Myoglobinuria: evaluation of methods in the clinical diagnosis acute renal failure.

Patients with red--brown urine which may be a sign of myoglobinuria, can develop acute renal failure. We assayed serum creatinine, blood urea nitrogen (BUN) and creatine kinase activity in a total of 33 patients of equal groups, A (automobile accident), B (trauma) and C (undergoing rhabdomyolysis). In addition we tested 132 urine samples for the presence of myoglobin using a dipstick assay. Only five patients in group A showed any sign of myoglobinuria with increased creatine kinase activity upto 7 times the normal value but their serum creatinine level and BUN were within the normal range. In contrast, all 22 patients in group B and C showed myoglobinuria and above normal concentrations of serum creatinine and BUN, with significantly increased (p < 0.0001) creatine kinase activity upto 150 times the normal range. Four of the most seriously ill patients in group C developed acute renal failure. Supplementation of routine determinations of serum creatinine and BUN and serum creatine kinase activity with a rapid test for myoglobinuria provides an extra indication of impending renal dysfunction. It may be beneficial in the emergency management of these patients.

Hypomagnesemia and clinical implications in children and neonates.

The prevalence of hypomagnesemia was studied in neonates and children. The specimens were selected randomly from those submitted to the clinical chemical laboratory for blood test. A serum magnesium concentration less than 0.74 mmol/L was considered hypomagnesemic. A total serum magnesium determinations of 910 patients showed that 188 (21.7% prevalence rate) patients contained low serum magnesium levels. Frequently encountered hypomagnesemia was found among neonates with clinical conditions as diarrhea 41 (21.8%), premature births 24 (12.8%), neonatal hepatitis 20 (10.6%) and respiratory distress syndrome 5 (2.7%). In children the clinical conditions most frequently encountered with low serum magnesium were seizure 30 (16%), renal disease 26 (13.8%), metabolic acidosis 18 (9.6%), ideopathic apnea 14 (7.4%) and tachycardia 10 (5.3%). The statistical analysis of low serum magnesium values of patients in various clinical groups showed a significant difference (p < 0.0001) upon using homogeneity of variances but this was insignificant with the application of Kruskal-Wallis 1-Way ANOVA since Chi-square = 12.5748.

Dyslipidemia: clinical approaches, evaluation of methods and strategies for standardization.

Disorders in lipid metabolism (dyslipidemia) can result to the chronic heart disease. The low density lipoprotein (LDL) is a critical subfraction of total cholesterol present in serum because it is directly linked to coronary heart disease (CHD). The growing awareness of the risks of CHD stipulates the need for more accurate and precise measurement of LDL cholesterol. Current approaches in diagnosing and monitoring CHD is largely dependent on calculated LDL (CLDL) value due to the inherent complexity of ultracentrifugation method. While friedwald's calculated formula may provide comparable values with ultracentrifugation method, it may provide a result which is different. This difference may be of clinical significance. The lipoprotein electrophoresis may be useful in measuring LDL cholesterol, in the diagnosis of type III hyperlipidemia (broad beta band) and when the triglyceride level exceeds 400 mg/dl. The result that compares the CLDL with that obtained by the electrophoresis showed a significant difference (P > or = 0.000) for LDL and insignificant difference (P = 0.068) for high density lipoprotein (HDL) cholesterol.

Metabolism of magnesium in health and disease.

Magnesium (Mg) is an intracellular cation. It is an essential element which catalyses more than 300 enzymatic reactions, in particular those involving ATP. Approximately half of the total Mg in the body is present intracellularly in soft tissues, and the other half is present in bone. Serum Mg determination represents only 1% of total body's Mg concentration. Modern instruments will soon be available to determine physiologically active intracellular ionised Mg. Despite the ubiquitous nature of Mg, low serum Mg occurs either from decreased absorption or due to increased excretion. Hypomagnesaemia is surprisingly common in hospital populations and is more prevalent in acute than in chronic cases but often remains undetected or overlooked. Magnesium deficiency may result in hypokalaemia and hypocalcaemia. Myocardial Mg depletion may result in influx of Na+ and Ca+2 into the mitochondria which may lead to myocardial cell death. Hence, low Mg concentration may be a factor for a wide variety of clinical conditions.