Hyponatremia and malnutrition: a comprehensive review.

BACKGROUND: Hyponatremia (serum sodium lower than 135 mmol/L) is the most frequent electrolyte alteration diagnosed in medical practice. It has deleterious clinical effects, being an independent predictor of mortality. Malnutrition encompasses pathological states caused by both nutrients excess and deficiency, being frequently documented in chronic kidney disease patients. In addition, chronic hyponatremia promotes adiposity loss and sarcopenia, while malnutrition can induce hyponatremia. This pathological interaction is mediated by four main mechanisms: altered electrolyte body composition (low sodium, low potassium, low phosphorus, or high-water body content), systemic inflammation (cytokines increase), hormonal mechanisms (renin-angiotensin-aldosterone system activation, vasopressin release), and anorexia (primary or secondary). CONCLUSION: Malnutrition can induce hyponatremia through hydro-electrolytic, hormonal, inflammatory, or nutritional behavior changes; while hyponatremia per se can induce malnutrition, so there is a pathophysiological feedback between both conditions.

Embarazo exitoso en paciente con hemodiafiltración on-line de alto volumen predilucional: ¿la mejor opción dialítica en mujeres con enfermedad renal crónica y embarazo? / Successful pregnancy in a patient with high volume predilution on-line haemodiafiltration. Is it the best dialysis option in women with chronic kidney disease?

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Sevelamer carbonate reduces the risk of hypomagnesemia in hemodialysis-requiring end-stage renal disease patients.

BACKGROUND: Sevelamer has been associated with less progression of vascular calcifications. This effect could be due to a reduction in serum phosphate levels but also to other additive effects. Magnesium has been also shown to prevent vascular calcification but the effect of sevelamer on serum magnesium levels has not been thoroughly evaluated. Our aim was to analyze whether the use of sevelamer reduces the risk of hypomagnesemia in hemodialysis (HD)-requiring end-stage renal disease patients. METHODS: All prevalent patients from the dialysis unit of the Hospital Italiano de Buenos Aires as of 1 June 2015 were evaluated. They were on three times per week bicarbonate/citrate-buffered HD. They were not receiving phosphate binders or magnesium-containing drugs. The average of three successive monthly magnesium serum levels was considered as the baseline magnesium concentration. Sevelamer carbonate use was retrieved from the patient's clinical records. RESULTS: One hundred and fifty-one patients were included. A large proportion of individuals were on proton pump inhibitors (PPIs) (66%) and more than 50% were using sevelamer carbonate. Serum magnesium levels were significantly higher in those receiving sevelamer compared with those who did not (2.05 ± 0.3 versus 1.8 ± 0.4 mg/dL; P < 0.05). A larger proportion of individuals receiving sevelamer were among those with normal serum magnesium (P = 0.02), while among those with hypomagnesemia, a larger proportion were on PPIs. In the multivariate model including the use of PPIs, sevelamer carbonate resulted in an independent protective factor for hypomagnesemia (odds ratio: 0.44; 95% confidence interval: 0.21-0.87). CONCLUSIONS: Hemodialysis patients receiving sevelamer show higher serum magnesium levels and a reduced risk of hypomagnesemia. This effect remains even after adjustment for PPI use. This effect could contribute to the still controversial superiority of sevelamer in preventing vascular calcifications.

Food-borne botulism in Argentina.

Botulism is a severe neuroparalytic disease caused by Clostridium botulinum toxins. Although the disease is uncommon it is a cause of great concern due to its high rate of mortality. Food-borne outbreaks of botulism occur worldwide and require immediate public health attention and acute care resources. Analysis of outbreaks showed that the food products most often involved were fermented fish products in Alaska; home-canned food, oil preservation and restaurant sauce in the rest of the United States (US) and in London and; and home-canned vegetables, airtight packed food with inappropriate refrigeration, and aerosols in Argentina. The diagnosis is based only on clinical findings matching the disease and previous exposure to suspicious food. Botulism must be immediately identified as even one case suggests the start of an epidemic and should be treated as a public health emergency. Therefore, the purpose of the following review is to recognize the risks associated with the consumption of potentially dangerous foods, and to encourage prevention by seeking to make all public health professionals aware of the dangers of this potentially lethal disease.

Prevention of foodborne listeriosis.

Listeria monocytogenes is a foodborne pathogen that can cause serious invasive illness, mainly in certain well-defined high-risk groups, including elderly and immunocompromised patients, pregnant women, newborns and infants. L. monocytogenes primarily causes abortion, septicemia or meningitis. Contaminated meats (such as hot dogs, delicatessen meats and patiota), dairy products and seafood have all been implicated in outbreaks of listeriosis. The public health importance of listeriosis is not always recognized, particularly because listeriosis is a relatively rare disease compared with other common foodborne illnesses such as salmonellosis or botulism. However, because of its high case fatality rate, listeriosis ranks among the most frequent causes of death due to foodborne illness, ranking second after salmonellosis. L. monocytogenes emerged as an important foodborne pathogen in the latter part of the 20th century. Extensive work has been performed in many countries during the last decade to prevent outbreaks and decrease the incidence of listeriosis. An important reduction occurred in listeriosis incidence in some of these countries during the 90s, suggesting a relationship between preventive measures and incidence decrease of human listeriosis.