Are Salt Tablets Effective in the Treatment of Euvolemic Hyponatremia?

OBJECTIVES: There is limited evidence for the use of salt tablets in the treatment of hyponatremia. This retrospective study evaluated the effectiveness of salt tablet administration in euvolemic hyponatremia. METHODS: This was a single-center, retrospective cohort study. Information on patients' demographics, clinical characteristics, and laboratory data were collected for retrospective review. Treatment for hyponatremia, including the amount of salt tablets, fluid restriction, and diuretics was collected. We compared hyponatremic patients with those who received salt tablets versus those who did not receive salt tablets. The primary outcome of interest was the change in serum sodium at 48 hours between the two groups. RESULTS: A total of 1258 medical records were initially screened with inclusion and exclusion criteria. After screening, there were 83 patients included in the study. Forty-two patients received salt tablets and 41 patients were in the group that did not receive salt tablets. Patients treated with salt tablets were older, more often female, and had lower body weight and lower initial serum sodium. The change in serum sodium after 48 hours was higher in the salt tablet group (5.2 mEq/L) than the non-salt tablet group (3.1 mEq/L; P < 0.001). This difference in serum sodium between the two groups remained statistically significant when adjusted for age, sex, weight, and initial serum sodium. CONCLUSIONS: The use of salt tablets in the treatment of euvolemic hyponatremia is associated with a small but significant improvement in serum sodium compared with patients who did not receive such therapy, even after adjusting for age, sex, weight, and initial serum sodium. This study supports the effectiveness of salt tablets in the treatment of euvolemic hyponatremia in medical patients.

0.9% saline versus Plasma-Lyte as initial fluid in children with diabetic ketoacidosis (SPinK trial): a double-blind randomized controlled trial.

BACKGROUND: Acute kidney injury (AKI) is an important complication encountered during the course of diabetic ketoacidosis (DKA). Plasma-Lyte with lower chloride concentration than saline has been shown to be associated with reduced incidence of AKI in adults with septic shock. No study has compared this in DKA. METHODS: This double-blind, parallel-arm, investigator-initiated, randomized controlled trial compared 0.9% saline with Plasma-Lyte-A as initial fluid in pediatric DKA. The study was done in a tertiary care, teaching, and referral hospital in India in children (> 1 month-12 years) with DKA as defined by ISPAD. Children with cerebral edema or known chronic kidney/liver disease or who had received pre-referral fluids and/or insulin were excluded. Sixty-six children were randomized to receive either Plasma-Lyte (n = 34) or 0.9% saline (n = 32). MAIN OUTCOMES: Primary outcome was incidence of new or progressive AKI, defined as a composite outcome of change in creatinine (defined by KDIGO), estimated creatinine clearance (defined by p-RIFLE), and NGAL levels. The secondary outcomes were resolution of AKI, time to resolution of DKA (pH > 7.3, bicarbonate> 15 mEq/L & normal sensorium), change in chloride, pH and bicarbonate levels, proportion of in-hospital all-cause mortality, need for renal replacement therapy (RRT), and length of ICU and hospital stay. RESULTS: Baseline characteristics were similar in both groups. The incidence of new or progressive AKI was similar in both [Plasma-Lyte 13 (38.2%) versus 0.9% saline 15 (46.9%); adjusted OR 1.22; 95% CI 0.43-3.43, p = 0.70]. The median (IQR) time to resolution of DKA in Plasma-Lyte-A and 0.9% saline were 14.5 (12 to 20) and 16 (8 to 20) h respectively. Time to resolution of AKI was similar in both [Plasma-Lyte 22.1 versus 0.9% saline 18.8 h (adjusted HR 1.72; 95% CI 0.83-3.57; p = 0.14)]. Length of hospital stay was also similar in both [Plasma-Lyte 9 (8 to 12) versus 0.9% saline 10 (8.25 to 11) days; p = 0.39]. CONCLUSIONS: The incidence of new or progressive AKI and resolution of AKI were similar in both groups. Plasma-Lyte-A was similar to 0.9% Saline in time to resolution of DKA, need for RRT, mortality, and lengths of PICU and hospital stay. TRIAL REGISTRATION: Clinical trial registry of India, CTRI/2018/05/014042 (ctri.nic.in) (Retrospectively registered).

