Severe Electrolyte Abnormalities and Distal Renal Tubular Acidosis in the Setting of Apremilast Use for Psoriatic Arthritis: A Case Report.

Renal tubular acidosis (RTA) involves dysfunction of the renal tubular system, which leads to electrolyte abnormalities and acid-base dysregulation. The case we present here discusses a patient with a past medical history of psoriatic arthritis who presented to the emergency department with progressive generalized weakness and anorexia in the preceding four weeks. She was found to have profound hypokalemia (1.2 mmol/L), hyperchloremic metabolic acidosis, and multiple other electrolyte abnormalities. Following an extensive workup, her principle problem was deemed to be distal (type 1) RTA. She was treated with sodium bicarbonate, spironolactone, and aggressive rehydration, which eventually led to the stabilization of her electrolytes alongside clinical improvement over the course of an eight-day hospitalization. The workup did not reveal a clear etiology for the RTA. One month prior to hospitalization, she was started on apremilast, a new medication for her psoriatic arthritis. Given the limited availability of alternative explanations and the temporality of clinical manifestations, our findings raise suspicion that apremilast might be associated with her clinical presentation.

Severe hypernatremia during postoperative care in patients with craniopharyngioma.

Purpose: We aimed to describe and predict the risk of severe hypernatremia after surgical resection of craniopharyngioma and to identify the association of water intake, urine output, and sodium level change in the patients. Method: The outcome was postoperative severe hypernatremia. We identified risk factors associated with hypernatremia using multivariable regression. We trained machine learning models to predict the outcome. We compared serum sodium change, intravenous input, oral input, total input, urine output, and net fluid balance according to different nurse shifts. Results: Among 234 included patients, 125 developed severe hypernatremia after surgery. The peak incidence occurred during day 0 and day 6 after surgery. The risk was increased in patients with gross total resection (odds ratio (OR) 2.41, P < 0.001), high Puget classification (OR 4.44, P = 0.026), preoperative adrenal insufficiency (OR 2.01, P = 0.040), and preoperative hypernatremia (OR 5.55, P < 0.001). The random forest algorithm had the highest area under the receiver operating characteristic curve (0.770, 95% CI, 0.727-0.813) in predicting the outcome and was validated in the prospective validation cohort. Overnight shifts were associated with the highest serum sodium increase (P = 0.010), less intravenous input (P < 0.001), and less desmopressin use (P < 0.001). Conclusion: The overall incidence of severe hypernatremia after surgical resection of craniopharyngioma was significant, especially in patients with gross total resection, hypothalamus distortion, preoperative adrenal insufficiency, and preoperative severe hypernatremia. Less intravenous input and less desmopressin use were associated with serum sodium increases, especially during overnight shifts.

Hypermagnesemia in Clinical Practice.

Hypermagnesemia is a relatively uncommon but potentially life-threatening electrolyte disturbance characterized by elevated magnesium concentrations in the blood. Magnesium is a crucial mineral involved in various physiological functions, such as neuromuscular conduction, cardiac excitability, vasomotor tone, insulin metabolism, and muscular contraction. Hypomagnesemia is a prevalent electrolyte disturbance that can lead to several neuromuscular, cardiac, or nervous system disorders. Hypermagnesemia has been associated with adverse clinical outcomes, particularly in hospitalized patients. Prompt identification and management of hypermagnesemia are crucial to prevent complications, such as respiratory and cardiovascular negative outcomes, neuromuscular dysfunction, and coma. Preventing hypermagnesemia is crucial, particularly in high-risk populations, such as patients with impaired renal function or those receiving magnesium-containing medications or supplements. Clinical management of hypermagnesemia involves discontinuing magnesium-containing therapies, intravenous fluid therapy, or dialysis in severe cases. Furthermore, healthcare providers should monitor serum magnesium concentration in patients at risk of hypermagnesemia and promptly intervene if the concentration exceeds the normal range.

Effects of hemoperfusion first aid process reengineering on electrolyte disturbance, liver function and prognosis in patients with acute poisoning.

