Effects of air exposure, time, temperature, and humidity on different serum electrolytes

Background: Pre-analytical, analytical, or post analytical variations can induce, change, or alter the tests results. Laboratory errors lead to unnecessary delays in test report and also increased costs by repeat samples which have become a pain to the patients. Aims and Objectives: The aims of this study were to determine alterations in the concentration of serum sodium (Na+), potassium (K+), and ionized calcium (Ca++) concentration with reference to air exposure, time, temperature, and humidity. Materials and Methods: Fifty samples as case and 50 samples as control were included from a normal healthy population in this study. After getting the samples, first readings were taken for case samples and were uncapped and the remaining samples were set aside capped at 24°C, 20% humidity for half an hour and followed by second reading which was taken. Results: Variation in the mean serum sodium between groups is 0.06 mEq/L (0.04%) and 0.08 mEq/L (0.07%) which is very negligible and insignificant (P > 0.05). The mean level of serum K+ in cases is 4.35 mEq/L and in controls is 4.27 mEq/L. After half an hour, the mean level of serum K+ in cases is 4.51 mEq/L and, in controls, is 4.29 mEq/L. Hence, the variation in results in cases is 0.16 mEq/L (3.68%) and in controls is 0.02 mEq/L (0.47%) which is highly significant (P < 0.05). The mean level of serum Ca++ in cases is 1.15 mmol/L and in controls is 1.17 mmol/L. After half an hour, the mean level of serum Ca++ in cases is 1.09 mmol/L and in controls is 1.16 mmol/L. Hence, the variation in results in cases is 0.06 mmol/L (5.22%) and in controls is 0.01 mmol/L (0.85%) which is highly significant (P < 0.05). Conclusion: Air exposure significantly alters the serum K+ and Ca++ level, but the alteration in serum Na+ level is not significant.

Comparison of serum calcium, serum magnesium, serum sodium and serum potassium in patients of preeclampsia and normal pregnant women-a cross-sectional study

Background: Preeclampsia is a clinical condition in which the patient is suffering from hypertension and proteinuria, which may be associated with pathological edema. There are multiple systems involved in pre-eclampsia which is the main culprit to complicate the pregnancy. In developing nations, approximately 4–18% of pregnancies are complicated by preeclampsia which is a major cause of morbidity and mortality globally. It does not affect pregnant females only, but may be life-threatening for growing fetuses too. If we consider the mortality in all pregnant females, about 10–15% of maternal deaths are due to pre-eclampsia. Aims and Objectives: The main objective of this study is to compare the serum calcium, magnesium, sodium and potassium level in preeclampsia patients and normal pregnant women. Materials and Methods: After taking written consent from the patients, randomly 50 pregnant females diagnosed by a gynecologist as suffering from preeclampsia were selected and for the control group 50 pregnant females who came for routine checkups were selected. 5 ml of blood was collected in the clot activator tube. The samples were analyzed for serum calcium, magnesium, sodium, and potassium on a fully automated biochemistry analyzer ”Erba XL 640” in HiTech, clinical biochemistry laboratory, B.J medical college, Ahmedabad. Results: The result showed a decreased level of serum calcium, magnesium, sodium, and potassium in the study group compared to the control group. The S. calcium level was (7.624 ± 0.84) and (8.52 ± 0.80) mg/dl in the study and control groups respectively. The S. magnesium level in the study and control were (1.47 ± 0.25) and (1.79 ± 0.18) mg/dl, respectively. S. sodium levels were (131.46 ± 6.96) and (139.92±7.86) mEq/L in the study and control groups, respectively. And the level of S. potassium in the study and control groups was (3.39 ± 0.52) and (3.67 ± 0.38) mEq/L, respectively. All the parameter values are significantly lower in a study group in comparison to control group patients (P < 0.001). Conclusion: From our study, we have concluded that the serum level of some parameters such as calcium, magnesium, sodium, and potassium was significantly decreased in patients suffering from preeclampsia. We can also conclude that these parameters can be used as a biomarker for the diagnosis of preeclampsia.

