Electrolyte Analysis and Replacement: Challenging a Paradigm in Surgical Patients.

Postoperative patients are susceptible to alterations in electrolyte homeostasis. Although electrolytes are replaced in critically ill patients, stable asymptomatic non-intensive care unit (ICU) patients often receive treatment of abnormal electrolytes. We hypothesize there is no proven benefit in asymptomatic patients. In 2016, using the electronic medical records and pharmacy database at a university academic medical center, we conducted a retrospective cost analysis of the frequency and cost of electrolyte analysis (basic metabolic panel [BMP], ionized calcium [Ca], magnesium [Mg], and phosphorus [P]) and replacement (potassium chloride [KCl], Mg, oral/iv Ca, oral/iv P) in perioperative patients. Patients without an oral diet order, with creatinine more than 1.4, age less than 16 years, admitted to the ICU, or with length of stay of more than 1 week were excluded. Nursing costs were calculated as a fraction of hourly wages per laboratory order or electrolyte replacement. One hundred thirteen patients met our criteria over 11 months. Mean length of stay was 4 days; mean age was 54 years; and creatinine was 0.67 ± 0.3. Electrolyte analysis laboratory orders (n = 1,045) totaled $6,978, and BMP was most frequently ordered accounting for 36% of laboratory costs. In total, 683 doses of electrolytes cost the pharmacy $1,780. Magnesium was most frequently replaced, followed by KCl, P, and Ca. Nursing cost associated with electrolyte analysis/replacement was $7,782. There is little evidence to support electrolyte analysis and replacement in stable asymptomatic noncritically ill patients, but their prevalence and cost ($146/case) in this study were substantial. Basic metabolic panels, pharmacy charges for potassium, and nursing staff costs accounted for the most significant portion of the total cost. Considering these data, further research should determine whether these practices are warranted.

Early maturing Bt cotton requires more potassium fertilizer under water deficiency to augment seed-cotton yield but not lint quality.

Exhaustive crops such as cotton require potassium (K) in copious amounts as compared to other crops. High yielding cultivars in cotton-wheat cropping system, have further increased its demand in cotton growing areas of Pakistan. As cotton is grown in arid and semiarid areas, therefore often prone to water deficiency. The reproductive growth particularly flowering and boll setting are highly sensitive to low soil water potentials, where enough K supply can play a vital role. In this two-year field studies, three cultivars (early, mid and late maturing) were cultivated at two K fertilizer levels 100, 200 kg K ha-1 along with control with no K fertilizer application at two irrigation levels. In first irrigation level, water was applied as per full irrigation schedule, while in water deficit irrigation water was applied at deficit irrigation schedule started after flowering till harvesting. It has been revealed that K application has impact on boll setting as well as seed cotton yield, however early and mid-maturing cultivars are more responsive to K fertilization. Furthermore, irrigation level had significant impact against K fertilization and relatively better response was observed in deficit irrigation as compared to full irrigation. Nevertheless, fiber quality parameters were unaffected by K fertilization. Considering the best benefit cost ratio under water deficiency, it is concluded that 100 kg K2O ha-1 should be applied at the time of seed bed preparation for economical seed-cotton yield of early maturing Bt cotton.

Cost-effectiveness of milk powder fortified with potassium to decrease blood pressure and prevent cardiovascular events among the adult population in China: a Markov model.

OBJECTIVE: To model the long-term cost-effectiveness of consuming milk powder fortified with potassium to decrease systolic blood pressure (SBP) and prevent cardiovascular events. DESIGN: A best case scenario analysis using a Markov model was conducted. PARTICIPANTS: 8.67% of 50-79 year olds who regularly consume milk in China, including individuals with and without a prior diagnosis of hypertension. INTERVENTION: The model simulated the potential impact of a daily intake of two servings of milk powder fortified with potassium (+700 mg/day) vs the consumption of a milk powder without potassium fortification, assuming a market price equal to 0.99 international dollars (intl$; the consumption of a milk powder without potassium fortification, assuming a market price equal to intl$0.99 for the latter and to intl$1.12 for the first (+13.13%). Both deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the results. MAIN OUTCOME MEASURES: Estimates of the incidence of cardiovascular events and subsequent mortality in China were derived from the literature as well as the effect of increasing potassium intake on blood pressure. The incremental cost-effectiveness ratio (ICER) was used to determine the cost-effectiveness of a milk powder fortified with potassium taking into consideration the direct medical costs associated with the cardiovascular events, loss of working days and health utilities impact. RESULTS: With an ICER equal to int$4711.56 per QALY (quality-adjusted life year) in the best case scenario and assuming 100% compliance, the daily consumption of a milk powder fortified with potassium shown to be a cost-effective approach to decrease SBP and reduce cardiovascular events in China. Healthcare savings due to prevention would amount to intl$8.41 billion. Sensitivity analyses showed the robustness of the results. CONCLUSION: Together with other preventive interventions, the consumption of a milk powder fortified with potassium could represent a cost-effective strategy to attenuate the rapid rise in cardiovascular burden among the 50-79 year olds who regularly consume milk in China.