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1.
Nutrients ; 13(5)2021 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-33946894

RESUMO

Increased marinobufagenin (MBG) synthesis has been suggested in response to high dietary salt intake. The aim of this study was to determine the effects of short-term changes in sodium intake on plasma MBG levels in patients with primary salt-sensitive and salt-insensitive hypertension. In total, 51 patients with primary hypertension were evaluated during acute sodium restriction and sodium loading. Plasma or serum concentrations of MBG, natriuretic pro-peptides, aldosterone, sodium, potassium, as well as hematocrit (Hct) value, plasma renin activity (PRA) and urinary sodium and potassium excretion were measured. Ambulatory blood pressure monitoring (ABPM) and echocardiography were performed at baseline. In salt-sensitive patients with primary hypertension plasma MBG correlated positively with diastolic blood pressure (ABPM) and serum NT-proANP concentration at baseline and with serum NT-proANP concentration after dietary sodium restriction. In this subgroup plasma MBG concentration decreased during sodium restriction, and a parallel increase of PRA was observed. Acute salt loading further decreased plasma MBG concentration in salt-sensitive subjects in contrast to salt insensitive patients. No correlation was found between plasma MBG concentration and left ventricular mass index. In conclusion, in salt-sensitive hypertensive patients plasma MBG concentration correlates with 24-h diastolic blood pressure and dietary sodium restriction reduces plasma MBG levels. Decreased MBG secretion in response to acute salt loading may play an important role in the pathogenesis of salt sensitivity.


Assuntos
Bufanolídeos/sangue , Hipertensão/induzido quimicamente , Sódio na Dieta/administração & dosagem , Adulto , Aldosterona/sangue , Fator Natriurético Atrial/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Renina/sangue , Sódio/sangue
2.
Eur J Endocrinol ; 185(1): 137-144, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-33950864

RESUMO

Objective: Hyponatremia is the most common electrolyte disorder in hospitalized patients and occurs in about 30% of patients with pneumonia. Hyponatremia has been associated with a worse outcome in several pathologic conditions The main objective of this study was to determine whether serum sodium alterations may be independent predictors of the outcome of hospitalized COVID-19 patients. Design and methods: In this observational study, data from 441 laboratory-confirmed COVID-19 patients admitted to a University Hospital were collected. After excluding 61 patients (no serum sodium at admission available, saline solution infusion before sodium assessment, transfer from another hospital), data from 380 patients were analyzed. Results: 274 (72.1%) patients had normonatremia at admission, 87 (22.9%) patients had hyponatremia and 19 (5%) patients had hypernatremia. We found an inverse correlation between serum sodium and IL-6, whereas a direct correlation between serum sodium and PaO2/FiO2 ratio was observed. Patients with hyponatremia had a higher prevalence of non-invasive ventilation and ICU transfer than those with normonatremia or hypernatremia. Hyponatremia was an independent predictor of in-hospital mortality (2.7-fold increase vs normonatremia) and each mEq/L of serum sodium reduction was associated with a 14.4% increased risk of death. Conclusions: These results suggest that serum sodium at admission may be considered as an early prognostic marker of disease severity in hospitalized COVID-19 patients.


Assuntos
/sangue , Índice de Gravidade de Doença , Sódio/sangue , Idoso , Idoso de 80 Anos ou mais , /mortalidade , Comorbidade , Cuidados Críticos/estatística & dados numéricos , Feminino , Fluorcarbonetos/sangue , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Hidrocarbonetos Bromados/sangue , Hipernatremia/epidemiologia , Hiponatremia/epidemiologia , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Vírus da SARS
3.
Nutrients ; 13(5)2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33925724

RESUMO

Arachidonic acid (ARA; 20:4n6) and docosahexaenoic acid (DHA; 22:6n3) are polyunsaturated fatty acids (FA) naturally present in breast milk and added to most North American infant formulas (IF). We investigated the safety and efficacy of novel sodium and potassium salts of arachidonic acid as bioequivalent to support tissue levels of ARA comparable to the parent oil; M. alpina oil (Na-ARA and K-ARA) and including a Na-DHA group. Pigs of both sexes were randomized to one of five dietary treatments (n = 16 per treatment; 8 male and 8 female) from postnatal day 2 to 23. ARA and DHA were included as either triglyceride (TG) or salt. Target dietary ARA/DHA concentrations as percent of total FA by weight were as follows: TT (0.47 TG/0.32 TG), NaT (0.47 Na-salt/0.32 TG), KT (0.47 K-salt/0.32 TG), and Na0 (0.47 Na-salt/0.00), NaNa (0.47 Na-salt/0.32 Na-salt). The primary outcome in this study was bioequivalence of ARA brain accretion. Growth performance; blood and tissue fatty acid levels; liver histology; complete blood cell counts; and serum chemistries were all evaluated. Overall, diets containing test sources of ARA and DHA did not affect growth performance; liver histology; or substantially influence hematological outcomes as compared with TT. The results confirm that the use of Na and K salt forms of ARA yield bioequivalent ARA accretion in the cerebral cortex and retinal tissue compared to TG-ARA. These findings confirm that use of Na-ARA and K-ARA salts in the young pig was safe and nutritionally bioequivalent to TG-ARA for critical neural tissues.