Predictive value of the initial MELD score and its derivative scores for early survival rate after liver transplantation in patients with liver failure / 器官移植

Objective To explore the predictive values of the initial model for end-stage liver disease (MELD) score, MELD combined with serum sodium (MELD-Na) score and MELD combined with serum lactic acid (MELD-Lac) score for early survival rate after liver transplantation in patients with liver failure. Methods Clinical data of 135 recipients undergoing liver transplantation for liver failure were retrospectively analyzed. All patients were divided into the early survival group (n=110) and early death group (n=25) according to the survival at postoperative 28 d. Clinical data were compared between two groups. The optimal cut-off values of MELD, MELD-Na and MELD-Lac scores for predicting early survival rate after liver transplantation in patients with liver failure were determined by the receiver operating characteristic (ROC) curve. The predictive values of different scores for early survival rate after liver transplantation in patients with liver failure were evaluated. Results Significant differences were observed in the initial MELD, MELD-Na and MELD-Lac scores after liver transplantation between two groups (all P < 0.05). For the initial MELD, MELD-Na and MELD-Lac scores in predicting early survival rate after liver transplantation in patients with liver failure, the AUC were 0.653 [95% confidence interval (CI) 0.515-0.792], 0.648 (95%CI 0.514-0.781) and 0.809 (95%CI 0.718-0.900), the optimal cut-off values were 18.09, 18.09 and 19.97, Youden's indexes were 0.398, 0.380 and 0.525, the sensitivity was 0.680, 0.680 and 0.840, and the specificity was 0.720, 0.700 and 0.690, respectively. The AUC of MELD-Lac score was higher than those of MELD and MELD-Na scores, and the differences were statistically significant (both P < 0.05). Conclusions Compared with the initial MELD and MELD-Na scores after liver transplantation, the initial MELD-Lac score is a more reliable index for predicting early survival rate after liver transplantation in patients with liver failure.

Clinico-Etiological Profile of Electrolyte Imbalance among Patients in a Government Hospital in Dakshina Kannada

Introduction: Hyponatremia is a state of electrolyteimbalance with a high prevalence rate, it is one of the leadingcause of morbidity and mortality in our settings. The aim ofthis study was to evaluate the clinical features and etiology ofhyponatremia in patients admitted in our government hospital.Material and methods: A 1-year prospective cross-sectionalobservational study was conducted on adult patients withmoderate-to-severe hyponatremia admitted to the hospital.Patients demographics were recorded and investigations weredocumented. Data were analyzed using independent samplet-test.Results: Vomiting (28) followed by confusion (26) was themost common complaint. Confusion was significantly highin patients with severe hyponatremia as compared to patientswith moderate. Increased urine sodium levels were observedin these patientsConclusion: Patients with hyponatremia secondary to aninfectious cause should be meticulously screened and timelyand effective treatment of hyponatremia is determined by theeffective understanding of pathophysiology and associatedrisk factors of hyponatremia.

Effects of different fluid replenishment methods on internal environment, body thermal regulation response and severe heatstroke of 5-km armed cross-country training soldiers / 中华危重病急救医学

To explore the effects of different fluid replenishment methods on the internal environment, body thermal regulatory response and severe heatstroke of 5-km armed cross-country training soldiers. Methods A Special Force officers and soldiers who participated in 5-km armed cross-country training (2-3 times a week, 25-30 minutes each time for 3 weeks) during summer training from June to July in 2018 were enrolled, and they were divided into three groups according to the random number table, with 300 trainees in each group. 200 mL of drinking fluids were given to each group 15 minutes before and after each 5-km armed cross-country training: A group with boiled water, B group with purified water, and C group with beverage prepared by pharmaceutical laboratory of the 990th Hospital of PLA Joint Logistics Support Force (100 mL containing 6 g carbohydrates, 42 mg sodium, and 11 mg potassium). The venous blood was collected before and after the last training or during the onset of severe heatstroke to do the following tests: serum cardiac troponin I (cTnI, chemiluminescence), MB isoenzyme of creatine kinase (CK-MB, immunosuppressive), serum creatinine (SCr, enzymatic method), urea nitrogen (BUN, enzymatic method), alanine aminotransferase (ALT, tryptase), aspartate transaminase (AST, tryptase), and Na+, K+, Cl- (electrode method). The heart rate (HR) and core temperature (Tc, anal temperature) were monitored at the same time. The amount of sweat in training and the occurrence of severe heatstroke were also recorded. Results There was no significant difference in heart, liver, kidney function, electrolyte and body heat regulation reaction among three groups of 5-km armed cross-country trainees before training. Compared with before training, the levels of serum cTnI, CK-MB, SCr, BUN, ALT, AST, HR and Tc were significantly increased after training or during the onset of severe heatstroke in three groups, while the contents of Na+, K+, Cl- were significantly decreased, but the increase or decrease of group C was relatively smaller compared with group A and group B [cTnI (μg/L): 0.9 (0.6, 1.4) vs. 1.1 (0.7, 2.8), 1.0 (0.6, 3.3); CK-MB (U/L): 7.0 (5.0, 11.0) vs. 9.0 (6.0, 14.5), 8.0 (6.0, 15.0); SCr (μmol/L): 92.09±18.64 vs. 102.78±18.77, 103.64±20.07; BUN (mmol/L): 7 (6, 9) vs. 9 (8, 11), 10 (8, 13); ALT (U/L): 27 (22, 34) vs. 36 (30, 43), 34 (27, 43); AST (U/L): 37 (31, 48) vs. 41 (34, 50), 39 (34, 51); HR (bpm):87.01±17.07 vs. 95.88±21.06, 96.59±22.04; Tc (℃): 37.73±0.81 vs. 38.03±1.05, 38.10±1.04; Na+ (mmol/L):150.14±3.86 vs. 144.18±8.89, 144.04±9.39; K+ (mmol/L): 4.32±0.57 vs. 4.15±0.62, 4.13±0.51; Cl- (mmol/L):100.43±3.71 vs. 98.42±4.24, 98.41±4.58; all P < 0.01]. The incidence of severe heatstroke in group C was significantly lower than that in group A and group B [1.67% (5/300) vs. 5.00% (15/300), 5.33% (16/300), χ2 = 6.424, P = 0.040]. There was no significant difference in sweating volume in groups A, B, C (g: 370.47±48.71, 370.85±50.66, 370.17±50.21, F = 0.014, P = 0.986). There was no significant difference in the above indexes between group A and group B (all P > 0.05). Bi-classification Logistic regression analysis showed that the increase of HR, Tc and excessive loss of Na+, K+, Cl- were risk factors for severe heatstroke [odds ratio (OR) was 0.848, 0.138, 1.565, 17.996 and 2.328 respectively, all P < 0.01]. Conclusions Timely supplementation of carbohydrate, sodium and potassium ions can effectively change the internal environment and body heat regulation reaction of 5-km armed cross-country trainees, so as to reduce the occurrence of severe heatstroke. The increases of HR, Tc and excessive loss of Na+, K+, Cl- are risk factors for severe heatstroke.

