A Comprehensive Review of Chloride Management in Critically Ill Patients.

Chloride, often overshadowed in electrolyte management, emerges as a crucial player in the physiological intricacies of critically ill patients. This comprehensive review explores the multifaceted aspects of chloride, ranging from its significance in cellular homeostasis to the consequences of dysregulation in critically ill patients. The pathophysiology of hyperchloremia and hypochloremia is dissected, highlighting their intricate impact on acid-base balance, renal function, and cardiovascular stability. Clinical assessment strategies, including laboratory measurements and integration with other electrolytes, lay the foundation for targeted interventions. Consequences of dysregulated chloride levels underscore the need for meticulous management, leading to an exploration of emerging therapies and interventions. Fluid resuscitation protocols, the choice between crystalloids and colloids, the role of balanced solutions, and individualized patient approaches comprise the core strategies in chloride management. Practical considerations, such as monitoring and surveillance, overcoming implementation challenges, and embracing a multidisciplinary approach, are pivotal in translating theoretical knowledge into effective clinical practice. As we envision the future, potential impacts on critical care guidelines prompt reflections on integrating novel therapies, individualized approaches, and continuous monitoring practices. In conclusion, this review synthesizes current knowledge, addresses practical considerations, and envisions future directions in chloride management for critically ill patients. By embracing a holistic understanding, clinicians can navigate the complexities of chloride balance, optimize patient outcomes, and contribute to the evolving landscape of critical care medicine.

Impact of Preoperative Plasma Potassium Levels on Oncological Outcomes, Major Complications, and 30-Day Mortality in Bladder Cancer Patients Undergoing Radical Cystectomy.

INTRODUCTION AND OBJECTIVES: We examined the impact of preoperative plasma potassium levels (PPLs) on outcomes in patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB), hypothesizing that potassium imbalances might influence outcomes. PATIENTS AND METHODS: In this retrospective study, 501 UCB patients undergoing RC from 2009 to 2017 at a tertiary center were analyzed. Blood samples collected a week prior to surgery defined normal and abnormal PPL based on institutional standards. We assessed overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), postoperative complications, 30-day mortality, and non-organ confined disease. Kaplan-Meier estimates, Cox proportional hazards, logistic regression, and decision curve analyses (DCA) were employed. RESULTS: 63 (13%) patients had abnormal preoperative PPLs, with 50 (10%) elevated and 13 (2.5%) decreased. In a 59 months median follow-up, 152 (31%) had disease recurrence, 197 (39%) died from any cause, and 119 (24%) from UCB. Multivariable cox regression analyses adjusting for perioperative parameters demonstrated abnormal PPL was associated with worse OS (HR=1.9, P=0.009), CSS (HR=2.8, P<0.001) and RFS (HR=2.1; P=0.007). Elevated preoperative PPLs also demonstrated significant associations with adverse outcomes in OS, CSS, and RFS (all P<0.05). In multivariable logistic regression analyses, abnormal and elevated PPLs were not associated with 30-day mortality, major 30-day postoperative complications, positive nodal disease, pT3/4 stage, and non-organ confined disease (all P>0.05). CONCLUSION: Abnormal and elevated preoperative PPLs correlate with adverse oncologic outcomes in UCB patients treated with RC. Pending external validation, preoperative PPLs might be a cost-effective, easily obtainable supplemental biomarker for enriching accuracy of outcome prediction in this highly variable maladie.

Electrolyte disorders induced by six multikinase inhibitors therapy for renal cell carcinoma: a large-scale pharmacovigilance analysis.

