Radioimmunoassay of plasma cyclic guanosine monophosphosphate level and its clinical implications as anew marker of heart failure

Plasma levels of cyclic guanosine monophosphate [cGMP] was determined by radioimmunoassay in 69 patients with heart failure due to various causes and in 15 healthy control subjects. Patients were classified according to functional New York Heart Association based on the left ventricular ejection fraction into 3 groups I [mild] II [moderate]. III [severe]. cGMP levels were significantly increased in the 3 groups compared to the control group [p<0.001]. The results were related to severity being significantly higher in each of group II and III than group I [p<0.001] and in group II than group I [p<0.05]. cGMP levels correlated negatively [r = 0.65, p < 0.05] with left ventricular ejection fraction but showed no significant correlation with age or sex [p > 0.05]. A statistical significant increase [p < 0.001] was detected after symptom limited exercise test in 10 patients with mild heart disease. Results of eighteen patients with severe heart failure who improved on treatment showed a statistical significant decrease in cGMP [p < 0.001] when compared with results on admission. The cut-off level of 4.9 nmol/L showed the maximum diagnostic sensitivity and specificity using the receiver operating characteristic curve. We conclude that cGMP can be used as a useful tool in evaluation of cardiac function and monitoring the response of therapy

Some electrolyte disturbances in mechanically ventilated patients

Serum sodium and potassium were measured using the flame photometry and serum phosphorus by the calorimetric method before, during, and after withdrawal of mechanical ventilation in 20 GOAD patients. Ten patients who were not in need of mechanical ventilation were taken as a control, serum sodium and potassium and phosphorus were also measured on admission and before discharge. It was found that serum sodium was statistically significantly higher during mechanical ventilation comparable with its level before mechanical ventilation [P < 0.01] and with its level after withdrawal of mechanical ventilation [P < 0.05]. Serum sodium level was also higher in the 10 control patients before discharge from the respisatory intensive care unit, when compared with its level on admission [P < 0.05]. Serum potassium and phosphorus levels were found to be lower during mechanical ventilation when compared with their level before mechanical ventilation P < 0.001. There was no statistically significant change in serum potassium nor phosphorus in the control group. We conclude that mechanical ventilation may be associated with hypernatremia, hypokalaemia, and hypophosphatemia, and so it is necessary to estimate serum electrolytes frequently to correct any changes early and to avoid complications

Electrolytes profile in IDDM: special emphasis on calcium metabolism

This study was carried out to detect the changes in serum electrolytes including calcium, phosphorus, sodium and potassium in children with IDDM. Kidney functions as well as full urine examination were done together with the calcium in 24 hours urinary specimens to detect hypercalciuria and its relation to any kidney damage in these children. The study included 40 children, 22 males and 18 females [mean age 9.1 +/- 2.2 years]. They were classified into Group Ia and Ib i.e. those who did not present clinically and those who presented clinically with diabetic ketoacidosis. Twenty healthy children of the same age and socioeconomic status served as control group [Group II]. All children were subjected to full history taking and thorough clinical examination. They were investigated for random blood glucose, serum creatinine, serum alkaline phosphatase, serum electrolytes [sodium, potassium, calcium and phosphorus]. Urine was examined for glucose, nitrites, ketones, albumin and casts. A 24 hours urinary specimen was tested for calcium as well as for creatinine levels. The results showed significant increase in level of serum alkaline phosphatase in Groups Ia +Ib when compared to controls. There was no significant difference in serum sodium level in group Ia while a significant decrease was detected in Group lb when compared to control. There was no significant difference in levels of both groups Ia, Ib when compared to control group. There was significant increase in serum phosphorus in group Ia but no significant difference in group Ib when compared to controls. Serum creatinine showed no significant difference in both groups Ia, lb when compared to control group. Hypercalcemia was detected in both groups Ia and lb when compared to control group. Correlation studies were carried out between variants and showed significant positive correlation between glycosuria and hypercalcemia in group Ia and significant positive correlation was detected between ketonemia and hypercalcemia in group Ib and perfect positive correlation between urinary calcium excretion in mg/kg/24 hours and urinary calcium/creatinine ratio in both groups Ia and lb. No significant correlation was detected between duration of IDDM and height or weight percentiles and urinary calcium excretion in groups Ia and Ib. So routine laboratory examination of urinary calcium excretion is recommended in diabetic children to avoid or to early predict hypercalciuria in these children which may result in bone mineral toss and to formation of stones