DOCSLIB.ORG

Altered Serum Electrolyte Status in Acute Stroke Patients in Western Odisha, a Predictor of Syndrome of Inappropriate

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Altered Serum Electrolyte Status in Acute Stroke Patients in Western Odisha, a Predictor of Syndrome of Inappropriate Original Article DOI: 10.7860/JCDR/2019/37933.12499 Altered Serum Electrolyte Status in Acute Section Biochemistry Stroke Patients in Western Odisha, A Predictor of Syndrome of Inappropriate ADH (SIADH) or Cerebral Salt Wasting Syndrome (CSWS) MANASWINI PANDA1, PRATIMA KUMARI SAHU2, MANMATH KUMAR MANDAL3, ALOK KUMAR MOHAPATRA4, SUBHA SOUMYA DANY5 ABSTRACT urea, creatinine, fasting blood glucose, age, BMI and other Introduction: Stroke is a major healthcare issue globally parameters were studied in these patients. with an incidence comparable to coronary events. It has Results: Out of 60 patients 41 (68%) were males and 19 (32%) multiple aetiologies and variable clinical manifestations. were females. Maximum number of cases had ischaemic stroke Dyselectrolytaemia is an important cause of morbidity and (62%) followed by haemorrhagic stroke (38%). Mean serum mortality in stroke. level of sodium was lower in cases as compared to the controls Aim: To observe the changes in serum electrolyte levels in which was statistically significant (p<0.0001). The serum Cerebrovascular Accident (CVA) patients and to find any relation calcium was lower in cases as compared to the controls which with other biochemical parameters and type of stroke. was statistically significant (p<0.0001). A total of 71.66% of stroke patients had hyponatraemia, while ~48.33% of patients Materials and Methods: A total of 60 clinically diagnosed and had hypocalcaemia. CT/MRI proven acute stroke patients (ischaemic/haemorrhagic) in age group 40-70 years were studied in the Department of Conclusion: Dyselectrolytaemia is highly prevalent in stroke Biochemistry, VIMSAR, Burla, for a duration of two years patients. Dyselectrolytaemia also varies with the type of stroke. (September 2013 to August 2015). Control group consisted Thus, serum electrolytes should be a part of the initial evaluation of 50 age and sex matched individuals. Serum electrolytes, in all stroke patients to prevent morbidity and mortality. Keywords: Dyselectrolytaemia, Haemorrhagic stroke, Ischaemic stroke INTRODUCTION stroke is headache and vomiting [7]. Vomiting is an important The World Health Organisation (WHO) defines stroke (previously cause of dyselectrolytaemia. In acute phase, complications like known as cerebrovascular accident or CVA) as rapidly developing dyselectrolytaemia are more common [6]. This electrolyte imbalance clinical symptoms and/or signs of focal and at times global may lead to shift of extracellular fluid to intracellular fluid, ultimately (applied to patients in deep coma and those with subarachnoid causing brain oedema. These changes in electrolytes and water haemorrhage) loss of brain function, with symptoms lasting more concentration can result in severe complications. than 24 hours or leading to death, with no apparent cause other Serum electrolytes can be easily measured in emergency service than that of vascular origin. About 85% of all first ever stroke are settings. Studies describing electrolyte status in CVA are rare in ischaemic, 10% are due to primary intracerebral haemorrhage and western Odisha. If they are estimated and corrected in early phase; 5% are due to subarachnoid haemorrhage. patients will have a better prognosis. This study was therefore Stroke is a major healthcare issue worldwide with an incidence undertaken to observe the changes in serum electrolyte levels in CVA patients and to find any relation with other biochemical comparable to coronary events, highlighting the importance of parameters and type of stroke. understanding risk factors for stroke and subsequent mortality. Stroke is the third most common cause of death in developed MATERIALS AND METHODS nations after ischaemic heart disease and cancer [1]. The prevalence The present study was undertaken in the Department of Biochemistry, rate of stroke in India is about 1.54 per 1000 and death rate 0.6 per VSS Institute of Medical Sciences and Research (VIMSAR), Burla, 1000 [2]. Advanced age, hypertension, diabetes mellitus, smoking Odisha, India, on diagnosed cases of acute stroke, admitted to the and atrial fibrillation have been found to be risk factors for stroke Department of General Medicine, during the period of September and relevant mortality in prospective studies [3]. 