Toxicity testing of "eco-friendly" de-icing formulations using Chironomus dilutus.

An influx of chloride ions from road de-icing solutions can result in toxicological effects to organisms in terrestrial and aquatic environments. As such, "eco-friendly" de-icing alternatives are sought to mitigate environmental impacts of de-icing impervious surfaces, while maintaining human safety. While many alternative de-icers are economically impractical for municipal use, the residential commercial market is flooded with de-icing formulations claiming to be "eco-friendly". Given the little regulation and guidance that surrounds eco-labeling, the meaning of "eco-friendly" remains unclear in the context of biological systems. The objective of the current study was to determine the toxicity of three "eco-friendly" de-icing formulations to Chironomus dilutus using 10 d toxicity tests. The toxicity of these three formulations was compared to a traditional formulation composed entirely of chloride salts. Two of the "eco-friendly" de-icers demonstrated LC50s of 6.61 and 6.32 g/L, which were similar in toxicity to the traditional sodium chloride formulation with a LC50 6.29 g/L. The comparable toxicities of these formulations is likely due to the presence of chloride salts in each of the "eco-friendly" de-icers. The third "eco-friendly" formulation, a urea-based de-icer, demonstrated toxicity an order of magnitude higher than that of the traditional formulation with an LC50 of 0.63 g/L. While C. dilutus may not have been the intended endpoint in consideration when marketing these products as "eco-friendly", consideration of how eco-labeling is utilized and the role of environmental scientists in determining the meaning of such claims must be considered to ensure continued and future protection of the environment.

Stability of tacrolimus injection diluted in 0.9% sodium chloride injection and stored in Excel bags.

PURPOSE: The chemical stability and physical compatibility of tacrolimus i.v. infusion solutions prepared in Excel bags and stored at 23 or 4 °C for up to nine days were studied. METHODS: Tacrolimus admixtures (2, 4, and 8 µg/mL) were prepared in Excel bags using 0.9% sodium chloride injection and stored at 23 °C without protection from light or at 4 °C in the dark. Test samples were withdrawn from triplicate bag solutions immediately after preparation and at predetermined time intervals (1, 3, 5, 7, and 9 days). Chemical stability was assessed by measuring tacrolimus concentrations using a validated stability-indicating high-performance liquid chromatography assay. The physical stability of the admixtures was assessed by visual examination and by measuring turbidity, particle size, and drug content. RESULTS: All test solutions stored at 23 or 4 °C had a no greater than 6% loss of the initial tacrolimus concentration throughout the nine-day study period. All test samples of tacrolimus admixtures, under both storage conditions, were without precipitation and remained clear initially and throughout the nine-day observation period. Changes in turbidities were minor; measured particulates remained few in number in all samples throughout the study. CONCLUSION: Extemporaneously prepared infusion solutions of tacrolimus 2, 4, and 8 µg/mL in 0.9% sodium chloride injection in Excel bags were chemically and physically stable for at least nine days when stored at room temperature (23 °C) without protection from light and when stored in a refrigerator (4 °C) in the dark.

Compatibility of butorphanol and droperidol in 0.9% sodium chloride injection.

PURPOSE: The compatibility and stability of butorphanol tartrate and droperidol in polyvinyl chloride (PVC) bags and glass bottles stored at 4°C and 25°C for up to 15 days were studied. METHODS: Admixtures were assessed initially and for 15 days after preparation in PVC bags and glass bottles using 0.9% sodium chloride injection as a diluent and stored at 4°C and 25°C. The initial drug concentrations were 0.08 mg/mL for butorphanol tartrate and 0.05 mg/mL for droperidol. Samples were withdrawn from each container immediately after preparation and at predetermined intervals (2, 4, 8, 24, 48, 72, 120, 168, 240, and 360 hours after preparation). The solutions were visually inspected for precipitation, cloudiness, and discoloration at each sampling interval. Drug concentrations were determined using a validated high-pressure liquid chromatography method. RESULTS: After 15 days of storage, all formulations tested retained >98% of the initial concentrations of both drugs. The drug mixtures were clear in appearance, and no color change or precipitation was observed. Throughout this period, pH values remained stable. CONCLUSION: Admixtures of butorphanol tartrate 0.08 mg/mL and droperidol 0.05 mg/mL in 0.9% sodium chloride injection were stable for at least 360 hours when stored in PVC bags or glass bottles at 4°C and 25°C and protected from light.

