Effect of controlled loss of 350 ml blood from human body on electrolytes and albumin levels – An observational study done in whole blood donors at a regional blood centre

Background: Researchers have studied the hemodynamic effect of hemorrhage widely but the biochemical alternations after blood loss are less explored. Knowledge about changes in electrolyte values after blood donation may help in assessing the effect on large quantity donations or massive hemorrhage. It may also be beneficial in donor counseling and reassurance. Aims and Objectives: Primary objective of the study was to quantify changes in plasma sodium, potassium, calcium, magnesium, and albumin before and after blood donation. Materials and Methods: Predonation electrolyte and albumin levels were tested in all study subjects as baseline and repeated after 45 min of completed blood donation. Both values were compared with paired t test in SPSS version 17. Results: After 45 min of donating 350 ml whole blood, no significant changes were observed in sodium and potassium levels. Reduction in calcium, magnesium, and albumin was 0.188 mg/dL, 0.0328 mg/dl, and 0.193 g/dl, respectively, which were statistically significant. About 15% of the blood donors were already deficient in magnesium. Conclusions: Calcium, magnesium, and albumin levels were reduced after blood donation but well maintained within the normal level and most of the donors had normal predonation levels. Hence, in large volume or repeated plasma donation and massive blood loss, baseline evaluation, and monitoring of these parameters may be worthwhile.

Ameliorating effects of ethanol extract of root bark of Salacia nitida on blood electrolyte and renal perturbations in Plasmodium berghei-infected mice

Abstract Malaria, a disease of public health concern is a known cause of kidney failure, and dependence on herbal medicines for its treatment is increasing due to the high cost of drugs. So this study is designed to evaluate the ameliorating effect of ethanol extract from Salacia nitida root bark on electrolyte and renal perturbations in Plasmodium berghei-infected mice. Thirty malariainfected mice divided into five groups of six mice each and another group of six uninfected mice were used for the study. 280, 430, and 580 mg/kg of extract were given to infected mice in groups B, C, and D, 4 mg/kg of artesunate given to group E mice, and 4 ml/kg of physiological saline given to group A and uninfected group F mice for five days. Serum Na+, K+, HCO3, Cl-, TB, urea, creatinine, BUN concentrations, and BUN/creatinine ratio were determined using standard methods. Results showed significant increases (p < 0.05) in Na+, K+, and HCO3 and decreases in Cl-, TB, urea, creatinine, BUN, and BUN/creatinine ratio in the infected treated mice in groups B - E. This study showed that ethanol extract of S. nitida root bark is efficient in the treatment of renal disorders and blood electrolyte perturbations

Effects of Plasma-Lyte® and 0. 9% saline in renal function after deceased-donor kidney transplant: a randomized controlled trial

Abstract Background The influence of different crystalloid solutions infused during deceased-donor kidney transplant on the incidence of delayed graft function remains unclear. We investigated the influence of Plasma-Lyte® vs. 0.9% saline on the incidence of delayed graft function in deceased-donor kidney transplant recipients. Methods We conducted a single-blind randomized controlled trial of 104 patients aged 18 to 65 years who underwent deceased-donor kidney transplant under general anesthesia. Patients were randomly assigned to receive either Plasma-Lyte® (n = 52) or 0.9% saline (n = 52), at the same infusion volume, for intraoperative fluid replacement. The primary outcome was the occurrence of delayed graft function. Secondary outcomes included metabolic and electrolytic changes at the end of surgery. Results Two patients in the Plasma-Lyte® group and one in the 0.9% saline group died postoperatively and were not included for analysis. The incidence of delayed graft function in Plasma-Lyte® and 0.9% saline groups were 60.0% (95% Confidence Interval [95% CI 46.2-72.4]) and 74.5% (95% CI 61.1-84.4), respectively (p= 0.140). Mean (standard deviation) values of immediate postoperative pH and serum chloride levels in Plasma-Lyte® and 0.9% saline groups were 7.306 (0.071) and 7.273 (0.061) (p= 0.013), and 99.6 (4.2) mEq.L-1 and 103.3 (5.6) mEq.L-1, respectively (p< 0.001). All other postoperative metabolic and electrolyte variables were not statistically different at the immediate postoperative period (p> 0.05). Conclusion In deceased-donor kidney transplant recipients, the incidence of delayed graft function is not influenced by Plasma-Lyte® or 0.9% saline used for intraoperative fluid replacement.

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.

