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1.
Fish Physiol Biochem ; 45(5): 1551-1562, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31583489

RESUMO

Portable clinical analysers are gradually being involved in on-site assessment of haematic parameters in fish. The purpose of this study was to evaluate the i-STAT portable clinical analyser (i-STAT PCA) for accuracy and reliability of measuring blood pH, partial pressure of oxygen (pO2), haematocrit, haemoglobin, sodium, potassium and calcium in Atlantic cod (Gadus morhua). Haematological parameters detected with the i-STAT PCA were compared with conventional laboratory techniques (CLTs). Two types of disposable cartridges were used (CHEM8+ and CG4+) with the i-STAT PCA, and experiments were performed at two different temperature regimes (5 °C and 15 °C) and four different carbon dioxide (CO2) levels (0%, 0.1%, 0.5% and 1%). All blood parameters measured with the i-STAT PCA showed heterogeneous inaccuracy under the tested conditions, but the highest discrepancies were registered in blood pO2. The i-STAT PCA systematically overestimated the pO2 measurements. Our research suggests that i-STAT PCA is not an appropriate tool for pO2 measurements especially in coldwater fish species. The i-STAT PCA consistently underestimated the pH and haematocrit values especially at a lower temperature, although those parameters indicate significant high correlation at 15 °C. Furthermore, the analysed ions showed overestimation of sodium and underestimation of potassium and calcium.


Assuntos
Análise Química do Sangue/instrumentação , Dióxido de Carbono , Gadus morhua/sangue , Temperatura Ambiente , Animais , Cálcio/sangue , Hematócrito , Concentração de Íons de Hidrogênio , Pressão Parcial , Potássio/sangue , Reprodutibilidade dos Testes , Sódio/sangue
2.
Lancet ; 394(10208): 1540-1550, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31533906

RESUMO

BACKGROUND: Spironolactone is effective at reducing blood pressure in patients with uncontrolled resistant hypertension. However, the use of spironolactone in patients with chronic kidney disease can be restricted by hyperkalaemia. We evaluated use of the potassium binder patiromer to allow more persistent use of spironolactone in patients with chronic kidney disease and resistant hypertension. METHODS: In this phase 2 multicentre, randomised, double-blind, placebo-controlled study, we enrolled participants aged 18 years and older with chronic kidney disease (estimated glomerular filtration rate 25 to ≤45 mL/min per 1·73 m2) and uncontrolled resistant hypertension from 62 outpatient centres in ten countries (Bulgaria, Croatia, Georgia, Hungary, Ukraine, France, Germany, South Africa, the UK, and the USA). Patients meeting all eligibility criteria at the final screening visit were stratified by local serum potassium measurement (4·3 to <4·7 mmol/L vs 4·7 to 5·1 mmol/L) and history of diabetes. Participants were randomly assigned (1:1) with an interactive web response system to receive either placebo or patiromer (8·4 g once daily), in addition to open-label spironolactone (starting at 25 mg once daily) and their baseline blood pressure medications. Participants, the study team that administered treatments and measured blood pressure, and the investigators were masked to assigned treatment groups. Dose titrations were permitted after 1 week (patiromer) and 3 weeks (spironolactone). The primary endpoint was the between-group difference at week 12 in the proportion of patients on spironolactone. Efficacy endpoints and safety were assessed in all randomised patients (intention to treat). The study was registered with Clinicaltrials.gov, NCT03071263. FINDINGS: Between Feb 13, 2017, and Aug 20, 2018, we screened 574 patients. 295 (51%) of 574 patients met all inclusion criteria and were randomly assigned to spironolactone in addition to double-blind treatment with either placebo (n=148) or patiromer (n=147). At week 12, 98 (66%) of 148 patients in the placebo group and 126 (86%) of 147 patients in the patiromer group remained on spironolactone (between-group difference 19·5%, 95% CI 10·0-29·0; p<0·0001). Adverse events were mostly mild or moderate in severity and occurred in 79 (53%) of 148 patients in the placebo group and 82 (56%) of 147 patients in the patiromer group. INTERPRETATION: In patients with resistant hypertension and chronic kidney disease, patiromer enabled more patients to continue treatment with spironolactone with less hyperkalaemia. Persistent spironolactone enablement in this population of patients has clinical relevance for the treatment of resistant hypertension. FUNDING: Relypsa, a Vifor Pharma Group Company.