Informe sobre fluoruración de la sal / Salt fluoridation report

La caries dental es una enfermedad infecciosa y transmisible que conduce a la destrucción de las estructuras del diente mediante la acción de las bacterias formadoras de ácido, presentes en el biofilm de placa dental. En el año 2006, la Organización Mundial de la Salud, la Federación Dental Internacional y la Asociación Internacional para la Investigación Dental convocaron a 80 expertos de 30 países a una consulta global sobre la salud bucodental mediante el fluoruro. Las recomendaciones plantearon, entre otras, la necesidad de que los gobiernos y otros organismos introduzcan legislación efectiva y los programas necesarios para asegurar el acceso al fluoruro para la salud dental en todos los países. La ley de fluoruración y defluoruración del agua de consumo público fue sancionada en 1975 (Ley 21.172) y no cumplida, salvo irregulares implementaciones en alguans ciudades argentinas. Debe considerarse que las medidas de prevención de aplicaicón masiva son instrumentos que cumplen con el atributo de equidad, ya que no discriminan según ingresos, educación ni etnia. A nivel internacional, las dosis óptimas recomendadas para la incorporación del ion F- son: en el agua de consumo público 0.7-1.5 mg F-, pero actualmente se está considerando llevar el máximo a 0.7 ppm; en la sal de consumo, las concentraciones oscilan entre 200 a 250 mg F-/kg. La evaluación de los programas preventivos de aplicación universal revelan que: todo programa de fluoruración, cualquiera sea el vehículo, debe contar con: suficiente dicumentación de línea basal, adecuada vigilancia epidemiológica para permitir reevaluación y el reajuste de dosificación, si fuese necesario, sistemático monitoreo para el control de la calidad de los procesos involucrados. El agua fluorada es la herramienta más pertinente para la prevención de caries a nivel poblacional. La fluoración de la sal, si bien es efectiva para el control de la caries dental, plantea riesgos asociados para la salud.

In vitro function of buffy coat-derived platelet concentrates stored for 9 days in CompoSol, PASII or 100% plasma in three different storage bags.

BACKGROUND AND OBJECTIVES: The aim of the study was to compare the in vitro quality of buffy coat-derived platelet concentrates (PC) during extended storage in plasma or additive solution in three different storage bags. MATERIALS AND METHODS: A pooled and split design was chosen so that identical PCs were produced in either 100% plasma, 70% PASII : 30% plasma or 70% CompoSol : 30% plasma (n = 6 each). This was repeated for three different manufacturers' platelet storage bags (Fresenius, Baxter and Pall). PCs were sampled on days 1, 5, 7 and 9 of storage and tested in vitro using a variety of tests of platelet function. For each bag type, storage in PASII or Composol was compared with plasma (data taken across the entire storage period), and differences occurring with time were analysed for all storage media. RESULTS: The pH of all PCs was > 6.8 at day 9 of storage. In vitro platelet function, as assessed by markers of platelet activation and metabolism, of PCs stored in CompoSol appeared to be similar to that of PCs stored in plasma over 9 days of storage. In contrast, PCs stored in PASII tended to have significantly higher levels of platelet activation (almost a twofold increase in % platelets positive for CD62P by day 5) and lower hypotonic shock response (approximately 40%, by day 7) compared to either PCs stored in 100% plasma or 70% CompoSol. The magnitude of the differences observed between platelet storage media appeared to be dependent on the type of platelet storage bag with the highest degree of platelet activation and lowest hypotonic shock response values being observed in Fresenius bags in combination with PASII. CONCLUSIONS: The maintenance of platelet function in vitro during extended storage of PCs in platelet additive solutions is dependent on the combination of type of additive solution and type of platelet storage bag. For all bag types studied, storage in PASII resulted in poorer platelet function in vitro.