Acute poisoning is a frequently encountered medical emergency in the emergency room, typically resulting from the incorrect use of drugs or pesticides, and is characterized by sudden onset of severe symptoms, often leading to fatalities. This research was to explore the effect of hemoperfusion first aid process reengineering on electrolyte disturbance, liver function and prognosis in patients with acute poisoning. From August 2019 to July 2021, 137 patients with acute poisoning who received first aid process reengineering were selected as the observation group, and 151 patients with acute poisoning who received routine first aid were selected as the control group. The success rate, first aid-related indicators, electrolyte, liver function, and prognosis and survival were recorded after first aid treatment. The observation group had a 100% effective rate on the third day of first aid, which was significantly higher than the control group (91.39%). The observation group also had shorter time for emesis induction, poisoning assessment, venous transfusion, consciousness recovery, opening of the blood purification circuit, and start of hemoperfusion than the control group (P < 0.05). Additionally, the observation group showed lower levels of alpionine aminotransferase, total bilirubin, serum creatinine, and urea nitrogen after treatment, and a significantly lower mortality rate (6.57%) than the control group (26.28%) (P < 0.05). Hemoperfusion first aid process reengineering in patients with acute poisoning can improve the success rate of first aid, shorten the time of first aid, improve the electrolyte disturbance, treatment effect, liver function and blood routine of the patients.

Acute kidney injury following induction of chemotherapy: Diagnosis and management in critical care.

A 48-year-old gentleman who had recently commenced chemotherapy for diffuse B-cell lymphoma was admitted to hospital with nausea and generalised weakness. He developed abdominal pain and oliguric acute kidney injury with multiple electrolyte derangements and was transferred to the intensive care unit (ICU). His condition deteriorated, requiring endotracheal intubation and renal replacement therapy (RRT). Tumour lysis syndrome (TLS) is a common and life-threatening complication of chemotherapy and represents an oncological emergency. TLS affects multiple organ systems and is best managed in the ICU with closer monitoring of fluid balance, serum electrolytes, cardiorespiratory and renal function. TLS patients may go on to require mechanical ventilation and RRT. TLS patients require input from a large multidisciplinary team of clinicians and allied health professionals.

Electrolyte Imbalance and Neurologic Injury.

Neurologic injury continues to be a debilitating worldwide disease with high morbidity and mortality. The systemic sequelae of a neural insult often lead to prolonged hospital stays and challenging nutritional demands that contribute to poorer prognoses. Clinical management of a given condition should prioritize preserving the homeostatic parameters disrupted by inflammatory response cascades following the primary insult. This focused review examines the reciprocal relationship between electrolyte disturbance and neurologic injury. A prolonged electrolyte imbalance can significantly impact morbidity and mortality in neurologic injuries. A detailed overview of the major electrolytes and their physiologic, iatrogenic, and therapeutic implications are included. The pathophysiology of how dysnatremias, dyskalemias, dyscalcemias, and dysmagnesemias occur and the symptoms they can induce are described. The manifestations in relation to traumatic brain injury, status epilepticus, and acute ischemic stroke are addressed. Each type of injury and the strength of its association with a disruption in either sodium, potassium, calcium, or magnesium is examined. The value of supplementation and replacement is highlighted with an emphasis on the importance of early recognition in this patient population. This review also looks at the current challenges associated with correcting imbalances in the setting of different injuries, including the relevant indications and precautions for some of the available therapeutic interventions. Based on the findings of this review, there may be a need for more distinct clinical guidelines on managing different electrolyte imbalances depending on the specified neurologic injury. Additional research and statistical data on individual associations between insult and imbalance are needed to support this potential future call for context-based protocols.

Analysis of clinical characteristics of 294 acute poisoning patients with gastric lavage / 中华急诊医学杂志