To provide evidence for optimization of multi-kinase inhibitors (MKIs) use in the clinic, we use the public database to describe and evaluate electrolyte disorders (EDs) related to various MKIs treated for renal cell carcinoma. We analyzed spontaneous reports submitted to the Food and Drug Administration Adverse Events Reporting System (FAERS) in an observational and retrospective manner. Selecting electrolyte disorders' adverse events to multikinase inhibitors (axitinib, cabozantinib, lenvatinib, pazopanib, sunitinib, and sorafenib). We used Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and multi-item gamma Poisson shrinker (MGPS) algorithms to analyze suspected adverse reactions of electrolyte disorders induced by MKIs (which were treated for renal cell carcinoma) between January 2004 and December 2022. As of December 2022, 2772 MKIs (which were treated for renal cell carcinoma) ICSRs were related to electrolyte disorders AEs. In general, there were more AEs cases in males, except lenvatinib and 71.8% of the cases were submitted from North America. ICSRs in this study, the age group most frequently affected by electrolyte disorders AEs was individuals aged 45-64 years for axitinib, cabozantinib, pazopanib, and sunitinib, whereas electrolyte disorders AEs were more common in older patients (65-74 years) for sorafenib and lenvatinib. For all EDs documented in ICSRs (excluding missing data), the most common adverse outcome was hospitalization(1429/2674, 53.4%), and the most serious outcome was death/life-threat(281/2674, 10.5%). The prevalence of mortality was highest for sunitinib-related EDs (145/616, 23.5%), excluding missing data (n = 68), followed by cabozantinib-related EDs (20/237, 8.4%), excluding missing data (n = 1). The distribution of time-to-onset of Each drug-related ICSRs was not all the same, and the difference was statistically significant (P = 0.001). With the criteria of ROR, the six MKIs were all significantly associated with electrolyte disorders AEs, the strongest association was the association between cabozantinib and hypermagnesaemia. MKIs have been reported to have significant electrolyte disorders AEs. Patients and physicians need to recognize and monitor these potentially fatal adverse events.

Bartter syndrome-like phenotype in a patient with type 2 diabetes mellitus.

Bartter syndrome (BS) is a rare genetic tubulopathy affecting the loop of Henle leading to salt wasting. It is commonly seen in utero or in the early neonatal period. Rare cases of acquired BS are reported in association with infections like tuberculosis, granulomatous conditions like sarcoidosis, autoimmune diseases and drugs. The mainstay of management includes potassium, calcium and magnesium supplementation. We report the case of a woman in her 50s with a history of type 2 diabetes mellitus for the last 10 years, who presented with diabetic foot ulcers and generalised weakness with ECG changes suggestive of hypokalaemia. She had severe hypokalaemia with high urine potassium excretion and hypochloraemic metabolic alkalosis. She poorly responded to intravenously administered potassium supplements and had persistent hypokalaemia. On further evaluation of the persistent hypokalaemia, a diagnosis of idiopathic Bartter-like phenotype was made. She responded well to tablet indomethacin and is presently asymptomatic and is being maintained on tablet indomethacin after 6 months of follow-up.

Can lettuce plants grow in saline soils supplemented with biochar?

Salt stress is presently a major environmental concern, given the huge number of soils affected by the presence of dissolved salts. Therefore, it is necessary to find solutions, preferably nature-based ones, to deal with this problem. In this study, biochar, a product made from plant biomass residues through the process of pyrolysis, was tested to alleviate salt stress on lettuce (Lactuca sativa L.) plants. Six different concentrations of NaCl were tested: 0, 50, 100, 200, 300 and 400 mM with and without the addition of 5% (w/w) biochar. Biochar ability to mitigate salinity damage was assessed by means of both biometric (fresh weight), physiological (chlorophyll content), and biochemical (i.e., electrolyte leakage, total antioxidant power, total soluble proteins, free amino acids, and mineral content) parameters. The experiment lasted four weeks. The results showed that NaCl has a negative effect from the concentration of 100-200 mM and that biochar was to some extent effective in mitigating the negative effects of salt on plant physiology; nevertheless, biochar failed to counteract Na accumulation. Similarly, biochar did not influence the content of free amino acids in lettuce leaves, but enhanced the expression of several parameters, such as total antioxidant power, fresh weight, chlorophyll content, total soluble protein, K content, although only clearly evident in some cases. Overall, the present study showed that biochar is a viable solution to counteract the damage caused by high salt concentrations on plant growth.

Physiological and molecular changes of onion (Allium cepa L.) seeds under different aging conditions.

