Clinical Profile and Management of Hyponatremia among Patients Admitted to a Tertiary Care Hospital: A Cross-sectional Study

Background: Hyponatremia is one of the most common laboratory dispute which may occur in many clinical conditions. Hyponatremia complication may include significant co-morbidities like heart failure, liver cirrhosis, and nephrotic syndrome in addition to diuretic use.Material & Methods:This study was a retrospective cross-sectional study, conducted at the department of Medicine in Tairunnessa Memorial Medical College. The study was conducted during the period ofJanuary 2019- April 2022. The total sample size for this study was 94.Results:Most patients 24(25.5%) were aged between 41-50 years and followed by 5(5.3%) were aged 11-20 years. Most of the respondents 65(69%) were female and 29(31%) were male. Most of the respondents 49(52.1%) were housewife. Diarrhoea was seen in 50(53.2%) cases and followed by vomiting in 27(28.7%), nausea in 15(16%), general weakness in 10(10.6%), anorexia in 41(43.6%). HTN&BA, DM, CKD in 6(6.4%), severe pre eclampsia in 3(3.2%), chronic kidney disease in 2(2.1%), COPD in 2(2.1%). Hyponatremia was found mild in 68(72.3%) cases, moderate in 24(25.5%) cases and severe in 2(2.1%) cases and followed by Hypokalaemia (K+ <3.6 mmol/l) was found in 59(62.8%), normal K+ level in 31(33%) cases and mild-moderate hyperkalaemia in 3(3.2%) cases. Hypochloridaemia (Cl– <96 mmol/l) was found in 62(66%), normal Cl– level in 29(30.9%) cases andhyperchloridaemia in 3(3.2%) cases. Tab. Nacl was prescribed to 67(71.3%) patients, normal saline to 79(84%), Hypertonic saline (3% Nacl saline) to 5(5.3%), Cholera Saline to 3(3.2%) and others suggestion along with prescribed medicine was given to 94(100%) patients.Conclusions:Hyponatremia is one of the common electrolyte abnormalities which can be seen among hospitalized patients. It is mostly seen in elderly and critically ill patients who are admitted to the ICU.

Electrolyte changes induced by massive transfusion in patients undergoing cardiac surgery / 中国输血杂志

【Objective】 To investigate the effect of electrolyte concentration on transfusion related complications in patients undergoing cardiac surgery after short-term massive transfusion (MT). 【Methods】 Seventy-six cases of adult cardiac surgery in our hospital from January 2018 to December 2019 were collected. According to their perioperative blood transfusion units, they were divided into the massive blood transfusion group (red blood cell units≥ 10 U/ person) and the control group[red blood cell units (0~1)U/ person]. The concentrations of Na+ , K+ and Ca2+ ions in serum were detected by ISE (ion selective electrode method) and NM-BAPTA before and after intraoperative blood transfusion. The changes of Na+ , K+ and Ca2+ ions in serum before and after intraoperative blood transfusion were analyzed and compared through T-test. 【Results】 There were 38 patients in the MT group and 38 in the control group, and the demographic variables and types of surgeries (number) of patients in the two groups were comparable (P>0.05). The serum K+ , Ca2+ and Na+ before operation were similar (P>0.05), and within the normal range. The mean values of serum K+ , Ca2+ and Na+ (mmol/l) in the massive blood transfusion group and the control after operation (blood transfusion) were 4.25±0.44 vs 4.01±0.53, 2.31±0.12 vs 2.45±0.43, 140.82±2.31 vs 146.44±4.35 (P<0.05). In the control, the serum K+ , and Ca2+ were slightly lower than those before operation, while the Na+ was slightly higher (all P>0.05), and all were within the normal range. 【Conclusion】 Patients undergoing cardiac surgery are prone to suffer electrolyte disorders after massive blood transfusion. Electrolyte concentration should be monitored in time during and after perioperative blood transfusion.