Objective:To describe the current situation of gastric lavage operation and put forward measures for improvement by analyzing the clinical characteristics of 294 patients with gastric lavage in Poisoning Treatment Center of The First Affiliated Hospital of Nanjing Medical University.Methods:The clinical data of 294 patients with acute poisoning and gastric lavage from 2019 to 2021 were collected and analyzed retrospectively, and the related parameters (poison type, gastric lavage volume, poisoning to gastric lavage time, etc.) of each year were compared.Results:A total of 653 poisoning patients underwent gastric lavage from 2019 to 2021, with an average age of (44.2 ±20.1) years, and 134 (45.6%) were male. The main causes of gastric lavage were pesticide poisoning (52.72%) and drug poisoning (42.86%). The volume of gastric lavage was less than 10 L for 43.8% of patients and 10-20 L for 32.7% of patients. Patients with gastric lavage within 60 min after ingestion of poison accounted for 45.3%, followed by 25.8% within 61-120 min. The in-hospital mortality rate was 17.7%. The common complications of gastric lavage were: the incidence of gastrointestinal bleeding (55/121, 45.5%), the incidence of aspiration pneumonia (54/140, 38.6%), and the incidences of electrolyte disorder (21% of low potassium, 29% low calcium, and 10.0% low sodium). Compared with the groups in different years, the proportion of gastric lavage in poisoning was 58.85% vs. 46.60% vs. 32.41%, which decreased year by year, with statistical difference ( P <0.05). And there was no difference in the period from ingestion to gastric lavage and gastric lavage fluid volume. There was an increasing trend in poison types between diquat and other insecticides, but there was no statistical difference. Conclusions:From 2019 to 2021, the most common causes of acute gastric lavage were pesticide poisoning and drug poisoning, and the proportion of diquat and other pesticides showed an overall upward trend. A majority of the patients (71.1%) had gastric lavage within 2 h, and 76.5% of the patients had less than 20 L gastric lavage fluid. In the future, we will further control the amount of gastric lavage fluid and pay attention to the gastric lavage operation of new insecticide poisoning.

McKittrick-Wheelock syndrome secondary to rectal adenocarcinoma

Introduction: McKittrick-Wheelock syndrome is a rare condition that arises from a hypersecretory state secondary to large colorectal tumors, mainly villous adenomas, leading to an electrolytic disorder associated with chronic diarrhea that usually persists for years. It is a relatively unknown disease that can lead to severe complications such as acute kidney injury, severe hyponatremia, and hypokalemia. In fact, it causes death in most untreated cases. Surgical removal of the tumor is the most successful treatment, and symptoms tend to disappear after proper management. Case Report: A 62-year-old man with a 2-year history of mucoid diarrhea preceded by abdominal pain presented with acute kidney injury, hyponatremia, and hypokalemia. A digital rectal examination and sigmoidoscopy were performed, and revealed a large laterally-spreading tumor in the rectum. Further investigation showed a rectal tubulovillous adenoma with secondary McKittrick-Wheelock syndrome. An anterior resection of the rectum with a colonic J-pouch and a diverting ileostomy were performed, and the patient improved with the resolution of the renal failure and electrolyte disturbances. The histopathological analysis revealed an invasive rectal adenocarcinoma. Discussion: McKittrick-Wheelock syndrome is a condition with a low incidence that needs early intervention and proper diagnosis. It is of extreme importance that this disease is included in the differential diagnoses for chronic diarrhea associated with an electrolytic disorder. (AU)

Ionized Hypomagnesemia Is Associated With Increased Incidence of Postoperative Atrial Fibrillation After Esophageal Resection: A Retrospective Study.

INTRODUCTION: Postoperative atrial fibrillation (POAF) is common after surgery for esophageal cancer and may prolong hospitalization and elevate mortality. POAF and hypomagnesemia are linked, but this is based on studies showing an association of POAF with serum total magnesium (tMg). In contrast, the relationship of POAF with ionized magnesium (iMg), which has physiological activity, has not been examined. In this study, the association between hypomagnesemia and POAF was investigated retrospectively to examine iMg as a possible predictive factor for POAF. METHODS: The subjects were 151 patients who underwent right transthoracoabdominal subtotal esophagectomy at Saitama Medical Center between January 2011 and December 2020. The incidence of POAF and predictive factors were examined retrospectively. Perioperative predictive factors were subjected to univariate analysis, and items with P<0.1 were then included in multivariate analysis, along with five potential POAF predictors reported in the literature (age, gender, body mass index, hypertension, and diabetes mellitus). P<0.05 was regarded as significant in the multivariate analysis. RESULTS: Of the 151 patients, 34 (23%) developed POAF. In univariate analysis, six factors with P<0.1 (oral statin, dyslipidemia, iMg level after anesthesia induction, maximum and minimum iMg during surgery, and iMg level immediately before admission to ICU) were identified. In multivariate analysis including these and the five literature factors as explanatory variables, iMg immediately before admission to ICU emerged as a predictive factor for POAF (iMg≥0.46 mmol/L, OR 0.32, 95%CI 0.14-0.74, p=0.01) (standard iMg range: 0.48-0.60 mmol/L). CONCLUSION: The iMg level immediately before admission to ICU may be associated with the development of POAF. A further study is needed to evaluate changes in iMg in the ICU and iMg at the time of onset of POAF.