BACKGROUND: Onion seeds have limited storage capacity compared to other vegetable seeds. It is crucial to identify the mechanisms that induce tolerance to storage conditions and reduce seed deterioration. To address this goal, an experiment was conducted to evaluate changes in germination, biochemical, physiological, and molecular characteristics of onion seed landraces (Horand, Kazerun landraces and Zargan cultivar) at different aging levels (control, three-days and six-days accelerated aging, and natural aging for one year). RESULTS: The findings suggest that there was an increase in glucose, fructose, total sugar, and electrolyte leakage in the Horand (HOR), Kazerun (KAZ) landraces, and Zarghan (ZAR) cultivar, with Kazerun exhibiting the greatest increase. The percentage and rate of germination of Kazerun decreased by 54% and 33%, respectively, in six-day accelerated aging compared to the control, while it decreased by 12% and 14%, respectively, in Horand. Protein content decreased with increasing levels of aging, with a decrease of 26% in Kazerun landrace at six days of aging, while it was 16% in Horand landrace. The antioxidant activities of catalase, superoxide dismutase, and glutathione peroxidase decreased more intensively in Kazerun. The expression of AMY1, BMY1, CTR1, and NPR1 genes were lower in Kazerun landraces than in Horand and Zargan at different aging levels. CONCLUSIONS: The AMY1, BMY1, CTR1, and NPR1 genes play a pivotal role in onion seed germination, and their downregulation under stressful conditions has been shown to decrease germination rates. In addition, the activity of CAT, SOD, and GPx enzymes decreased by seed aging, and the amount of glucose, fructose, total sugar and electrolyte leakage increased, which ultimately led to seed deterioration. Based on the results of this experiment, it is recommended to conduct further studies into the molecular aspects involved in onion seed deterioration. More research on the genes related to this process is suggested, as well as investigating the impact of different priming treatments on the genes expression involved in the onion seed aging process.

The impact of tubular dysfunction and its relationship with acute kidney injury in children.

BACKGROUND: Tubular dysfunction can cause electrolyte disturbances with potentially serious consequences. We studied the epidemiology and outcomes of electrolyte disturbances and tubular dysfunction among critically ill children and evaluated their relationships with acute kidney injury (AKI). METHODS: We conducted a prospective cohort study recruiting children aged 1 month to ≤ 18 years old admitted to the pediatric intensive care unit (PICU) from 6/2020 to 6/2021. The serum levels of sodium, potassium, calcium, phosphate, and magnesium were reviewed and simultaneous urinary investigations for tubular function were performed among children with electrolyte disturbances. RESULTS: Altogether there were 253 episodes of admission. The median (interquartile) age was 4.9 (1.3-11.0) years and 58.1% were male. The median number of electrolyte disorders was 3 (2-4) types. Hypophosphatemia (74.2%), hypocalcemia (70.3%) and hypermagnesemia (52.9%) were the three commonest types of disturbances. Urinary electrolyte wasting was commonly observed among children with hypomagnesemia (70.6%), hypophosphatemia (67.4%) and hypokalemia (28.6%). Tubular dysfunction was detected in 82.6% of patients and urinary ß2-microglobulin level significantly correlated with the severity of tubular dysfunction (p < 0.001). The development of tubular dysfunction was independent of AKI status. Tubular dysfunction was associated with mortality (p < 0.001) and was an independent predictor of PICU length of stay (LOS) (p < 0.001). The incorporation of the tubular dysfunction severity into the AKI staging system improved the prediction of PICU LOS. CONCLUSIONS: Tubular dysfunction was associated with both morbidity and mortality in critically ill children and its assessment may help to capture a more comprehensive picture of acute kidney insult.

Rebound hyperkalemia in a dog with albuterol toxicosis after cessation of potassium supplementation.