2013 to August 2015 (two years). It was a retrospective case control Medical management of stroke focuses on the prevention of study and included a total of 60 clinically diagnosed and Computed sub-acute complications of stroke like malnutrition, aspiration Tomography/Magnetic Resonance Imaging (CT/MRI) proven acute pneumonia, electrolyte disturbances, bowel or bladder dysfunction, stroke patients (ischaemic/haemorrhagic) in the age group of 40- Deep Vein Thrombosis (DVT), pulmonary embolism, contractures, 70 years. Control group consisted of 50 age and sex matched joint abnormalities and skin breakdown [4]. normal healthy individuals. Complications such as seizure or death in stroke may be due to Pregnant females, patients receiving dialysis for Chronic Renal electrolyte disturbances resulting from Syndrome of Inappropriate Failure (CRF), patients with severe hyperglycaemia (>300 mg/dL), Antidiuretic Hormone (SIADH) or Cerebral Salt Wasting (CSW), hyperlipidaemia, persons receiving medications altering serum elevation of Brain Natriuretic Peptide (BNP), inappropriate fluid intake electrolytes including anti-hypertensives, cases of subarachnoid or loss [5,6]. Most common clinical presentation in haemorrhagic haemorrhage, convulsive disorder, and patients with liver disease 10 Journal of Clinical and Diagnostic Research. 2019 Jan, Vol-13(1): BC10-BC13 www.jcdr.net Manaswini Panda et al., Altered Serum Electrolyte Status in Acute Stroke Patients were excluded from the study. Patients who did not survive the Controls (n=50) Cases (n=60) stroke incident were not included into the study. All procedures Parameters p-value Mean±SD Range Mean±SD Range performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or Age (Years) 58.88±8.12 40-70 59.78±7.64 41-70 >0.05 national research committee. BMI (kg/m2) 21.98±2.25 19.6-24.8 25.51±3.08 24.8-30.2 <0.0001 Blood pressure was measured by standard sphygmomanometer SBP (mm Hg) 124.76±10.37 110-136 174.13±17.68 146-176 <0.0001 with right arm in supine position. A structured questionnaire was DBP (mm Hg) 80.21±3.13 75-89 99.33±7.99 91-116 <0.0001 used to obtain data on family history of diabetes and/or hypertension, [Table/Fig-3]: Clinical parameters in the groups studied. past and present illness, dietary pattern, addiction, and medication. Approval from the ethical committee was obtained before the study Parameters (mg/ Controls (n=50) Cases (n=60) p-value and informed consent was obtained from participants or their dL) Mean±SD Range Mean±SD Range relatives. Patients admitted within 48 hours of the onset of stroke FBS 86.36±8.21 70-104 88.08±9.36 70-120 p>0.05 were enrolled for this study and at the same time samples were Urea (mg/dL) 33.94±5.51 22-44 39.72±18.34 21-78 <0.05 collected for assessment. Samples were analysed immediately without any delay. Association of electrolyte imbalance among Creatinine (mg/dL) 0.98±0.23 0.5-1.4 1.54±0.71 0.5-3.1 <0.0001 stroke patients were identified and correlated. [Table/Fig-4]: Comparison of biochemical parameters in study groups. Anthropometric parameters like height (cm), weight (kg), and Body [Table/Fig-5-7] shows that serum sodium in controls was Mass Index (BMI) was calculated during the time of admission and 138.86±7.28 mEq/L with a range of 125-146 mEq/L and for blood pressure was taken in normal supine posture three times cases 128.48±4.61 mEq/L with a range of 122-146 mEq/L. and the mean was used. Biochemical parameters like fasting Serum sodium was lower in cases as compared to the controls blood glusose (FBG) and lipid profile (Total cholesterol, Triglyceride, which was statistically significant (p<0.0001). Serum potassium in HDL) were estimated in all subjects as per standard guidelines controls was 4.432±0.51 mEq/L and for cases 4.49±0.55 mEq/L. [8-11]. The estimation was done by the help of semi-automated The difference was statistically not significant (p>0.05). Serum Biochemical Analyser (ACCULAB-AT-112+) using marketed kits. chloride level