Study on electrolytes variation in middle aged type 2 diabetics and hypertensive diabetics in comparison with normal individuals

Background: Chronic hypertension, cellular dehydration, features of renal failure, and lack of certain important electrolytes - all show an interconnected pattern of development during courses of Type 2 diabetes mellitus. Aim and Objective: The present study was undertaken to evaluate and compare the electrolytes changes in short-term, middle-aged Type 2 diabetics and in diabetics, also associated with primary hypertension so as to evaluate the association of diabetes and hypertension on electrolytes metabolism. Materials and Methods: In the present study, estimation of fasting blood glucose and glycated hemoglobin was done by automatic analyzer. Similarly, serum electrolytes such as calcium, sodium, potassium, chloride, magnesium, and phosphorus were estimated in different groups in the central laboratory, using auto analyzer. Results: It is evident in the present study that serum sodium, potassium, magnesium, chloride, phosphorus, and glycosylated hemoglobin showed a statistical significant variation in hypertensive diabetics compared to control and other groups. Whereas, serum creatinine is unchanged in any group. However, all these variations are within the normal expected range of the parameters, studied. Conclusion: Variation observed with all the electrolytes even in the initial stage of treatment in hypertensive, diabetics, and in hypertensive diabetics, suggesting to maintain electrolytes balance by alteration in dietary habits to prevent their deficiency/excess in these patients. Providing magnesium supplementation to these patients in the early diagnose phase may prevent further complications related to it.

Polymyxin Acute Kidney Injury: a case of severe tubulopathy / Nefropatia por polimixina B: a tubulopatia pode ser muito séria!

Abstract Polymyxins are antibiotics developed in the 1950s. Polymyxin-induced neurotoxicity has been often described in medical literature. The same cannot be said of nephrotoxicity or tubulopathy in particular. This report describes the case of a patient prescribed polymyxin B to treat a surgical wound infection, which led to significant increases in fractional excretion of calcium, magnesium, and potassium and subsequent persistent decreases in the levels of these ions, with serious consequences for the patient. Severe hypocalcemia, hypomagnesemia, and hypokalemia may occur during treatment with polymyxin. Calcium, magnesium and potassium serum levels must be monitored during treatment to prevent life-threatening conditions.

Resumo Polimixinas são um grupo de antibióticos desenvolvidos na década de 1950. Seus efeitos neurotóxicos são comumente descritos na literatura, porém há menos relatos sobre seus efeitos nefrotóxicos, especialmente tubulopatias. O objetivo deste relato é descrever o uso de polimixina B em uma paciente para tratamento de infecção de ferida operatória, promovendo grande aumento das frações de excreção de cálcio, magnésio e potássio e acarretando reduções graves e persistentes desses íons, com sérias consequências para a paciente. Hipocalcemia, hipomagnesemia e hipocalemia severas podem ocorrer durante terapia com polimixina e é sugerido que sejam monitorizadas as concentrações séricas desses eletrólitos durante o tratamento como forma de evitar condições de risco à vida.

Association between serum electrolyte concentrations and the risk of cardiovascular events in physical examination population / 中华健康管理学杂志

Objective:To analyse the relationship between serum electrolyte concentrations and risk of cardiovascular events in physical examination population.Methods:A cross-sectional study design was applied to survey 8 445 adults whose serum high-sensitivity cardiac tropon Ⅰ (hs-cTnⅠ) and serum electrolytes (chloride, phosphorus, calcium, sodium, potassium and magnesium) concentrations were measured at the health examination center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 1, 2018 to February 28, 2022. The risk of cardiovascular events was classified into three levels according to the serum hypersensitive cardiac troponin Ⅰ(hs-cTnⅠ) concentration: low, middle or high risk group. One-way analysis of variance was applied to compare the differences in serum electrolyte concentrations of participants with different risk levels of cardiovascular events. Ordered multi-category logistic regression was performed to analyze the correlation between serum electrolyte levels and the risk of cardiovascular events.Results:The concentration of potassium and magnesium ion in the subjects with low risk of cardiovascular events were both higher than those in the middle and high risk group [potassium ion (4.28±0.29) vs (4.24±0.34), (4.23±0.36) mmol/L, magnesium ion (0.88±0.06) vs (0.87±0.07), (0.87±0.07) mmol/L](both P<0.05), while the concentration of sodium ion was lower [(140.54±1.75) vs (140.88±1.73), (140.81±2.20) mmol/L]( P<0.001); the concentration of phosphorus ion in the high-risk group was lower than those in the middle and low risk groups [(1.04±0.17) vs (1.08±0.16), (1.05±0.15) mmol/L]( P=0.001); no significant difference was found in the concentrations of chloride and calcium ion among the three groups (both P>0.05). Compared to subjects with normal concentrations of electrolyte, the risk level of cardiovascular events in subjects with hypokalemia ( OR=6.96, 95% CI: 3.67-13.10) and hypomagnesemia ( OR=5.00, 95% CI: 1.01-24.50) was higher(both P<0.05). Within the normal range, sodium concentration was positively correlated with the risk of cardiovascular events ( OR=1.08, 95% CI: 1.03-1.14; P<0.001). Conclusions:The serum sodium, potassium and magnesium concentrations in health examination subjects are correlated with the risk of cardiovascular events. Maintaining the balanced concentration of serum potassium and magnesium, as well as low sodium levels within normal limits may help prevent cardiovascular events.

