The effect of exercise during hemodialysis on serum levels of albumin, calcium, phosphorus and parathyroid hormone: a randomized clinical trial

Introduction: Disorders in the levels of blood electrolytes are often considered as complications of kidney illnesses which are responsible for various systemic problems experienced by patients. Objectives: The aim of this study was to investigate the efficiency of an exercise program during hemodialysis on serum levels of biochemical factors such as albumin, calcium, phosphorus and intact parathyroid hormone (iPTH). Patients and Methods: Sixty patients undergoing hemodialysis were evaluated in the clinical trial. The patients in the intervention group pedaled on a stationary bicycle for one hour in every hemodialysis session for eight weeks. At the beginning of the study and at the end of it, the patients’ blood samples were sent to hospital’s laboratory to measure the levels of biochemical factors in blood. Data were analyzed by SPSS software. Results: The serum levels of electrolytes showed no significant improvement between the study groups before and after the exercise program (P>0.05). A significant improvement was observed after the program in serum phosphorus and iPTH (P=0.04). In contrast, serum albumin (P=0.3) and calcium (P=0.5) did not alter significantly after the exercise program. Conclusion: Exercise improved some biochemical factors of blood in the patients undergoing hemodialysis. Exercise is therefore a complementary procedure for these patients. Trial Registration: The trial protocol was approved in the Iranian Registry of Clinical Trial (#IRCT20150116020675N4; https://en.irct.ir/trial/50492, ethical code# IR.MUI.MED.REC.1399.212).

Evaluation of blood electrolyte alterations in cats during elec-tive laparoscopic ovariectomy

In a clinical setting, we tested the hypothesis of whether hypercapnia developed during carbon dioxide pneumoperitoneum is associated with changes in blood electrolytes. This prospective study involved ten female cats that underwent elective laparoscopic ovariectomy. Venous blood samples for assessment of electrolytes were collected in the following sequence: T1- before anaesthesia induction, T2 - 10 minutes after anaesthesia induction, T3 - 30 minutes of pneumoperitoneum and T4 - at the end of pneumoperitoneum. Statistical analysis revealed AB disturbances associated with general anaesthesia and pneumoperitoneum, manifested with decreased blood pH, whereas blood PvCO2, PO2 and BE were increased. A constant increase of K+ concentration was recorded in all animals during pneumoperitoneum (P<0.05), whereas iMg registered a significant increase only at T3 (P<0.05). Correlations were recorded between blood pH and Na+, iCa, iMg, as well as between Na+ and Cl¯ at different time points during anaesthesia. No correlations were noted between pH and K+ or PvCO2 and K+. In conclusion, electrolyte imbalance represents a possible complication associated with laparoscopic surgery in healthy cats. However, further studies should investigate the causes involved in K+ concentration elevation.

Identification of the toxic threshold of 3-hydroxybutyrate-sodium supplementation in septic mice

Background In septic mice, supplementing parenteral nutrition with 150 mg/day 3-hydroxybutyrate-sodium-salt (3HB-Na) has previously shown to prevent muscle weakness without obvious toxicity. The main objective of this study was to identify the toxic threshold of 3HB-Na supplementation in septic mice, prior to translation of this promising intervention to human use. Methods In a centrally-catheterized, antibiotic-treated, fluid-resuscitated, parenterally fed mouse model of prolonged sepsis, we compared with placebo the effects of stepwise escalating doses starting from 150 mg/day 3HB-Na on illness severity and mortality (n = 103). For 5-day survivors, also the impact on ex-vivo-measured muscle force, blood electrolytes, and markers of vital organ inflammation/damage was documented. Results By doubling the reference dose of 150 mg/day to 300 mg/day 3HB-Na, illness severity scores doubled (p = 0.004) and mortality increased from 30.4 to 87.5 % (p = 0.002). De-escalating this dose to 225 mg still increased mortality (p ≤ 0.03) and reducing the dose to 180 mg/day still increased illness severity (p ≤ 0.04). Doses of 180 mg/day and higher caused more pronounced metabolic alkalosis and hypernatremia (p ≤ 0.04) and increased markers of kidney damage (p ≤ 0.05). Doses of 225 mg/day 3HB-Na and higher caused dehydration of brain and lungs (p ≤ 0.05) and increased markers of hippocampal neuronal damage and inflammation (p ≤ 0.02). Among survivors, 150 mg/day and 180 mg/day increased muscle force compared with placebo (p ≤ 0.05) up to healthy control levels (p ≥ 0.3). Conclusions This study indicates that 150 mg/day 3HB-Na supplementation prevented sepsis-induced muscle weakness in mice. However, this dose appeared maximally effective though close to the toxic threshold, possibly in part explained by excessive Na+ intake with 3HB-Na. Although lower doses were not tested and thus might still hold therapeutic potential, the current results point towards a low toxic threshold for the clinical use of ketone salts in human critically ill patients. Whether 3HB-esters are equally effective and less toxic should be investigated.

