk of retinopathy of prematurity (ROP). Iron supplementation of low birth weight infants reduces the risk of behavioral problems. However, due to the risk of adverse effects, iron supplementation of very preterm infants in the NICU should be individualized, considering birth weight, postnatal age, diet, and serum ferritin concentrations. Sodium intakes should be minimized during the first 3 days of life in very preterm infants to avoid hypernatremia. However, after 4 days of age, sodium supplements can reduce hyponatremia and improve growth. Adequate parenteral and enteral calcium and phosphorus intakes are crucial for the prevention of osteopenia of prematurity. Screening of serum phosphate concentrations is useful. Deficiencies of docosahexaenoic acid (DHA) and arachidonic acid (AA) are frequently observed in extremely preterm infants. A recent Swedish study suggests that combined DHA and AA supplementation may reduce the risk of severe ROP. When prescribing enteral and parenteral nutrition for preterm infants, it is important to consider micronutrients. Many preterm infants will need different micronutrient supplements.

An industrial pathway to emerging presodiation strategies for increasing the reversible ions in sodium-ion batteries and capacitors

Sodium-ion batteries (SIBs) and capacitors (SICs) have been drawing considerable interest in recent years and are considered two of the most promising candidates for next-generation battery technologies in the energy storage industry. Therefore, it is essential to explore feasible strategies to increase the energy density and cycling lifespan of these technologies for their future commercialization. However, relatively low Coulombic efficiency severely limits the energy density of sodium-ion full cells, particularly in the initial cycle, which gradually decreases the number of recyclable ions. Presodiation techniques are regarded as effective approaches to counteract the irreversible capacity in the initial cycle and boost the energy density of SIBs and SICs. Their cyclic stability can also be enhanced by the slow release of supplemental sodium and high-content recyclable ions during cycling. In this review, a general understanding of the sodium-ion loss pathways and presodiation process towards full cells with high Coulombic efficiency is summarized. From the perspectives of safety, operability and efficiency, the merits and drawbacks of various presodiation techniques are evaluated. This review attempts to provide a fundamental understanding of presodiation principles and strategies to promote the industrial development of SIBs and SICs.

Minerals in gastroliths and foods consumed by band‐tailed pigeons

AbstractBand‐tailed pigeons (Patagioenas fasciata) congregate at and use mineral sites (mineralized water or soil) primarily within the breeding range of the Pacific Coast band‐tailed pigeon (P. f. monilis), but the Interior band‐tailed pigeon (P. f. fasciata) generally does not exhibit this behavior. Differences in supplemental minerals used between subspecies could be explained by differences in the diet (grit and foods) of these birds between their regional ranges. We necropsied 1,169 band‐tailed pigeons and sampled 35 primary foods of band‐tailed pigeons in the United States range of the Interior (AZ, CO, NM, and UT) and Pacific Coast (CA, OR, and WA) band‐tailed pigeons to evaluate regional differences in mineral and moisture in gastroliths and food items, and the association of grit with food items consumed. Grit and food types consumed by pigeons were similar between subspecies, but grit amount varied with foods consumed and food items varied with season and region in association with plant distribution and phenology. Gastroliths contained small amounts (≤3.3% each) of calcium, sodium, and potassium and were smooth and polished, indicating relatively long‐term retention and use primarily in food abrasion. Foods universally contained low amounts of sodium (0–328 ppm), moderate calcium (100–7,250 ppm), and high potassium (4,400–22,600 ppm), but varied somewhat with food type (e.g., acorns, berries, cultivated grains, pine seeds). Moisture and mineral content of grit consumed and foods used by Interior and Pacific Coast band‐tailed pigeons did not differ between their regional ranges in explaining differential use of supplemental mineral sites. Band‐tailed pigeon's use of supplemental sodium may not be necessary for survival and reproduction because Interior pigeons rarely use supplemental mineral sites unlike Pacific Coast pigeons despite similarities in moisture and mineral content of grit and foods consumed. Band‐tailed pigeons are able to concentrate sodium and calcium in crop milk to meet the nutritional needs of hatchlings despite a diet low in sodium and calcium.

Autoimmune encephalitis with coexistent LGI1 and GABABR1 antibodies: case report

BackgroundAutoimmune encephalitis (AE) with multiple auto-antibodies is of great clinical significance because its complex clinical manifestations and atypical imaging increase the difficulty of diagnosis, differential diagnosis and treatment, which may aggravate the disease, increase the recurrence rate and mortality. The coexistence of anti-Leucinie-rich Glioma Inactivated 1 (LGI1) and anti-γ-aminobutyric acid-beta-receptor 1 (GABABR1) has not been published before.Case presentationWe herein present the case of a 60-year-old man with slow response, behavioral changes, psychosis and sleep disorders. Laboratory test included serum hyponatremia, positive serum LGI1 and GABABR1 antibodies using transfected cell-based assays. Electroencephalogram exhibited moderate diffusion abnormality. The patient responded well to steroid impulse treatment and sodium supplement therapy, and did not recur during the follow-up.ConclusionsHere we report the first AE characterized by positive LGI1 and GABABR1 antibodies, as well as summarizing AE with multiple auto-antibodies reported so far, hopefully to provide experience for clinical practice.