Nutrición de yodo en escolares de una zona con alta ingesta de yodo (Calama)comparada con zona de ingesta normal (Punta Arenas) / Iodine nutritional status in school-age children from an area of high iodine intake (Calama) compared with an area of normal intake (Punta Arenas)

Se evaluó la prevalencia de bocio por palpación de la glándula tiroidea en 1296 escolares de educación básica de una zona con alta ingesta de yodo (Calama) y se comparó con la de otra zona de ingesta normal de yodo (Punta Arenas). En una sub muestra del 10 por ciento de los escolares se midió la excreción de yodo urinaria y los niveles de hormonas tiroídeas en sangre. En ambas localidades se seleccionaron aleatoriamente del comercio 148 muestras de sal para consumo humano en las que se determinó la concentración de yodo. Se encontró una prevalencia de bocio de 11,1 por ciento (10,0 por ciento en varones y 12,5 por ciento en mujeres) mayoritariamente bocio grado Ia (7,2por ciento), sin diferencias por zona (11,6 por ciento en Calama y 10,6 por ciento en Punta Arenas). La concentración de yodo en la sal de consumo humano en ambas localidades fue adecuada a la exigencia actual del Reglamento Sanitario de los Alimentos (RSA) (33,3 µgI/g sal en Calama, 34,0 en Punta Arenas). La excreción de yodo en la orina fue significativamente más alta en Calama (460 ± 190 µgI/L)que en Punta Arenas (273 ± 155). No se detectaron diferencias en los niveles de T4 y TSH (Calama 7.1 ± 1.5 y 3.3 ± 1.8 y Punta Arenas 7.2 ± 1.1 y 2.9 ± 1.2 respectivamente) en tanto que las valores de T3 en ambas localidades mostraron diferencias significativas (103.9 ± 33.1 y 145.0 ± 26.0 respectivamente, p<0.001) . Se observó sólo una tendencia al aumento de la prevalencia de bocio, con persistencia de valores elevados de yoduria en Calama, lo que sugiere una fuente de yodo extra en esta localidad, cuya procedencia desconocemos y es necesario investigar.

Goiter prevalence determined by palpation of thyroid gland was evaluated in 1296 primary school age children from an area of high iodine intake (Calama) and compared with an area of normal iodine intake (Punta Arenas). Urinary iodine excretion and plasmatic thyroid hormones were measured in 10 percent of school children. In both areas 148 samples of salt for human consumption were randomly selected to measure iodine concentration. A goiter prevalence of 11,1 percent (10,0 percent in males and 12,5 percent in females) mainly goiter grade Ia (7,2 percent), without differences per area (11,6 percent in Calama and 10,6 percent in Punta Arenas) was found. Iodine concentration in salt for human consumption at both areas was adequated according the present Food Sanitary Regulation (FSR) in Chile (33,3 (gI/g salt in Calama, and 34,0 in Punta Arenas). Urinary iodine excretion was significantly higher in Calama (460 ( 190 (g I/L) than in Punta Arenas (273 ( 155 (g I/L). No differences were detected in T4 and TSH plasma levels (Calama 7.1 ( 1.5 and 3.3 (1.8; and Punta Arenas 7.2 ( 1.1 and 2.9 ( 1.2 respectively), while T3 plasma levels were significantly higher in Punta Arenas (103.9 ( 33.1 y 145.0 ( 26.0 respectivamente, p<0.001) . Only a tendency to a higher goiter prevalence with persistent and significantly higher urinary iodine excretion in children at Calama was observed, suggesting an extra source of iodine in this area, with an unkown origen that must be investigated.

Physico-chemical stability and sterility of previously prepared saline infusion solutions for use in out-of-hospital emergencies.

OBJECTIVE: The topic of this research was to determine whether out-of-hospital emergency teams could make use of previously prepared saline solutions (SS). The objective was to discover the physical, chemical and sterility characteristics of previously prepared saline infusions stored in ambulances and ascertain how long they remained in optimum condition. METHOD: Randomised clinical trial, triple blind, where study units consisted of saline solutions prepared with an infusion system and a three-way valve. The duration of the study was 12 months. Six intervention groups were designed on the basis of time of exposure and location. Samples consisted of 672 units. Twelve microbiological cultures were made and the pH, density, viscosity and CINa concentration were determined. We compared hypotheses with four models of linear regression for the variables and a model of logistic regression for the variables. A value of P < 0.05 was considered significant. RESULTS: We obtained results from 669 saline solutions (98.82%). Neither multivariant analysis nor ANOVA tests showed any significant association for a power greater than 99% with regard to the physical-chemical characteristics. The model of logistic regression also did not find any significant association for sterility. Colonisation was present in 1.7% of the 8,028 cultures made and more than 5 CFU per millilitre was found in only two cases. CONCLUSION: There is no evidence to suggest that recently prepared saline infusion solutions are any different from a physical-chemical and sterility point of view than those exposed for 24, 48, or 72 h. It was concluded that use can be made of previously prepared saline solutions with a guarantee their stability and sterility.