OBJECTIVE: To describe the presentation of rebound hyperkalemia as a delayed side effect of albuterol toxicity in a dog. CASE SUMMARY: A 3-year-old female neutered mixed-breed dog was presented for albuterol toxicosis that led to a severe hypokalemia, hyperlactatemia, and hyperglycemia. The dog also experienced sinus tachycardia and generalized weakness. Treatment was instituted with intravenous fluid therapy and potassium supplementation, and the dog was monitored with a continuous electrocardiogram. Resolution of hypokalemia was documented 12 hours after initial presentation, at which time fluid therapy and potassium supplementation were discontinued. There were no further periods of sinus tachycardia, but instead the dog developed ventricular ectopy with rapid couplets (instantaneous rates of 300/min). An echocardiogram revealed normal cardiac size and function. Twenty-four hours after presentation, the patient developed severe hyperkalemia, despite discontinuation of fluids and potassium supplementation for 12 hours. Serial venous and urinary electrolytes were performed for determination of the fractional excretion of electrolytes. These data confirmed rebound hyperkalemia (7.0 mmol/L), consistent with a markedly increased fractional excretion of potassium, and secondary to the release of potassium from inside the cells. Fluid therapy with dextrose supplementation was provided until 36 hours postpresentation. The hyperkalemia resolved, and the dog was discharged after 44 hours of hospitalization. NEW OR UNIQUE INFORMATION PROVIDED: This case documents rebound hyperkalemia following treatment of albuterol toxicosis in a dog. This case highlights the importance of understanding the distribution of total body potassium when treating serum hypokalemia. Transcellular shifts of potassium, as in the case of albuterol toxicosis, can lead to rebound hyperkalemia even after discontinuation of potassium supplementation. This case further explores the utility of fractional excretion of electrolytes in elucidating the etiology and management of electrolyte disturbances.

The effects of feeding sodium chloride pellets on the gastric mucosa, acid-base, and mineral status in exercising horses.

BACKGROUND: Electrolyte supplementation may be a risk factor for gastric mucosal lesions, but relevant evidence is limited in horses. HYPOTHESIS: Investigate the effects of PO sodium chloride (NaCl) supplementation on the gastric mucosa of exercising horses. We hypothesized that NaCl supplementation would neither cause nor exacerbate existing gastric mucosal damage. ANIMALS: Fifteen 3-year-old healthy Warmblood stallions from a stud farm. METHODS: Placebo-controlled study with a crossover design. Horses were fed either a NaCl pellet at a dosage adequate to replace the electrolyte losses in 10 L sweat or a placebo for 19 days with a washout period of 14 days between treatments. The gastric mucosa was evaluated by gastroscopy before and after treatment. Blood samples were collected for evaluation of acid-base status, packed cell volume (PCV), and total protein, creatinine and blood urea nitrogen concentrations. Urine was collected, and urine specific gravity, electrolyte, creatinine, and urea concentrations were measured. RESULTS: The initial prevalence of gastric mucosal lesions was 85%. Sodium chloride pellets did not adversely affect the gastric mucosa and treatment did not significantly alter the hematologic and serum biochemical variables. Urine creatinine concentrations significantly decreased and urinary sodium concentrations significantly increased after supplementation with NaCl pellets. Water intake did not significantly differ between treatments. CONCLUSIONS AND CLINICAL IMPORTANCE: Daily NaCl pellet supplementation is a palatable and safe way to replace electrolyte losses from sweating in exercising horses and has no negative effects on the gastric mucosa.

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.

Molecular-Cling-Effect of Fluoroethylene Carbonate Characterized via Ethoxy(pentafluoro)cyclotriphosphazene on SiOx/C Anode Materials - A New Perspective for Formerly Sub-Sufficient SEI Forming Additive Compounds.

Effective electrolyte compositions are of primary importance in raising the performance of lithium-ion batteries (LIBs). Recently, fluorinated cyclic phosphazenes in combination with fluoroethylene carbonate (FEC) have been introduced as promising electrolyte additives, which can decompose to form an effective dense, uniform, and thin protective layer on the surface of electrodes. Although the basic electrochemical aspects of cyclic fluorinated phosphazenes combined with FEC were introduced, it is still unclear how these two compounds interact constructively during operation. This study investigates the complementary effect of FEC and ethoxy(pentafluoro)cyclotriphosphazene (EtPFPN) in aprotic organic electrolyte in LiNi0.5 Co0.2 Mn0.3 O ∥ SiOx /C full cells. The formation mechanism of lithium ethyl methyl carbonate (LEMC)-EtPFPN interphasial intermediate products and the reaction mechanism of lithium alkoxide with EtPFPN are proposed and supported by Density Functional Theory calculations. A novel property of FEC is also discussed here, called molecular-cling-effect (MCE). To the best knowledge, the MCE has not been reported in the literature, although FEC belongs to one of the most investigated electrolyte additives. The beneficial MCE of FEC toward the sub-sufficient solid-electrolyte interphase forming additive compound EtPFPN is investigated via gas chromatography-mass spectrometry, gas chromatography high resolution-accurate mass spectrometry, in situ shell-isolated nanoparticle-enhanced Raman spectroscopy, and scanning electron microscopy.