in controls was 101.48±4.25 mEq/L and for (ACCUREX Diagnostics). Serum electrolytes were estimated by cases 101.17±3.81 mEq/L. The difference was statistically direct Ion Selective Electrode (ISE) method enlite series electrolyte not significant (p>0.05). Serum calcium level in controls was analyser (Accurex biomedical pvt., ltd.,) [12]. Hyponatraemia and 9.00±0.53 mg/dL and for cases 8.6±0.46 mg/dL. [Table/Fig-8] hypocalcaemia were considered if serum levels of sodium and shows that serum sodium was positively correlated to serum calcium were <135 mEq/L and 8.7 mg/dL respectively. All data were urea in suspected SIADH cases and negatively correlated to collected in case record form. Association between variables were serum urea in suspected CSWS cases, which was statistically determined using Microsoft Excel. Correlation between parameters significant. was analysed using the Statistical Package for the Social Sciences (SPSS) version 20 software. Controls (n=50) Cases (n=60) Parameters p-value RESULTS Mean±SD Range Mean±SD Range The study comprised of 60 diagnosed cases of clinically and S.Sodium (mEq/L) 138.86±7.28 125-146 128.48±4.61 122-146 <0.0001 CT/MRI proven acute stroke patients (ischaemic/haemorrhagic) S.Potassium (mEq/L) 4.432±0.51 3.4-5.3 4.49±0.55 3.2-5.4 >0.05 and 50 age and sex matched normal healthy persons as control S.Chloride (mEq/L) 101.48±4.25 96-110 101.17±3.81 94-110 >0.05 [Table/Fig-1,2].
Load more

Recommended publications
  • CARE PLAN Electrolyte and Fluid Imbalance
    CARE PLAN Electrolyte and Fluid Imbalance . Related to: Check all that apply Endocrine dysfunction Treatment/Drug side effects Urinary difficulties Nutritional deficiency Tissue trauma Renal dysfunction Post-op complications Trauma Other _____________ Status: Achieved/ Progressing/Not Date/Select Outcome Select Interventions Met (comment for negative variances) Serum electrolytes, Perform initial/routine BUN, blood gases will assessments, assess be within desired limits for neurological manifestations indicating electrolyte imbalance. Report findings to clinician (MD, PA, NP) promptly. Implement therapeutic actions (i.e., appropriate diet, administer replacement electrolytes—sodium bicarb, mag sulfate, etc., as ordered) Assess/monitor serum levels of electrolytes; report finding to MD promptly Monitor for associated complications Absence of cardiac Assess/monitor cardiac dysrhythmias rhythm Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2016, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace,
    [Show full text]
  • The Association Between Hypocalcemia and Outcome in COVID-19 Patients: a Retrospective Study
    The Association Between Hypocalcemia and Outcome in COVID-19 Patients: a Retrospective Study Bhagwan Singh Patidar All India Institute of Medical Sciences Tapasyapreeti Mukhopadhayay All India Institute of Medical Sciences Arulselvi Subramanian ( [email protected] ) All India Institute of Medical Sciences https://orcid.org/0000-0001-7797-6683 Riicha Aggarwal All India Institute of Medical Sciences Kapil Dev Soni All India Institute of Medical Sciences Neeraj Nischal All India Institute of Medical Sciences Debasis Sahoo All India Institute of Medical Sciences Surbhi Surbhi All India Institute of Medical Sciences Ravindra Mohan Pandey All India Institute of Medical Sciences Naveet Wig All India Institute of Medical Sciences Rajesh Malhotra All India Institute of Medical Sciences Anjan Trikha All India Institute of Medical Sciences Research Article Keywords: Calcium, Coronavirus, Laboratory parameters, Mortality, NLR, Pandemic Posted Date: March 16th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-302159/v1 Page 1/14 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/14 Abstract Background: Calcium has been shown to have a vital role in the pathophysiology of SARS-CoV and MERS-CoV diseases but less is known about hypocalcemia in COVID-19 patients and its association with the disease severity and the nal outcome. Therefore, this study was conducted with an aim to assess the clinical features in the COVID-19 patients having hypocalcemia and to observe its impact on COVID- 19 disease severity and nal outcome. Method: In this retrospective study, consecutive COVID-19 patients of all age groups were enrolled.