Derivation of a salinity target for the Lower Murray Darling Valley.

The NSW Government commissioned catchment management boards (CMBs) to set the direction and process for catchment scale natural resource management. In the Lower Murray Darling, Rivers are highly regulated and water resources shared between three states. The Catchment Board only has jurisdiction over the northern bank of the Murray but salt and water enter the river from many locations upstream and along the area boundary. River salt and flow modelling has continually been improved to reflect and contribute to an increased understanding of salinity processes. The MDBC Salt Load study correlates 10 years of actual measured data with its modelled outputs, and estimates river salinities for 2020, 2050 and 2100. Routing models such as SALTFLO and MURKEY generate percentile salinity levels at different nodes in the River Murray downstream of the Lower Darling confluence. National, Murray-Darling Basin and NSW salinity management policy and legislative requirements were considered, MDBC model output was used to ensure the interim targets are achievable, auditable, and appropriate to the catchment. The method for an end-of-valley river based target for salinity is described. A target of less than 463 microS/cm for Lock 6, a point in the lower reaches of the Murray River is recommended for year 2010. Catchment management targets that express the main river salinity risk in five hydrologically distinct management zones are also recommended. Salinity management changes are needed in each zone to meet the end-of-valley target.

An evaluation of the efficacy of Aqualox for microbiological control of industrial cooling tower systems.

A comprehensive sampling protocol was employed to evaluate the efficacy of Aqualox, a biocide based on electrochemically activated water, against legionellae and heterotrophic bacteria in two industrial cooling tower systems. Both of the towers in the study remained free from evidence of Legionella spp. contamination throughout a five-month evaluation period, despite the previously demonstrated presence of legionellae in one of the test towers, and in two other towers on the same site, at levels well in excess of UK Health and Safety Commission (HSC) Approved Code of Practice and Guidance (ACOP) upper action limits. Levels of heterotrophic bacteria were controlled below 10(4) cfu/mL in both towers throughout most of the trial. Results also provided indirect evidence of significant activity against biofilm bacteria, with biofilm removal beginning almost immediately after commissioning of the Aqualox treatment systems. The results were particularly encouraging as the two towers studied had a long history of poor microbiological control using conventional bromine-based biocide products. Significant differences were observed between laboratory measurements of total viable counts on frequent liquid samples and those obtained from dip slides following HSC recommendations.

When one liter does not equal 1000 milliliters: implications for the tumescent technique.