Prepartum anionic diet induces hyperchloremic acidosis in high-producing dairy cows without preventing subclinical hypocalcemia / Dieta aniônica pré-parto provoca acidose hiperclorêmica em vacas leiteiras de alta produção mas não evita a hipocalcemia subclínica

In this study we evaluated the effects of the prepartum anionic diet on the electrolyte balance and calcemia of high producing dairy cows in the first days of lactation, and investigated the impact on the frequency of subclinical hypocalcemia (SCH). Sixty healthy Holstein cows, producing 30 kg of milk/day, handled in intensive system (compost barn), were distributed in groups (n=15) according to lactation order: first, second, third, and fourth to sixth. In the last three weeks before calving they received a diet with negative DCAD (-6mEq/100g DM) and high chloride content. After calving, they received a diet with positive DCAD (18mEq/100g DM). Urine pH was measured before calving. Serum Na+, Cl-, K+, and total Ca concentrations, and the strong ion difference (SID3) were determined in samples taken soon after calving (0h), 24, 48, 72 and 96h after. The frequencies of SCH were determined considering the critical value of 2.125mmol/L (8.5mg/dL). Two-way repeated measures ANOVA and chi-square test were used for comparisons. The cows eliminated acidic urine before calving. Na+, K+, Cl-, and SID3 values did not differ between groups. Na+ and K+ did not vary between days; Cl- was elevated at calving and decreased until 72h; and SID3 was reduced at calving and increased up to 48h. The Ca levels were reduced until 24h and increased up to 72h. Cows of third and fourth to sixth lactations presented lower values up to 24h. SCH was observed in almost half of the cows (43.3% to 55%) until 48h. The maintenance of hypocalcemia for three or more consecutive days occurred in 53.3% of third and fourth to sixth lactations cows. Ingestion of a high chloride prepartum anionic diet led to hyperchloremic acidosis and this imbalance was reversed on the second postpartum day. The induced effects on electrolyte and acid-base balances were not able to prevent the occurrence of SCH in the first days of lactation.(AU)

Os objetivos do estudo foram avaliar os efeitos que a dieta aniônica pré-parto provoca sobre o equilíbrio eletrolítico e sobre a calcemia de vacas leiteiras de alta produção nos primeiros dias de lactação, e verificar o impacto sobre a frequência da hipocalcemia subclínica (HSC). Sessenta fêmeas hígidas HPB, com produção de 30 kg de leite/dia, manejadas em sistema intensivo (compost barn), foram distribuídas por grupos (n=15) de acordo com a ordem de lactação: primeira, segunda, terceira e quarta a sexta. Nas três semanas pré-parto receberam dieta com DCAD negativa (-6mEq/100g MS) e teor de cloreto elevado. Após o parto receberam dieta com DCAD positiva (18mEq/100g MS). O pH da urina foi mensurado antes do parto. As concentrações séricas de Na+, Cl-, K+ e Ca total e a diferença de íons fortes (SID3) foram determinadas em amostras colhidas ao parto (0h), 24, 48, 72 e 96h após. As frequências de HSC foram determinadas considerando-se o valor crítico de 2,125mmol/L (8,5mg/dL). ANOVA de medidas repetidas e teste de qui-quadrado foram empregados para as comparações. As vacas eliminavam urina ácida antes do parto. Os valores de Na+, K+, Cl- e SID3 não diferiram entre os grupos. Na+ e K+ não variaram entre os dias; Cl- era elevado ao parto e diminuiu até 72h; e SID3 era reduzida ao parto e aumentou até 48h. A calcemia era reduzida até 24h e se elevou até 72h. Vacas de terceira e de quarta a sexta lactações apresentaram valores mais baixos até 24h. A HSC foi observada em quase metade das vacas (43,3% a 55%) até 48h. A manutenção de hipocalcemia por três ou mais dias seguidos ocorreu em 53,3% das vacas de terceira e de quarta a sexta lactações. A ingestão de dieta aniônica pré-parto com alto teor de cloreto provocou acidose hiperclorêmica e este desequilíbrio se reverteu no segundo dia pós-parto. Os efeitos induzidos sobre os equilíbrios eletrolítico e ácido base não foram capazes de prevenir a ocorrência de HSC nos primeiros dias da lactação.(AU)

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.