Assuntos
Ácido Araquidônico/administração & dosagem , Ácido Araquidônico/sangue , Dieta/métodos , Potássio/administração & dosagem , Sódio/administração & dosagem , Animais , Feminino , Masculino , Modelos Animais , Potássio/sangue , Sais/administração & dosagem , Sais/sangue , Sódio/sangue , Suínos
4.
Pan Afr Med J ; 38: 66, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889232

RESUMO

Introduction: tuberculosis (TB) remains a global health issue with high morbidity and mortality rates especially in the developing countries. It is a multi-organ disease and can influence biochemical changes. This study sought to determine the influence of tuberculosis and its drug treatment on serum biochemical parameters in patients in Nigeria. Methods: it was a descriptive observational cohort study on 150 subjects whose blood samples were analyzed for serum albumin, serum sodium, and serum potassium. The subjects were grouped into 3: TB group= 50 new TB subjects not on treatment, F group= 50 TB subjects on treatment for 2/12 or more and C group= 50 non-TB control subjects. These biochemical variables were compared between the 3 groups. Results: male/female ratio was 1: 1.5, mean age 37.1±0.92 years, and range 18-65 years. The differences in mean values of serum albumin, calcium and sodium between the three groups were significant (p<0.001), whereas that of serum potassium was not significant (p=0.056). Those patients with new case TB had a significantly lower serum sodium, serum albumin and serum calcium than the control group and those on treatment, p<0.001. There was significant positive correlation between serum albumin and serum calcium (r=0.0.420, p<0.001) as well as serum sodium (r=0.310, p<0.001) in the study population. Similarly, the correlation between serum calcium and serum sodium was positive and significant (r=0.200, p=0.014). In contrast, the correlation between serum potassium and serum albumin and that between serum potassium and serum calcium was not significant. Conclusion: tuberculosis with or without anti-tuberculous medications was associated with significant reduction in serum albumin, serum sodium and serum calcium in this study.


Assuntos
Cálcio/sangue , Albumina Sérica/análise , Sódio/sangue , Tuberculose/sangue , Adolescente , Adulto , Idoso , Antituberculosos/administração & dosagem , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Potássio/sangue , Tuberculose/tratamento farmacológico , Adulto Jovem
5.
J Investig Med High Impact Case Rep ; 9: 2324709621999954, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33686899

RESUMO

Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (COVID-19), which has become a global pandemic. Apart from the mild features of the disease, long-term complications involve many systems including both endocrine and cardiovascular systems. Myocarditis, secondary to COVID-19, has become a well-known complication of the disease. However, endocrine complications are generally not common, particularly isolated pituitary abnormalities. There is one other report of diabetes insipidus developing as a late sequela of COVID-19. In this article, we report a case of a young male who presented with features of myocarditis but developed diabetes insipidus on day 7 of admission as a long-term complication after recovery from COVID-19 infection. His laboratory test results at the time of developing the complication revealed a high serum sodium level and low urine osmolality. The patient recovered on administration of desmopressin and was discharged after 16 days of hospitalization.


Assuntos
/complicações , Diabetes Insípido/etiologia , Miocardite/virologia , Adulto , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Concentração Osmolar , Sódio/sangue , Tomografia Computadorizada por Raios X , Urina/química
6.
Am J Case Rep ; 22: e930135, 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33760803

RESUMO

BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic of 2020, varied presentations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported. The present report is of a case of hyponatremia and encephalopathy due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) as the main presentation of SARS-CoV-2 infection in a 55-year-old woman. CASE REPORT A 55-year-old woman with type II diabetes mellitus presented with confusion and slurring of speech, with a temperature of 38.5°C, heart rate of 120 bpm, blood pressure of 159/81 mmHg, and oxygen saturation of 98% on room air. She did not have edema on examination. Laboratory testing showed a low sodium level of 116 mEq/L (reference range, 135-145 mEq/L) with urine osmolarity of 364 mOsm/kg, urinary sodium of 69 mEq/L, urinary potassium of 15.6 mEq/L, and serum osmolarity of 251 mOsm/kg. The patient had normal serum thyroid-stimulating hormone and cortisol levels. A chest X-ray should no pulmonary infiltrates nor did a lumbar puncture reveal signs of infection. A real-time SARS-CoV-2 polymerase chain reaction assay was positive for COVID-19. Brain imaging with computed tomography was negative for acute infarct, intracranial hemorrhage, and mass effect. Based on findings from laboratory testing and physical examination, a diagnosis of SIADH was made. The patient was treated with 3% hypertonic saline, followed by salt tablets and fluid restriction, with improvement in her clinical symptoms and serum sodium level. CONCLUSIONS The present report is of a rare but previously reported association with SARS-CoV-2 infection. Encephalopathy and hyponatremia associated with SIADH without pneumonia or other symptoms of infection should be an indication for testing for SARS-CoV-2 infection.