    [Show full text]
  • Versus High-Chloride-Containing Hypertonic Solution for the Treatment
    Sadan et al. Journal of Intensive Care (2020) 8:32 https://doi.org/10.1186/s40560-020-00449-0 RESEARCH Open Access Low-chloride- versus high-chloride- containing hypertonic solution for the treatment of subarachnoid hemorrhage– related complications: The ACETatE (A low ChloriE hyperTonic solution for brain Edema) randomized trial Ofer Sadan1*, Kai Singbartl2, Jacqueline Kraft1, Joao McONeil Plancher1, Alexander C. M. Greven3, Prem Kandiah1, Cederic Pimentel1, C. L. Hall1, Alexander Papangelou4, William H. Asbury5, John J. Hanfelt6 and Owen Samuels1 Abstract Background: Recent reports have demonstrated that among patients with subarachnoid hemorrhage (SAH) treated with hypertonic NaCl, resultant hyperchloremia has been associated with the development of acute kidney injury (AKI). We report a trial comparing the effect of two hypertonic solutions with different chloride contents on the resultant serum chloride concentrations in SAH patients, with a primary outcome aimed at limiting chloride elevation. Methods: A low ChloridE hyperTonic solution for brain Edema (ACETatE) trial is a single-center, double-blinded, double-dummy, randomized pilot trial comparing bolus infusions of 23.4% NaCl and 16.4% NaCl/Na-acetate for the treatment of cerebral edema in patients with SAH. Randomization occurred when patients developed hyperchloremia (serum Cl− ≥ 109 mmol/L) and required hyperosmolar treatment. Results: We enrolled 59 patients, of which 32 developed hyperchloremia and required hyperosmolar treatment. 15 patients were randomized to the 23.4% NaCl group, and 17 patients were randomized to the 16.4% NaCl/Na- acetate group. Although serum chloride levels increased similarly in both groups, the NaCl/Acetate group showed a significantly lower Cl− load at the end of the study period (978mEq vs.
    [Show full text]
  • Clinical Physiology Aspects of Chloremia in Fluid Therapy: a Systematic Review David Astapenko1,2* , Pavel Navratil2,3, Jiri Pouska4,5 and Vladimir Cerny1,2,6,7,8,9
    Astapenko et al. Perioperative Medicine (2020) 9:40 https://doi.org/10.1186/s13741-020-00171-3 REVIEW Open Access Clinical physiology aspects of chloremia in fluid therapy: a systematic review David Astapenko1,2* , Pavel Navratil2,3, Jiri Pouska4,5 and Vladimir Cerny1,2,6,7,8,9 Abstract Background: This systematic review discusses a clinical physiology aspect of chloride in fluid therapy. Crystalloid solutions are one of the most widely used remedies. While generally used in medicine for almost 190 years, studies focused largely on their safety have only been published since the new millennium. The most widely used solution, normal saline, is most often referred to in this context. Its excessive administration results in hyperchloremic metabolic acidosis with other consequences, including higher mortality rates. Methods: Original papers and review articles eligible for developing the present paper were identified by searching online in the electronic MEDLINE database. The keywords searched for included hyperchloremia, hypochloremia, and compound words containing the word “chloride,” infusion therapy, metabolic acidosis, renal failure, and review. Results: A total of 21,758 papers published before 31 May 2020 were identified; of this number, 630 duplicates were removed from the list. Upon excluding articles based on their title or abstract, 1850 papers were screened, of which 63 full-text articles were assessed. Conclusions: According to the latest medical concepts, dyschloremia (both hyperchloremia and hypochloremia) represents a factor indisputably having a negative effect on selected variables of clinical outcome. As infusion therapy can significantly impact chloride homeostasis of the body, the choice of infusion solutions should always take into account the potentially adverse impact of chloride content on chloremia and organ function.