Effect of preoperative serum sodium concentration on the early prognosis of liver transplantation recipients / 国际外科学杂志

Objective To analyze the relationship between preoperative serum sodium concentration and preoperative status of liver transplantation recipients and it's effect on early prognosis. Methods Retrospectively collected the clinical data of 281 patients underwent liver transplantation in First Affiliated Hospital of Zhengzhou University from January 2016 to September 2017. According to the preoperative serum sodium concentration, they were divided into hyponatremia group (< 130 mmol/L) 18 patients, normonatremia group (130-145 mmol/L)232 patients and hypernatremia group(> 145 mmol/L) 31 patients. The SPSS 21.0 statistical software was used to analyze the difference of preoperative MELD score, Child-Pugh score, postoperative survival rate and the incidence of graft dysfunction among three groups. Multivariate comparisons of measurement data were performed using analysis of variance. Pairwise comparisons between groups were performed using the LSD-t test. Chi-square tests were used to compare the count data sets. Results The preoperative MELD score was(19.27 ±7.35) scores, Child-Pugh score was(10.39±2.28) scores, serum creatinine concentration was(95.89 ± 49.40) μmol/L in hyponatremia group, the preoperative MELD score was(12.17土8.79) scores(P=0.001), Child-Pugh score was(8.50±2.68) scores (P =0.004) and serum creatinine was(66.07 ±24.13) μmol/L(P <0.05) in normonatremia group, the difference between two groups were statistically significant. There were no significant difference in the length of postoperative ICU stay and postoperative hospital stay among the three groups, there were no significant difference between the 30th and 90th postoperative survival rates and the incidence of graft dysfunction. Conclusions Hyponatremia is an indicator of poor preoperative status in liver transplantation recipients. Preoperative serum sodium concentration has no significant effect on early prognosis of liver transplantation.

Risk factors analysis of renal replacement therapy after liver transplantation and prognosis effect of initial treatment time / 中华危重病急救医学