Assuntos
Encefalopatias/virologia , Hiponatremia/virologia , Síndrome de Secreção Inadequada de HAD/virologia , /diagnóstico , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Solução Salina Hipertônica/uso terapêutico , Sódio/sangue , Cloreto de Sódio/uso terapêutico
7.
J Int Soc Sports Nutr ; 18(1): 22, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33722257

RESUMO

BACKGROUND: Muscle cramp is a painful, involuntary muscle contraction, and that occurs during or following exercise is referred to as exercise-associated muscle cramp (EAMC). The causes of EAMC are likely to be multifactorial, but dehydration and electrolytes deficits are considered to be factors. This study tested the hypothesis that post-exercise muscle cramp susceptibility would be increased with spring water ingestion, but reduced with oral rehydration solution (ORS) ingestion during exercise. METHODS: Ten men performed downhill running (DHR) in the heat (35-36 °C) for 40-60 min to reduce 1.5-2% of their body mass in two conditions (spring water vs ORS) in a cross-over design. The body mass was measured at 20 min and every 10 min thereafter during DHR, and 30 min post-DHR. The participants ingested either spring water or ORS for the body mass loss in each period. The two conditions were counter-balanced among the participants and separated by a week. Calf muscle cramp susceptibility was assessed by a threshold frequency (TF) of an electrical train stimulation to induce cramp before, immediately after, 30 and 65 min post-DHR. Blood samples were taken before, immediately after and 65 min after DHR to measure serum sodium, potassium, magnesium and chroride concentrations, hematocrit (Hct), hemoglobin (Hb), and serum osmolarity. Changes in these varaibles over time were compared between conditions by two-way repeated measures of analysis of variance. RESULTS: The average (±SD) baseline TF (25.6 ± 0.7 Hz) was the same between conditions. TF decreased 3.8 ± 2.7 to 4.5 ± 1.7 Hz from the baseline value immediately to 65 min post-DHR for the spring water condition, but increased 6.5 ± 4.9 to 13.6 ± 6.0 Hz in the same time period for the ORS condition (P < 0.05). Hct and Hb did not change significantly (P > 0.05) for both conditions, but osmolarity decreased (P < 0.05) only for the spring water condition. Serum sodium and chloride concentrations decreased (< 2%) at immediately post-DHR for the spring water condition only (P < 0.05). CONCLUSIONS: These results suggest that ORS intake during exercise decreased muscle cramp susceptibility. It was concluded that ingesting ORS appeared to be effective for preventing EAMC.


Assuntos
Água Potável , Exercício Físico/fisiologia , Temperatura Alta , Águas Minerais/efeitos adversos , Cãibra Muscular/etiologia , Soluções para Reidratação/administração & dosagem , Adulto , Índice de Massa Corporal , Cloretos/sangue , Estudos Cross-Over , Suscetibilidade a Doenças , Ingestão de Líquidos , Hematócrito , Hemoglobina A/análise , Humanos , Magnésio/sangue , Masculino , Águas Minerais/administração & dosagem , Cãibra Muscular/sangue , Cãibra Muscular/prevenção & controle , Concentração Osmolar , Potássio/sangue , Corrida/fisiologia , Sódio/sangue , Fatores de Tempo , Adulto Jovem
8.
Int J Palliat Nurs ; 27(1): 46-52, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33629907

RESUMO

BACKGROUND: Dyselectrolytaemia and dehydration are common symptoms in people with terminal stomach cancer. AIMS: To determine factors related to dyselectrolytemia and dehydration in patients with terminal stomach cancer. METHODS: An analysis of 134 patients with terminal stomach cancer admitted to the palliative care unit was conducted, through an audit of the patients' medical records. The average age of women was 63.1 years and that of men was 64.9 years. FINDINGS: Dehydrated patients were more likely to: have dyselectrolytaemia; have a higher PS scale score; be taking opioids as an analgesic; have a high sodium concentration; experience dyspnoea, constipation, nausea and vomiting during hospitalisation; and require glucocorticoids administration both during and before hospitalisation. Patients with dyselectrolytaemia were more likely to: be admitted to the palliative care unit from the emergency department; experience cachexia and dehydration during hospitalisation and constipation at discharge; have a lower albumin level; and have a higher glucose level. Patients with dyselectrolytaemia also had a shorter duration of treatment and a 2.48 greater chance for death compared with those who did not have it. CONCLUSIONS: Knowledge of the adverse factors connected with dehydration and dyselectrolytaemia will allow health professionals to avoid dangerous clinical symptoms and prolong the life of those with terminal stomach cancer, as they might be able to foresee the occurrence of these conditions based on the medication the patient has been taking and symptoms they have been experiencing. Nurses will have a greater understanding of the importance of fluid therapy to resolve ionic disturbances and the need to address dehydration and dyselectrolytemia as a means to prolong and improve quality of life.