    [Show full text]
  • Electrolyte Imbalance in Children with Severe Acute Malnutrition at a Tertiary Care Hospital in Pakistan: a Cross-Sectional Study
    Open Access Original Article DOI: 10.7759/cureus.10541 Electrolyte Imbalance in Children With Severe Acute Malnutrition at a Tertiary Care Hospital in Pakistan: A Cross-Sectional Study Mohammad Raza 1, 2 , Sohail Kumar 3 , Muzamil Ejaz 2 , Dua Azim 3 , Saad Azizullah 2 , Azhar Hussain 4, 5 1. Pediatrics, The Indus Hospital, Karachi, PAK 2. Pediatrics, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK 3. Internal Medicine, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK 4. Healthcare Administration, Franklin University, Columbus, USA 5. Medicine, Xavier University School of Medicine, Oranjestad, ABW Corresponding author: Mohammad Raza, [email protected] Abstract Background Malnutrition is a significant public health concern and a leading contributor to the global burden of children’s diseases, affecting 50 to 150 million children under the age of five years worldwide. Globally, undernutrition accounts for approximately 33% of the deaths among under-fives. South Asia alone contributes to 50% and 38.8% of the world’s population of wasted and stunted children, respectively. In Pakistan, malnutrition is the leading cause of childhood mortality, accounting for nearly 35% of all deaths under five years of age. Severe acute malnutrition (SAM), the most severe form of malnutrition, is often associated with electrolyte imbalances. This study aimed to determine the frequency of electrolyte imbalance in children with SAM admitted at a tertiary care hospital. Methods This cross-sectional study includes 184 patients with SAM aged between 6 and 60 months, who were admitted at the inpatient Department of Pediatrics, Dr. Ruth K.
    [Show full text]
  • Magnesium: the Forgotten Electrolyte—A Review on Hypomagnesemia
    medical sciences Review Magnesium: The Forgotten Electrolyte—A Review on Hypomagnesemia Faheemuddin Ahmed 1,* and Abdul Mohammed 2 1 OSF Saint Anthony Medical Center, 5666 E State St, Rockford, IL 61108, USA 2 Advocate Illinois Masonic Medical Center, 833 W Wellington Ave, Chicago, IL 60657, USA; [email protected] * Correspondence: [email protected] Received: 20 February 2019; Accepted: 2 April 2019; Published: 4 April 2019 Abstract: Magnesium is the fourth most abundant cation in the body and the second most abundant intracellular cation. It plays an important role in different organ systems at the cellular and enzymatic levels. Despite its importance, it still has not received the needed attention either in the medical literature or in clinical practice in comparison to other electrolytes like sodium, potassium, and calcium. Hypomagnesemia can lead to many clinical manifestations with some being life-threatening. The reported incidence is less likely than expected in the general population. We present a comprehensive review of different aspects of magnesium physiology and hypomagnesemia which can help clinicians in understanding, identifying, and treating this disorder. Keywords: magnesium; proton pump inhibitors; diuretics; hypomagnesemia 1. Introduction Magnesium is one of the most abundant cation in the body as well as an abundant intracellular cation. It plays an important role in molecular, biochemical, physiological, and pharmacological functions in the body. The importance of magnesium is well known, but still it is the forgotten electrolyte. The reason for it not getting the needed attention is because of rare symptomatology until levels are really low and also because of a lack of proper understanding of magnesium physiology.
    [Show full text]
  • Renal Tubular Acidosis in Children: State of the Art, Diagnosis and Treatment
    www.medigraphic.org.mx Bol Med Hosp Infant Mex 2013;70(3):178-193 REVIEW ARTICLE Renal tubular acidosis in children: state of the art, diagnosis and treatment Ricardo Muñoz-Arizpe,1 Laura Escobar,2 Mara Medeiros3 ABSTRACT Overdiagnosis of renal tubular acidosis (RTA) has been recently detected in Mexican children, perhaps due to diagnostic errors as well as due to a lack of knowledge regarding the pathophysiology and molecular biochemistry involved in this illness. The objective of the present study is to facilitate the knowledge and diagnosis of RTA, a clinical condition infrequently seen worldwide. RTA is an alteration of the acid-base equilibrium due to a bicarbonate wasting in the proximal renal tubules [proximal RTA, (pRTA) or type 2 RTA] or due to a distal nephron hy- drogen ion excretion defect [distal RTA (dRTA) or type 1 RTA]. Hyperkalemic, or type 4 RTA, is due to alterations in aldosterone metabolism. RTA may be primary, secondary, acquired or hereditary and frequently presents secondary to an array of systemic diseases, usually accom- panied by multiple renal tubular defects. The main defect occurs in the transmembrane transporters such as carbonic anhydrase (CA I and + - - + - II), H -ATPase, HCO3 /Cl (AE1) exchanger and Na /HCO3 (NBCe1) cotransporter. Diagnosis should include the presence of hyperchloremic metabolic acidosis with normal serum anion gap (done in an arterial or arterialized blood sample), lack of appetite, polyuria, thirst, growth failure, and rickets; nephrocalcinosis and renal stones (in dRTA); abnormal urine anion gap and abnormal urine/serum pCO2 gradient. Diagnosis of a primary systemic disease must be made in cases of secondary RTA.
