A Case of Inappropriate Antidiuretic Hormone Secretion Syndrome Associated With COVID-19 Pneumonia Treated With Boluses of Hypertonic Saline for Reversal of Symptomatic Hyponatremia

Hyponatremia is the most common electrolyte disorder, which can occur in outpatients and hospitalized patients, so both first-contact doctors and specialists must keep up-to-date on the prevention, recognition, diagnosis and management of this complication. A 68-year-old male patient presents to Dos de Mayo National Hospital Emergency Department. He was diagnosed as COVID-19 pneumonia and hospitalized for management of acute respiratory failure. The patient had neurological impairment associated with poor oral tolerance. Initial laboratory examinations were C-reactive protein in 363.5 mg/L, serum sodium of 128.42 mmol/L and urine sodium was 83 meq/L. Osmolality in plasma was 266.15 mOsm/Kg and urine osmolality was 420 mOsm/Kg. Thyroid function tests as well as cortisol levels were in normal range. Our patient was diagnosed as SIAD by hyponatremia, osmolality in plasma <275 mOsm / kg, urine osmolality > 100 mOsm / kg, urine sodium > 40 mEq / l, euvolemic state and exclusion of cortisol and thyroid hormone deficiency. Treatment of hyponatremia was initiated and rapidly elevate plasma sodium by 4 meq/l in the first 6 hours. There was clinical improvement. Blood sodium levels ranged from 115 to 135 mmol/L with bolus therapy of hypertonic solutions in 72 hours. Intravenous boluses of hypertonic saline should be administered to rapidly elevate plasma sodium by 4 to 6 mEq/L in the first 6 hours. The data shows that fluid bolus therapy is more effective in acutely elevating plasma sodium than traditional low-dose hypertonic saline infusion that may lead to avoidable deaths according to recent guidelines. In this case a strategy based with bolus therapy for reversal of hyponatremia was used effectively. A number of cases of COVID-19 pneumonia are associated with SIAD. The presence of SIAD could be a clue to diagnosing COVID-19. SIAD is a major complication of COVID-19 and could be the first and only manifestation. In cases of SIAD without a clear etiology we should suspect COVID-19 in a patient with respiratory distress in the current pandemic. Syndrome of inappropiate antidiuresis (SIAD) should be assessed in every patient with COVID-19 as their treatment and early identification decreases mortality. The association between COVID-19 pneumonia and SIAD should be further identified, requiring doctors to be aware of this condition. Additional studies are required to determine the incidence and pathogenesis of SIAD in patients with COVID-19.

Creatine Kinase and Lactate Dehydrogenase Responses After Different Resistance and Aerobic Exercise Protocols

The aim of this study was to investigate the responses of creatine kinase (CK) and lactate dehydrogenase (LDH) after performing different resistance and aerobic exercise protocols. Twelve recreationally trained men (age, 23.2 ± 5.6 years; body mass, 84.3 ± 9.3 kg; body height, 178.9 ± 4.5 cm; and BMI, 26.3 ± 2.3 kg·m2) volunteered to participate in this study. All subjects were randomly assigned to four experimental protocols (crossover): (a) aerobic training at 60% of VO2max, (b) aerobic training at 80% of VO2max, (c) a resistance exercise (RE) session with a bi-set protocol, and (d) an RE session with a multiple sets protocol. Blood samples were collected before, immediately after and 24 hours following the experimental protocols. After 24 hours, there was a significant increase in CK for the 80% of VO2max protocol vs. the bi-set RE session (p = 0.016). Immediately after the protocols, we observed a significant increase in LDH among certain groups compared to others, as follows: multiple sets RE session vs. 60% of VO2max, bi-set RE session vs. 60% of VO2max, multiple sets RE session vs. 80% of VO2max, and bi-set RE session vs. 80% of VO2max (p = 0.008, p = 0.013; p = 0.002, p = 0.004, respectively). In conclusion, aerobic exercise performed at 80% of VO2max appears to elevate plasma CK levels more than bi-set RE sessions. However, the bi-set and multiple sets RE sessions appeared to trigger greater levels of blood LDH compared to aerobic protocols performed at 60% and 80% of VO2max.