CHANGES IN HYDROGEN INDEX AND BLOOD ELECTROLYTES DURING RECOVERY PERIOD AFTER BLOOD LOSS WITH FOLLOWING ADMINISTRATION OF MAGNETITE NANOPARTICLES

Magnetite nanoparticles are one of the extensively investigated and implemented into medical practice. They are known as having significant therapeutic potential in providing rapid recovery of hematological parameters after acute blood loss. Since the pathogenesis of acute blood loss, except of anaemia, includes other components (hypoxia, hypovolemia, acidosis), it is important to know how magnetite nanoparticles affect the parameters of these processes. The aim of this study was to investigate the effect of magnetite nanoparticles on changes in hydrogen index (pH) and blood electrolytes induced by acute blood loss. Materials and methods. The experiment was performed on 47 white male rats. Blood loss (25% of circulating blood) was simulated by puncture of the heart under the ether anesthesia. The nanoparticles’ solution (5-8 nm) was administered intraperitoneally immediately after the blood loss in a dose of 6.75 mg Fe/kg in a volume of at least 1 ml. In 3, 24 and 72 hours, and in 5 day interval, the blood pH and content of HCO3–, Na+, K+ and Ca2+ were checked. The data obtained were processed using one-way variance analysis ANOVA (Statistica for Windows 8.0). Results and discussion. It is shown that magnetite nanoparticles elevated the pH level in 3 hours, reduced in 24 hours and did not affect it in 72 hours and 5 days as compared to the control pathology. The administration of magnetite nanoparticles after 3 hours, 24 hours and 5 days resulted in increase in Na+ content compared to that in blood loss. An increase in the content of K+ took place after 24 hours as compared to the control pathology. Magnetite nanoparticles contributed to the normalization of Ca2+ after 72 hours. The content of HCO3– in all terms of observations ranged within normal limits, except for that in blood loss with magnetite nanoparticles introduced after 24 hours caused the increase of HCO3–in 1.2 times compared to the control pathology. Conclusion. Magnetite nanoparticles, administered to manage the acute blood loss syndrome, are able to modify the acid-base balance and electrolyte content in the blood for 5 days of recovery period that largely depends on the ability of non-iron to accelerate erythropoiesis and thus to restrain other components in the pathogenesis.

Bee Venom Acupuncture Therapy Ameliorates Neuroinflammatory Alterations in a Pilocarpine-Induced Epilepticus Model

Background: Bee venom (BV) is applied in different traditional medicinal therapies and is used worldwide to prevent and treat many acute and chronic diseases. Epilepsy has various neurological effects, e.g., epileptogenic insults; thus, it is considered a life-threatening condition. Seizures and their effects add to the burden of epilepsy because they can have health effects including residual disability and even premature mortality. The use of antiinflammatory drugs to treat epilepsy is controversial; therefore, the alternative nonchemical apitherapy benefits of BV were evaluated in the present study by assessing neuroinflammatory changes in a pilocarpine-induced epilepticus model. Methods: Levels of electrolytes, neurotransmitters, and mRNA expression for some gate channels were determined. Moreover, ELISA assays were conducted to detect pro- and anti-inflammatory cytokines, whereas RT-PCR was performed to assess mRNA expression of Foxp3 and CTLA-4.Results: BV ameliorated the interruption in electrolytes and ions through voltage- and ligand-gated ion channels, and it limited neuronal excitability via rapid repolarization of action potentials. In addition, BV inhibited the high expression of proinflammatory cytokines.Conclusions: Acupuncture with BV was effective in preventing some of the deleterious consequences of epileptogenesis associated with high levels of glutamate and DOPA in the hippocampus. BV ameliorates changes in the expression of voltage-gated channels, rebalances blood electrolytes and neurotransmitters, and modulates the levels of pro- and anti-inflammatory cytokines. Thus, BV could reduce the progression of epileptogenesis as a cotherapy with other antiepileptic drugs.

Moringa oleifera Extract Extenuates Echis ocellatus Venom-Induced Toxicities, Histopathological Impairments and Inflammation via Enhancement of Nrf2 Expression in Rats

Echis ocellatus snakebite causes more fatalities than all other African snake species combined. Moringa oleifera reportedly possesses an antivenom property. Therefore, we evaluated the effectiveness of M. oleifera ethanol extract (MOE) against E. ocellatus venom (EOV) toxicities. Thirty male rats were grouped as follows (n = 5): Group 1 (normal control received saline), groups 2 to 6 were administered intraperitoneally, 0.22 mg/kg (LD50) of EOV. Group 2 was left untreated while group 3 to 6 were treated post-envenoming with 0.2 mL of polyvalent antivenom, 200, 400, and 600 mg/kg of MOE respectively. MOE significantly (p<0.05) normalized the altered haematological indices and blood electrolytes profiles. MOE attenuated venom-induced cellular dysfunctions, characterized by a significant increase in NRF2, and concomitant downregulation of increased antioxidant enzymes (SOD and CAT) activities in the serum and heart of the treated rats. MOE normalized the elevated TNF-α and IL-1β in serum and heart tissues. Furthermore, the IgG titre value was significantly (p<0.5) higher in the envenomed untreated group compared to the MOE-treated groups. Hemorrhagic, hemolytic and coagulant activities of the venom were strongly inhibited by the MOE dose, dependently. Lesions noticed on tissues of vital organs of untreated rats were abolished by MOE. Our findings substantiate the effectiveness of MOE as a potential remedy against EOV toxicities.

