Effects of salt loading during exercise in a hot dry climate

Strenuous work or sports activities in a hot environment can cause significant fluid and salt losses due to excessive sweating. Fluid replacement is commonly accepted to be beneficial, but controversy surrounds the necessity of adding salt to the dietary intake in hot climates. Five healthy young men participated in a self-controlled experiment designed to investigate the effects of salt loading on acclimatized people exercising under controlled laboratory conditions. The additional salt ingestion was found to cause an increase in body weight, rectal temperature, heart rate, urinary sodium and potassium concentrations and in the total amounts of sodium and chloride excreted in urine during the exercise. Furthermore, it decreased plasma aldosterone level and sweat chloride excretion, but did not affect fluid intake, urine output, sweat rate, skin temperature, excretion of sodium and potassium in sweat or urinary potassium content and chloride concentration. Neither did the additional salt intake affect plasma electrolyte levels, renin activity or acid base balance. It is concluded that acclimatized people living in a hot dry climate need no supplementary salt to their daily dietary intake while engaging in physical exercise or sports activities up to two hours a day. Salt loading has no beneficial effects in these conditions and may even be hazardous.     

Analysis of peritoneal fluid in urinary ascites

Urinary ascites may be the most common cause of ascites in the neonate, and should be suspected in an infant with abdominal distention, oliguria, hyponatremia, and hyperkalemia. The diagnosis is confirmed when analysis of the peritoneal fluid shows creatinine, urea, and potassium concentrations higher than corresponding serum concentrations. The establishment of adequate urinary drainage by catheterization of the bladder or nephrostomy rapidly corrects electrolyte abnormalities.     

Magnesiuric and calciuric effects of terbutaline in man

1. The effect of terbutaline infusion over 4 h on serum levels of potassium, ionized calcium, phosphate and magnesium and urinary excretion of potassium, calcium, magnesium and adenosine 3':5'-cyclic monophosphate was studied in six healthy volunteers. 2. Serum levels of potassium, calcium, phosphate and magnesium decreased. Urinary excretion of potassium decreased, whereas those of calcium, magnesium and adenosine 3':5'-cyclic monophosphate increased. 3. These results indicate that the hypocalcaemic and hypomagnesaemic effects of terbutaline can, at least partly, be explained by enhanced urinary excretion of calcium and magnesium. This may have important implications for the short-term terbutaline treatment of patients with, for example, cardiac disease.     

The value of urinary chloride measurement in distinguishing surreptitious vomiting from Bartter's syndrome

Urinary chloride measurement is a simple and common procedure but its value in clinical practice is not extensive. This case report highlights a practical and important use of this test. A patient presented with most of the clinical and metabolic derangements of Bartter's syndrome but was found to have extremely low or absent urinary chloride excretion. Her ability to excrete chloride was, however, intact during a chloride load test. The finding of low urinary chloride excretion did not support the diagnosis of Bartter's syndrome and suggested an extrarenal loss of chloride. This was confirmed when she eventually admitted to surreptitious vomiting.     

Prognostic significance of urinary neopterin levels in patients with hepatocellular carcinoma

Urinary neopterin levels were measured by high-performance liquid chromatography in 15 patients with liver cirrhosis, 18 patients with hepatocellular carcinoma and 20 normal subjects. The mean levels of urinary neopterin in patients with hepatocellular carcinoma were significantly elevated (p less than 0.01) compared to those in cirrhotics and normal subjects, but did not significantly differ between cirrhotics and normal subjects. Urinary neopterin levels correlated significantly with tumor size in patients with hepatocellular carcinoma but not with serum alpha-fetoprotein. Hepatocellular carcinoma patients with high urinary neopterin levels appeared to have more serious hepatic dysfunction than those with normal urinary neopterin levels, and moreover, there was a significant difference (p less than 0.05) in survival between the two groups. These findings suggest that urinary neopterin excretion may be a good biochemical marker to assess the progression of tumor and a useful prognostic indicator in patients with hepatocellular carcinoma.     

The urine osmolal gap: a clue to estimate urine ammonium in "hybrid" types of metabolic acidosis

The urine osmolal gap is defined as the difference between measured urine osmolality and the sum of the concentrations of sodium, potassium, chloride, bicarbonate, urea and glucose. Normally, this gap is 80-100 mosmol/kg H2O. A determination of the urine osmolal gap may be useful to ascertain the etiology of metabolic acidosis which is of the mixed wide and normal plasma anion gap type ("hybrid" metabolic acidosis). For example, with "hybrid" metabolic acidosis, a low urine osmolal gap will suggest the absence of excessive organic aciduria (ketoacidosis) and the basis of the normal anion gap type of acidosis will be determined by the urine anion gap or "net charge". Where "hybrid" metabolic acidosis has occurred due to wide anion gap metabolic acidosis with loss of organic acid anion in the urine, the urine osmolal gap will be high and can be used in a semi-quantitative fashion to estimate the sum of urinary ammonium plus ketone body anion concentrations.     