Objective To analyze the risk factors of renal replacement therapy (RRT) in acute kidney injury (AKI) patients after liver transplantation, and to investigate the prognosis effect of initial RRT treatment time. Methods Clinical data of 132 recipients undergoing organ donation for cardiac death (DCD) allograft orthotopic liver transplantation admitted to Ningbo Medical Center Lihuili Hospital and Ningbo Medical Center Lihuili Eastern Hospital from July 2014 to July 2018 was retrospectively analyzed. AKI was defined and staged by the criteria of Kidney Disease Improving Global Outcomes (KDIGO) guideline in the first 7 days. According to the implementation of RRT, the patients were divided into non-RRT group and RRT group. The differences in gender, age, body mass index (BMI), model for end-stage liver disease with serum sodium (MELD-Na) score, serum creatinine (SCr), and intraoperative norepinephrine (NE) dose, blood loss, fluid infusion, anhepatic phase time, duration of operation between two groups were compared. The statistically significant risk factors of AKI found by univariate analysis were selected and analyzed to find independent risk factors of RRT in AKI patients after liver transplantation with multivariate Logistic regression analysis. The receiver operating characteristic (ROC) curve was drawn to evaluate the test efficiency of all risk factors of RRT implementation. According to the implementation of RRT on KDIGO stage-2, all the patients on KDIGO stage-2 and stage-3 were divided into early group (initial RRT on KDIGO stage-2) and delayed group (including self-improvement without RRT on KDIGO stage-2 and initial RRT on KDIGO stage-3). The duration of mechanical ventilation, the length of intensive care unit (ICU) stay, AKI duration, incidence of catheter related bloodstream infection (CRBSI) and 28-day mortality were compared between the two groups. Results All 132 receptors were enrolled in the final analysis, and 77 patients developed AKI, accounting for 58.3%, among which 52 cases were in RRT group (67.5%) and 25 were in non-RRT group (32.5%). As shown by univariate analysis, the MELD-Na score (21.6±4.4 vs. 18.0±4.3), intraoperative NE dose (μg·kg-1·h-1: 7.5±1.2 vs. 5.2±1.7), blood loss [mL: 3 000 (2 200, 4 000) vs. 2 600 (1 800, 3 200)], fluid infusion [mL: 6 400 (4 500, 7 800) vs. 5 600 (4 200, 6 800)], and anhepatic period (minutes: 65.6±4.5 vs. 63.0±5.0) were significantly increased in RRT group as compared with those in non-RRT group (all P < 0.05). There was no significant difference in gender, age, BMI, SCr before operation or the duration of operation. It was shown by multivariate Logistic regression analysis that MELD-Na score before operation [odds ratio (OR) = 1.398, 95% confidence interval (95%CI) = 1.062-1.841, P = 0.017], intraoperative NE dose (OR = 4.724, 95%CI = 2.036-10.961, P = 0.000) and fluid infusion (OR = 1.002, 95%CI = 1.001-1.004, P = 0.010) were independent risk factors of RRT implementation in AKI patients after liver transplantation. It was shown by ROC curve analysis that the area under the ROC curve (AUC) of MELD-Na score, NE dose and fluid infusion for predicting the implementation of RRT in AKI patients after liver transplantation was 0.719, 0.867, and 0.670, respectively, which suggesting that NE dose had moderate predictive value, but MELD-Na score and fluid infusion had low predicative value. When the optimal cut-off value of NE dose was 6.5 μg·kg-1·h-1, the sensitivity was 84.6% and the specificity was 80.0%. The 28-day mortality was both 0 in early group (n = 25) and delayed group (n = 39). Compared with the early group, the duration of mechanical ventilation (hours: 41.0±1.0 vs. 35.8±6.7) and the length of ICU stay (hours: 98.8±6.6 vs. 94.2±7.3) were significantly increased in delayed group (both P < 0.05), there was no significant difference in AKI duration (days: 11.8±4.2 vs. 10.6±4.9) or the incidence of CRBSI [5.1% (2/39) vs. 4.0% (1/25), both P > 0.05]. Conclusions MELD-Na score, intraoperative NE dose and fluid infusion were the independent risk factors of RRT implementation in AKI patients after liver transplantation. NE dose had moderate predictive value, but MELD-Na score and fluid infusion had low predicative value. Initial RRT on KDIGO stage-2 could reduce the duration of mechanical ventilation and the length of ICU stay.

Medication Analysis of Electrolyte Disturbance with Suspected Deteriorated Demyelination Post PCI / 医药导报

Objective A case would be discussed on suspected demyelination due to electrolyte disturbance to provide references for clinical pharmacists to carry out pharmaceutical care. Methods A pharmaceutical care case on PCI postoperative acute heart failure and contrast induced nephropathy with suspected demyelization due to electrolyte disturbance was introduced through a combination of analysis on clinical symptoms,renal function,electrolyte,blood glucose level and further discussion on consciousness change reason, diuretic use, electrolyte management, and other related issues. Results Clinical pharmacist should provide more care to patients with abnormal blood sodium and osmotic pressure,pay more attention to the calculation and evaluation of rehydration sodium/filling quantity and speed, accumulate more knowledge of contrast induced nephropathy, and raise their awareness on the identification of high risk population. Conclusion Arrhythmia,heart failure,renal failure,infection can beincentives to one another,and thus doctors and pharmacists must pay more attention to the comprehensive situations.