Flexible ammonia handling strategies using both cutaneous and branchial epithelia in the highly ammonia-tolerant Pacific hagfish

Hagfish consume carrion, potentially exposing them to hypoxia, hypercapnia, and high environmental ammonia (HEA). We investigated branchial and cutaneous ammonia handling strategies by which Pacific hagfish ( Eptatretus stoutii) tolerate and recover from high ammonia loading. Hagfish were exposed to HEA (20 mmol/l) for 48 h to elevate plasma total ammonia (TAmm) levels before placement into divided chambers for a 4-h recovery period in ammonia-free seawater where ammonia excretion ( JAmm) was measured independently in the anterior and posterior compartments. Localized HEA exposures were also conducted by subjecting hagfish to HEA in either the anterior or posterior compartments. During recovery, HEA-exposed animals increased JAmm in both compartments, with the posterior compartment comprising ~20% of the total JAmm compared with ~11% in non-HEA-exposed fish. Plasma TAmm increased substantially when whole hagfish and the posterior regions were exposed to HEA. Alternatively, plasma TAmm did not elevate after anterior localized HEA exposure. JAmm was concentration dependent (0.05–5 mmol/l) across excised skin patches at up to eightfold greater rates than in skin sections that were excised from HEA-exposed hagfish. Skin excised from more posterior regions displayed greater JAmm than those from more anterior regions. Immunohistochemistry with hagfish-specific anti-rhesus glycoprotein type c (α-hRhcg; ammonia transporter) antibody was characterized by staining on the basal aspect of hagfish epidermis while Western blotting demonstrated greater expression of Rhcg in more posterior skin sections. We conclude that cutaneous Rhcg proteins are involved in cutaneous ammonia excretion by Pacific hagfish and that this mechanism could be particularly important during feeding.

Systematic Review of Chinese Traditional Exercise Baduanjin Modulating the Blood Lipid Metabolism

Background. Baduanjin exercise is considered to be beneficial to modulate the blood lipid metabolism. The purpose of the systematic review was to assess the potential efficacy and safety of Baduanjin exercise.Methods. MEDLINE, EMBASE, CBM, CNKI, VIP, Chinese Important Conference Papers Database, and Chinese Dissertation Database were searched for all prospective-controlled trials of Baduanjin exercise from their inception to December 31, 2011.Results. A total of 14 studies were included. Comparing with no treatment, Baduanjin exercise significantly reduced the levels of TC, TG, LDL-C in plasma, and elevated plasma HDL-C level for healthy participants, and the pooled MD (95% confidence interval, CI) was −0.58 mmol/L (−0.86, −0.30 mmol/L), −0.22 mmol/L (−0.31, −0.13 mmol/L), −0.35 mmol/L (−0.54, −0.17 mmol/L), 0.13 mmol/L (0.06, 0.21 mmol/L), respectively. Baduanjin exercise also obviously decreased the levels of TG, LDL-C in plasma comparing with no treatment for patients, and the pooled MD (95% CI) was −0.30 mmol/L (−0.40, −0.19 mmol/L), −0.38 mmol/L (−0.63, −0.13 mmol/L), but there was not obvious to decrease plasma TC level or elevate plasma HDL-C level in patients with the pooled MD (95%CI), −0.39 mmol/L (−1.09, 0.31 mmol/L) and 0.22 mmol/L (−0.11, 0.55 mmol/L), respectively. In addition, the obvious advantage was not observed to modulate the blood lipid metabolism in comparing Baduanjin exercise with other exercises, regardless for health participants or patients.Conclusion. Studies indicated that Baduanjin exercise could significantly decrease the levels of TC, TG, LDL-C levels in plasma and elevate plasma HDL-C level for the healthy people. It also was helpful that Baduanjin exercise modulated the blood lipid metabolism for patients. Moreover, the Baduanjin exercise did not have an obvious advantage on modulating the lipid metabolism comparing with other exercises. But the evidence was uncertain because of the small sample size and low-methodological quality.