Severe refeeding syndrome after starvation ketoacidosis requiring stopping feeds.

INTRODUCTION: Starvation ketoacidosis (SKA) is a rare cause of ketoacidosis in the general population but can be seen with malignancy. Patients often respond well to treatment, but some rarely develop refeeding syndrome (RFS) as their electrolytes drop to dangerous levels causing organ failure. Typically, RFS can be managed with low-calorie feeds, but sometimes patients require a halt in feeds until their electrolyte imbalances are managed. CASE REPORT: We discuss a woman with synovial sarcoma on chemotherapy who was diagnosed with SKA and then developed severe RFS after treatment with intravenous dextrose. Phosphorus, potassium, and magnesium levels dropped precipitously and remained fluctuant for 6 days. She also developed normal sinus ventricular tachycardia, premature ventricular beats, and bigeminy. She could not tolerate calorie supplementation at that time. She was managed with electrolyte repletions until clinically stable and then progressed to a liquid diet. DISCUSSION: We present a unique case of severe SKA that resulted in RFS requiring nihil per orem (NPO) treatment for 6 days. There are no specific guidelines for SKA or RFS management. Patients with pH < 7.3 may benefit from baseline serum phosphorus, potassium, and magnesium levels. Clinical trials are needed to further study which patients may benefit from starting at a low-calorie intake versus those that require holding nutrition until clinically stable. CONCLUSION: Completely stopping caloric intake until a patient's electrolyte imbalance improves is an important management aspect of RFS to underscore and study, as grave complications can occur even with cautious refeeding regimens.

Severe hypocalcaemia episodes in a patient of primary hypoparathyroidism precipitated by underlying stress due to haemophagocytic lymphohistiocytosis (HLH) secondary to pulmonary tuberculosis.

A man in his 20s who had previously experienced multiple episodes of transient loss of consciousness, majorly attributable to the seizures, presented with a 1-month history of increased seizure frequency, high-grade fever and weight loss. Clinically, he had postural instability, bradykinesia and symmetrical cogwheel rigidity. His investigations revealed hypocalcaemia, hyperphosphataemia, inappropriately normal intact parathyroid hormone, metabolic alkalosis, normomagnesemic magnesium depletion, and increased plasma renin activity and serum aldosterone concentration. CT scan of the brain revealed symmetrical calcification of the basal ganglia. The patient had primary hypoparathyroidism (HP). A similar presentation of his brother indicated a genetic cause, most likely autosomal dominant hypocalcaemia with Bartter's syndrome type 5. The patient's fever was caused by underlying haemophagocytic lymphohistiocytosis secondary to pulmonary tuberculosis, which triggered acute episodes of hypocalcaemia. This case represents a complex interplay of a multifaceted relationship between primary HP, vitamin D deficiency and an acute stressor.

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.

Effect of citrus-coconut electrolyte blend on growth performance, haemato-biochemical status, organs development and intestinal morphology of broiler chickens.

INTRODUCTION: In a bid to mitigate growing concerns regarding the use of antibiotics in food animals OBJECTIVES: This study determined the growth performance, haemato-biochemical status, organ development and intestinal morphology of Arbor Acre broiler chicken strain on oral administration of citrus-coconut electrolyte blend (CCEB) for 26 days. METHODS: One-hundred ninety-two chicks were brooded for 2 weeks and thereafter divided on a weight equalization basis into four groups (0, 5, 10 and 15 ml CCEB per litre of water) of six replicates each and eight birds per replicate. Phytochemical screening of CCEB was determined, while data collected for growth performance, organ proportions and intestinal morphology were subjected to a one-way analysis of variance. RESULTS: Phytochemical composition revealed the abundance of phenols (128.40 mg/100g) and tannins (78.10 mg/100g) in CCEB. All productive performance parameters measured were not significantly (p < 0.05) different across treatment means. However, significantly (p < 0.05) highest concentrations (134.47 and 66.48 mg/dl, respectively) for total cholesterol and high-density lipoprotein (HDL) and the lowest concentration (38.34 mg/dl) for low-density lipoprotein (LDL) were recorded in birds on 15 ml of CCEB/litre of water. Furthermore, a progressive reduction (p < 0.05) in the bursa of Fabricius was observed with increasing CCEB/litre of water. The supplementation of CCEB did not influence (p > 0.05) duodenal morphological parameters. CONCLUSION: The study concluded that 15 ml of CCEB/litre of water enhanced the production of HDL, reduced LDL, and improved immunity via the reduction of the bursa of Fabricius in broiler chickens.