Artificial urinary sphincter, Part I: Overview

Urinary incontinence has a tremendous impact on an individual's quality of life and self-esteem. A number of patients will fail both conservative medical as well as conservative surgical treatments in their pursuit to regain urinary control. The surgical implantation of an artificial urinary sphincter (AUS) is a definitive surgical option to reestablish continence. However, there are many challenges that may arise as a patient progresses through the rigorous preparation, surgical procedure, and recovery process. Understanding the history, various indications, and risks of AUS surgery will aid in counseling patients considering AUS.     

Salivary electrolytes and serum digoxin in the Assessment of digitalis intoxication (author's transl)]

Salivary electrolytes (potassium and calcium), as well as serum digoxin levels were measured in 114 patients receiving digoxin or one of its derivatives. The mean value of the product of salivary potassium (mVal/I) and calcium (mVal/i in digoxin-treated patients without signs of digitalis intoxication (group 1) was 235 +/- 137 (SD) and with digitalis intoxication (group 2) 404 +/- 161 (SD). The difference in these values was not of statistical significance. The mean serum digoxin levels were 1.38 +/- 0.6 ng/ml (SD) in group 1 and 2.97 +/- 0.7 ng/ml (SD) in group 2; this difference is highly significant (p less than 0.001). Both salivary electrolytes and serum digoxin levels were falsely elevated in 11% of group 1 patients. 50% of the cases in group 2 showed salivary electrolyte values within the range of group 1, but there was only 1 patient with a serum digoxin level of below 2 ng/ml. It can, thus, be concluded that measurement of the salivary electrolytes is a test of only limited value in the assessment of digitalis intoxication, whereas determination of the serum digoxin level is a valuable diagnostic tool.     

Nurses experiences discussing sexuality with urinary catheter patients

The aim of this article was to establish registered nurses experiences of discussing sexuality with urinary catheter patients. A urinary catheter is used to provide drainage for those people who are unable to drain their bladder independently. Urinary catheters can cause issues with sex, sexuality and body image. This is a qualitative research study using thematic concept analysis to review data. The study used semi‐structured interviews that were audio‐taped during 2015. Nine community nurses participated in this study. Four themes emerged: the importance of the nurse–patient relationship, peer support and role models, maintaining professionalism and lack of experience, training and knowledge. The nurses reported barriers that they felt discouraged them from discussing sexuality, such as their own lack of knowledge, discussing sexuality with older people, nurse embarrassment and causing patient embarrassment. Nurses at all levels were reluctant to discuss issues relating to a patients' sexuality, and they were often uncomfortable doing so. Further training is required for nurses in supporting urinary catheter patients with sexual quality of life. Nursing assessments that allow sexuality to be assessed as part of any holistic nursing assessment are needed in practice. More acknowledgement of older urinary catheter users' sexual quality of life is required by nurses. It is the responsibility of the nurse to address any issues relating to a patients' sexuality with a urinary catheter as part of holistic care.     

Emergency management and commonly encountered outpatient scenarios in patients with hyperkalemia

Hyperkalemia is a common electrolyte disorder with potentially lethal consequences. Severe hyperkalemia can lead to life-threatening cardiac dysrhythmias, making a clear understanding of emergency management crucial. Recognition of patients at risk for cardiac arrhythmias should be followed by effective strategies for reduction in serum potassium levels. In the outpatient setting, diagnosis of hyperkalemia can be complicated by factitious elevations in serum potassium levels. True elevations in serum potassium levels are commonly due to medications used for cardiovascular disease in the setting of impaired glomerular filtration rate. The prevalence of chronic kidney disease is steadily increasing, likely leading to increases in risk of hyperkalemia. A systematic approach will aid in timely diagnosis and management of hyperkalemia.     

Urinary N-acetyl-beta-D-glucosaminidase as a marker of renal injury in adjuvant arthritis

In the present study we have determined if renal damage occurs with adjuvant arthritis (AA). As a sensitive indicator of renal injury in tubular cells, urinary N-acetyl-beta-D-glucosaminidase (NAG) was measured at predetermined times after arthritis induction. Urinary protein, sodium and potassium excretion were also evaluated. NAG levels in arthritic animals were higher than those in healthy ones from day 12 after induction and the levels remained high during the study period. A significant positive correlation was noted between urinary NAG excretion and disease severity reflected by hind paw edema. Protein excretion also increased in arthritic animals but there was no correlation between urinary protein, NAG levels, and degree of inflammation. Changes in urine sodium and potassium levels did not reach statistical significance. Thus, we can conclude that some renal damage occurred in this experimental model of chronic inflammation.     