Biochemical and histopathological evaluations of chronic renal failure rats treated with pluripotent human stem cells

Abstract Regeneration of damaged kidney cells using stem cells is the current research approach in the treatment of chronic renal failure (CRF). In the present study, the histopathological and biochemical techniques were used to evaluate stem cells' (SCs) role in treatment of CRF. Sixty-four rats were divided into eight groups. Group I (GI): rats were injected with doxorubicin (15 mg/kg) to initiate CRF. GII-GVII: rats were injected with doxorubicin and treated with SCs (1x106 MSCs or/and 2x104 HSCs/rat) with/without growth factors extract (200 µL/rat) and/or immunosuppressor (cyclosporine A, 5 mg/kg/day). GVIII: rats treated with PBS (100 µL/kg/day). Levels of creatinine, urea and uric acid were increased in rats sera after injection with doxorubicin, while blood electrolyte levels of Na, K, P and Mg were decreased. Also, histopathological abnormalities such as hyalinized blood vessels, degenerated hyalinized glomerulus tubules and cell debris in the lumen and degeneration of renal tissues were observed in these rats. After treatment with SCs, all these parameters restore their normal values with regeneration of the damaged cells as demonstrated in histopathology of the treated groups. It can be concluded that, the use of SCs in treatment of kidney diseases is a promising approach and needs more efforts.

Oral sulfate solution versus polyethylene glycol for colonoscopy bowel preparation: a randomized controlled study in phase Ⅲ / 中华消化内镜杂志

Objective:To compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol (PEG) electrolyte powder for colonoscopy bowel preparation.Methods:A total of 283 randomized patients from 9 centers in China taking OSS ( n=143) or PEG ( n=140) using two-day split bowel preparation regimen received colonoscopy and assessment. The primary index was the bowel preparation success rate [global Boston bowel preparation scale (BBPS)≥ 6 by independent assessment center]. Secondary indices included BBPS global and segmental scores, investigator satisfaction (5-point Likert scale) with the quality of bowel preparation, patient satisfaction assessed by questionnaires, and patient tolerance assessed by Sharma scale. Compliance and safety were compared between the two groups. Results:The bowel preparation success rates were 100.0% for OSS and 99.3% for PEG [adjusted difference 0.7% (95% CI: -5.3% - 6.7%), P<0.001 for non-inferiority]. The BBPS global score in OSS group was significantly higher than that in PEG group (8.1 VS 7.7, P<0.001). The segment BBPS scores were also higher in OSS group than those in PEG group for all 3 segments (right colon: 2.4 VS 2.3, P=0.002; transverse colon: 2.8 VS 2.7, P=0.018; left colon: 2.8 VS 2.7, P=0.007). Investigator Likert score in the OSS group was significantly higher than that in the PEG group (2.6 VS 2.3, P<0.001). There was no significant difference in compliance between OSS and PEG, except for the second dose (90.9% VS 82.6%, P=0.039). There was no significant difference in patient satisfaction, Sharma score or proportion of patients with tolerance-related symptoms between the two groups. Safety was comparable between the two groups, and all adverse events were mild to moderate. Conclusion:OSS has comparable efficacy with PEG, with higher BBPS scores in all segments, better investigator satisfaction, better compliance in split dose, and comparable patient tolerance and safety.

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.