Assuntos
Diuréticos/administração & dosagem , Hipertensão/tratamento farmacológico , Polímeros/administração & dosagem , Espironolactona/administração & dosagem , Adulto , Idoso , Diuréticos/efeitos adversos , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Hiperpotassemia/prevenção & controle , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Insuficiência Renal Crônica/complicações , Espironolactona/efeitos adversos , Resultado do Tratamento
3.
Biochem Med (Zagreb) ; 29(3): 030703, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31379461

RESUMO

Introduction: Communication of laboratory critical risk results is essential for patient safety, as it allows early decision making. Our aims were: 1) to retrospectively evaluate the current protocol for telephone notification of critical risk results in terms of rates, efficiency and recipient satisfaction, 2) to assess their use in clinical decision making and 3) to suggest alternative tools for a better assessment of notification protocols. Materials and methods: The biochemical critical risk result notifications reported during 12 months by routine and STAT laboratories in a tertiary care hospital were reviewed. Total number of reports, time for the notification and main magnitudes with critical risk results were calculated. The use of notifications in clinical decision making was assessed by reviewing medical records. Satisfaction with the notification protocol was assessed through an online questionnaire to requesting physicians and nurses. Results: Critical result was yielded by 0.1% of total laboratory tests. Median time for notification was 3.2 min (STAT) and 16.9 min (routine). The magnitudes with a greater number of critical results were glucose and potassium for routine analyses, and troponin, sodium for STAT. Most notifications were not reflected in the medical records. Overall mean satisfaction with the protocol was 4.2/5. Conclusion: The results obtained indicate that the current protocol is appropriate. Nevertheless, there are some limitations that hamper the evaluation of the impact on clinical decision making. Alternatives were proposed for a proper and precise evaluation.


Assuntos
Tomada de Decisão Clínica , Análise Química do Sangue , Humanos , Laboratórios Hospitalares , Registros Médicos/normas , Potássio/sangue , Estudos Retrospectivos , Sódio/sangue , Centros de Atenção Terciária , Fatores de Tempo
4.
Biochem Med (Zagreb) ; 29(3): 031001, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31379463

RESUMO

Introduction: Phlebotomy is an error-prone process in which mistakes are difficult to reveal. This case report describes the effect on laboratory results originating from a blood sample collected in close proximity to an intravenous catheter. Materials and methods: A 69-year-old male patient was referred to the Emergency department where pneumonia was suspected. Phlebotomy was performed to collect blood samples to assess electrolytes, renal function, liver function, infection and haematological parameters. Results: The laboratory analysis showed reduced potassium and calcium concentrations. To prevent life-threatening cardiac failure the clinician decided to correct those electrolytes. Remarkably, the electrocardiogram showed no abnormalities corresponding to hypokalaemia and hypocalcaemia. This observation, in combination with an overall increase in laboratory parameters with the exception of sodium and chloride, led to the suspicion of a preanalytical error. Retrospectively, an intravenous catheter was inserted in close proximity of the puncture place but no continuous infusion was started prior to phlebotomy. However, the intravenous catheter was flushed with sodium chloride. Since potential other causes were excluded, the flushing of the intravenous catheter with sodium chloride prior to phlebotomy was the most probable cause for the deviating laboratory results and subsequently for the unnecessary potassium and calcium suppletion. Conclusion: This case underlines the importance of caution in the interpretation of laboratory results obtained from specimens that are collected in the proximity of an intravenous catheter, even in the absence of continuous infusion.


Assuntos
Cateteres , Flebotomia/métodos , Idoso , Cálcio/sangue , Eletrocardiografia , Serviço Hospitalar de Emergência , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Potássio/sangue , Fase Pré-Analítica , Cloreto de Sódio/química
5.
Food Chem Toxicol ; 131: 110534, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150781

RESUMO

Acute and subacute toxicities of the ethanol extract from Epigynum auritum (EAE) wereperformed by oral administration in pathogen-free mice. Acute toxicity study was performed at a single dose of 5000 mg/kg for 14 consecutive days, while subacute toxicity test was conducted by daily oral administration of EAE at doses of 312, 625, 1250, and 2500 mg/kg for 28 days. Acute toxicity study showed that LD50 of EAE was over 5000 mg/kg. The results of subacute toxicity showed no significant adverse effect of EAE at 312 mg/kg. Moreover, EAE exhibited toxicities to liver, spleen and kidney in mice determined by hematological, serum biochemical and histological analyses during daily oral administration of 1250 mg/kg and 2500 mg/kg EAE. The results revealed that the dose of EAE lower than 625 mg/kg can be regarded as safe.


Assuntos
Apocynaceae/química , Componentes Aéreos da Planta/química , Extratos Vegetais/toxicidade , Administração Oral , Animais , Relação Dose-Resposta a Droga , Etanol/química , Feminino , Rim/patologia , Fígado/patologia , Pulmão/patologia , Masculino , Camundongos Endogâmicos ICR , Extratos Vegetais/administração & dosagem , Extratos Vegetais/isolamento & purificação , Potássio/sangue , Sódio/sangue , Baço/patologia , Testes de Toxicidade Aguda , Testes de Toxicidade Subaguda
6.
J Vet Emerg Crit Care (San Antonio) ; 29(4): 399-406, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31225690