Electrolyte dysfunction in myocardial infarction patients

Background: Myocardial Infarction (MI) is the term given for a state of myocardial necrosis which is secondary to an acute interruption of the coronary blood supply. Severity is dependent on level of occlusion, length of time of occlusion and presence or absence of collateral circulation. Myocardial infarction is now considered part of a spectrum referred to as acute coronary syndrome. It is a spectrum of acute myocardial ischemia that also includes unstable angina (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI). The changes in serum electrolytes were studied in this study with a special focus on sodium and potassium serum levels in patients suffering from AMI. Hence, the aim of the study was to examine the changes in serum electrolytes among AMI patients and then comparison was done with the healthy persons.Methods: The study comprised of 80 subjects, which were divided equally into study group and control group. The study group comprised cases of confirmed diagnosis of recent onset of AMI. Clinical data was collected using interviewing questionnaires. The blood samples of both groups were analysed for serum electrolytes (Na+, K+, Cl-, Ca+ and Mg+) with the help of ion sensitive electrode analyser along with quality control sera.Results: There was statistically significant decrease in sodium and potassium levels in AMI patients. It was found that there was decrease in sodium serum levels in AMI patients suffering with hypertension. Potassium levels were increased in AMI patients suffering from Diabetes Mellitus and Hypertension, which was found to be statistically significant.Conclusions: Hyponatremia and hypokalemia are indicators of acute myocardial infarction. Serum sodium and potassium levels are prognostic indicators, i.e., rise in sodium levels after initial fall was indicative of clinical improvement. Therefore, estimation of sodium and potassium level in acute MI patients can help assess their prognosis.

Effect of Consumption of Artesunate and/or Palm Wine on Serum Electrolytes, Urea, Creatinine and Estimated Glomerular Filtration Rate

Aim: Artesunate (artemisinin derivative) prophylaxis is one of the preferred treatments for malaria including Plasmodium falciparum malaria in Nigeria as well as other tropical and subtropical countries. Also widely consumed in the tropics for its taste and alcohol content is palm wine. It is not uncommon to find some individuals on artesunate medication consuming palm wine with the belief that such a combination makes malaria treatment more effective. Therefore, this study is aimed at assessing the effects of artesunate intake and palm wine consumption on renal function. Study Design: Thirty participants aged 18 to 35 years were randomly assigned into 3 groups of 10 persons per group namely; palm wine and artesunate, palm wine only and artesunate only groups. Each group received their treatments for 7 days. Methodology: This study employs the use of pre-treatment and post-treatment design, with each subject serving as its control. Serum levels of electrolytes, urea, creatinine and estimated glomerular filtration rate (eGFR) were assessed before and after 7 days of treatment. Participants were all Africans (n=30) and were the staff of the Faculty of Basic Medical Sciences, University of Calabar. Results: Significant increase (p<0.05) in serum Na+ and a decrease in K+ levels above pretreatment values were observed in the palm wine and artesunate group. Creatinine concentrations of both palm wine and artesunate, as well as artesunate only groups, were significantly increased above control values. Creatinine clearance rate was significantly reduced (p<0.05) in the palm wine and artesunate group. Conclusion: Combined consumption of fresh palm wine and artesunate decreased creatinine clearance rate as well as eGFR. This decrease may be followed by a decline in the other renal function indices.

Serum Calcium, Magnesium And Potassium In Acute Diarrhoea Patients Coming To Pravara Rural Hospital

