Plasma and electrolyte changes in exercising humans after ingestion of multiple boluses of pickle juice.

CONTEXT: Twenty-five percent of athletic trainers administer pickle juice (PJ) to treat cramping. Anecdotally, some clinicians provide multiple boluses of PJ during exercise but warn that repeated ingestion of PJ may cause hyperkalemia. To our knowledge, no researchers have examined the effect of ingesting multiple boluses of PJ on the same day or the effect of ingestion during exercise. OBJECTIVE: To determine the short-term effects of ingesting a single bolus or multiple boluses of PJ on plasma variables and to characterize changes in plasma variables when individuals ingest PJ and resume exercise. DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Nine euhydrated men (age = 23 ± 4 years, height = 180.9 ± 5.8 cm, mass = 80.7 ± 13.8 kg, urine specific gravity = 1.009 ± 0.005). INTERVENTION(S): On 3 days, participants rested for 30 minutes, and then a blood sample was collected. Participants ingested 0 or 1 bolus (1 mL · kg(-1) body weight) of PJ, donned sweat suits, biked vigorously for 30 minutes (approximate temperature = 37 °C, relative humidity = 18%), and had a blood sample collected. They either rested for 60 seconds (0- and 1-bolus conditions) or ingested a second 1 mL · kg(-1) body weight bolus of PJ (2-bolus condition). They resumed exercise for another 35 minutes. A third blood sample was collected, and they exited the environmental chamber and rested for 60 minutes (approximate temperature = 21 °C, relative humidity = 18%). Blood samples were collected at 30 and 60 minutes postexercise. MAIN OUTCOME MEASURE(S): Plasma sodium concentration, plasma potassium concentration, plasma osmolality, and changes in plasma volume. RESULTS: The number of PJ boluses ingested did not affect plasma sodium concentration, plasma potassium concentration, plasma osmolality, or changes in plasma volume over time. The plasma sodium concentration, plasma potassium concentration, and plasma osmolality did not exceed 144.6 mEq · L(-1) (144.6 mmol · L(-1)), 4.98 mEq · L(-1) (4.98 mmol · L(-1)), and 289.5 mOsm · kg(-1)H2O, respectively, in any condition at any time. CONCLUSIONS: Ingesting up to 2 boluses of PJ and resuming exercise caused negligible changes in blood variables. Ingesting up to 2 boluses of PJ did not increase plasma sodium concentration or cause hyperkalemia.

End-stage kidney disease: a survey of recent research to support a palliative approach.

This survey examines the quantity, quality, and accessibility of recent research that contributes to the evidence-based implementation of a palliative approach to end-stage kidney disease (ESKD). An electronic search identified published articles (between September 2009 and August 2011) relevant to adults with ESKD (n = 1628). Few articles (n = 136) referred to key themes in a palliative approach to care: life-limiting illness, holistic care, and unit of care. Most of the relevant empirical articles used designs that did not allow a causal variable to be identified, and evaluations of interventions were rare. The literature was dispersed and often in journals unlikely to be regularly accessed by renal clinicians. Literature supporting the implementation of a full evidence-based palliative approach to ESKD is expanding but remains limited and is difficult to identify and access.

The geriatric depression scale in palliative care.

OBJECTIVE: This research examined the psychometric properties of previously published short forms of the Geriatric Depression Scale (GDS) in patients receiving palliative care. It also uses the full form of the GDS to examine the prevalence of nonsomatic symptoms of depression in palliative patients. METHOD: Participants were 84 patients with advanced cancer attending palliative care outpatient clinics. Scores for short forms of the GDS were derived from administering the original 30-item scale. Patients also completed the single item numerical analogue scale for depression from the Edmonton Symptom Assessment System and parallel numerical analogue scales for will-to-live and hope. A subset of the sample completed the measures twice. Short forms were judged on the extent to which they captured information gained from the full scale and their internal consistency, test-retest reliability, convergent and concurrent validity, and their distribution of scores. RESULTS: Overall, five short forms showed good psychometric properties at both visits. Two of these forms were very brief. Some nonsomatic symptoms assessed on the full GDS were reported with high frequency. However, few individuals reported a large number of symptoms. At both visits, patients identified as likely to have severe depression gave different responses from other patients on most items on the GDS-30. SIGNIFICANCE OF RESULTS: Several short forms of the GDS may be appropriate for use in palliative care. Patients identified as likely to have severe depression showed many of the same symptoms that characterise depression in other geriatric populations.

When symptoms of disease overlap with symptoms of depression.

BACKGROUND: The diagnosis of depression is often dependent on somatic symptoms which overlap with the symptoms of many medical illnesses. METHOD: We analysed tape recorded interviews of 46 out of 61 eligible community dwelling older adults with advanced disease and many somatic symptoms of depression. Participants answered an open question about feelings, and structured questions about symptoms of depression. RESULTS: Twenty-four (39%) patients met DSM-IV symptom criteria for depression when somatic symptoms were included, and only 1 (2%) when they were excluded. Of the 24, 22 (92%) reported two or more psychological symptoms of depression and 14 of the 17 (82%) for whom transcripts were available disclosed feelings of psychological distress. DISCUSSION: Although every older adult with advanced disease reported somatic symptoms of depression, most did not meet DSM-IV criteria of depression even when all somatic symptoms are included. Including somatic symptoms accurately identifies patients who warrant follow up when psychological distress in unstructured interviews is used as the gold standard. There is no need to exclude somatic symptoms when considering a diagnosis of major depression in medical patients.

Identifying palliative care patients with symptoms of depression: an algorithm.

INTRODUCTION: Even though depression has serious and wide-ranging effects on outcomes in palliative care, errors in the identification of depressed patients are common. OBJECTIVES: To examine the clinical validity of widely publicised one- and two-question screening tools for depression in two palliative care settings. Also, to examine the construct validity and acceptability of a new empirically derived algorithm. METHOD: Participants were Australian palliative care patients in an inpatient hospice (n=22) or the community (n=69). Patients completed an unstructured interview about their feelings, questions relevant to three reference standards, two screening questions for depression and questions about the acceptability of the screening questions. RESULTS: The clinical validity of the one- and two-question screening tools did not generalise across the two care settings. In contrast, the algorithm met stringent criteria for clinical validity for two reference standards in both settings. The algorithm also selectively identified patients whose unstructured interviews referred to themes consistent with depression. The algorithm includes potentially sensitive questions about anhedonia and depressed affect. However, almost all patients and staff reported that asking such questions soon after referral was acceptable. CONCLUSIONS: A four-question algorithm designed to identify patients who warrant follow-up for depression showed clinical validity, generalizability and construct validity, and the content was acceptable to patients and clinicians.