RESUMO

OBJECTIVE: To compare intravenous and intraosseous blood aspirates using point-of-care diagnostic equipment available in veterinary hospitals. DESIGN: Prospective study. SETTING: Private referral hospital. ANIMALS: Dogs undergoing a tibial plateau leveling osteotomy or extracapsular anterior cruciate ligament stabilization procedure were enrolled. METHODS: Under general anesthesia, simultaneous 0.5 mL intravenous and intraosseous blood samples were collected from the jugular vein and proximal tibia, respectively. Samples were evaluated in duplicate within 10 minutes of collection and averaged for each of the following parameters: blood urea nitrogen (BUN), glucose, packed cell volume, total plasma protein (TPP), plasma lactate, sodium, potassium, chloride, urea, glucose, pH, anion gap, pO2, and pCO2 . Normalcy was tested with Kolmogorov-Smirnov test. A Student's t-test and Bland-Altman plot were used to compare intravenous and intraosseous samples. RESULTS: Twelve dogs were recruited into the study. There were statistically significant differences between intravenous and intraosseous samples for sodium (P = 0.0216), chloride (P = 0.0225), BUN (P = 0.014), and potassium (P < 0.0001), respectively. No significant differences were detected for the other parameters evaluated. DISCUSSION: The intraosseous space provides an easily accessible, noncollapsible alternative for assessing blood parameters. Omitting potassium, the statistically significant differences noted between sites was not felt to be clinically significant. Although statistically insignificant, the large difference in hematocrit values indicates that the samples should not be used interchangeably. CONCLUSION: Intraosseous aspirates, excluding potassium and hematocrit, appear to be a reliable alternative for assessing most point-of-care analytes in healthy dogs, although a larger sample size should be investigated. The application of these data in shock patients is unknown.


Assuntos
Medula Óssea/fisiologia , Cães/sangue , Emergências/veterinária , Testes Imediatos , Equilíbrio Ácido-Base , Animais , Gasometria , Nitrogênio da Ureia Sanguínea , Cloretos/sangue , Hematócrito/veterinária , Infusões Intraósseas/métodos , Veias Jugulares , Ácido Láctico/sangue , Projetos Piloto , Potássio/sangue , Estudos Prospectivos
7.
J Vet Intern Med ; 33(4): 1814-1821, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31099949

RESUMO

BACKGROUND: Hypokalemia is of clinical relevance in cattle. Different mostly empirical treatment options are suggested. HYPOTHESIS/OBJECTIVES: To evaluate if oral administration of potassium influences the plasma concentration, the intracellular concentration in erythrocytes and in muscle, renal excretion of potassium, and to assess if there are differences in the efficacy of the potassium formulations. ANIMALS: Thirty cows with hypokalemia (plasma concentration <3.5 mmol/L) were systematically allocated to 3 treatment groups (10 cows/group). METHODS: The cows received 52 g of potassium in different formulations: group B-potassium chloride bolus (release over 12 hours); group G-potassium propionate gel (release over 2 hours); and group S-potassium chloride solution (immediately available). Potassium concentrations were repeatedly measured in plasma, erythrocytes, muscle, and urine using ICP-OES. RESULTS: Plasma potassium concentrations for all preparations increased within 30 minutes and the increase lasted for 12 hours. The concentrations of potassium in the erythrocytes and in the muscle, renal potassium excretion, and total urine volume were not affected by administration of any product. There were no differences between the treatments groups. The feed intake increased in 50% of cows within 2 hours after potassium application, which may contribute to the increase of plasma potassium concentration. CONCLUSIONS AND CLINICAL IMPORTANCE: All the studied potassium formulations are equally effective to treat hypokalemia in dairy cows for over 12 hours but do not influence intracellular concentration or renal excretion of potassium. The plasma potassium concentration should be reevaluated after 12 hours.


Assuntos
Doenças dos Bovinos/tratamento farmacológico , Hipopotassemia/veterinária , Cloreto de Potássio/administração & dosagem , Potássio/sangue , Administração Oral , Animais , Bovinos , Doenças dos Bovinos/sangue , Feminino , Hipopotassemia/sangue , Hipopotassemia/tratamento farmacológico , Lactação , Músculos/química , Potássio/metabolismo , Potássio/urina , Propionatos/administração & dosagem , Eliminação Renal/efeitos dos fármacos
8.
Clin J Am Soc Nephrol ; 14(6): 798-809, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31110051