Introduction:Diarrhoea is a leading cause of morbidity and mortality across all age groups and regions of the world. Electrolyte imbalances are very common with the severity of acute diarrhoea. The aim of present study was to study the Serum Calcium, Magnesium and Potassium levels in patients of acute diarrhea.Materials and methods:This was a descriptive longitudinal study carried out in Department of Medicine, of PRH, Loni. Patients of diagnosed of acute diarrhea of age 18 and above of either gender willing to participate by giving written informed consent were includ-ed in the study. Patients with history of electrolyte abnormalities, history of chronic gastroenteritis, irritable bowel disease, congestive cardiac failure, liver cirrhosis, renal diseases, history of any disease deranging serum electrolyte levels and those on diuretics or any drugs which causes electrolyte imbalance were excluded from the study. Patients included in the study were subjected to demographic profile and serum electrolytes before and after treatment. Re-sults:100 patients were included in the study. Male patients were more in number (56) as compared to female pa-tients. Signs of dehydration were present in 70 patients. The patients suffering from hypokalemia, hyponatremia, hypocalcaemia and hypomagnesaemia were 23, 35, 78 and 84 respectively. Thus electrolyte imbalances are quite common in patients suffering from acute diarrhea. On comparing the serum Calcium, Magnesium and Sodium levels before and after treatment, statistically significant difference was seen. It was not significant for serum Potassium levels. Conclusion:Electrolyte imbalances are quite common in patients suffering from acute diarrhea. The serum electrolytes of patients suffering from acute diarrhea should be routinely examined to rule out electrolyte abnormali-ties and prompt treatment.

Haematological and Kidney Function Indices of Piliostigma thonningii Leaf Extract Administration Following Pefloxacin Induced Toxicity in Wistar Rats.

Aims: The study investigated haematological and kidney function indices of Wistar rats administered Piliostigma thonningii ethanol leaf extract after being induced with therapeutic doses of pefloxacin (400 mg/5 mL). Place and Duration of Study: Department of Medical Biochemistry, Cross River University of Technology, Okuku Campus, between August 2013 and June 2014. Methodology: Twenty four male Wistar rats weighing between 185-200 g were assigned into four groups. Administration was orally, with groups A (control), B and C receiving 0.5 mL each of distilled water, P. thonningii extract and pefloxacin respectively, while group D was co-administered P. thonningii extract and pefloxacin (1:1). The rats were sacrificed after 21 days and blood collected for study. Results: P. thonningii extract co-administration with pefloxacin produced a significant (P<0.05) increase in hematocrit (HCT), lymphocytes and neutrophils and a significant (P<0.05) decrease in platelets count compared with the rest of the groups. The effects of pefloxacin co-administration with P. thonningii extract on serum electrolyte and kidney function indices were not clear-cut, however creatinine levels were normal. Conclusion: Synergistic and antagonistic effects of pefloxacin co-administration with P. thonningii leaf extract were demonstrated. These effects when properly harnessed could be useful in the management of anaemic conditions, immune responses as well as bone demineralization relating to drug toxicity.

Effect of chronic Consumption of two Forms of palm oil diet on serum Electrolytes, Creatinine and urea in rabbits.

Palm oil is one of the most widely employed cooking oils in Nigeria today. This study compares the effects of long term consumption of the two forms of palm oil – fresh palm oil (FPO) and thermally oxidized palm oil (TPO) on serum electrolytes, creatinine and urea, which gives vital information on the state of the renal system. Eighteen male New Zealand rabbits weighing 750 – 1000 g were used for this study. They animals were randomly assigned one of three groups (n = 6) thus; control group, FPO fed group and TPO fed group. The control group received animal feed and clean water only. Fresh palm oil group received animal feed mixed with fresh palm oil in the ratio 85:15g respectively, TPO fed group received animal feed mixed with thermoxidised palm oil in the ratio 85:15g respectively. The feeding lasted for 6 months. Food intake, water intake and body weight were measured daily. At the end of the feeding period, the animals were sacrificed under chloroform anaesthesia and blood was collected for assessment of serum electrolytes, creatinine and urea. Results obtained showed that serum concentration of sodium was significantly (p<0.001) lower in FPO fed group, compared with control, but significantly (p<0.05) higher in TPO fed group, compared with control. Serum concentration of sodium was also significantly (p<0.001) higher in TPO fed group, compared with FPO fed group. Serum concentration of chloride was significantly lower in FPO fed group compared with control (p<0.05) and TPO fed group (p<0.001). Bicarbonate concentration was significantly (p<0.05) lower in FPO fed group, compared with control. Creatinine concentration was significantly higher (p<0.05) in TPO fed group, compared with control and FPO fed group. The observed changes in serum electrolyte and creatinine concentrations following 6 months of feeding was more in TPO fed group than FPO fed group, and is possibly detrimental to electrolyte balance.

