Haematological profile of Chronic Kidney Disease Stage 5 patients undergoing maintenance Hemodialysis at a tertiary care centre.

Background: Kidneys play a central role in the regulation of body fluids, electrolytes and acid- base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. Timely intervention and effective management will minimize complications and can potentially be lifesaving. Aim: To study the haematological profile in patients of chronic kidney disease (CKD) Stage 5 undergoing haemodialysis and to correlate the relation if any, between the study parameters. Material and Methods: Study was conducted on 60 patients undergoing hemodialysis thrice a week. Complete hemogram, RFT, LFT, serum sodium, potassium, calcium and phosphorus values were obtained and their associations were statistically analysed. Results: Out of 60 patients studied, 20% (n=12) had hemoglobin values <8 g/dl, 36% (n=36) had 8-10 g/dl and 12% (n=12) had ?10 g/dl. 18% (n=11) had mild hyponatremia (130-135 mEq/L), 38% (n=23) had moderate (125-129 mEq/L) and 44% (n=26) had severe (<125 mEq/L) hyponatremia.80% of the study group (n=48) had serum calcium <9 mg/dl and 20% (n=12) had >9 mg/dl. 68% (n=41) of the patients had serum phosphorus >5.5 mg/dl and 32% (n=19) of them had <5.5 mg/dl. There was a significant positive correlation of serum sodium with serum calcium (r=0.752, p=0.0001), serum albumin (p=0.0001), hemoglobin (p=0.0001) and significant negative correlation with serum phosphorus (r=-0.730, p=0.0001), serum uric acid (p=0.003). Conclusion: Anemia, hyponatremia, hyperkalemia, hypocalcemia and hyperphosphatemia are most commonly seen in hemodialysis patients. Appropriate timely intervention can significantly prevent the long-term morbidity in such patients.

Risk Factors for Dyselectrolytemia in Children with Acute Diarrhoea in the Inpatient Setting in North India

Background: Dyselectrolytemia is a common accompaniment of acute diarrheal illnesses and contributes to increased morbidity and mortality. Aim: To study the incidence and identify the risk factors for developing dyselectrolytemia in children getting admitted with acute diarrhoea. Study design: Prospective observational study. Methods: Detailed history, examination, and investigations were recorded in specially designed proforma. Serum electrolyte levels were measured at admission in all the study subjects and correlated with clinical presentation and demographic profile. Results: Out of 107 children, 64.5% had no dehydration, 31.8% had some dehydration, and only 3.4% were severely dehydrated at the time of admission. Most common electrolyte abnormality were hyponatremia(25.2%) and hypochloraemia (25.2%), followed by hypokalaemia (11.2%), hyperchloremia (9.3%) and hypernatremia (6.5%). The degree of dehydration was found to significantly affect serum electrolyte profile (p value<0.05). Hyponatremia (41%), hypokalaemia(26.5%), and hypochloraemia(35%) were seen more commonly in patients with some dehydration, while a higher proportion of patients with severe dehydration had hypernatremia (50%) and hyperkalaemia (25%). Consumption of diluted ORS was significantly associated with the development of hyponatremia (73.9%), hypokalaemia(34.8%), and hypochloraemia(56.5%) p value<0.05. Conclusion: Dyselectrolytemia is a common accompaniment of diarrheal dehydration, the most common being hyponatremia. The severity of dehydration and dilute ORS administration are important risk factors for dyselectrolytemia.

Electrolyte disturbances and lipid profiles in ischaemic and hemorrhagic stroke patients in Aisyiyah Bojonegoro Hospital, Indonesia