RESUMO

BACKGROUND AND OBJECTIVES: Oral sodium zirconium cyclosilicate (formerly ZS-9) binds and removes potassium via the gastrointestinal tract. Sodium zirconium cyclosilicate-associated restoration and maintenance of normokalemia and adverse events were evaluated in a two-part, open label, phase 3 trial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In the correction phase, adult outpatients with plasma potassium ≥5.1 mmol/L (i-STAT Point-of-Care) received sodium zirconium cyclosilicate 10 g three times daily for 24-72 hours until normokalemic (potassium =3.5-5.0 mmol/L). Qualifying participants entered the ≤12-month maintenance phase and received sodium zirconium cyclosilicate 5 g once daily titrated to maintain normokalemia without dietary or medication restrictions. Prespecified primary end points were restoration of normal serum potassium values (3.5-5.0 mmol/L) during the correction phase and maintenance of serum potassium ≤5.1 mmol/L during the maintenance phase. Adverse events were assessed throughout. RESULTS: Of 751 participants, 746 (99%) achieved normokalemia during the correction phase (mean serum potassium =4.8 mmol/L; 95% confidence interval, 4.7 to 4.8) and entered the maintenance phase; 466 (63%) participants completed the 12-month trial. Participants were predominantly white, men, and age ≥65 years old; 74% had an eGFR<60 ml/min per 1.73 m2, and 65% used renin-angiotensin-aldosterone system inhibitors. Mean time on sodium zirconium cyclosilicate was 286 days. Mean daily sodium zirconium cyclosilicate dose was 7.2 g (SD=2.6). Over months 3-12, mean serum potassium was 4.7 mmol/L (95% confidence interval, 4.6 to 4.7); mean serum potassium values ≤5.1 and ≤5.5 mmol/L were achieved by 88% and 99% of participants, respectively. Of 483 renin-angiotensin-aldosterone system inhibitor users at baseline, 87% continued or had their dose increased; 11% discontinued. Among 263 renin-angiotensin-aldosterone system inhibitor-naïve participants, 14% initiated renin-angiotensin-aldosterone system inhibitor therapy. Overall, 489 (66%) participants experienced adverse events during the maintenance phase, and 22% experienced a serious adverse event. Of eight (1%) deaths, none were considered related to sodium zirconium cyclosilicate. Nine (1%) and 34 (5%) participants experienced serum potassium <3.0 and 3.0-3.4 mmol/L, respectively. CONCLUSIONS: After achieving normokalemia, individualized once daily sodium zirconium cyclosilicate was associated with maintenance of normokalemia without substantial renin-angiotensin-aldosterone system inhibitor changes for ≤12 months.


Assuntos
Hiperpotassemia/sangue , Adulto , Idoso , Humanos , Masculino , Potássio/sangue , Sistema Renina-Angiotensina/efeitos dos fármacos , Silicatos
9.
Anaesth Intensive Care ; 47(2): 120-127, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31070468

RESUMO

Blood gas analysers are point-of-care testing devices used in the management of critically ill patients. Controversy remains over the agreement between the results obtained from blood gas analysers and laboratory auto-analysers for haematological and biochemistry parameters. We conducted a prospective analytical observational study in five intensive care units in Western Australia, in patients who had a full blood count (FBC), urea, electrolytes and creatinine (UEC), and a blood gas performed within 1 h of each other during the first 24 h of their intensive care unit admission. The main outcome measure was to determine the agreement in haemoglobin, sodium, and potassium results between laboratory haematology and biochemistry auto-analysers and blood gas analysers. A total of 219 paired tests were available for haemoglobin and sodium, and 215 for potassium. There was no statistically significant difference between the results of the blood gas and laboratory auto-analysers for haemoglobin (mean difference -0.35 g/L, 95% confidence interval (CI) -1.20 to 0.51, P = 0.425). Although the mean differences between the two methods were statistically significant for sodium (mean difference 1.49 mmol/L, 95% CI 1.23-1.76, P < 0.0001) and potassium (mean difference 0.19 mmol/L, 95% CI 0.15-0.24, P < 0.0001), the mean biases on the Bland-Altman plots were small and independent of the magnitude of the measurements. The two methods of measurement for haemoglobin, sodium and potassium agreed with each other under most clinical situations when their values were within or close to normal range suggesting that routine concurrent blood gas and formal laboratory testing for haemoglobin, sodium and potassium concentrations in the intensive care unit is unwarranted.


Assuntos
Gasometria , Hemoglobinas , Potássio , Sódio , Automação , Gasometria/normas , Hemoglobinas/análise , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Potássio/sangue , Estudos Prospectivos , Sódio/sangue , Austrália Ocidental
10.
Clin Biochem ; 70: 46-48, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31059687

RESUMO

OBJECTIVE: Develop sample acceptability rules by determining the relationship between free hemoglobin level (hemolysis) and potassium or ionized calcium in blood gas samples collected intraoperatively. DESIGN AND METHODS: Hemolysis was assessed visually or by H index for lithium heparin blood gas samples collected intraoperatively. During periods one and three this was done using two different rules for visual assessment of centrifuged lithium heparin plasma. During period two H index was measured for all visually hemolyzed samples on a Roche Cobas c501 analyzer to determine acceptability. Potassium and ionized calcium were measured in 75 lithium heparin whole blood samples on a Radiometer ABL90 to correlate H index and potassium or ionized calcium. RESULTS: During period one 35 of 5808 (0.6%) blood gas samples had visual hemolysis levels exceeding tolerance for reporting of potassium. By switching to measured H index using a laboratory-established threshold, during period 2 we estimate that 171 of 5396 (3.2%) blood gas samples exceeded the H index threshold for reporting of potassium. In 75 intraoperative blood gas samples with H index and whole blood potassium and ionized calcium measured; we observed no relationship between H index and potassium or ionized calcium. During period 3 we switched to visual assessment of hemolysis with a greater tolerance for hemolysis; with only 3 of 5345 (0.06%) samples exceeding the new visual hemolysis threshold. CONCLUSION: For blood gas samples collected intraoperatively, there is no relationship between hemolysis and measured potassium or ionized calcium. The results suggest that only grossly hemolyzed intraoperative blood gas samples should be rejected for measurement of whole blood potassium and ionized calcium.