    [Show full text]
  • Novel Mutations Associated with Inherited Human Calcium-Sensing
    1 180 A García-Castaño, Novel mutations in the calcium 180:1 59–70 Clinical Study L Madariaga and others receptor gene Novel mutations associated with inherited human calcium-sensing receptor disorders: A clinical genetic study Alejandro García-Castaño1,*, Leire Madariaga1,2,*, Gustavo Pérez de Nanclares1,2, Gema Ariceta3, Sonia Gaztambide1,2 and Luis Castaño1,2 on behalf of Spanish Endocrinology Group and Renal Tube Group Correspondence should be addressed 1Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain, 2Hospital Universitario Cruces, to L Castaño UPV/EHU, Barakaldo, Spain, and 3Hospital Universitario Materno-Infantil Vall d’Hebron, Autonomous University of Email Barcelona, Barcelona, Spain LUISANTONIO. *(A García-Castaño and L Madariaga contributed equally to this work) CASTANOGONZALEZ@ osakidetza.eus Abstract Objective: Molecular diagnosis is a useful diagnostic tool in calcium metabolism disorders. The calcium-sensing receptor (CaSR) is known to play a central role in the regulation of extracellular calcium homeostasis. We performed clinical, biochemical and genetic characterization of sequence anomalies in this receptor in a cohort of 130 individuals from 82 families with suspected alterations in the CASR gene, one of the largest series described. Methods: The CASR gene was screened for mutations by polymerase chain reaction followed by direct Sanger sequencing. Results: Presumed CaSR-inactivating mutations were found in 65 patients from 26 families. These patients had hypercalcemia (median: 11.3 mg/dL) but normal or abnormally high parathyroid hormone (PTH) levels (median: 52 pg/ mL). On the other hand, presumed CaSR-activating mutations were detected in 17 patients from eight families. These patients had a median serum calcium level of 7.4 mg/dL and hypoparathyroidism (median: PTH 13 pg/mL).
    [Show full text]
  • Hyponatremia in Hepatic Cirrhosis Following Paracentesis
    HYPONATREMIA IN HEPATIC CIRRHOSIS FOLLOWING PARACENTESIS William P. Nelson III, … , Jack D. Rosenbaum, Maurice B. Strauss J Clin Invest. 1951;30(7):738-744. https://doi.org/10.1172/JCI102487. Research Article Find the latest version: https://jci.me/102487/pdf HYPONATREMIA IN HEPATIC CIRRHOSIS FOLLOWING PARACENTESIS 1 By WILLIAM P. NELSON, III, JACK D. ROSENBAUM, AND MAURICE B. STRAUSS (From the Medical Service, Cushing Veterans Administration Hospital, Framingham, Mass.) (Submitted for publication January 15, 1951; accepted April 23, 1951) The retention of water without a physiologically modification of the Folin procedure (14); non-protein equivalent amount of sodium following abdominal nitrogen by micro-Kjeldahl with Nesslerization (15); and sodium and potassium by means of the Barclay internal paracentesis has been studied in two patients with standard flame photometer. Except where otherwise advanced cirrhosis of the liver. In each there de- noted, urine was collected over 24 hour periods and was veloped manifestations considered characteristic analyzed for chloride by the Volhard-Harvey method of sodium deficit, although there was no change in (16), for total nitrogen by the micro-Kjeldahl procedure the total body sodium at the time these appeared. (11), and for creatinine, sodium, and potassium by the methods employed for serum. Change in total body water Such retention of water in excess of salt, regularly (liters) was taken to equal change in weight (kilograms). observed when large external losses of salt and water are replaced with water alone (1-3), has CASE REPORTS AND RESULTS been noted in certain cases of heart failure and chronic renal disease (4-6) as well as in decom- Case I.