Correlación entre sodio, cloro y potasio del cuerpo vítreo y el intervalo postmortem sobre los 2. 850 msnm / Correlation between sodium, chlorine and potassium of the vitreous body and the postmortem interval above 2. 850 msnm

RESUMEN: El intervalo Postmortem (IPM) es un importante desafío por resolver en la patología forense, y consiste en poder determinar el tiempo transcurrido desde la muerte hasta el momento de la autopsia. Dada la poca confiabilidad de algunos métodos por la gran influencia de factores externos y propios del cadáver, la bioquímica forense ha recibido considerable atención por sus niveles de seguridad. La ciudad de Quito se ubica en la cordillera de Los Andes a 2850 msnm, sin embargo, en la literatura no existen reportes de medición de estos parámetros a una altura como ésta. El objetivo fue establecer una correlación entre sodio (Na+), cloro (Cl-) y potasio (K+) del humor vítreo del cuerpo vítreo y el IPM a la altura de la ciudad de Quito. Para el estudio se utilizaron 128 muestras de cuerpo vítreo provenientes de 16 autopsias practicadas en la Unidad de Medicina Legal Zona 9, en IPM de 6, 12, 24, 48, 72, 96, 120 y 144 horas. Para la obtención del humor vítreo se siguió el método convencional, se dividió para las 8 alícuotas y se llevó a congelación -20 °C hasta el momento de su análisis. La cuantificación de la concentración de electrolitos Na+, Cl- y Potasio+ se realizó mediante analizador ISE de Roche Cobas (Roche Diagnostics) C501, calibrado para uroanálisis, y no fue necesaria la dilución. Durante la calibración y cada tres muestras, se midió un estándar interno para corregir los efectos de la desviación sistemática en la calibración. El enfoque estadístico se basó en un análisis de correlación lineal, utilizando el coeficiente de correlación de Spearman. La correlación entre las horas postmortem y las concentraciones de los diferentes electrolitos, fueron estadísticamente significativas. Se pudo corroborar una correlación lineal significativa entre el IPM y el aumento del K+ en el HV.

SUMMARY: The postmortem interval (PMI) is an important challenge to be solved in forensic pathology, and it consists of being able to determine the time elapsed from death to the moment of autopsy. Given the unreliability of some methods due to the great influence of external factors and those specific to the corpse, forensic biochemistry has received considerable attention for its levels of safety. The city of Quito is located in the Andes mountain range at 2850 meters above sea level, however, in the literature there are no reports of measurement of these parameters at a height like this. The objective was to establish a correlation between sodium (Na+), chlorine (Cl-) and potassium (K+) of the vitreous humor and the MPI at a height of 2,850 masl. For the study, 128 samples of vitreous humor were used from 16 autopsies performed in the Zone 9 Legal Medicine Unit, in IPM of 6, 12, 24, 48, 72, 96, 120 and 144 hours. To obtain the vitreous humor, the conventional method was followed, it was divided for the 8 aliquots and it was frozen at -20 ° C until the moment of its analysis. The quantification of the concentration of electrolytes Na+, Cl- and K+ was carried out using an ISE analyzer from Roche Cobas (Roche Diagnostics) C501, calibrated for urinalysis, and no dilution was necessary. During calibration and every third sample, an internal standard was measured to correct for the effects of systematic deviation on the calibration. The statistical approach was based on a linear correlation analysis, using the Spearman correlation coefficient. The correlation between the postmortem hours and the concentrations of the different electrolytes were statistically significant. A significant linear correlation between the PMI and the increase in K+ in vitreous humor could be corroborated.

Deshidratación en el paciente adulto / Dehydration in Adult Patients

Resumen: La deshidratación es un estado clínico como consecuencia de la pérdida de agua y solutos, las causas en adultos son diversas, entre ellas están las pérdidas gastrointestinales, renales, alteraciones en la piel (quemaduras) o secuestro del tercer espacio (fracturas). El diagnóstico es clínico, los signos y síntomas determinan el grado de deshidratación y el tratamiento a implementar. En este trabajo se hace una revisión sobre la fisiología, fisiopatología, cuadro clínico, y manejo terapéutico del paciente adulto, ya que existe escasa literatura dirigida a este grupo etario.

Abstract: Dehydration is a clinical state due to the loss of water and solutes; in adults the causes of this clinical state are diverse: gastrointestinal and renal losses, skin alterations (burns) or sequestration of the third space (fractures). The diagnosis is clinical, the signs and symptoms determine the degree of dehydration and the treatment to be implemented. In this work a review is made on the physiology, pathophysiology, clinical picture and therapeutic treatment of the adult patient, since there is little literature directed to this age group.