Assuntos
Gasometria/métodos , Cálcio/sangue , Hemoglobinas/análise , Hemólise , Heparina/sangue , Lítio/sangue , Potássio/sangue , Testes Hematológicos , Período Intraoperatório , Manejo de Espécimes
11.
J Stroke Cerebrovasc Dis ; 28(7): 1951-1957, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31060790

RESUMO

OBJECTIVE: Cerebral vasospasm is associated with poor prognosis in patients with aneurysmal subarachnoid hemorrhage (SAH), and biomarkers for predicting poor prognosis have not yet been established. We attempted to clarify the relationship between serum glucose/potassium ratio and cerebral vasospasm in patients with aneurysmal SAH. METHODS: We studied 333 of 535 aneurysmal SAH patients treated between 2006 and 2016 (123 males, 210 females; mean age 59.7 years; range 24-93). We retrospectively analyzed the relationship between cerebral vasospasm grade and clinical risk factors, including serum glucose/potassium ratio. RESULTS: Postoperative angiography revealed cerebral vasospasm in 112 patients (33.6%). Significant correlations existed between the ischemic complication due to cerebral vasospasm and glucose/potassium ratio (P < .0001), glucose (P = .016), and potassium (P = .0017). Serum glucose/potassium ratio was elevated in the cerebral vasospasm grade dependent manner (Spearman's r = 0.1207, P = .0279). According to the Glasgow Outcome Scale (GOS) score at discharge, 185 patients (55.5%) had a poor outcome (GOS scores 1-3). Serum glucose/potassium ratio was significantly correlated between poor outcome (GOS scores 1-3) and age (P < .0001), serum glucose/potassium ratio (P < .0001), glucose (P < .0001), potassium (P = .0004), white blood cell count (P = .0012), and cerebral infarction due to cerebral vasospasm (P < .0001). Multivariate logistic regression analyzes showed significant correlations between cerebral infarction due to cerebral vasospasm and serum glucose/potassium ratio (P = .018), glucose (P = .027), and potassium (P = .052). CONCLUSIONS: Serum glucose/potassium ratio in cases of aneurysmal SAH was significantly associated with cerebral infarction due to cerebral vasospasm and GOS at discharge. Therefore, this factor was useful to predict prognosis in patients with cerebral vasospasm and aneurysmal SAH.


Assuntos
Glicemia/análise , Infarto Cerebral/etiologia , Potássio/sangue , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Angiografia Cerebral , Infarto Cerebral/sangue , Infarto Cerebral/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/diagnóstico , Vasoespasmo Intracraniano/sangue , Vasoespasmo Intracraniano/diagnóstico por imagem , Adulto Jovem
12.
Biomed Res Int ; 2019: 6025726, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30937312

RESUMO

Background: Hyperkalemia is a serious complication in cirrhotic patients. However, the clinical characteristics, risk factors, and its impact on the outcomes in acute-on-chronic liver failure (ACLF) patients remain unclear. Methods: We retrospectively recruited 650 ACLF patients in this study. The risk factors associated with hyperkalemia and its relationship with 90-day mortality were analyzed using multivariable regression models. Results: Among 650 patients with ACLF, 12.2% (79/650) had hyperkalemia during hospitalization. Higher admission serum potassium levels and the presence of acute kidney injury (AKI) were independent risk factors for hyperkalemia. The prevalence rates of hyperkalemia in patients with and without AKI were 23.6% and 4.6%, respectively (P<0.001). Hyperkalemia was a predictor of mortality in AKI and non-AKI patients. The 90-day mortality rates in non-AKI patients with and without hyperkalemia were 44.4% and 24.7%, respectively (P<0.001), and in AKI patients with and without hyperkalemia were 80.3% and 56.6%, respectively (P<0.001). Hepatic encephalopathy (HE), gastrointestinal bleeding, AKI, hyperkalemia, elevated total bilirubin (TBIL) and international normalized ratio (INR) values, and higher Model for End-Stage Liver Disease (MELD) and chronic liver failure-sequential organ failure assessment (CLIF-SOFA) scores were independent risk factors for predicting the 90-day mortality in ACLF patients. Conclusions: Hyperkalemia increases the 90-day mortality in ACLF patients; hyperkalemia is associated with AKI. Patients with both AKI and hyperkalemia had the worst outcome.