Ameliorative Effects of Magnesium and Copper Sulphates on Blood glucose and Serum Electrolytes Levels in Fructose-induced Diabetic Wistar Rats.

The aim of this study is to evaluate the effects of magnesium and copper sulphates on blood glucose and serum electrolytes levels in fructose-induced diabetic Wistar rats. Diabetes was induced by administration of 20% (20g/100ml) of fructose dissolved in distilled water and administered to the animals for a period of six (6). After which the animals were randomly assigned into 4 groups of 6 rats each. Group I served as diabetic control and were administered distilled water, Group II were administered Magnesium sulphate (250 mg/kg b w), Group III were administered Copper sulphate (250 mg/kg b w) and Group IV administered Metformin (250 mg/kg b w). All treatments were given orally for a period of seven days. The results obtained showed a statistically significant decrease (p<0.05) in the blood glucose levels in groups administered with 250 mg/kg b w of magnesium and copper sulphate after day 3 and 7 when compared to diabetic control group. The results also showed that magnesium and copper sulphates at doses tested i.e 250 mg/kg b w, produced a significantly decreased (p<0.05). With regard to serum levels of sodium, potassium and bicarbonate ions when compared to diabetic untreated control group. However, there was no significant difference in the levels of serum chloride in the groups treated with 250mg/kg b w of magnesium and copper sulphate when compared to diabetic control group.

Effects of Rosiglitazone and Acarbose (with and without Cornstarch Diet) on Serum Electrolytes in Diabetic Rats.

The purpose of this study is to highlight potential risks associated with the use of oral hypoglycemics as monotherapy in treatment of type 2 diabetes mellitus. For this study 40 Wistar albino rats were equally divided into four groups. Group I served as diabetic control and II, III and IV were treated with acarbose with regular diet, acarbose with cooked cornstarch diet and rosiglitazone respectively. Diabetes was induced with a single dose of alloxan monohydrate IP at a dose of 150 mg/kg body weight. Drug samples were administered orally for a period of 4 weeks and effects of the drugs were studied on day 7, 15 and 30 for serum level of sodium and potassium. Results showed decrease in sodium and potassium level in all treated groups on day 7. On day 30 levels were increased in group II and IV but decreased significantly in group III. It has been concluded that chronic doses of rosiglitazone and acarbose with regular diet may cause abnormal levels of electrolytes which may cause irregular cardiac contractility. Administration of acarbose with cornstarch diet may be beneficial in regulating cardiac contractility.

Serum lipids, proteins and electrolyte profiles in rats following total body irradiation / Perfiles de lípidos, proteínas y electrolitos plasmáticos en ratas tras irradiación corporal total

OBJECTIVE: Serum lipid and electrolyte imbalances are common in critically ill patients undergoing radiation therapy. Although multiple disease states and medication may be responsible for the development of these disorders, the aim of this research is to sequentially document the effect of total body radiation on body function utilizing the sequential changes in the serum lipids, electrolytes and protein in rats. METHODS: Serum protein and lipids contents were assessed using kits while electrolytes were assessed with flame photometry in rats exposed to total body irradiations of 1.27 Gy/min in cumulative doses to the fourth irradiation at five-day intervals. RESULTS: Total cholesterol and triacylglycerols serum levels were significantly reduced by irradiation (p < 0.05). No significant differences between experimental and control groups for HDL-C serum levels were detected. Serum electrolyte concentration remained within the normal range after each total body irradiation. Sodium, bicarbonate and chloride were significantly (p < 0.05) higher than control while potassium and creatinine were significantly reduced after the first irradiation only. Sodium/potassium ratio was significantly (p < 0.05) elevated. Serum protein was significantly (p < 0.05) elevated with increasing radiation. CONCLUSION: There are subtle but significant changes in serum lipids, electrolytes and protein after total body irradiation of normal rats. These variations could be due to non-specific stress reactions; as such, they are important markers in radiation induced injury diagnosis.