Assuntos
Desidratação/complicações , Neoplasias Gástricas/complicações , Doente Terminal , Desequilíbrio Hidroeletrolítico/complicações , Analgésicos Opioides/uso terapêutico , Glicemia/análise , Caquexia/complicações , Constipação Intestinal/complicações , Desidratação/etiologia , Delusões/complicações , Uso de Medicamentos , Dispneia/complicações , Feminino , Glucocorticoides/uso terapêutico , Alucinações/complicações , Hemoglobinas/análise , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/complicações , Prognóstico , Estudos Retrospectivos , Albumina Sérica/análise , Sódio/sangue , Neoplasias Gástricas/mortalidade , Vômito/complicações , Desequilíbrio Hidroeletrolítico/etiologia
9.
Eur J Endocrinol ; 184(5): 647-655, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33635825

RESUMO

Objective: Treatment of symptomatic hyponatremia is not well established. The European guidelines recommend bolus-wise administration of 150 mL of 3% hypertonic saline. This recommendation is, however, based on low level of evidence. Design: Observational study. Methods: Sixty-two consecutive hyponatremic patients admitted to the emergency department or intensive care unit of the University Hospital Wuerzburg were divided in subgroups according to treatment (150 mL bolus of 3% hypertonic saline or conventional treatment) and symptom severity. Treatment target was defined as an increase in serum sodium by 5-10 mEq/L within first 24 h and maximum 8 mEq/L during subsequent 24 h. Results: Thirty-three out of sixty-two patients (53%) were presented with moderate symptoms and 29/62 (47%) with severe symptoms. Thirty-six were treated with hypertonic saline and 26 conventionally. In the hypertonic saline group, serum sodium increased from 116 ± 7 to 123 ± 6 (24 h) and 127 ± 6 mEq/L (48 h) and from 121 ± 6 to 126 ± 5 and 129 ± 4 mEq/L in the conventional group, respectively. Overcorrection at 24 h occurred more frequent in patients with severe symptoms than with moderate symptoms (38% vs 6%, P < 0.05). Diuresis correlated positively with the degree of sodium overcorrection at 24 h (r = 0.6, P < 0.01). Conventional therapies exposed patients to higher degrees of sodium fluctuations and an increased risk for insufficient sodium correction at 24 h compared to hypertonic saline (RR: 2.8, 95% CI: 1.4-5.5). Conclusion: Sodium increase was more constant with hypertonic saline, but overcorrection rate was high, especially in severely symptomatic patients. Reducing bolus-volume and reevaluation before repeating bolus infusion might prevent overcorrection. Symptoms caused by hypovolemia can be misinterpreted as severely symptomatic hyponatremia and diuresis should be monitored.


Assuntos
Hiponatremia/tratamento farmacológico , Solução Salina Hipertônica/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos/métodos , Feminino , Hidratação/métodos , Humanos , Hiponatremia/sangue , Hiponatremia/patologia , Síndrome de Secreção Inadequada de HAD/sangue , Síndrome de Secreção Inadequada de HAD/tratamento farmacológico , Síndrome de Secreção Inadequada de HAD/patologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Sódio/sangue , Resultado do Tratamento , Adulto Jovem
10.
J Clin Endocrinol Metab ; 106(6): 1637-1648, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33624101

RESUMO

CONTEXT: Dysnatremia is an independent predictor of mortality in patients with bacterial pneumonia. There is paucity of data about the incidence and prognostic impact of abnormal sodium concentration in patients with coronavirus disease 2019 (COVID-19). OBJECTIVE: This work aimed to examine the association of serum sodium during hospitalization with key clinical outcomes, including mortality, need for advanced respiratory support and acute kidney injury (AKI), and to explore the role of serum sodium as a marker of inflammatory response in COVID-19. METHODS: This retrospective longitudinal cohort study, including all adult patients who presented with COVID-19 to 2 hospitals in London over an 8-week period, evaluated the association of dysnatremia (serum sodium < 135 or > 145 mmol/L, hyponatremia, and hypernatremia, respectively) at several time points with inpatient mortality, need for advanced ventilatory support, and AKI. RESULTS: The study included 488 patients (median age, 68 years). At presentation, 24.6% of patients were hyponatremic, mainly due to hypovolemia, and 5.3% hypernatremic. Hypernatremia 2 days after admission and exposure to hypernatremia at any time point during hospitalization were associated with a 2.34-fold (95% CI, 1.08-5.05; P = .0014) and 3.05-fold (95% CI, 1.69-5.49; P < .0001) increased risk of death, respectively, compared to normonatremia. Hyponatremia at admission was linked with a 2.18-fold increase in the likelihood of needing ventilatory support (95% CI, 1.34-3.45, P = .0011). Hyponatremia was not a risk factor for in-hospital mortality, except for the subgroup of patients with hypovolemic hyponatremia. Sodium values were not associated with the risk for AKI and length of hospital stay. CONCLUSION: Abnormal sodium levels during hospitalization are risk factors for poor prognosis, with hypernatremia and hyponatremia being associated with a greater risk of death and respiratory failure, respectively. Serum sodium values could be used for risk stratification in patients with COVID-19.