Assuntos
Insuficiência Hepática Crônica Agudizada/complicações , Hiperpotassemia/complicações , Lesão Renal Aguda/complicações , Insuficiência Hepática Crônica Agudizada/sangue , Insuficiência Hepática Crônica Agudizada/fisiopatologia , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Feminino , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/fisiopatologia , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Fatores de Risco , Sódio/sangue , Análise de Sobrevida
13.
PLoS One ; 14(3): e0213192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845156

RESUMO

Data on hyperkalemia frequency among chronic kidney disease (CKD) patients receiving renin-angiotensin aldosterone system inhibitors (RAASis) and its impact on subsequent RAASi treatment are limited. This population-based cohort study sought to assess the incidence of clinically significant hyperkalemia among adult CKD patients who were prescribed a RAASi and the proportion of patients with RAASi medication change after experiencing incident hyperkalemia. We conducted a retrospective, population-based cohort study (1 January 2013-30 June 2017) using Australian national general practice data from the NPS MedicineWise's MedicineInsight program. The study included adults aged ≥18 years who received ≥1 RAASi prescription during the study period and had CKD (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73m2). Study outcomes included incident clinically significant hyperkalemia (serum potassium >6 mmol/L or a record of hyperkalemia diagnosis) and among patients who experienced incident hyperkalemia, the proportion who had RAASi medication changes (cessation or dose reduction during the 210-day period after the incident hyperkalemia event). Among 20,184 CKD patients with a median follow-up of 3.9 years, 1,992 (9.9%) patients experienced an episode of hyperkalemia. The overall incidence rate was 3.1 (95% CI: 2.9-3.2) per 100 person-years. Rates progressively increased with worsening eGFR (e.g. 3.5-fold increase in patients with eGFR <15 vs. 45-59 ml/min/1.73m2). Among patients who experienced incident hyperkalemia, 46.6% had changes made to their RAASi treatment regimen following the first occurrence of hyperkalemia (discontinuation: 36.6% and dose reduction: 10.0%). In this analysis of adult RAASi users with CKD, hyperkalemia and subsequent RAASi treatment changes were common. Further assessment of strategies for hyperkalemia management and optimal RAASi use among people with CKD are warranted.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Hiperpotassemia/tratamento farmacológico , Insuficiência Renal Crônica/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Medicina Geral , Taxa de Filtração Glomerular , Humanos , Hiperpotassemia/complicações , Hiperpotassemia/diagnóstico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/complicações , Sistema Renina-Angiotensina , Estudos Retrospectivos , Adulto Jovem
14.
J Vet Intern Med ; 33(3): 1266-1271, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30865322

RESUMO

BACKGROUND: Lowering the dose of desoxycorticosterone pivalate (DOCP) for the treatment of dogs with primary hypoadrenocorticism (PH) decreases costs and could lead to increased owner motivation to treat their affected dogs. OBJECTIVE: To evaluate the efficacy of a low-dose DOCP treatment protocol in dogs with PH. ANIMALS: Prospective study, 17 client-owned dogs with naturally occurring PH (12 newly diagnosed, 5 previously treated with fludrocortisone acetate [FC]). METHODS: Dogs with newly diagnosed PH were started on 1.5 mg/kg DOCP SC; dogs previously treated with FC were started on 1.0-1.8 mg/kg DOCP SC. Reevaluations took place at regular intervals for a minimum of 3 months and included clinical examination and determination of serum sodium and potassium concentrations. The DOCP dosage was adjusted to obtain an injection interval of 28-30 days and to keep serum electrolyte concentrations within the reference interval. RESULTS: Median (range) follow-up was 16.2 months (4.5-32.3 months). The starting dosage was sufficient in all but 2 dogs and had to be significantly decreased after 2-3 months to a median dosage (range) of 1.1 mg/kg (0.7-1.8). Dogs 3 years of age or younger needed significantly higher dosages compared to older dogs. None of them, however, needed the 2.2 mg/kg DOCP dosage, recommended by the manufacturer. CONCLUSIONS AND CLINICAL IMPORTANCE: A starting dosage of 1.5 mg/kg DOCP is effective in controlling clinical signs and serum electrolyte concentrations in the majority of dogs with PH. An additional dose reduction often is needed to maintain an injection interval of 28-30 days. Young and growing animals seem to need higher dosages.


Assuntos
Doença de Addison/veterinária , Desoxicorticosterona/análogos & derivados , Doenças do Cão/tratamento farmacológico , Mineralocorticoides/administração & dosagem , Doença de Addison/tratamento farmacológico , Doença de Addison/economia , Fatores Etários , Animais , Desoxicorticosterona/administração & dosagem , Desoxicorticosterona/economia , Desoxicorticosterona/uso terapêutico , Doenças do Cão/economia , Cães , Feminino , Masculino , Mineralocorticoides/economia , Mineralocorticoides/uso terapêutico , Potássio/sangue , Estudos Prospectivos , Sódio/sangue
15.
Praxis (Bern 1994) ; 108(3): 207-213, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-30838955

RESUMO

CME: Evaluation of Hypokalemia Abstract. Hypokalemia is a common electrolyte abnormality in clinical practice. While often asymptomatic, it can be associated with severe adverse outcomes. The etiology is often obvious or can be established based on clinical history. In other cases, a systematic approach and knowledge of the physiologic and pathophysiologic key players are necessary. Pathophysiologically, inadequate intake, extra- to intracellular shift and potassium loss (renal, gastrointestinal, sweat) or a combination thereof can contribute to hypokalemia. In this article we discuss the differential diagnosis and the diagnostic approach to this common electrolyte abnormality.