Association of Low Magnesium Level With Duration and Severity of Type 2 Diabetes.

INTRODUCTION: Type 2 diabetes mellitus can give rise to several complications in the body, including electrolyte imbalance. In this study, we aim to find the association of hypomagnesemia with the duration and severity of diabetes. Understanding the association between magnesium and diabetes may assist in the early detection of hypomagnesemia and help manage the complications associated with electrolyte imbalance. METHODS: This cross-sectional study was conducted in the internal medicine department of a tertiary care hospital in Pakistan from January to March 2021. Three hundred (n = 300) patients with a confirmed diagnosis of type 2 diabetes were enrolled in the study after informed consent via consecutive convenient non-probability sampling. Three hundred (n = 300) patients were included in the study as a reference group. Blood was drawn via phlebotomy and sent to the laboratory to assess glycated hemoglobin (HbA1c) and magnesium levels. RESULTS: In uncontrolled diabetic patients, mean magnesium level was significantly lower as compared to diabetic patients with good glycemic control (1.34 ± 0.3 mg/dL vs. 1.81 ± 0.5; p-value: <0.0001). Prevalence of hypomagnesemia was significantly more in patients with uncontrolled diabetes, compared to the controlled diabetic group (65.8% vs. 50.8%; p-value: 0.009). In patients with a duration of diabetes of more than 10 years, the mean magnesium level was significantly lower, compared to patients with less than 10 years of diabetes (1.32 ± 0.3 mg/dL vs. 1.78 ± 0.5; p-value: <0.0001). Prevalence of hypomagnesemia was significantly more in patients with diabetes for more than 10 years (64.7% vs. 51.9%; p-value: 0.02). CONCLUSION: Hypomagnesemia is prevalent in diabetes and is directly related to the severity and duration of diabetes. It is important to include electrolyte screening as a part of routine screening in diabetic patients for early detection and management of electrolyte imbalance, including hypomagnesemia.

Hyperchloremic metabolic acidosis during bipolar transurethral resection of the prostate: a report of two cases.

Compared with monopolar transurethral resection of the prostate (TURP), which requires electrolyte-free irrigation fluid, normal saline can be used as the irrigation solution in bipolar and laser TURP. The risk of TURP syndrome and severe electrolyte disturbance is minimized when normal saline is used as the irrigation fluid. However, the use of isotonic saline also causes acid-base imbalance and electrolyte disturbance. We experienced two patients who developed hyperchloremic metabolic acidosis during bipolar TURP. After proper intervention, hemodynamic instability resolved, and laboratory test results normalized. Anesthesiologists must pay attention to acid-base and electrolyte status when rapid absorption of excessive isotonic solution is suspected, even during bipolar and laser TURP, which use normal saline as the irrigation fluid.

The successful treatment of multiple organ dysfunction syndrome and severe hypernatremia, secondary to joint supplement toxicity in a dog.

OBJECTIVE: To describe a case of the successful management of hypernatremia and multiple organ dysfunction syndrome secondary to joint supplement toxicity in a dog. CASE SUMMARY: A 6-year-old neutered male Dachshund was presented for severe hypernatremia and neurological abnormalities after ingestion of a large quantity of joint supplements. The patient developed evidence of multiple organ dysfunction in the form of increased hepatocellular enzymes, prolongation of prothrombin and partial thromboplastin times, azotemia, and thrombocytopenia. Treatment was successful at correcting the hypernatremia and restoring neurological function, and organ dysfunction was successfully managed. Following multiple days of hospitalization and aggressive supportive care, the patient survived to discharge. NEW OR UNIQUE INFORMATION PROVIDED: This case report describes the successful management and survival of multiple organ dysfunction associated with joint supplement toxicity. It also serves to highlight the potential for joint supplement overdose in veterinary patients, which is currently believed to be underrecognized.

Conventional Chemotherapy Nephrotoxicity.

Conventional chemotherapies remain the mainstay of treatment for many malignancies. Kidney complications of these therapies are not infrequent and may have serious implications for future kidney function, cancer treatment options, eligibility for clinical trials, and overall survival. Kidney adverse effects may include acute kidney injury (via tubular injury, tubulointerstitial nephritis, glomerular disease and thrombotic microangiopathy), long-term kidney function loss and CKD, and electrolyte disturbances. In this review, we summarize the kidney complications of conventional forms of chemotherapy and, where possible, provide estimates of incidence, and identify risk factors and strategies for kidney risk mitigation. In addition, we provide recommendations regarding kidney dose modifications, recognizing that these adjustments may be limited by available supporting pharmacokinetic and clinical outcomes data. We discuss management strategies for kidney adverse effects associated with these therapies with drug-specific recommendations. We focus on frequently used anticancer agents with established kidney complications, including platinum-based chemotherapies (cisplatin, carboplatin, oxaliplatin), cyclophosphamide, gemcitabine, ifosfamide, methotrexate and pemetrexed, among others.