BACKGROUND: Tumescent anesthesia has revolutionized the practice of liposuction. Inherent to the tumescent technique is the use of large volumes of dilute solutions of lidocaine with epinephrine instilled into subcutaneous fat deposits. Precise formulation of the tumescent anesthesia is essential to liposuction technique. OBJECTIVES: To determine the actual volumes of fluids contained in intravenous (IV) 1 L bags of saline used for tumescent anesthesia, to calculate volumes supplied in 50 cc stock solutions of 1% lidocaine, and to measure the amount of fluid retained by peristalic pump tubing used for infiltration. METHODS: The amount of saline contained in fifteen 1 L saline bags from three different manufacturers was calculated using graduated cylinder methodology. The volume of tumescent anesthesia retained by peristaltic pump tubing was calculated by expelling the contents of the filler tubing and measuring it. The actual amount of 1% lidocaine contained within fifteen 50 ml "stock" 1% lidocaine bottles from different manufacturers and with different lot numbers was calculated by transferring the contents into graduated cylinders. RESULTS: One liter IV bags of physiologic saline contained an average volume of 1051 ml (range 1033-1069 ml). The 50 ml bottles of 1% lidocaine with epinephrine contain an average of 54 ml of anesthetic (range 52.5-55 ml). Infusion tubing for use with peristaltic pumps may retain 46-146 ml of tumescent anesthesia. CONCLUSION: One liter IV bags of normal saline contain more than 1 L, having an average volume of 1051 ml. Common methods of preparation of 0.05% lidocaine with 1:1,000,000 epinephrine and sodium bicarbonate can increase the total amount of fluid in the tumescent anesthesia to 1112 ml for 0.05% solutions and preparation of a 0.1% solution contains an average volume of 1162 ml. The fluid contained in each bag may be increased over labeling by as much as 11-16%. Final concentrations of lidocaine in tumescent anesthesia may be reduced due to extra fluids. A 0.05% lidocaine solution may have a final lidocaine concentration of 0.045% and a 0.1% lidocaine solution may have an actual concentration of 0.086%. Lidocaine concentrations may be reduced by as much as 10-14%. Extra anesthesia fluid is also contained within stock 50 ml bottles of 1% lidocaine. Dermatologic surgeons should be aware of extra fluid possibly contained within tumescent anesthetic preparation, be aware of the extra anesthesia supplied in standard 1% lidocaine bottles, and possible decreased concentration of lidocaine within the final tumescent anesthesia.

Prospective randomized investigation for evaluation of postoperative changes in the microbial climate of paranasal mucosa by the use of different dissoluting techniques during postoperative care.

Endonasal dissolution by the use of NaCl-solution is a common postoperative treatment of the nasal mucosa after endonasal surgery. These procedure involve for example endonasal shower and sterilized solutions. The contamination of nasal shower in case of unprofessional cleaning after treatment was an argument against this technique in earlier discussions. The danger of such an infection should be avoided by the use of sterilized solution. Therefore the dependence of nasal microbial climate on different nasal dissoluting techniques was investigated by the use of such named endonasal shower (Siemens und Co, Bad Ems, Germany) in comparison with sterilized solution (Rhinomer, Zyma SA, Nyon, France). Microbial cultures were investigated of 80 patients after endonasal surgery (53 m, 27 f; 31 +/- 21 age). Surgery was done for the treatment of chronic polypous sinusitis. Pre-, intra- and postoperative samples were taken in 640 cases to proceed microbial cultures. Material was transferred with the use of a Port-A-Cul-transport medium and preparation of the microbial cultures was done during the first four hours. As a result 895 bacterial clones were cultivated. These consisted of 87% aerob and 13% anaerob bacteria. Staphylococcus aureus (39%) and members of the family of Enterobactericae (30%) were the most common microbes. There was neither an evidence for postoperative microbes on the nasal mucosa nor a correlation between the dissoluting technique and the postoperative outcome. The use of sterilized solutions for the postoperative care of endonasal mucosa does not cause an additional worthful effect on neither the postoperative microbial climate nor the outcome in comparison to endonasal shower.

Nutritional value of succinic acid monoethyl ester in starvation.

Rats were fasted for 48 h, but infused with either NaCl or the sodium salt of monoethyl succinic acid (EMS), both delivered at a rate of 80 mumol/g body weight per day. The infusion of EMS, as compared to NaCl, failed to affect paraovarian adipose tissue or liver weight, liver or muscle glycogen, and insulinemia. It accentuated the starvation-induced fall in body weight, and decreased both liver and muscle protein content. Nevertheless, the succinate ester increased plasma D-glucose concentration, delayed the rise in ketonemia, maintained a higher glucokinase/hexokinase activity ratio in liver and pancreatic islets, and allowed for a more efficient stimulation of insulin release by D-glucose or 2-ketoisocaproate in isolated pancreatic islets. These findings indicate that monoethyl succinate displays a significant nutritional value when infused in starved rats.

Hyponatraemia and non-electrolyte solutions in labouring primigravida.

We performed a prospective randomised study on one hundred primigravid women who required oxytocin to augment labour, comparing dextrose infusion with normal saline. After delivery, the 45 patients whose oxytocin was infused in dextrose had significantly lower serum sodium levels in both mother and baby compared to the 48 patients who had their oxytocin administered in normal saline. This was particularly evident in those cases where epidural analgesia was employed.