Assuntos
/epidemiologia , Sódio/sangue , Lesão Pulmonar Aguda/epidemiologia , Lesão Pulmonar Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Hipernatremia/etiologia , Hipernatremia/mortalidade , Hiponatremia/etiologia , Hiponatremia/mortalidade , Incidência , Tempo de Internação , Londres/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Respiração Artificial , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/etiologia
11.
PLoS One ; 16(1): e0245499, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33449937

RESUMO

BACKGROUND: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is one of the most common causes of hypotonic hyponatremia. In our previous work, we have derived a novel model (Voets equation) that can be used by clinicians to predict the effect of crystalloid intravenous fluid therapy on the plasma sodium concentration in SIADH. METHODS: In this retrospective chart review, the predictive accuracy of the Voets equation and the Adrogue-Madias equation for the plasma sodium response to crystalloid infusate was compared for fifteen plasma sodium response measurements (n = 15) in twelve SIADH patients. The medical records of these patients were accessed anonymously and none of the authors were their treating physicians. The Pearson correlation coefficient r and corresponding p-value were calculated for the predictions by the Voets model compared to the measured plasma sodium response and for the predictions by the Adrogue-Madias model compared to the measured plasma sodium response. RESULTS AND CONCLUSION: The presented results show that the Voets model (r = 0.94, p < 0.001) predicted the aforementioned plasma sodium response significantly more accurately than the Adrogue-Madias model (r = 0.49, p = 0.07) in SIADH patients and could therefore be a clinically useful addition to the existing prediction models.


Assuntos
Bioestatística/métodos , Hidratação , Síndrome de Secreção Inadequada de HAD/sangue , Síndrome de Secreção Inadequada de HAD/terapia , Sódio/sangue , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Retrospectivos
12.
BMC Surg ; 21(1): 62, 2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33499844

RESUMO

BACKGROUND: In hospitalized patients, abnormal plasma electrolyte concentrations are frequent and have been linked to poor outcomes following acute surgery. The aim of this study was to assess whether preoperative plasma levels of potassium, sodium, and creatinine at the time of admission were associated with 30-day mortality in patients following open abdominal surgery. METHODS: This was a single-center register-based retrospective study. By means of electronic search in a maintained surgery database, all patients (n = 4177) aged ≥ 60 years old undergoing open surgery in our department from January 2000 to May 2013 were identified. Plasma was assessed within 30 days prior to surgery. The primary endpoint was 30-day postoperative mortality. The association between mortality and plasma levels of potassium, sodium, and creatinine were examined using Cox proportional hazard models. RESULTS: A total of 3690 patients were included in the study cohort. The rates of abnormal preoperative plasma levels were 36, 41, and 38% for potassium, sodium, and creatinine, respectively. The overall 30 day mortality was 20%. A predictive algorithm for 30 day mortality following abdominal surgery was constructed by means of logistic regression showing excellent distinction between patients with and without a fatal postoperative outcome. CONCLUSION: Apart from demographic factors (age, sex, and emergency surgery), preoperative imbalance in potassium, sodium and creatinine levels were significant independent predictors of early mortality following open abdominal surgery.


Assuntos
Abdome , Creatinina , Potássio , Sódio , Procedimentos Cirúrgicos Operatórios , Abdome/cirurgia , Estudos de Coortes , Creatinina/sangue , Humanos , Potássio/sangue , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Risco , Sódio/sangue , Procedimentos Cirúrgicos Operatórios/mortalidade , Resultado do Tratamento
13.
Eur J Endocrinol ; 184(1): 9-17, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33112271

RESUMO

Objective: Severe hyponatraemia (plasma sodium concentration, pNa <120 mmol/L) is reported to be associated with mortality rates as high as 50%. Although there are several international guidelines for the management of severe hyponatraemia, there are few data on the impact of treatment. Design and methods: We have longitudinally reviewed rates of specialist input, active management of hyponatraemia, treatment outcomes and mortality rates in patients with severe hyponatraemia (pNa <120 mmol/L) in 2005, 2010 and 2015, and compared the recent mortality rate with that of patients with pNa 120-125 mmol/L. Results: Between 2005 and 2010 there was a doubling in the rate of specialist referral (32 to 68%, P = 0.003) and an increase in the use of active management of hyponatraemia in patients with pNa <120 mmol/L (63 to 88%, P = 0.02), associated with a reduction in mortality from 51 to 15% (P < 0.001). The improved rates of intervention were maintained between 2010 and 2015, but there was no further reduction in mortality. When data from all three reviews were pooled, specialist consultation in patients with pNa <120 mmol/L was associated with a 91% reduction in mortality risk, RR 0.09 (95% CI: 0.03-0.26), P < 0.001. Log-rank testing on in-hospital survival in 2015 found no significant difference between patients with pNa <120 mmol/L and pNa 120-125 mmol/L (P = 0.56). Conclusion: Dedicated specialist input and active management of severe hyponatraemia are associated with a reduction in mortality, to rates comparable with moderate hyponatraemia.