Predictors of acute cardiovascular events following acute exacerbation period for patients with COPD: a nested case-control study.

BACKGROUND: It has been noted that there is an increase in the incidence of acute cardiovascular events (CVEs) in patients with chronic obstructive pulmonary disease (COPD) during an acute exacerbation (AE), thereby causing increased inpatient mortality. Thus, we have tried to identify predictors of acute CVEs in patients with AECOPD via a nested case-control study. METHODS: A total of 496 cases hospitalized for AECOPD were included in this study, and followed-up for up to 6 months after discharge. Acute CVEs in the AE period were defined as a new or worsening acute coronary syndrome (ACS), arrhythmia, or left ventricular disfunction (LVD). Predictors of CVEs were selected from several variables, including baseline characteristics and treatments in the stable period as well as symptoms, laboratory tests, complications and treatments in the AE period. RESULTS: Thirty cases (6.05%) had acute CVEs, namely 2 had ACS, 13 had LVD and 19 experienced some form of arrhythmia. Four deaths were observed in the CVE group, with significantly increased death risk compared with the non-CVE group (P = 0.001, OR = 5.81). Moreover, patients who had CVEs were more prone to have re-exacerbation within 3 months. Multivariate analysis showed that previous LVD history (P = 0.004, OR = 5.06), 20% increase in heart rate (HR) (P = 0.003, OR = 10.19), electrolyte disturbance (P = 0.01, OR = 4.24) and diuretics (P = 0.002, OR = 6.37) were independent predictors of CVEs. In addition, usage of theophylline, fluoroquinolone and inhaled beta agonists in the AE period were not statistically associated with acute CVEs. CONCLUSIONS: Our preliminary study indicates that patients hospitalized for AECOPD with previous LVD history or increased HR need close observation and diuretics should be cautiously used with regular electrolyte monitoring. These findings need to be confirmed in a large cohort.

Predictors of Mortality in Patients with Chronic Heart Failure: Is Hyponatremia a Useful Clinical Biomarker?

BACKGROUND: Chronic heart failure (CHF) is a global health burden. Despite advances in treatment, there remain well-recognised morbidity and mortality. Risk stratification requires the identification and validation of biomarkers, old and new. Hyponatremia has re-emerged as a prognostic marker in CHF patients. METHODS: This is a retrospective cohort study on 241 CHF patients recruited from King Fahd Hospital of the University, Al-Khobar, Saudi Arabia (January 2005-December 2016). Their serum sodium and biochemical parameters were measured at baseline, along with 2-D echocardiographic assessments of left ventricular mass and ejection fraction. The primary endpoint was the association between hyponatremia and all-cause mortality (ACM) after a follow-up period of 24 months. RESULTS: Mean age of patients was 60.61 ± 12.63 (SD) years; 65.1% were males, and type 2 diabetes mellitus (DM) was present in 71%. Baseline serum sodium was 138.00 (136, 140) (median and interquartile range). Hyponatremia (<135 meq/L) was present in 14.1%. After follow-up, 46 deaths had occurred. Multivariate Cox-proportional hazard model showed that type 2 DM, New York Heart Association (NYHA) class (III-IV vs I-II), age, and left ventricular mass index (LVMI) were significant and independent predictors of ACM, with HR 3.03 (95% CI; 1.13, 8.16) (P=0.028), HR 2.31 (95% CI; 1.11, 4.82) (P=0.026), HR 1.06 (95% CI; 1.03, 1.09) (P<0.001), and HR 1.01 (95% CI; 1.00, 1.02) (P=0.039), respectively. Estimated glomerular filtration rate (eGFR) was not a significant predictor. Kaplan-Meier survival analysis was used for the analysis of NYHA class and hyponatremia interactions and showed that hyponatremia had an association with poorer survival in patients with NYHA class III-IV rather than I-II (Log-rank test, P= 0.0009). CONCLUSION: Hyponatremia was a feature in CHF patients, and ACM was predicted by type 2 DM, NYHA class, age, and LVMI. Hyponatremia impact on survival was in patients with more advanced disease.