Changes of serum sodium and urine sodium of children with febrile seizures and its clinical significance / 中国基层医药

Objective To analyze the changes of the urine sodium and serum sodium in different types and different duration and different temperature in children with febrile seizures,to explore its clinical significance. Methods The children with febrile seizures(n =50)were selected as the group Ⅰ,and the children with fever but without seizure(n =50)were selected as the group Ⅱ,both of them were from pediatric ward.The control group(n =20)without fever or seizure was from Children's Health Section.All the children were checked serum sodium level and urine sodium and urine creatinine level.Results The sodium/creatinine ratio in the groupⅠ[(25.07 ±6.517)] was significantly higher than that in the group Ⅱ[(20.43 ±5.48)]and group Ⅲ[(14.88 ±5.11)](F =33.519, P <0.05),but there was no significant difference of the sodium/creatinine ratio in different ages and different types of the group Ⅰ,and there was negative relevance between the serum sodium and the sodium/creatinine ratio in the groupⅠ(r =-0.517,P <0.05).The mean serum sodium level in the groupⅠ[(133.50 ±3.14)mmol/L]was signifi-cantly lower than that in the group Ⅱ[(137.60 ±2.59)mmol/L]and group Ⅲ[(138.90 ±2.24)mmol/L](F =39.220,P <0.05),but there were no significant differences of the serum sodium in different types and different dura-tion and different temperature of seizure in the group Ⅰ.Conclusion The study shows that serum sodium is lower and the urine sodium is higher in children with febrile seizures,the changes of the urine sodium and serum sodium are not related to the types.The children with febrile seizures should be timely monitoring of serum sodium,urine sodium levels,and according to changes in the level of serum sodium,urine sodium,early appropriate supplement containing sodium liquid and maintaining the blood sodium to normal levels can reduce the recurrence of seizure.

Serum sodium and potassium levels in newly diagnosed essential hypertensive patients in Government Dharmapuri Medical College, Dharmapuri

Introduction: Mean platelet volume (MPV) and Platelet Distribution Width (PDW) is a relatively simple, inexpensive tool that indicates the platelets size, the rate of platelet production, platelet activation and the severity of inflammation since inflammation plays an important role in COPD, any alteration in platelet activity can cause alteration in MPV. Red blood cell distribution width (RDW) reflects morphology of erythrocytes whereas RDW can also vary due to systemic inflammation and ineffective erythropoiesis. Hence we aimed to study Platelet indices in patients with exacerbation of COPD. Aim and objectives: Our aim is to evaluate the role of platelet Indices in COPD patients. Since only limited data were available on the relationship between COPD and platelet indices, we aimed to evaluate and find out the correlation between Mean Platelet Volume (MPV), Red Cell Distribution Width (RDW), Platelet Distribution Width (PDW) and Plateletcrit (PCT) in exacerbation of COPD patients at a tertiary care hospital in south India. Materials and methods: A total of 135 subjects, 79 men and 56 women, who were admitted in our hospital with exacerbation of COPD during a period of one year were enrolled in this prospective Ragulan R, Viswambhar V, Krishnaveni R, Meenakshi Narasimhan, Aruna Shanmuganathan, Nisha Ganga, Gangaiamaran M. Evaluation of platelet indices among patients with exacerbation of COPD in a tertiary care center in South India. IAIM, 2017; 4(7): 161-166. Page 162 observational study. The levels of MPW, RDW, PDW and PCT were assessed during the course of hospital stay in patients with COPD exacerbation Results: In our study we found out that there exists a statistical significance among male and female COPD exacerbation patients with respect to Mean Platelet Volume (P=<0.0001) and Red Cell Distribution Width (P=<0.0001). There also exists statistical significance between our COPD patients with other study stable controls (p=<0.005). Using ROC curve, considering optimal level of MPV <8.8Fl, male population showed sensitivity of 95% and specificity of 85% with Average age in men with diagnosed COPD is 49 and average age of female COPD patient is 55. Conclusion: Our study suggests that Mean Platelet Volume and Red Cell Distribution Width values may be useful for identifying patients who are at high risk for exacerbation of COPD. RDW per se is an important risk factor for Ischemic heart disease (IHD) and elevated RDW may suggest increase in risk of IHD in patients with COPD

Comparison of serum sodium and potassium levels in patients with senile cataract and age-matched individuals without cataract.