Assuntos
Hipopotassemia , Diagnóstico Diferencial , Humanos , Hipopotassemia/diagnóstico , Hipopotassemia/etiologia , Rim/fisiopatologia , Potássio/sangue
16.
Cell Stress Chaperones ; 24(2): 409-418, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30838506

RESUMO

The genetic mechanisms underlying the cattle resilience to severe cold temperatures are still unknown. In this study, we observed that four blood biochemical parameters were significantly altered, i.e., blood adrenocorticotropic hormone (ACTH), triiodothyronine (T3), thyroxine (T4), and potassium (K+) after expose to - 32 °C for 3 h. This was observed using 105 healthy Sanhe heifers with similar weight (398.17 ± 34.06 kg) and age (19.30 ± 4.91 months). A total of 20 single nucleotide polymorphisms (SNPs) were identified in 5'-flanking region of the hsp70 gene in Sanhe cattle, while only 10 SNPs were segregating when comparing genetic variations between Sanhe cattle and 285 Chinese Holstein samples. Statistically significant associations between the genomic markers SNP-42-, SNP-105+, SNP-181+, and SNP-205+ with blood T3 and between SNP-105+ and blood T4 were observed by applying the general linear model procedure and Bonferroni t test. Furthermore, we demonstrated that the T alleles of SNP-42- and SNP-205+ in the GC box and Kozak sequence of the hsp70 gene, respectively, significantly decreased the green fluorescent proteins activity in vitro GFP reporter assays. These findings suggest that these two SNPs are causative polymorphisms involved in the regulation of hsp70 promoter activity and might contribute to the observed association between the hsp70 gene and T3 and T4 levels in Sanhe cattle. Thus, hsp70 gene is a promising candidate gene to be validated in independent cattle populations and functional studies related to cold stress resilience in cattle.


Assuntos
Bovinos/genética , Resposta ao Choque Frio/genética , Proteínas de Choque Térmico HSP70/genética , Hormônio Adrenocorticotrópico/sangue , Animais , Biomarcadores/sangue , Bovinos/fisiologia , China , Polimorfismo de Nucleotídeo Único , Potássio/sangue , Regiões Promotoras Genéticas , Tiroxina/sangue , Tri-Iodotironina/sangue
17.
Anaesth Intensive Care ; 47(1): 52-59, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30864476

RESUMO

Electrical cardioversion (ECV) is a potentially life-saving treatment for haemodynamically unstable new-onset atrial fibrillation (AF); however, its efficacy is unsatisfactory. We aimed to elucidate the factors associated with successful ECV and prognosis in patients with AF. This retrospective observational study was conducted in two mixed intensive care units (ICUs) in a university hospital. Patients with new-onset AF who received ECV in the ICU were enrolled. We defined an ECV session as consecutive shocks within 15 minutes. The success of ECV was evaluated five minutes after the session. We analysed the factors associated with successful ECV and ICU mortality. Eighty-five AF patients who received ECV were included. ECV was successful in 41 (48%) patients, and 11 patients (13%) maintained sinus rhythm until ICU discharge. A serum potassium level ≥3.8 mol/L was independently associated with successful ECV in multivariate analysis (odds ratio (OR), 3.13; 95% confidence interval (CI), 1.07-9.11; p = 0.04). Maintenance of sinus rhythm until ICU discharge was significantly associated with ICU survival (OR 9.35; 95% CI 1.02-85.78, p = 0.048). ECV was successful in 48% of patients with new-onset AF developed in the ICU. A serum potassium level ≥3.8 mol/L was independently associated with successful ECV, and sinus rhythm maintained until ICU discharge was independently associated with ICU survival. These results suggested that maintaining a high serum potassium level may be important when considering the effectiveness of ECV for AF in the ICU.