Background: The prevalence of stroke continues to increase every year. Electrolyte imbalance and metabolic disorder can cause high morbidity and mortality of stroke. There are very few studies conducted on serum electrolytes and lipid levels in stroke patients. Authors aimed to know the electrolyte disturbance and lipid profiles in acute stroke.Methods: Retrospective case analysis was used in this study. Patients who diagnosed with hemorrhagic and ischaemic stroke in Aisyiyah Bojonegoro Hospital from January to September 2019 were selected trough electronic medical records system. Authors examine the electrolyte levels and lipid profiles. Patients with a previous history of stroke, complication that might affect electrolyte level and incomplete data in medical records were excluded. Independent T-test or Mann Whitney test were used to analyze the difference of parameters between hemorrhagic and ischaemic stroke patients. P value was considered as significant at p<0.05.Results: Most common electrolyte imbalance in both hemorrhagic and ischaemic stroke was hypokalemia which is statistically significant. Comparison between stroke patients was statistically significant for mean potassium and high density lipoprotein (HDL), while other mean serum values were not different. Potassium significantly lower (p=0.002) in hemorrhagic stroke and HDL significantly lower (p=0.034) in ischaemic stroke.Conclusions: This study reveals that hypokalemia was higher in hemorrhagic stroke and HDL was lower in ischaemic stroke. Regular monitoring of lipid levels in patients with high risk factors and correction of electrolytes imbalance for stroke patients will help in decreasing the mortality and morbidity.

Study on electrolyte disturbances in dengue fever in a tertiary care centre

Background: Dengue is a mosquito borne disease of significant morbidity and mortality. Dengue viral infection has been shown to be associated with electrolyte abnormalities and renal dysfunction. It is necessary to have a thorough understanding about electrolyte disturbances in Dengue, so as to predict, diagnose and treat them accordingly. The aim and objective of this study is to study electrolyte disturbances in dengue fever and its correlation with severity of dengue fever.Methods: This study was performed in a tertiary care centre in Bangalore , India. The study was a prosspective observational study. 200 Patients diagnosed with Dengue were enrolled for the study. Patients demographic data, clinical history, electrolyte values were recorded and analysed.Results: In our study majority of patients belonged to 5-12 years age group ie 47%. Fever was found to be the most common presentation in 196 patients (98%) followed by myalgia in 142 patients (71%), headache in 102 patients (51%), skin rash in 43 patients (21.5%). The mean value of serum sodium observed was 133.69 mEq/L and of serum potassium was 3.58 mEq/L and there was positive and significant correlation between difference in serum sodium and potassium levels with severity of dengue fever.Conclusions: Dyselectrolytemia is more common in dengue fever. Serum electrolytes testing early is very important in dengue patients during management so that if abnormalities are found, they can be appropriately managed as some of these abnormalities may lead to increased severity as well as mortality.

A Unusal Presentation Of Bartter Syndrome

Bartter Syndrome is a rare congenital disease that manifests as hypokalemia, hyponatremia and hypotension. The disease occurs due to defective genes that are responsible for the reabsorption of certain electrolytes in the renal tubules. Hence it results in salt-wasting dyselectrolytemia. By its inheritable nature, the usual presentation of the disease is in the infants and children. But this case report presents an adult with symptoms of Bartter Syndrome which was discovered by chance while the patient was being treated for Acute gastroenteritis. Adult onset of Bartter Syndrome is incredibly rare and has been reported only in few other cases.

A Hospital Based Observational Study on Clinical Profile of Hyponatremia in Elderly

Introduction: Hyponatremia, which is defined as a plasmasodium concentration less than (<) 135mmol/L, is a verycommon disorder and can occur in up to 22% of hospitalisedpatients. Its prevalence among non-hospitalised elderlypatients has been estimated to be between 7% to 11.4%,increasing to 11% to 22.5% among the hospitalised patients. Itis also the most common dyselectrolytemia seen in thegeriatric population which occurs due to impaired water andelectrolytes balance in response to diet, drugs andenvironmental changes.Aims and Objectives: The aims of the study were to describethe clinical features and different causes of hyponatremia inhospitalised elderly patients and to find out the types ofhyponatremia and to assess the short term outcomes duringhospital stay.Methods and Materials: The study was a hospital basedobservational study conducted in Medicine Department andGeriatric Regional Centre, Gauhati Medical College andHospital, Guwahati for a period of one year from August 2017to September 2018. Ethical clearance was obtained from theethical committee. A total of 106 patients with hyponatremiawere included in the study with aged greater than or equal to(≥) 60 years.Results and Observations: The mean age was 70.04 yearswith a standard deviation of 6.73 years. Male and Female ratiowas 1: 1.12. The mean serum sodium level was 124.8 mmol/Lwith a standard deviation of 5.8 mmol/L. Altered sensorium (48cases, 45.3%) was the most common presenting symptomfollowed by lethargy (21 cases ,19.8%). The most commonetiology was found to be SIADH (32 cases, 30.2%) followed byrenal failure (19 cases, 18%) and intake of drugs like diuretics(18 cases, 17%). Among SIADH majority of the cases werefound to have pneumonia (12 cases, 37.5%) followed by stroke(9 cases, 28.1%) and brain infections like meningitis andencephalitis (5 cases, 15.6%). In hyponatremia, majority of thecases was found to be in euvolemic status (55 cases, 51.9%).The overall mortality of hyponatremic patients was 8.5%. Shortterm outcomes in patients with comorbid condition like chronickidney disease was found to be significantly higher (pvalue=0.0396).Conclusion: Hyponatremia is a very common dyseletrolytemiaand clinical problem encountered in the elderly population andis associated with high morbidity and mortality particularlywhen associated with comorbidities.