Aim: The study was to analyze mean serum sodium and potassium levels in cataract patients and agematched individuals without cataract. Methods and Materials: It was a prospective case-control study. Individuals more than 50 years of age who attended our ophthalmic center in the year 2007-2010 were grouped into those having cataract and those without cataract. Mean serum sodium and potassium levels in the cataract groups were calculated and compared with the control group. Statistical software SPSS14 was used for statistical analysis. Results: Mean serum sodium levels in cataract group was 135.1 meqv/l and 133 meqv/l in the control group. Mean potassium was 3.96 meqv/l in the case study group and 3.97 meqv/l in controls. Mean sodium levels among cases were significantly higher than control group. No difference was seen in the PSC group and control. The difference in mean potassium among the two groups was statistically insignificant. Conclusion: Diets with high sodium contents are a risk factor for senile cataract formation and dietary modifications can possibly reduce the rate of progression cataract.

Clinical Observation of Torasemide in the Treatment of Chronic Heart Failure / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of torasemide in the treatment of chronic heart failure(CHF). METHODS:94 patients with CHF were selected and randomly divided into control group and observation group,with 47 cases in each group. Control group were treated with routine treatment,such as bed rest,oxygen inhalation,control of total body fluid in-take,routine anti-heart failure therapy and use of diuretic in 24 h. Based on the above treatment,observation group were treated with Torasemide injection with initial dose of 5-10 mg,qd,gradually increasing to 20 mg/d,maximal does of 40 mg/d. Both group re-ceived 7 days of continuous treatment. Clinical efficacies were observed in 2 groups as well as serum potassium and sodium,Scr,24 h urine volume and the rate ofⅠ-Ⅱgrade cardiac function before and after treatment. The occurrence of ADR was compared between 2 groups. RESULTS:The total effective rate of observation group was 61.70%,which was significantly higher than that of control group (46.81%),with statistical significance (P0.05). There was no statistical significance in 24 h urine volume and the rate ofⅠ-Ⅱgrade cardiac function between 2 groups before and after treatment(P>0.05);after treatment,24 h urine volume and the rate ofⅠ-Ⅱgrade cardiac function of 2 groups were increased significantly,the observation group was higher than the control group, with statistical significance (P0.05). CONCLUSIONS:Torasemide is effective for CHF,and can promote diuresis and the recovery of cardiac function with good safety.

Unusual presentation of Sheehan's syndrome with severe hyponatremia and recurrent symptomatic hypoglycemia: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;">Sheehan's syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. The onset in most cases is several months or even years after the inciting delivery, so it is often unrecognized and not adequately treated. Because SS often evolves slowly, it is usually diagnosed late. We report a 47-year old woman with loss of consciousness. Fourteen years ago, she had postpartum hemorrhage with subsequent amenorrhea and failure to lactate. Laboratory investigation showed low blood sugar and serum sodium levels, amid normal cortisol and thyroid function tests. Magnetic resonance imaging (MRI) of the pituitary revealed an empty sella consistent with SS. The presentation of hypoglycemia and hyponatremia are less known complications of Sheehan's syndrome with only a few documented in case reports.</p>

Effects of dimethyltin chloride on renal H~+K~+-ATPase and Na~+K~+-ATPase activity in rats / 中国职业医学

OBJECTIVE: To study the effects of dimethyltin chloride( DMT) on the activity of renal H~+K~+-ATPase( HKA)and Na~+K~+-ATPase( NKA) in SD rats. METHODS: i) In vitro experiment. Five specific pathogen free( SPF) healthy female SD rats were used. The kidney homogenates made with 0. 90% sodium chloride solution was added with DMT( mass concentration,1. 0 g/L) to make final concentrations of 0,1,25,125 and 625 mg/L respectively,then the HKA and NKA activities were detected by the enzyme-linked immunosorbent assay( ELISA). ii) In vivo experiment. Forty SPF healthy SD rats were divided into control group and exposure group,with 20 rats( 10 males and 10 females) in each group. The exposure group was given one-time intraperitoneal injection with DMT( 16. 000 mg / kg body weight),while the control group was given one-time intraperitoneal injection with same volume of 0. 90% sodium chloride solution. The rats were executed 1 and 24 hours after exposure. The kidney tissue was extracted to make kidney homogenates for determination of HKA and NKA activity by microplate reader. The blood from abdominal aorta was collected to measure the levels of serum K~+,Na~+and Cl-. RESULTS: i) In vitro experiment. The HKA activity was inhibited by DMT,and the effect of inhibition increased with the increase of DMT exposure dose( P < 0. 01),showing a dose-effect relationship. The DMT had no effect on NKA activity( P > 0. 05). ii) In vivo experiment. The body weight of rats at 24 hours time point in exposed group was lower than that in control group( P < 0. 01). The HKA activity of the kidney tissue in rats in exposed group was lower than that of control group( P < 0. 01). The NKA activity in kidney tissue of rats and the level serum K~+,Na~+and Cl-did not show statistical difference in main and interactive effects concerning treatment and exposure time( P > 0. 05). CONCLUSION: DMT could inhibit the HKA activity in kidney homogenates,but had no obvious effect on NKA activity.