Assuntos
Gerenciamento Clínico , Hiponatremia/mortalidade , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Especialização/estatística & dados numéricos , Idoso , Feminino , Humanos , Hiponatremia/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Sódio/sangue , Resultado do Tratamento
14.
Anim Sci J ; 91(1): e13494, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33368854

RESUMO

Assessing the resilience of Awassi sheep to water shortages during pregnancy, thereby investigating the effects of water scarcity on gestation efficiency in animals, could provide valuable and pertinent insight into future scenarios posed by climate change risks. In this study, 40 pregnant Awassi ewes randomly allocated to free watering group (C, n = 20) received water ad libitum and the water restricted group (WR) received 50% less water than the amount provided to group C. Water restriction decreased (p < .05) lambs' birth weights, placental weights (PWs), and cotyledon numbers (CNs). Placental efficiency (PE) and cotyledon efficiency (CE) were significantly higher in the WR group (p < .05). A marked difference in cotyledon weight - an increase of 12.1% - was recorded in the C group. The body weights of the pregnant ewes in the WR group decreased significantly (p < .05) by 22% during pregnancy. Significant increases (p < .05) in plasma ADH, cholesterol, Cl- , and Na+ levels were observed in the WR group ewes, indicating intense dehydration. We conclude that the Awassi breed of sheep can endure 50% water restriction during pregnancy and maintain successful parturition, a key outcome for sustainability.


Assuntos
Secas , Placenta/fisiologia , Prenhez/metabolismo , Prenhez/fisiologia , Ovinos/metabolismo , Ovinos/fisiologia , Privação de Água/fisiologia , Animais , Peso ao Nascer/fisiologia , Cloro/sangue , Colesterol/sangue , Mudança Climática , Feminino , Tamanho do Órgão , Placenta/anatomia & histologia , Gravidez , Sódio/sangue , Vasopressinas/sangue
15.
Int J Mol Sci ; 21(24)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33322108

RESUMO

Sodium is an essential mineral and nutrient used in dietary practices across the world and is important to maintain proper blood volume and blood pressure. A high sodium diet is associated with increased expression of ß-myosin heavy chain, decreased expression of α/ß-myosin heavy chain, increased myocyte enhancer factor 2/nuclear factor of activated T cell transcriptional activity, and increased salt-inducible kinase 1 expression, which leads to alteration in myocardial mechanical performance. A high sodium diet is also associated with alterations in various proteins responsible for calcium homeostasis and myocardial contractility. Excessive sodium intake is associated with the development of a variety of comorbidities including hypertension, chronic kidney disease, stroke, and cardiovascular diseases. While the American College of Cardiology/American Heart Association/Heart Failure Society of America guidelines recommend limiting sodium intake to both prevent and manage heart failure, the evidence behind such recommendations is unclear. Our review article highlights evidence and underlying mechanisms favoring and contradicting limiting sodium intake in heart failure.


Assuntos
Insuficiência Cardíaca/epidemiologia , Hipertensão/epidemiologia , Cloreto de Sódio na Dieta/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Dieta Hipossódica , Medicina Baseada em Evidências , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão/fisiopatologia , Política Nutricional , Sódio/efeitos adversos , Sódio/sangue , Sódio/metabolismo , Cloreto de Sódio na Dieta/sangue , Cloreto de Sódio na Dieta/metabolismo , Estados Unidos
16.
Cerebrovasc Dis ; 49(5): 531-539, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017822

RESUMO

OBJECTIVE: Hyponatremia is a common electrolyte disorder in patients with stroke, which leads to various fatal complications. We performed a systematic review and meta-analysis to investigate the outcomes of acute stroke patients with hyponatremia. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Library databases for relevant literature in English published up to March 2020. Two review authors independently screened and selected the studies by assessing the eligibility and validity based on the inclusion criteria. Mortality at 90 days was set as the primary end point, and in-hospital mortality and length of hospital stay were set as the secondary end points. We conducted the data synthesis and analyzed the outcomes by calculating the odds ratio (OR) and mean difference. RESULTS: Of 835 studies, 15 studies met the inclusion criteria (n = 10,745). The prevalence rate of stroke patients with hyponatremia was 7.0-59.2%. They had significantly higher 90-day mortality (OR, 1.73; 95% confidence interval (CI), 1.24-2.42) and longer length of hospital stay (mean difference, 10.68 days; 95% CI, 7.14-14.22) than patients without hyponatremia. Patients with hyponatremia had a higher tendency of in-hospital mortality than those without hyponatremia (OR, 1.61; 95% CI, 0.97-2.69). CONCLUSIONS: The development of hyponatremia in the clinical course of stroke is associated with higher short-term mortality and a longer hospital stay. Although the causal relationship is unclear, hyponatremia could be a significant predictor of poor outcomes after stroke.