Silicon Supplementation Alleviates the Salinity Stress in Wheat Plants by Enhancing the Plant Water Status, Photosynthetic Pigments, Proline Content and Antioxidant Enzyme Activities.

Silicon (Si) is the most abundant element on earth after oxygen and is very important for plant growth under stress conditions. In the present study, we inspected the role of Si in the mitigation of the negative effect of salt stress at three concentrations (40 mM, 80 mM, and 120 mM NaCl) in two wheat varieties (KRL-210 and WH-1105) with or without Si (0 mM and 2 mM) treatment. Our results showed that photosynthetic pigments, chlorophyll stability index, relative water content, protein content, and carbohydrate content were reduced at all three salt stress concentrations in both wheat varieties. Moreover, lipid peroxidation, proline content, phenol content, and electrolyte leakage significantly increased under salinity stress. The antioxidant enzyme activities, like catalase and peroxidase, were significantly enhanced under salinity in both leaves and roots; however, SOD activity was drastically decreased under salt stress in both leaves and roots. These negative effects of salinity were more pronounced in WH-1105, as KRL-210 is a salt-tolerant wheat variety. On the other hand, supplementation of Si improved the photosynthetic pigments, relative water, protein, and carbohydrate contents in both varieties. In addition, proline content, MDA content, and electrolyte leakage were shown to decline following Si application under salt stress. It was found that applying Si enhanced the antioxidant enzyme activities under stress conditions. Si showed better results in WH-1105 than in KRL-210. Furthermore, Si was found to be more effective at a salt concentration of 120 mM compared to low salt concentrations (40 mM, 80 mM), indicating that it significantly improved plant growth under stressed conditions. Our experimental findings will open a new area of research in Si application for the identification and implication of novel genes involved in enhancing salinity tolerance.

The Effects of Magnesium Coadminstration During Treatment of Hypokalemia in the Emergency Department.

BACKGROUND: Hypokalemia is a common disorder that can negatively affect organ function. Magnesium supplementation is frequently recommended despite limited evidence to support its use. OBJECTIVES: The purpose of this study was to evaluate the clinical effects of magnesium coadministration in patients treated for hypokalemia in the emergency department (ED). METHODS: This retrospective, single-center study evaluated adults treated with intravenous (i.v.) potassium for hypokalemia (serum potassium <3.5 mMol/L) in the ED between July 1, 2016 and June 30, 2020. Patients given magnesium supplementation within 4 h of potassium administration (MG+) were compared with those not given concurrent magnesium (MG-). The primary outcome was time to potassium normalization (≥ 3.5 mMol/L). Secondary outcomes included clinical effects, adverse effects, and dosing of magnesium and potassium. RESULTS: Two hundred patients were included (MG+ = 100; MG- = 100). Patients in the MG- group more frequently had history of myocardial infarction (16% vs. 6%; p = 0.02) and alcoholism (16% vs. 6%; p = 0.02). Patients in the MG+ group had higher incidence of symptomatic hypokalemia (34% vs. 19%; p = 0.02) and severe hypokalemia (serum potassium < 2.5 mMol/L) (15% vs. 8%; p = 0.03). There were no differences in time to serum potassium normalization, change in serum potassium after treatment, or incidence of potassium normalization within 24 h of treatment. MG+ patients required more potassium within 24 h of treatment and more frequently developed hypermagnesemia (serum magnesium >1.1 mMol/L). CONCLUSIONS: Magnesium coadministration during hypokalemia treatment did not affect time to serum potassium normalization but was associated with more hypermagnesemia.