Serum Electrolyte Level As A Marker Of Morbidity In Critically Sick Children: A Study From A Rural Tertiary Care Hospital

Objectives- To nd out the association between dyselectrolytemia and morbidity in critically ill children and also to evaluate the association between degree of hyponatremia and morbidity. Material And Methods- Children aged 1 month–12 yrs, admitted in Pediatric Intensive Care Unit (PICU) were included in the study. This was a hospital based, observational, cross sectional study. Morbidity was dened as PICU stay > 5 days. Results-Total 200 children aged 1 mo-12 yrs were included in the study. Abnormal serum sodium level and abnormal serum potassium levels were signicantly associated with increased hospital stay (p value 0.000). Association between degree of hyponatremia and hospital stay was also signicant. (p value 0.003). Conclusion-Electrolyte abnormalities are common in critically ill children and contribute to signicant morbidity

Study of effect of malaria parasitemia on serum electrolytes in south-east Rajasthan

Background: Malaria is a life threatening disease caused by Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Aim: To study of effect of malaria parasitemia on serum electrolytes in south east Rajasthan. Materials and methods: It was a hospital based study done on malaria indoor patients from June 2017 to March 2018 in Jhalawar Medical College, Jhalawar in South East Rajasthan. The relevant history, systemic examinations and thick and thin peripheral blood smear, malaria antigen detection rapid card test was performed and serum electrolytes like sodium, potassium and calcium level were done for all patients. All patients were categorized into three groups like P.falciparum, P.vivax and mixed infection (both P.falciparum, P.vivax). Results: We observed that female was out numbered than male. Most common affected age group was 35-45 years and most of the patients came from the rural region. Severe dyselectrolytemia was noted in mixed infection (both P.falciparum and P.vivax) and P.falciparum cases. Conclusion: Serum electrolytes level are influenced by the presence of all types of malaria severely with mixed infection and P.falciparum positive cases so severe dyselectolytemia in malaria infections should be treated timely to prevent grave complications

Acid-Base Imbalance and Dyselectrolytemia in Falciparum Malaria.

Malaria is re-emerging as the major infectious killer and it is the top priority tropical disease of the World Health Organization. Indian sub-continent harbours a global threat in the form of epicenter of multidrug resistant plasmodium falciparum. High prevalence of Complicated Falciparum Malaria in Costal Andhra Pradesh requiring ICU admission with high morbidity and mortality prompted this study. 60 cases of falciparum malaria in 3 sub groups, i.e, uncomplicated falciparum, severe falciparum with ARF, severe falciparum without ARF are taken. In Group-II, i.e, severe falciparum with ARF pts., mean serum potassium is 5.06 -hyperkalemia, mean PaO2 and PaCO2 are 80.33 and 32.75 respectively and mean bicarbonate value is 19.83, mean PH is 7.10, which reflects underlying metabolic acidosis and compensatory respiratory alkalosis, also mortality is 6 in Group-II out of total 9 deaths. Hence electrolytes and acid-base disturbance, especially hyperkalemia and acidosis are important cause of mortality in severe falciparum malaria. In acute renal failure setting, which is associated with both hyperkalemia and acidosis, prognosis is worsened. “Humanity has but three great enemies : fever, famine and war; of these by far the greatest, by far the most terrible, is fever(William Osler).