Assuntos
Hiponatremia/etiologia , Sódio/sangue , Acidente Vascular Cerebral/complicações , Equilíbrio Hidroeletrolítico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Mortalidade Hospitalar , Humanos , Hiponatremia/mortalidade , Hiponatremia/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Medicine (Baltimore) ; 99(36): e22052, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899066

RESUMO

Reversible splenial lesion syndrome (RESLES) is a clinico-radiological entity that defines a reversible lesion in the splenium of the corpus callosum (SCC) on magnetic resonance imaging (MRI). The clinical and radiological characteristics of RESLES are poorly defined and most RESLES literature is in the form of case reports. We reviewed the clinical and radiological data from 11 RESLES patients in order to more clearly describe the characteristics of this disorder in adults.Patients included in this study were diagnosed with RESLES from May 2012 to March 2018. We collected clinical, imaging, and laboratory data of 11 adult patients from Neurology Department of the Affliated Yantai Yuhuangding Hospital of Qingdao University. After analyzing various clinico-radiological features and laboratory parameters, including serum sodium, pathogen testing, cerebrospinal fluid (CSF) studies, electroencephalography (EEG), and MRI findings, we made a diagnosis of RESLES based on the criteria proposed previously by Garcia-Monco et al.Of the 11 patients, 7 (63.63%) were male and 4 (36.36%) were female, ranging in age from 24 to 62 years with an average age of 31.48 ±â€Š11.47 years. Seven cases occurred in the months of winter and spring (December-March). The primary clinical symptoms were headache, seizure, disturbance of consciousness, mental abnormality, and dizziness. All 11 patients had lesions in the SCC and all the lesions disappeared or significantly improved on follow-up imaging that was done within a month of symptom resolution.We found 5 (45.45%) patients had a CSF opening pressure >180 mmH2O, in addition to elevated protein and(or) leukocytes levels in 3 (27.27%) patients. The serum sodium concentration in 6 (54.55%) patients was low (<137 mmol/L) and EEG showed nonspecific slowing in waves 4 (36.36%) patients.When we encounter clinical manifestations such as headache accompanied with mental symptoms, disturbance of consciousness or epilepsy, and brain MRI finds lesions of the corpus callosum, we should consider whether it is RESLES. In order to find out the possible cause of the disease, we should carefully inquire about the history of the disease, complete etiology examination, and CSF tests. Of course, it is one of the necessary conditions for the diagnosis that the lesions in the corpus callosum are obviously relieved or disappeared.


Assuntos
Encefalopatias/diagnóstico , Encefalopatias/terapia , Corpo Caloso/patologia , Músculos Paraespinais/diagnóstico por imagem , Adulto , Encefalopatias/sangue , Encefalopatias/líquido cefalorraquidiano , Líquido Cefalorraquidiano/citologia , Líquido Cefalorraquidiano/metabolismo , Líquido Cefalorraquidiano/fisiologia , Pressão do Líquido Cefalorraquidiano , Eletroencefalografia/métodos , Feminino , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Músculos Paraespinais/patologia , Estudos Retrospectivos , Convulsões/tratamento farmacológico , Convulsões/etiologia , Sódio/sangue , Síndrome , Resultado do Tratamento , Vertigem/tratamento farmacológico , Vertigem/etiologia
18.
PLoS One ; 15(9): e0239318, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970708

RESUMO

BACKGROUND: Early risk stratification for guiding treatment priority in the emergency department (ED) is becoming increasingly important. Existing prediction models typically use demographics, vital signs and laboratory parameters. Laboratory-based models require blood testing, which may cause substantial delay. However, these delays can be prevented by the use of point-of-care testing (POCT), where results are readily available. We aimed to externally validate a laboratory-based model for mortality and subsequently assessed whether a POCT model yields comparable performance. METHODS: All adult patients visiting the ED of a university hospital between January 1st, 2012 and December 31st, 2016 were retrospectively reviewed for inclusion. Primary outcome was defined as 30-day mortality after ED presentation. We externally validated one existing prediction model including age, glucose, urea, sodium, haemoglobin, platelet count and white blood cell count. We assessed the predictive performance by discrimination, expressed as Area under the Curve (AUC). We compared the existing model to an equivalent model using predictors that are available with POCT (i.e. glucose, urea, sodium and haemoglobin). Additionally, we internally validated these models with bootstrapping. RESULTS: We included 34,437 patients of whom 1,942 (5.6%) died within 30 days. The AUC of the laboratory-based model was 0.794. We refitted this model to our ED population and found an AUC of 0.812, which decreased only slightly to 0.790 with only POCT parameters. CONCLUSIONS: Our POCT-model performs similar to existing laboratory-based models in identifying patients at high risk for mortality, with results available within minutes. Although the model needs further validation and evaluation, it shows the potential of POCT for early risk stratification in the ED.