Calcium chloride is a better calcium source rather than calcium carbonate for weanling pigs.

Two experiments were conducted to evaluate the effects of calcium (Ca) levels in weanling pigs (Landrace × Yorkshire × Duroc). In experiment 1, one hundred and eighty weanling pigs were randomly allotted to one of the three treatments. The treatments were low (Ca 0.60% in phase 1 and 0.50% in phase 2), standard (Ca 0.72% in phase 1 and 0.66% in phase 2), and high (Ca 0.84% in phase 1 and 0.72% in phase 2). In experiment 2, hundred and forty weanling pigs were randomly assigned to one of four treatments differing in Ca levels (high and low) and sources (CaCl2 and CaCO3) in a 2 × 2 factorial arrangement. There were 10 pigs per replicate in both experiments, with 6 replicates in each treatment, and they were conducted in two phases (phase 1, days 0-14; phase 2, days 15-28). In experiment 1, body weight (BW), average daily gain (ADG), and growth to feed ratio (G/F) increased as the Ca level decreased (p < 0.05). P digestibility was higher in the low-Ca diet group than in the high-Ca diet group (p <0.05). In experiment 2, the final BW, ADG, and G/F increased in the CaCl2 diet group compared with the case in the CaCO3 diet group (p < 0.05). The digestibility of crude protein (CP), Ca, and P was higher in the CaCl2 diet group than in the CaCO3 diet group (p < 0.05). Cl- levels were higher in the CaCl2 diet group than in the CaCO3 diet group (p < 0.05). The bicarbonate (HCO3 -), base excess (BE), and electrolyte balance (EB) levels were lower in the CaCl2 diet group than in the CaCO3 diet group (p < 0.05). Hematocrit increased as the Ca level decreased (p < 0.05). The HCO3 - interacted with the Ca sources and thus, affected the Ca levels (p < 0.05). Bone ash, Ca, and P were downregulated in the low-Ca diet group compared with the case in the high-Ca diet group. Overall, the low dietary Ca supplementation led to greater growth performance. Furthermore, CaCl2 appeared to be a better Ca source than CaCO3 because of the greater digestibility of CP, Ca, and P, and improved EB.

Effects of total parenteral nutrition associated with glutamine, enteral fluid therapy with or without glutamine, and fluid therapy on the acid-base and electrolyte balance of horses starved after exploratory laparotomy.

This study aimed to evaluate the effects of the total parenteral nutrition associated with glutamine, enteral fluid therapy with or without glutamine, and fluid therapy on the acid-base and electrolyte balance of horses starved after exploratory laparotomy. Sixteen healthy male and female adult horses of mixed breed, aged between 4 and 14 years, and having a mean body weight of 248.40 ± 2.28 kg and a body score index of 3-4 (scale of 1-5) were divided into four groups with four animals per group. After an adaptation period of 30 days, they were randomly divided into four experimental groups: enteral fluid therapy, enteral fluid therapy associated with glutamine, total parenteral nutrition associated with glutamine, and parenteral fluid therapy. The experiment was further divided into two phases: Phase 1 and Phase 2. In Phase 1, an exploratory laparotomy was performed, treatments were administered to the groups and the horses received no food or water other than those given to their respective groups. In Phase 2, the animals were re-fed. Each phase had a total duration of 144 h. Venous blood samples were collected every 24 h throughout the experimental period for blood gas and electrolyte analyses. The following parameters were evaluated: pH, partial pressure of carbon dioxide, total carbon dioxide, bicarbonate, base shift, anion gap, sodium, potassium, chloride, total calcium and magnesium. Completely randomized designs with a 4 × 7 factorial scheme (groups × harvest time) in Phase 1 and a 4 × 6 factorial scheme (groups × harvest time) in Phase 2 were used with four replications. All values were considered significant when p≤0.05 (95% probability). Blood pH, bicarbonate concentration, and base shift in the PARGL group decreased, indicating metabolic acidosis. Changes in the acid-base and electrolyte balance were more intense in the PARGL group than in the other groups. These results demonstrated the need to monitor blood gas and electrolyte balance in horses with food restriction under nutritional support or prolonged fluid therapy so that such changes are promptly corrected.