    [Show full text]
  • Hyperchloremia – Why and How
    Document downloaded from http://www.elsevier.es, day 23/05/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. n e f r o l o g i a 2 0 1 6;3 6(4):347–353 Revista de la Sociedad Española de Nefrología www.revistanefrologia.com Brief review Hyperchloremia – Why and how Glenn T. Nagami Nephrology Section, Department of Medicine, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, United States a r t i c l e i n f o a b s t r a c t Article history: Hyperchloremia is a common electrolyte disorder that is associated with a diverse group of Received 5 April 2016 clinical conditions. The kidney plays an important role in the regulation of chloride concen- Accepted 11 April 2016 tration through a variety of transporters that are present along the nephron. Nevertheless, Available online 3 June 2016 hyperchloremia can occur when water losses exceed sodium and chloride losses, when the capacity to handle excessive chloride is overwhelmed, or when the serum bicarbonate is low Keywords: with a concomitant rise in chloride as occurs with a normal anion gap metabolic acidosis Hyperchloremia or respiratory alkalosis. The varied nature of the underlying causes of the hyperchloremia Electrolyte disorder will, to a large extent, determine how to treat this electrolyte disturbance. Serum bicarbonate Published by Elsevier Espana,˜ S.L.U. on behalf of Sociedad Espanola˜ de Nefrologıa.´ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
    [Show full text]
  • Electrolyte Imb-Hypercalcemia
    HYPERCALCEMIA (Last updated 01/10/2020; Last reviewed 03/11/2017; Reviewers: Rudy Tedja, DO, Bibek Karki, MBBS) PRESENTING COMPLAINT: Weakness, fatigue, constipation, depression FINDINGS A Check airway B ↓/N RR C ↑/N BP, ↓HR D Variable altered (V,P,U,D)* E Profound muscle weakness, bone pain LPC ↑Ca, ↑/↓/N PTH, ↑/↓/N P UPC Renal stone *V (verbal), P (pain), U (unconsciousness), D (delirious) UPC (point of care ultrasound) LPC (point of care labs) OTHER HISTORY Signs and symptoms Neurological: Lethargy, confusion, stupor, coma Cardiac: Shortened QT interval, supraventricular, ventricular arrhythmias, bradycardia Renal: Polyuria, nephrolithiasis, nephrogenic diabetes insipidus, renal insufficiency, renal tubular acidosis MSK: Bone pain GI: Nausea/vomiting, abdominal pain, pancreatitis Predisposing Conditions: Elderly are predisposed to neuropsychiatric symptoms and known history of malignancy DIFFERENTIAL DIAGNOSIS Other causes of drug induced or metabolic encephalopathy/coma, delirium, intracranial pathology OTHER INVESTIGATIONS Lab: Creatinine Severity: Mild: Calcium < 12 mg/dL; moderate: Calcium 12-14 mg/dL; severe: Calcium >14 mg/dL Monitoring: Calcium level every 8 hours THERAPEUTIC INTERVENTIONS Initial therapy 1 o Stop any offending agents, such as thiazides, lithium, exogenous calcium, vitamin A supplementation, vitamin D supplementation o Intravascular volume repletion with isotonic saline at initial rate of 200-300 ml/hr . Depending on renal function and history of CHF . Titrate rate of normal saline to goal urine
    [Show full text]
  • Electrolyte and Acid-Base Disorders Triggered by Aminoglycoside Or Colistin Therapy: a Systematic Review
    antibiotics Review Electrolyte and Acid-Base Disorders Triggered by Aminoglycoside or Colistin Therapy: A Systematic Review Martin Scoglio 1,* , Gabriel Bronz 1, Pietro O. Rinoldi 1,2, Pietro B. Faré 3,Céline Betti 1,2, Mario G. Bianchetti 1, Giacomo D. Simonetti 1,2, Viola Gennaro 1, Samuele Renzi 4, Sebastiano A. G. Lava 5 and Gregorio P. Milani 2,6,7 1 Faculty of Biomedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland; [email protected] (G.B.); [email protected] (P.O.R.); [email protected] (C.B.); [email protected] (M.G.B.); [email protected] (G.D.S.); [email protected] (V.G.) 2 Department of Pediatrics, Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; [email protected] 3 Department of Internal Medicine, Ospedale La Carità, Ente Ospedaliero Cantonale, 6600 Locarno, Switzerland; [email protected] 4 Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; [email protected] 5 Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, 1011 Lausanne, Switzerland; [email protected] 6 Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy 7 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy * Correspondence: [email protected] Citation: Scoglio, M.; Bronz, G.; Abstract: Aminoglycoside or colistin therapy may alter the renal tubular function without decreasing Rinoldi, P.O.; Faré, P.B.; Betti, C.; the glomerular filtration rate. This association has never been extensively investigated.
    [Show full text]