Hyperchloremia and acute kidney injury: a retrospective observational cohort study on a general mixed medical-surgical not ICU-hospitalized population.

The aim of this observational retrospective cohort study was to analyze the association between hyperchloremia and serum chloride variation with in-hospital acute kidney injury (AKI) and mortality in a general, no-ICU hospitalized population. We performed a retrospective study on inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 2010 and December 2014 with inclusion of adult patients with at least two values available for chloride, sodium and creatinine. Hyperchloremia was defined as serum chloride concentration ≥ 108 mmol/L (moderate hyperchloremia: chloremia between 108-110 mmol/L, severe hyperchloremia: chloremia > 110 mmol/L). According to the time of onset of the electrolyte disturbance, hyperchloremia was then classified as hospital acquired (HA) and community acquired (CA). In patients with HA-hyperchloremia, chloride variation (ΔCl) was calculated. In-hospital AKI was defined according to creatinine kinetics criteria occurring 48 h after hospital admission. Logistic regression analysis was used to evaluate the association between the exposures of interest and in-hospital AKI and mortality. A total of 24,912 hospital admissions met the inclusion criteria. Regression analyses showed that only severe HA-hyperchloremia was associated with increased risk of in-hospital AKI [odds ratio (OR) 2.60, 95% confidence interval (CI) 1.58, 4.30, p value < 0.001] and death (OR 3.89, 95% CI 2.11, 7.18, p value < 0.001). With increasing ΔCl, the OR of in-hospital AKI increased progressively (p value for trend = 0.005). In conclusion, severe hyperchloremia is an independent predictor for in-hospital AKI and mortality; HA-hyperchloremia is more detrimental for patient outcome; higher ΔCl from hospital admission is associated with increased risk of AKI.

Association Between Low Serum Magnesium Level And Type 2 Diabetes Mellitus In Abbottabad.

BACKGROUND: Magnesium serves as a cofactor for various oxidation reactions in the body and helps in glucose transport across cell membrane. Deficiency of magnesium is a common electrolyte abnormality in type 2 diabetic patients and is linked to development of various diabetic complications. This study was conducted to determine the association between low serum magnesium level and type 2 diabetes mellitus presenting at Medical B ward, BBS Hospital Abbottabad. METHODS: This descriptive study was conducted over a period of 6 months starting July 1, 2017. One hundred & eighty diagnosed diabetic patients aged at least 40 years, were included in the study. Their serum magnesium level was checked after withdrawing blood under strict aseptic conditions. Fasting & random blood glucose and the level of glycosylated haemoglobin were measured and age, gender, duration of illness were recorded on a proforma. RESULTS: Sixty-one patients (33.89%) had hypomagnesemia. There was no significant association between hypomagnesemia and age and sex of patients (p>0.05). However, hypomagnesemia was found to be significantly associated with the duration of diabetes mellitus among study population (p=0.02). CONCLUSIONS: Hypomagnesemia is frequently present in patients with diabetes mellitus and it appears that its prevalence increases with the duration of diabetes mellitus.

Hyponatremia could identify patients with intrabdominal sepsis and anastomotic leak after colorectal surgery: a systematic review of the literature.

Anastomotic leak (AL) is a serious post-operative complication in colorectal surgery. It can lead to devastating morbidity and mortality. Clinicians usually depend on a combination of clinical, biochemical and radiological findings to diagnose this problem. In our article, we tried to look if electrolyte disturbances could be indicators for intra-abdominal sepsis due to AL. Systematic review of the literature identifies a potential correlation between electrolyte alterations and AL in digestive surgery. The following databases were searched: PubMed, EMBASE and MIDLINE. The review adhered to the PRISMA statement for systematic review. Our literature search did not identify any articles linking any electrolyte disturbances-except for hyponatremia-to AL. Pathophysiology of these electrolyte disturbances does not seem to be linked to AL, except for hyponatremia which might be explained. Our review included 442 patients with intra-abdominal sepsis and 1133 controls. The mean specificity of hyponatremia being associated with intra-abdominal sepsis is 86%, whereas mean sensitivity is 28%. Hyponatremia seems to be a significant and clinically relevant marker for of intra-abdominal sepsis and AL.