Total electrolyte balance for laying hens / Balanço eletrolítico total para galinhas poedeiras

ABSTRACT: This study was done to determine the best value of the total electrolyte balance (BET) concerning the variables of performance and egg quality of the laying hens. We investigated 240 Hy-Line Brown laying hens, of 30 to 46 weeks of age, adopting the completely randomized experimental design, which included five treatments (1000, 1250, 1500, 1750 and 2000 μeq / kg), 8 repetitions and 6 birds per unit. The performance and quality of the birds' eggs were evaluated in the different treatments. The results were subjected to the analysis of variance and, wherever significant effect was noted, the regression equations were estimated, taking into account the electrolyte balance (μeq / kg) as a concomitant variable, applying the SAS statistical program (2001). The consumption, production, and feed conversion variables by dozen eggs, final bird weight, egg density, yolk color, Haugh Unit, albumen weight, shell weight, and egg weight, were found to be unaffected by the experimental BET values. The values of the feed conversion per egg mass, yolk weight and uniformity were affected by the different BETs. The electrolyte balance values showing minimum feed conversion, higher yolk weight, and better uniformity were, respectively, BET = 1400, 1330, and 1250 in μeq / kg of loads at the different temperatures. From the regression equations, the value indicated was BET=1390 for the 30- to 46-week-old laying hens. The electrolyte balance of the diet was found to affect the laying hens in terms of performance and egg quality.

RESUMO: Objetivou-se avaliar o melhor valor de balanço eletrolítico total (BET) para as variáveis de desempenho e qualidade dos ovos de galinhas poedeiras. Foram utilizadas 240 galinhas poedeiras da linhagem HyLine Brown, durante o período de 30 a 46 semanas de idade, distribuídos em um delineamento inteiramente casualizado, com cinco tratamentos (1000, 1250, 1500, 1750 e 2000 μeq/kg), oito repetições e seis aves por unidade experimental. Foram avaliados o desempenho e a qualidade dos ovos das aves com os diferentes tratamentos. Foi realizada análise de variância e, no caso de efeito significativo, foram estimadas equações de regressão considerando como variável concomitante o balanço eletrolítico (μeq/kg), usando o programa estatístico SAS (2001). As variáveis de consumo, produção, conversão alimentar por dúzia de ovos, peso final das aves, densidade do ovo, coloração da gema, Unidade Haugh, peso do albúmen, peso da casca e peso do ovo, não foram afetados pelos BET experimentais. Os valores de conversão alimentar por massa de ovos, peso de gema e uniformidade foram influenciados pelos diferentes BET. Os valores de balanço eletrolítico que propiciaram conversão alimentar mínima, melhor peso de gema e melhor uniformidade foram, respectivamente: BET=1400, BET = 1330 e BET = 1250 em μeq/kg de cargas nas rações. Conforme as equações de regressão indica-se o valor de BET de 1390 para poedeiras de 30 a 46 semanas de idade. O balanço eletrolítico da dieta afeta o desempenho e a qualidade dos ovos de galinhas poedeiras.

Trastornos electrolíticos inducidos por fármacos y sustancias tóxicas / Electrolyte disorders induced by drugs and toxic substances

Las enfermedades pueden generar un desequilibrio de electrolitos como parte de su fisiopatología, al igual que los medicamentos usados crónicamente y algunas sustancias tóxicas disponibles en nuestro medio. A pesar de todos los datos estadísticos existentes, la incidencia global de los trastornos electrolíticos secundarios a fármacos o sustancias tóxicas permanece desconocida, y, posiblemente, subregistrada; por lo tanto, el objetivo de esta revisión es analizar los trastornos electrolíticos que causan algunos medicamentos y sustancias tóxicas, y describir el mecanismo a través del cual se producen las alteraciones, en particular, del sodio, potasio, magnesio, calcio y fósforo, con el fin de alertar a los profesionales de la salud en el momento de enfrentarse a este tipo de condiciones en su práctica clínica. El conocimiento de los efectos adversos relacionados con medicamentos y tóxicos es importante para prevenir, identificar y gestionar de forma eficaz, complicaciones que son potencialmente peligrosas. Esta revisión pretende ser un referente de apoyo para los profesionales de la salud en estas situaciones

Diseases can generate an electrolyte imbalance as part of their pathophysiology, as well as chronic use of some medications, and toxic substances available in our environment. Despite all the separate statistical data, the overall incidence of fluid and electrolyte disorders secondary to drugs or toxic substances remains unknown, and possibly underreported; therefore, the objective of this review is to analyze electrolyte disorders caused by some medications and toxic substances, and describe the mechanism through which changes in sodium, potassium, magnesium, calcium and phosphorus occur, in particular, in order to alert health professionals when facing this type of conditions in their clinical practice. Knowledge of drug and toxic-related adverse effects is important to effectively prevent, identify, and manage complications that can be potentially life-threatening. This review intends to be a reference for supporting health professionals in these situations