Este estudo teve como objetivo avaliar os efeitos da nutrição parenteral total associada à glutamina, fluidoterapia enteral com ou sem glutamina e fluidoterapia no equilíbrio ácido-base e eletrolítico de equinos submetidos à inanição após laparotomia exploratória. Dezesseis cavalos adultos saudáveis, machos e fêmeas, sem raça definida, com idade entre 4 e 14 anos, com peso corporal médio de 248,40 ± 2,28 kg e índice de escore corporal de 3 a 4 (escala de 1 a 5) foram divididos em quatro grupos com quatro animais por grupo. Após um período de adaptação de 30 dias, foram divididos aleatoriamente em quatro grupos experimentais: fluidoterapia enteral, fluidoterapia enteral associada à glutamina, nutrição parenteral total associada à glutamina e fluidoterapia parenteral. O experimento foi ainda dividido em duas fases: Fase 1 e Fase 2. Na Fase 1, os tratamentos foram administrados aos grupos, a laparotomia exploratória foi realizada e os cavalos não receberam alimentos ou água além daqueles dados aos seus respectivos grupos. Na Fase 2, os animais foram realimentados. Cada fase teve uma duração total de 144 h. Amostras de sangue venoso foram coletadas a cada 24 h durante todo o período experimental para análises gasométricas e eletrolíticas. Foram avaliados os seguintes parâmetros: pH, pressão parcial de dióxido de carbono, dióxido de carbono total, bicarbonato, desvio de base, anion gap, sódio, potássio, cloreto, cálcio total e magnésio. Delineamentos inteiramente casualizados com esquema fatorial 4 × 7 (grupos × época de colheita) na Fase 1 e esquema fatorial 4 × 6 (grupos × época de colheita) na Fase 2 foram utilizados com quatro repetições. Todos os valores foram considerados significativos quando p≤0,05 (95% de probabilidade). O pH sanguíneo, a concentração de bicarbonato e o desvio de base no grupo PARGL diminuíram, indicando acidose metabólica. As alterações no equilíbrio ácido-base e eletrolítico foram mais intensas no grupo PARGL do que nos outros grupos. Esses resultados demonstraram a necessidade de monitorar o equilíbrio hemogasométrico e eletrolítico em equinos com restrição alimentar sob suporte nutricional ou fluidoterapia prolongada para que tais alterações sejam prontamente corrigidas.

Patterns and levels of serum electrolyte imbalance among women with obstructed labor in Uganda: A cross-sectional study.

OBJECTIVE: To determine the patterns and levels of imbalance in sodium, potassium, and chloride electrolytes, and the factors associated with each electrolyte imbalance among women with obstructed labor. DESIGN: In this cross-sectional study, we collected data on personal and obstetric factors using a structured questionnaire. We drew 3 mls of blood from the antecubital vein and analyzed for sodium, potassium, and chloride ions using Cobas Integra 400. Multivariable logistic regression was employed to analyze factors independently associated with each electrolyte imbalance. SETTING: Obstetrics and Gynaecology Unit, Mulago National Referral Hospital, Kampala, Uganda. PARTICIPANTS: Women with obstructed labor. MEASUREMENTS: Imbalance in sodium, potassium, and chloride electrolytes, measured on a binary scale using the normal third-trimester pregnancy electrolyte values: 130-148 mmol/Litre for sodium, 3.3-5.1 mmol/Litre for potassium, and 97-109 mmol/Litre for chloride. Women with electrolyte values outside the respective normal ranges were regarded as having an imbalance. FINDINGS: We studied 299 women and found 22/299 (7.4%) had sodium imbalance, 254/299 (84.9%) had potassium imbalance, and 284/299 (95.0%) had chloride imbalance. In multivariable logistic regression analysis, herbal medicine use was associated with sodium imbalance (adjusted odds ratio (aOR), 2.72; 95% confidence interval (CI), 1.11-6.95). KEY CONCLUSIONS: Potassium and chloride imbalances were more prevalent among women with obstructed labor relative to sodium imbalance. Herbal medicine use during pregnancy is associated with a higher likelihood of sodium electrolyte imbalance. IMPLICATIONS FOR PRACTICE: There is a need to routinely monitor women with obstructed labor for electrolyte imbalance.