The Analysis of Prognostic Factors in Patients with Decompensated Liver Cirrhosis Admitted to the Medical Intensive Care Unit / 대한구급학회지

BACKGROUND: Patients with decompensated liver cirrhosis usually resulted in admission to the intensive care unit (ICU) during hospitalization. When admitted to the ICU, the mortality was high. The aim of this study is to identify multiple prognostic factors for mortality and to analyze the significance of prognostic survival model with each scoring system in patients with decompensated liver cirrhosis who was admitted to the ICU. METHODS: From January 2008 to December 2008, 60 consecutive patients with decompensated liver cirrhosis were admitted in the ICU and retrospectively reviewed. Prognostic models used were Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), model for end-stage liver disease with incorporation of serum sodium (MELD-Na), acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA). The predictive prognosis was analyzed using the area under the receiver's operating characteristics curve (AUC). RESULTS: The median follow up period was 20 months, and ICU mortality was 17% (n = 10). A total of 24 patients (40%) died during the study period. The average survival of five prognostic models was related with the severity of the disease. All of the five systems showed significant differences in the cumulative survival rate, according to the scores on admission, and the MELD-Na had the highest AUC (0.924). Multivariate analysis showed that bilirubin and albumin were significantly related to mortality. CONCLUSIONS: The CPT, MELD, MELD-Na, APACHE II, and SOFA may predict the prognosis of patients with decompensated liver cirrhosis. The MELD-Na could be a better prognostic predictor than other scoring systems.

A comparative study of the clinico-aetiological profile of hyponatremia at presentation with that developing in the hospital

Background & objectives: Hyponatremia is a common problem encountered in patients presenting with nonspecific symptoms. We undertook this study to investigate the clinical profile of patients with hyponatremia, the precipitating factors, the response to therapy and to compare, using these parameters, hyponatremia at presentation to that developing in the hospital. Methods: Seventy consecutive patients with serum sodium less than or equal to 125 mmol/l at presentation or at any time during hospital admission were identified and studied using a proforma. The severity of hyponatremia, therapy given and time taken for recovery were analysed. Results: The mean age of patients was 48.1 ± 16.1 yr. The mean serum sodium was 117.8 ± 6.4 mmol/l. Confusion, headache and malaise were the most common symptoms, two patients had seizures, and 20.0 per cent patients showed no clinical manifestations. Nausea was significantly (P<0.05) more common in patients presenting with hyponatremia. 22 patients (31.4%) developed hyponatremia during their stay in the hospital. 3 patients (4.3%) presented with hyponatremia which got worse during the admission period. Most had multiple precipitating factors, decreased intake being the most common (82.9%), followed by increased losses (65.7%) and miscellaneous factors (70.0%). Drugs, fluid overload and inappropriate Ryle's tube feeds more commonly precipitated hyponatremia in in-hospital patients. Time taken for recovery showed negative correlation with the serum sodium. Patients with in-hospital hyponatremia took significantly longer time to recover (P<0.05). Interpretation & conclusions: Decreased intake was found to be the commonest cause of hyponatremia, thus, ensuring adequate oral intake, especially in patients on liquid diet and in manual labourers, and correction of hyponatremia as soon as an abnormality is detected is important.

Electrolyte status in birth asphyxia.

Objective. To study electrolyte status in asphyxiated newborns of different severity in early neonatal period and compare with controls. Methods. Sodium, potassium and total calcium levels were estimated in the serum samples of asphyxiated newborns of different severity and control group immediately after birth. Results. Mean serum sodium level was significantly lower (122.1 ± 6.0 mEq/L vs 138.8 ± 2.7 mEq/L; P < 0.001), mean serum potassium was higher (5.05 ± 0.63 mEq/L vs 4.19 ± 0.40 mEq/L; P < 0.001) and mean serum calcium level was found lower (6.85 ± 0.95 mg/dl vs 9.50 ± 0.51 mg/dl; P < 0.001) in cases than controls. Among cases, a strong positive linear correlation was found between the serum sodium, serum calcium levels and their Apgar scores, between sodium levels and total calcium levels and significant negative linear correlation between Apgar scores and serum potassium level. Conclusion. Among cases, hyponatremia and hypocalcemia developed early and simultaneously and the decrease in their serum levels was directly proportional to each other and to the degree of asphyxia. Though, mean potassium level was within the normal limit, the value was higher among cases than controls and directly proportional to asphyxia.