Blood Electrolyte Levels in Male and Female Pitbull Dogs

The study evaluates blood electrolytes in male and female pit bull dogs to ascertain their level of predominance in extracellular fluid. Blood samples were collected, processed and analyzed for electrolyte levels using standard protocol and absorbance reading taken by spectrophotometric method. Post statistical package for social science (SPSS) analysis indicates that mean serum electrolyte levels of male pit bull dogs were 179.2±66.79 mmol/l for sodium, 3.54±0.55 mmol/l for potassium, 43.72±2.72 mmol/l for bicarbonate, chloride was 116±12.81 mmol/l, phosphorus was 4.26±0.61, calcium and magnesium were 1.74±0.50 and 1.48±0.18 mmol/l respectively. The female pit bulls had a mean serum electrolyte level of 157.4±76.07 mmol/l for sodium, 5.12±1.23 mmol/l for potassium, 75.98±27.98 mmol/l for bicarbonate, chloride and phosphorus are 123.5±17.98 mmol/l and 4.06±0.95 mmol/l, calcium and magnesium were 1.56±0.16 and 1.70±0.39 mmol/l respectively. The result implies that serum concentration of sodium, bicarbonate, chloride, phosphorus and magnesium in both male and female pit bull dogs were significantly (p<0.05) higher than normal electrolyte range, while potassium and calcium levels were within range. The electrolyte imbalance could lead to impaired fluid level and electrolyte osmolarity resulting in neurological consequences such as seizure disorders, hypoparathyroidism, metabolic acidosis and alkalosis.

Effect of blood storage on electrolyte levels

Background: Blood transfusion can be an immediate life saving measure in several acute conditions such as hemorrhage and anemia. However, various post transfusion complications are observed in patients which may be associated with the storage conditions of the collected blood. Electrolytes play a major role in maintaining homeostasis within the cells. Potassium is the most important extracellular cation responsible for maintenance of the cell integrity. Prolonged and improper storage of blood can lead to leakage of electrolytes, thus changing the cell morphology. This can adversely affect the patients who receive such blood. This study helps us analyze the effect of blood storage on electrolyte levels.Methods: For the study, 10ml of blood was collected from 30 blood bags containing CPDA-1 at the time of blood donation from 30 different volunteers. This blood containing the CPDA-1 was divided into 5 parts of 2ml and each 2ml sample was stored in plain bulbs. All the samples were stored at 4°C. Samples were tested to check for changes in the electrolyte (Na+, K+, Cl-) levels on day 0, 3, 7, 14 and 21. ANOVA was used to calculate the variance in the electrolyte levels.Results: Average sodium level on day 0 was 152.9±3.8 mEq/l. There was a significant decrease and it was measured at 139.5±4.8 mEq/l on day 21. Average potassium level on day 0 was 4.2±0.4 mEq/l. A significant spike was observed in potassium levels. The final reading of potassium level on day 21 was 15.2±0.7 mEq/l. Average chloride level on day 0 was 71.9±6.6 mEq/l which significantly declined to 67±5.9 mEq/l.Conclusions: Though blood is stored in proper conditions, a biochemical change occurs within the cells due to prolonged storage and thus affects its viability.

Correlation between Arterial and Venous Blood Electrolytes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-sectional Study

Introduction: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is a common health problem coupled with huge mortality and morbidity across the world. Acute exacerbation in COPD patients leads to electrolyte disturbances. Routinely, electrolytes are measured from venous blood. Electrolytes can also be measured from whole blood by blood gas analyser along with blood gases measurement. Aim: To study the correlation between venous and arterial blood electrolytes in AECOPD patients. Materials and Methods: The cross-sectional study was conducted at Clinical Biochemistry Laboratory, Government Medical College and Sir Takhtsinhji General Hospital, Bhavnagar, Gujarat, India, from December 2013 to May 2014. Arterial and venous blood were taken at same time from 150 patients of AECOPD and analysed for electrolytes (sodium, potassium and ionised calcium) in arterial blood gas analyser. Correlation of arterial and venous blood electrolyte levels was done by Pearson’s correlation. Results: This study comprised 109 (72.67%) male and 41 (27.33%) female AECOPD patients. Mean age of subjects was 59.01±11.42 years. Mean level of arterial sodium was 143.1±8.81 mmol/L and venous sodium was 144.8±8.47 mmol/L (p-value=0.0973). Mean level of arterial potassium was 3.53±0.73 mmol/L and venous potassium was 3.19±0.56 mmol/L (p-value <0.0001). Mean level of arterial ionised calcium was 0.83±0.13 mmol/L and venous ionised calcium was 0.76±0.17 mmol/L (p-value <0.0001). Correlation coefficient values for sodium, potassium and ionised calcium were 0.878, 0.762 and 0.537, respectively. Conclusion: Arterial sodium and potassium can be used as a substitute of venous sodium and potassium in management of AECOPD patients, while arterial ionised calcium should not be used in place of venous ionised calcium in management of such patients.