OBJETIVO: Los desequilibrios de lípido y electrolito plasmáticos son comunes en los pacientes críticos sometidos a terapia radioactiva. Aunque los múltiples estados de la enfermedad y la medicación pueden ser responsables del surgimiento de estos trastornos, el objetivo de esta investigación es documentar de manera secuencial el efecto de la radiación corporal total sobre la función corporal, utilizando los cambios secuenciales en los lípidos, electrolitos y proteínas plasmáticos en las ratas. MÉTODOS: Los contenidos de lípidos y proteínas plasmáticos fueron evaluados utilizando kits, en tanto que los electrolitos fueron evaluados mediante fotometría de llama en ratas expuestas a irradiaciones corporales totales de rayos X de 1.27 Gy/min, en dosis cumulativas hasta la cuarta irradiación en intervalos de cinco días. RESULTADOS: El colesterol total y los niveles plasmáticos de triacilgliceroles fueron reducidos significativamente por la irradiación (p < 0.05). No se detectaron diferencias significativas entre; os grupos experimentales y de control en relación con los niveles plasmáticos de colesterol HDL. La concen-tración de electrolito plasmático se mantuvo dentro de los límites normales luego de cada irradiación corporal total de rayos X. La relación sodio/potasio fue significativamente elevada (p < 0.05). La proteína plasmática se elevaba significativamente (p < 0.05) al aumentar la radiación. CONCLUSIÓN: Tras la irradiación corporal total de las ratas normales, seproducen cambios sutiles pero significativos en los lípidos, electrolitos y proteínas del plasma. Estas variaciones podrían ser debidas a reacciones de estrés no específicas, y como tal, son marcadores importantes en el diagnóstico de las lesiones inducidas por la radiación.

Serum electrolyte changes in pediatric patients stung by scorpions

Scorpion sting is a health problem in some places of Mexico. The clinical manifestations of scorpion envenomation are variable and include metabolic alterations. Hyperkalemia is the most frequently reported metabolic alteration. We conducted a prospective, observational, descriptive and transversal study in an emergency room at Hospital del Niño Morelense, Mexico. Eighty-two patients were included and classified as mild (17 percent) moderate (33 percent) and severe (46 percent). The mean serum level of sodium was 146.4meq/l, standard deviation (SD) 5.58; potassium 3.86meq/l, SD 0.53, and calcium 9.55mg/dl, SD 0.76. We found 30.4 percent hypernatremia, 12 percent hypokalemia, 10.9 percent abdominal distension, and 14.6 percent visual alterations.

Effects of Transurethral Electrovaporization on Serum Electrolyte, Osmolality and Blood Loss / 대한비뇨기과학회지

PURPOSE: We did electrovaporization to reduce the absorbed volume of irrigant and bleeding during TURP, and compared the effects on intraoperative and postoperative serum electrolyte, osmolality, and blood loss between this method and the classic TURP. MATERIALS AND METHOD: Of the 45 BPH patients, 21 patients underwent TURP (Group l), while the other 24 patients were electrovaporized with vaportrode(Group ll). They were followed preoperatively, 30 min intraoperatively, immediate postoperatively, 6 hours and 24 hours postoperatively with measurements of serum sodium, potassium, glucose and BUN. The amount of absorbed irrigant, serum osmolality, effective osmolality, blood loss were calculated and compared between the two groups. RESULTS: Although the group ll showed a longer operation time and used a larger amount of irrigant than the group l, there was not a significant difference in the amount of blood loss between the two groups and lesser amount of irrigant was absorbed than the group l. There was not a significant decrease in postoperative serum Hb and Hct level compared with preoperative level in the group ll. Serum sodium level were significantly decreased during postoperative period every patients in the group l. The serum osmolality and effective osmolality levels were significantly decreased postoperatively as compared with the preoperative levels in the group l, but were not in the group ll. CONCLUSIONS: These results show that electrovaporization may be the effective method in preventing complications such as hyponatremia and hypoosmolality during perioperative period. This method may also be helpful in reducing blood loss.