Effects of humid heat environment conditioning on post-training serum K+, Na+ concentrations and blood leukocyte count / 第二军医大学学报

Objective: To identify the effects of humid heat environment conditioning on the serum K+, Na+ concentrations and blood leukocyte count after weight-loading physical ability test (PAT), and to investigate the parameter changes with humid heat environment conditioning. Methods: A total of 59 male healthy volunteers, aged 18-23 years old, were divided into two groups, with 30 in the training group and 29 in the control group. The fasting venous blood samples were taken in the morning in both groups for determination of serum K+, Na+ concentrations and blood leukocyte count. The subjects in the training group received physical training (weight-loading) under humid heat environment condition for 6 weeks, and those in the control group received no training. Then the serum K+, Na+ concentrations and blood leukocyte count were determined again the next morning after they had participated a weight-loading PAT. Results: The serum K +, Na+ concentrations and blood leukocyte counts were similar in the 2 groups before training. The increase of electrolyte concentration after PAT was more prominent in the control group compared with the baseline level before training in the training group (F= 9.27, P = 0.0035; F= 366.46, P<0.0001 for K+ and Na+, respectively). Meanwhile, the control group also exhibited a significant elevation of total leukocyte count after PAT compared with the baseline level before training in the training group (F=10.20, P = 0.0023), mainly attributable to the increase of neutrophils (F= 12.25, P = 0.0009). Conclusion: The post-PAT serum Na +, K+ concentrations and white blood cell count, mainly neutrophils count, increase much more remarkably in the subjects undergoing no training in humid heat environment than those have been trained in humid heat environment.

Evaluation of postoperative short·-term survival rate after liver transplantation for benign end-stage hepatopathy by model for end-stage liver disease score and serum sodium concentration and ascites condition / 中华消化外科杂志

Objective To investigate the efficiency of model for end-stage liver disease(MELD)score,serum sodium concentration and aseites condition in the evaluation of short-term survival rate of patients with benign end-stage hepatopathy after liver transplantation.Methods The clinical data of 98 patients with benign end-stage hepatopathy who had undergone liver transplantation in Fuzhou General Hospital from January 1999 to February 2007 were retrospectively analyzed.The relationship between serum sodium concentration.ascites condition and the prognosis of patients with the same MELD score was analyzed.Kaplan-Meier survival curve was drawn.The 1-year survival rate of the patients was analyzed by chi-square test.The mortality of patients with the same MELD score at the end of the third month after operation was analyzed by Fisher's exact test.Results MELD score of aIJ patients was 15-25 or＞25.The postoperatire 3-month mortality rates of patients with serum sodium concentration≥130 mmol/L were 5%and 15%.which were significantly lower than 33%and 55%of those with serum sodium concentration＜1 30 mmol/L.The difference upon 1-year survival rates between them had statistical significance(x2:12.88,P＜0.05).The postoperative 3-month mortality rates of patients without ascites were 5%and 8%.which were lower than 35%and 57%of those with aseites.and the difference upon 1-year survival rates between them had statistical significance(X2=15.26.P＜0.05).Conclusions It is more accurate to evaluate the short-term survival rate after liver transplantation for benign end-stage hepatopathy by combining the MELD score with serum sodium concentration and ascites condition.

Transurethral resection syndrome during transurethral vaporization of the prostate / 医学研究生学报

Objective:To summarize the influencing factors and the preventative strategies of transurethral resection syndrome(TURS) in transurethral vaporization of the prostate(TVP). Methods:Among the consecutive 1360 patients who underwent TVP from Feb 1998 to 2004 Dec,using Circon vaporization device and vaporizaton-resection electrode,irrigating with 5% GS,TURS occured in 12 cases.The clinical materials were reviewed retrospectively. Results:At the end of operation,serum sodium declined and blood glucose rose apparently in the TURS cases.Of the 12 patients,mean operative time was 136 min(90-180min),prostate volume were Ⅲ?(50-75 g),perforation of the prostate capsule occurred in 8 cases,chill occued in 8 cases.TURS occurrence rate was relatively high in the high risk cases.The 12 patients were cured. Conclusion:The risk of TURS that still exists during TVP is relevant to: perforation of the prostate capsule,operative time,irrigating pressure,the high risk cases,prostate volume and(so on.)