Assuntos
Mortalidade Hospitalar , Testes Imediatos , Adulto , Idoso , Área Sob a Curva , Serviço Hospitalar de Emergência , Feminino , Hospitais Universitários , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Contagem de Plaquetas , Curva ROC , Estudos Retrospectivos , Sódio/sangue , Ureia/sangue
19.
J Zhejiang Univ Sci B ; 21(8): 628-636, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32748578

RESUMO

BACKGROUND: Currently, there are no drugs that have been proven to be effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Because of its broad antiviral activity, interferon (IFN) should be evaluated as a potential therapeutic agent for treatment of coronavirus disease 2019 (COVID-19), especially while COVID-19-specific therapies are still under development. METHODS: Confirmed COVID-19 patients hospitalized in the First Affiliated Hospital, School of Medicine, Zhejiang University in Hangzhou, China, from January 19 to February 19, 2020 were enrolled in a retrospective study. The patients were separated into an IFN group and a control group according to whether they received initial IFN-α2b inhalation treatment after admission. Propensity-score matching was used to balance the confounding factors. RESULTS: A total of 104 confirmed COVID-19 patients, 68 in the IFN group and 36 in the control group, were enrolled. Less hypertension (27.9% vs. 55.6%, P=0.006), dyspnea (8.8% vs. 25.0%, P=0.025), or diarrhea (4.4% vs. 19.4%, P=0.030) was observed in the IFN group. Lower levels of albumin and C-reactive protein and higher level of sodium were observed in the IFN group. Glucocorticoid dosage was lower in the IFN group (median, 40 vs. 80 mg/d, P=0.025). Compared to the control group, fewer patients in the IFN group were ventilated (13.2% vs. 33.3%, P=0.015) and admitted to intensive care unit (ICU) (16.2% vs. 44.4%, P=0.002). There were also fewer critical patients in the IFN group (7.4% vs. 25.0%, P=0.017) upon admission. Although complications during admission process were comparable between groups, the discharge rate (85.3% vs. 66.7%, P=0.027) was higher and the hospitalization time (16 vs. 21 d, P=0.015) was shorter in the IFN group. When other confounding factors were not considered, virus shedding time (10 vs. 13 d, P=0.014) was also shorter in the IFN group. However, when the influence of other factors was eliminated using propensity score matching, virus shedding time was not significantly shorter than that of the control group (12 vs. 15 d, P=0.206). CONCLUSIONS: IFN-α2b spray inhalation did not shorten virus shedding time of SARS-CoV-2 in hospitalized patients.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Interferon alfa-2/administração & dosagem , Sprays Nasais , Pneumonia Viral/tratamento farmacológico , Eliminação de Partículas Virais/efeitos dos fármacos , Albuminas/análise , Antivirais/administração & dosagem , Betacoronavirus , Proteína C-Reativa/análise , Estudos de Casos e Controles , China , Glucocorticoides/farmacologia , Hospitalização , Humanos , Pandemias , Pontuação de Propensão , Estudos Retrospectivos , Sódio/sangue
20.
Nat Commun ; 11(1): 4337, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32859897

RESUMO

Intracellular Na elevation in the heart is a hallmark of pathologies where both acute and chronic metabolic remodelling occurs. Here, we assess whether acute (75 µM ouabain 100 nM blebbistatin) or chronic myocardial Nai load (PLM3SA mouse) are causally linked to metabolic remodelling and whether the failing heart shares a common Na-mediated metabolic 'fingerprint'. Control (PLMWT), transgenic (PLM3SA), ouabain-treated and hypertrophied Langendorff-perfused mouse hearts are studied by 23Na, 31P, 13C NMR followed by 1H-NMR metabolomic profiling. Elevated Nai leads to common adaptive metabolic alterations preceding energetic impairment: a switch from fatty acid to carbohydrate metabolism and changes in steady-state metabolite concentrations (glycolytic, anaplerotic, Krebs cycle intermediates). Inhibition of mitochondrial Na/Ca exchanger by CGP37157 ameliorates the metabolic changes. In silico modelling indicates altered metabolic fluxes (Krebs cycle, fatty acid, carbohydrate, amino acid metabolism). Prevention of Nai overload or inhibition of Na/Camito may be a new approach to ameliorate metabolic dysregulation in heart failure.


Assuntos
Reprogramação Celular/fisiologia , Citoplasma/metabolismo , Insuficiência Cardíaca/metabolismo , Miocárdio/metabolismo , Sódio/metabolismo , Animais , Modelos Animais de Doenças , Metabolismo Energético , Técnicas de Introdução de Genes , Coração , Hipertrofia , Preparação de Coração Isolado , Masculino , Doenças Metabólicas/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Ratos , Ratos Wistar , Sódio/sangue , Trocador de Sódio e Cálcio/efeitos dos fármacos , Tiazepinas/farmacologia
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