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)

Fluidoterapia y electrolitos parenterales en pediatría / Fluid therapy and electrolytes in pediatrics

RESUMEN La administración de líquidos y electrolitos parenterales es una terapia fundamental de soporte en niños agudamente enfermos si la vía oral no permite la administración de la cantidad o composición requeridas de fluidos, por ejemplo en enfermedades de tipo gastrointestinal, respiratorio, neurológico, o en el período transoperatorio. Al momento de planificar la administración de líquidos y electrolitos parenterales en niños a partir del mes de edad, se debe considerar componentes relacionados con la cantidad de líquidos a infundir considerando los requerimientos secundarios a pérdidas hídricas habituales o requerimientos para reacciones metabólicas, evaluar el grado de deshidratación para la administración de líquidos que complementen el déficit, corregir las pérdidas que se han producido secundarios a una noxa externa (enfermedad, procedimiento quirúrgico, trauma, etc.) y finalmente aportar la cantidad adecuada de fluido que permita re-establecer la perfusión tisular. Es necesario conocer los cambios instaurados basados en la evidencia actual con la finalidad de incorporar a el manejo frecuente de los pacientes considerando también la toxicidad ya sean cualitativos o cuantitativos de esta terapéutica tan necesaria en el manejo del paciente pediátrico

ABSTRACT The administration of parenteral fluids and electrolytes is a fundamental support therapy in acutely ill children if the oral route does not allow the ad-ministration of the required amount or composition of fluids, for example in gastrointestinal, respiratory, neurological, or transoperative diseas-es. When planning the administration of parenteral fluids and electrolytes in children from one month of age onwards, components related to the amount of fluids to be infused should be considered, taking into account the requirements secondary to habitual water loss or requirements for meta-bolic reactions, evaluating the degree of dehydration for the administration of fluids to supplement the deficit, correcting the losses that have oc-curred secondary to an external noxa (illness, surgical procedure, trauma, etc.) and finally providing the adequate amount of fluid to allow re-es-tablishment of tissue perfusion. It is necessary to know the changes established based on current evidence in order to incorporate to the frequent management of patients, also considering the toxicity, either qualitative or quantitative, of this therapy, so necessary in the management of the pediatric patient.

Study of electrolyte disturbances and renal parameters in acute gastroenteritis under 5 years of age in a tertiary care hospital of Bengaluru, India

Background: Diarrhoea still continues to be a major cause of hospitalization and death in under fives. Electrolyte disturbances play an important role in the associated morbidity and mortality.  Acute renal failure is one of the important complications of acute gastroenteritis (AGE) in children. Early intervention and proper fluid replacement may lessen this risk. This study was designed to find out the incidence of acute gastroenteritis and the status of associated electrolyte derangements and renal involvement.Methods: This was a cross sectional study conducted at KIMS, Bengaluru in which 117 children from the age of 1 month to 5 years with acute diarrhea were included based on a predefined inclusion and exclusion criteria. Demographic profile of the patients, details of diarrhea, clinical examination and accompanying degree of dehydration (defined as per WHO criteria) were recorded. Serum electrolytes along with renal parameters were investigated.Results: Total 117 children with acute gastroenteritis were enrolled in the study as per the inclusion criteria which constituted 5% of total paediatric admissions. Children aged 1-12 months had the highest incidence of diarrhea (50%). Male to female ratio is 1.3:1. 65% had some dehydration, 19% no dehydration and 16% had severe dehydration. Isonatremia was seen in 58% followed by hyponatremia in 35% and hypernatremia in only 7%. 83% had isokalemia, hypokalemia in 12%, hyperkalemia in 5%. Levels of serum sodium and potassium decreased with the severity of dehydration. Serum urea and creatinine were significantly high in severe dehydration (p value 0.001). Out of 28 children who were given diluted ORS before admission, majority had hyponatremia (39%) and all of them who received concentrated ORS had hypernatremia.Conclusions: Hyponatremic dehydration is the second most common type of dehydration next to isonatremic dehydration, but it is more common in children who took diluted ORS. Increased awareness regarding ORS preparation may help in preventing electrolyte imbalance in AGE. The levels of serum sodium and potassium decreased and urea and creatinine increased with severity of dehydration. Measurements of serum electrolytes and renal parameters early can help to predict the complications due to AGE and may help in the prevention of diarrhea related complications in children.