Assuntos
Fibrilação Atrial , Cardioversão Elétrica , Potássio , Fibrilação Atrial/terapia , Humanos , Unidades de Terapia Intensiva , Potássio/sangue , Estudos Retrospectivos , Resultado do Tratamento
18.
J Biol Regul Homeost Agents ; 33(2): 477-483, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30919610

RESUMO

Vitamin and mineral disturbances may interfere with glucose metabolism. Elderly persons with diabetes type 2 (T2DM) are more prone to mineral disturbances and vitamin deficiencies. The aim of this study was to analyze concentrations of vitamins B12 and D and macro- and microelements among diabetic elderly patients. The study enrolled 347 patients with T2DM of whom 247 were elderly (median 76 years of age) (SenDM group) and 100 younger T2DM (median 59 years of age) (Y-DM group), and 320 patients aged 65 years and above without T2DM (mean 77 years of age) - Sen-nonDM - as a control group. Patient clinical and biochemical characteristics were recorded (drugs taken and glucose concentration, glycated hemoglobin level, complete blood count, concentration of Na, K, Ca, Fe and serum vitamins D and B12 levels). All elderly patients had insufficient/deficient vitamin D concentration. Vitamin B12 levels were below the reference limit for 15.6% of the SenDM group. No significant differences in Na, K, were observed among the investigated groups. 30.7% of the SenDM were Fe-deficient. In the SenDM group, vitamin B12-deficient patients did not develop macrocytic anaemia while Fe-deficient patients with T2DM tended to develop microcytic anaemia. The prevalence of vitamin deficiencies in elderly patients with T2DM is clinically relevant. Elderly patients with T2DM are clinically predisposed to Fe deficiencies. We suggest to monitor vitamin B12 and Fe concentration toward developing a full clinical picture as it may accelerate the treatment options and improve elderly patients' outcome.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Deficiência de Vitamina B 12/complicações , Vitamina B 12/sangue , Vitamina D/sangue , Idoso , Anemia Macrocítica/complicações , Cálcio/sangue , Humanos , Ferro/sangue , Pessoa de Meia-Idade , Potássio/sangue , Sódio/sangue , Vitaminas
19.
Niger J Clin Pract ; 22(2): 186-193, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30729941

RESUMO

Background: Alteration in the homeostasis of trace elements such as magnesium may play a role in the development of epileptic seizures. This study aims to investigate the levels of serum magnesium in people with idiopathic generalized epileptic (IGE) seizures and symptomatic seizures in Northeast Nigeria. Materials and Methods: Serum magnesium level was measured using atomic absorption spectrometry among 40 adults with IGE, 20 adults with symptomatic epileptic seizures, and 30 healthy controls. Serum calcium, potassium, phosphate, and albumin were also measured. Results: The mean serum magnesium level was significantly lower among people with epilepsy compared with the controls [0.79 ± 0.18 mmol/L vs 0.90 mmol/L ± 0.17, P = 0.007, 95% confidence interval (CI): (-0.189 to -0.031)]. People with IGE had significantly lower levels of magnesium compared with those with symptomatic seizures [0.74 ± 0.17 mmol/L vs 0.9 ± 0.16 mmol/L, P < 0.001 95% CI: (-0.251 to -0.069)]. The mean magnesium level for all groups was in the reference range, but the lowest levels were observed in those with IGE. There is no significant correlation between the level of serum magnesium and the severity of seizure attacks. There was significantly lower level of calcium in people with IGE compared with those with symptomatic seizures [2.3 ± 0.13 mmol/L vs 2.4 ± 0.16 mmol/L, P = 0.012, 95% CI: (-0.177 to 0.023)] or controls [2.3 ± 0.13 mmol/L vs 2.4 ± 0.12 mmol/L, P < 0.01, 95% CI: (-0.156 to -0.044)]. No significant differences were observed in the levels of potassium, phosphate, and albumin. Conclusion: This study suggests that low serum magnesium and calcium may play a role in IGE, and supplementation may be useful in reducing seizures in Black patients with epilepsy.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Magnésio/sangue , Convulsões/tratamento farmacológico , Adolescente , Adulto , Albuminas/metabolismo , Cálcio/sangue , Estudos Transversais , Epilepsia/sangue , Epilepsia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Fosfatos/sangue , Potássio/sangue , Convulsões/sangue , Convulsões/epidemiologia , Espectrofotometria Atômica , Adulto Jovem
20.
Mayo Clin Proc ; 94(2): 347-355, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30711130

RESUMO

Abdominal wall pain (AWP) is a common and underrecognized cause of chronic abdominal pain. The etiology of AWP varies. History and physical examination are critical to an accurate diagnosis of AWP. Trigger point injection using either a corticosteroid, a local anesthetic, or a combination of both often gives relief of pain and is of diagnostic and therapeutic value. Increased awareness of AWP as a cause of chronic, nonvisceral abdominal pain can prevent fruitless searches for intra-abdominal pathology and reduce medical costs.


Assuntos
Dor Abdominal/etiologia , Hiperpotassemia/complicações , Insuficiência Renal Crônica/complicações , Dor Abdominal/sangue , Dor Abdominal/diagnóstico , Parede Abdominal , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Gluconato de Cálcio/administração & dosagem , Diagnóstico Diferencial , Diuréticos/administração & dosagem , Furosemida/administração & dosagem , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/terapia , Infusões Intravenosas , Lisinopril/uso terapêutico , Masculino , Potássio/sangue , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/terapia
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