Aspectos prácticos para la clasificación, diagnóstico y manejo de hiponatremia en el paciente hospitalizado / Practical aspects for the classification and management of hyponatremia in the hospitalized patient

Resumen La hiponatremia es el trastorno hidroelectrolítico más frecuente observado en pacientes hospitalizados y es importante resaltar que se ha asociado a morbilidad y mortalidad de estos. Esta entidad representa un proceso fisiopatológico relacionado con una alteración en la homeostasis del agua, en la cual los pacientes presentan síntomas en su mayoría neurológicos, que se correlacionan con el nivel de sodio y el tiempo de aparición del trastorno. Se realizó una búsqueda en las bases de datos PubMed y Lilacs de monografías, artículos de revisión y artículos originales con el objetivo de revisar aspectos sobre la clínica, diagnóstico y manejo de la entidad. Para el diagnóstico, la batería de estudios se solicita en función del contexto clínico, actuando temprano y permitiendo la corrección del trastorno de acuerdo al escenario respectivo. La hiponatremia es un problema médico frecuente que bajo un abordaje práctico y sencillo permite tomar decisiones clínicas de forma oportuna. MÉD.UIS. 2020;33(2):85-93.

Abstract Hyponatremia is the most frequent hydroelectrolytic disorder observed in hospitalized patients and it is important to note that it has been associated with morbidity and mortality in this patients. This entity represents a pathophysiological process related to an alteration in water homeostasis, in which patients present symptoms mostly neurological, that correlate with the sodium level and the time of onset of the disorder. A search of the PubMed and Lilacs databases of monographies, review articles and originals articles was performed with the objective to review clinical, diagnostic and management aspects of this entity. For diagnosis, the clinical laboratory studies are requested depending on the clinical context, acting early and allowing correction of the disorder according to the respective scenario. Hyponatremia is a frequent medical problem that requires a practical and simple approach favoring clinical decisions in a timely manner. MÉD.UIS. 2020;33(2):85-93.

Electrolyte imbalance in type 2 diabetes: a case study from the West region of Cameroon

Background: Diabetes mellitus remains a global public health challenge despite advances in medicine, with Cameroon harboring about half a million patients. Electrolyte imbalance has been reported to contribute to the complications observed in diabetes. The aim of this study was to investigate electrolyte disturbances in type 2 diabetic (T2D) patients under follow up in two health facilities (Dschang District Hospital and Bafoussam Regional Hospital) of the West Region of Cameroon.Methods: The study involved 200 T2D patients and 50 non-diabetic control subjects. A questionnaire was used to acquire demographic, anthropometric, clinical and psychosocial data. Fasting blood samples were collected for the determination of fasting plasma glucose (FPG), glycated haemoglobin, calcium, potassium and sodium levels. The diabetic population was divided into two and three groups according to their glycated hemoglobin and FPG levels respectively. The Student’s t-test was used to compare mean values between patients and controls, while the chi square test was used to assess for differences between categorical variables. The significance level was set at 5%.Results: Almost all diabetic patients were diagnosed of hypernatremia (98%) versus 70% for the control group (p<0.001). There was no record of hyponatremia. Hypercalcemia was observed in 30% of the diabetic patients and hypocalcemia in 48%. The prevalence of hyperkalemia was comparable between patients and controls, while control subjects tended to be more hypokalemic (p=0.038). For all three electrolytes investigated, more than 70% of the imbalances were observed in patients with hyperglycemia when compared to patients having normal FPG or hypoglycemia.Conclusions: Electrolyte imbalance is common in type 2 diabetic patients from the West Region of Cameroon, especially those presenting with hyperglycemia.

Electrolyte changes related to muscle pain after resistance exercises / Alterações eletrolíticas relacionadas à dor muscular após exercícios resistidos / Alteraciones electrolíticas relacionadas al dolor muscular después de ejercicios resistidos

ABSTRACT Introduction Resistance exercises (RE) performed at high intensity cause an inflammatory response and electrolyte abnormalities in blood plasma. Objectives To study the plasma electrolyte changes resulting from a high-intensity session of RE in untrained volunteers, and to correlate these with delayed onset muscle soreness (DOMS). Methods Twenty volunteers, aged 26.9 (±4.4) years, underwent an RE session. The workout (leg extension, squat and leg press) consisted of four sets of 10 maximum repetitions. Electrolytes (Na+, K+, Ca2+ e Mg2+) were evaluated before the training (baseline), immediately (0 min), and 30 minutes after the RE. The DOMS was assessed 24 hours after the sessions. Results The Na+ increased immediately after the RE and returned to normal after 30 min (p<0.001). After 30 min, K+ increased compared to baseline levels and immediately after the RE (p<0.001). Ca2+ and Mg2+ levels did not change throughout the study. Changes in Na+ and K+ levels were correlated immediately (r=-0.511; p=0.021) and 30 min (r=-0.455; p=0.049) after RE. Plasma concentrations of Na+ 0 min were correlated (r=-0.520; p=0.018) with the DOMS. Conclusion High-intensity RE in untrained volunteers leads to changes in plasma concentrations of Na+ and K+. Na+ concentrations immediately after RE were related to DOMS; individuals that presented smaller alterations in this electrolyte reported more muscular pain. Level of evidence II; Diagnostic Studies - Development of diagnostic criteria on consecutive patients (with universally applied reference "gold" standard).

RESUMO Introdução Os exercícios resistidos (ER) realizados em alta intensidade provocam uma resposta inflamatória e alterações eletrolíticas no plasma sanguíneo. Objetivo Estudar as alterações eletrolíticas plasmáticas resultantes de uma sessão de ER de alta intensidade em voluntários destreinados e correlacionar com a dor muscular de início tardio (DMIT). Métodos Vinte voluntários com 26,9 (±4,4) anos de idade foram submetidos à sessão de ER. A sessão de exercícios (cadeira extensora, agachamento e leg press) consistiu em quatro séries de 10 repetições máximas. Os eletrólitos (Na+, K+, Ca2+ e Mg2+) foram avaliados previamente (basal), imediatamente (0 min) e 30 minutos após os ER. A DMIT foi avaliada 24 horas após as sessões. Resultados O Na+ aumentou imediatamente após os ER e retornou ao normal após 30 min (p<0,001). Em 30 min, o K+ aumentou em relação aos valores basais e imediatamente após os ER (p<0,001). O Ca2+ e o Mg2+ não se modificaram ao longo do estudo. As alterações de Na+ e de K+ correlacionaram-se imediatamente (r=-0,511; p=0,021) e 30 min (r=-0,455; p=0,049) após os ER. As concentrações plasmáticas de Na+ 0 min correlacionam-se (r=-0,520; p=0,018) com a DMIT. Conclusão Os ER de alta intensidade em voluntários destreinados aumentaram as concentrações plasmáticas de Na+ e de K+. As concentrações de Na+ imediatamente após os ER correlacionaram-se com a DMIT, em que os indivíduos que apresentam menores alterações desse eletrólito sentem mais dor muscular. Nível de Evidência II; Estudos diagnósticos - Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com padrão de referência "ouro" aplicado).

RESUMEN Introducción Los ejercicios resistidos (ER) realizados en alta intensidad provocan una respuesta inflamatoria y alteraciones electrolíticas en el plasma sanguíneo. Objetivo Estudiar las alteraciones electrolíticas plasmáticas resultantes de una sesión de ER de alta intensidad en voluntarios desentrenados y correlacionar con el dolor muscular de inicio tardío (DMIT). Métodos Veinte voluntarios con 26,9 (±4,4) años de edad fueron sometidos a la sesión de ER. La sesión de ejercicios (mesa extensora, sentadillas y leg press) consistió en cuatro series de 10 repeticiones máximas. Los electrólitos (Na+, K+, Ca2+ y Mg2+) fueron evaluados previamente (basal), inmediatamente (0 min) y 30 minutos después de los ER. La DMIT fue evaluada 24 horas después de las sesiones. Resultados El Na+ aumentó inmediatamente después de los ER y retornó a lo normal después de 30 min (p<0,001). En 30 min el K+ aumentó con relación a los valores basales e inmediatamente después de los ER (p<0,001). El Ca2+ y el Mg2+ no se modificaron a lo largo del estudio. Las alteraciones de Na+ y de K+ se correlacionaron inmediatamente (r=-0,511, p=0,021) y 30 min (r=-0,455, p=0,049) después de los ER. Las concentraciones plasmáticas de Na+ 0 min se correlacionan (r=-0,520, p=0,018) con la DMIT. Conclusión Los ER de alta intensidad en voluntarios desentrenados aumentaron las concentraciones plasmáticas de Na+ y de K+. Las concentraciones de Na+ inmediatamente después de los ER se correlacionaron con la DMIT, en que los individuos que presentan menores alteraciones de ese electrolito sienten más dolor muscular. Nivel de evidencia II; Estudios diagnósticos - Desarrollo de criterios diagnósticos en pacientes consecutivos (con estándar de referencia "oro" aplicado).