达格列净对2型糖尿病患者血、尿电解质的影响

目的 观察单用二甲双胍血糖控制不佳（糖化血红蛋白,HbA1c＞7.5%）的2型糖尿病（T2DM）患者,应用达格列净后对血电解质（血钠、血钾、血钙）、尿电解质（24小时尿钠、24小时尿钾、24小时尿钙）、尿渗透浓度及其他代谢指标的影响,评估用药后的安全性。方法 选取在2017年9月至2019年4月期间,于沧州市人民医院本部院区内分泌门诊及住院部就诊的103例T2DM患者,按照随机抽样法分成对照组（55例）和试验组（48例）。对照组给予二甲双胍治疗,试验组给予二甲双胍联合达格列净治疗。观察用药24周后患者血电解质、尿电解质、尿渗透浓度及其他代谢指标较基线和对照组的变化以及评估用药的安全性。结果 治疗24周后,试验组的尿电解质、尿渗透浓度水平较基线及对照组均有所升高,差异有统计学意义(P＜0.05);试验组的血糖参数、总胆固醇（TC）、甘油三酯（TG）、24小时尿蛋白、体重指数（BMI）、体重水平较基线及对照组降低,差异存在统计学意义(P＜0.05);血电解质、尿pH、低密度脂蛋白胆固醇（LDL C）、高密度脂蛋白胆固醇（HDL C）、估算的肾小球滤过率（eGFR）水平较基线及对照组无明显变化,差异无统计学意义(P＞0.05)。结论 在单用二甲双胍控制不佳的T2DM患者中联合应用达格列净治疗,可有降低血糖、改善血脂、减轻体重、减少尿蛋白等多重获益,虽然会引起尿电解质增多及尿渗透浓度升高,但血电解质水平无明显改变,无严重不良事件发生,使用上更安全。     

Acute renal failure due to urinary tract obstruction

Urinary tract obstruction is a frequent cause of acute renal failure that is potentially life threatening but reversible, if it is promptly recognized and corrected. The level of urinary tract obstruction is variable, dependent on the underlying disease, and may range from the loop of Henle to the urethral meatus. Clinical manifestations are most commonly due to renal failure, but the history and physical examination can aid in determining the localization and cause of the obstruction. Laboratory findings may suggest urinary tract obstruction as the etiology for acute renal failure. Radiologic procedures, most prominently ultrasonography, can establish the diagnosis. Treatment is variable, but patient management may need to be altered during the postobstructive phase of urinary tract obstruction owing to physiologic response to reestablishment of urine flow.     

Nursing measures in the prevention and treatment of renal cell damage associated with cisplatin administration

Renal tubule damage as a result of the nephrotoxic effects of cisplatin is a well-documented effect of cisplatin administration. This damage results in electrolyte imbalances through electrolyte wasting and electrolyte reabsorption failure in the renal tubule. Electrolytes most commonly affected are magnesium, calcium, and potassium. Other indicators of renal cell damage are elevations in blood urea nitrogen and serum creatinine and a decrease in creatinine clearance levels. Individuals with marginal renal function or those who have had multiple doses of cisplatin or other nephrotoxic drugs are at increased risk for developing nephrotoxicity. Early assessment of risk factors and the implementing and evaluating of interventions to facilitate prevention of nephrotoxicity will presumably minimize the incidence and degree of renal damage.     

Effects of experimental potassium depletion on renal function and urinary prostanoid excretion in normal women during hypotonic polyuria

Summary. During hypotonic polyuria renal function studies by the clearance (cl.) method, and urinary PGE₂, 6-keto-PGF_1α and TxB₂ determinations were performed on 14 healthy women in normal potassium balance (N) and 14 healthy women in sustained potassium depletion (KD) induced by low dietary potassium intake (≤ 10 mmol day^-1) and natriuretic treatment. By using different depletive patterns, two groups with estimated cumulative potassium deficits of 160 ± 43 mmol (KD1, n= 8) and 198 ± 22 mmol (KD2, n= 6), respectively, were obtained. (1) In both the KD1 and KD2 groups as compared to normal potassium balance (N), plasma potassium concentration and urinary potassium excretion were significantly lower; plasma renin activity was significantly higher. (2) Only in KD2 did significant changes appear in renal function and urinary prostanoid excretions. Besides a decrease in creatinine c1. and the urinary flow rate, an increase in fractional chloride excretion and a reduction in distal fractional chloride reabsorption were manifest. The plasma chloride concentration was reduced too. Urinary prostanoid excretions were significantly (6-keto-PGF_1α, TxB₂) or tendentially (PGE₂) lower. (3) Indomethacin treatment resulted in changes in mean arterial pressure (increase) and creatinine cl. (decrease) which were not significantly different in normal potassium balance and KD groups. Only in KD2 did the drug significantly reduce the fractional salt and water excretions and the fractional sodium and chloride deliveries to the diluting segments. However, indomethacin was unable to correct the inhibition of distal fractional chloride reabsorption. Therefore, the potassium depletion attained in the KD2 group was efficacious in depressing renal prostanoid synthesis. This fact, in the presence of high levels of angiotensin II, induced a reduction of the glomerular filtration rate thus contributing to renal ability to retain chloride and potassium.     

尿血红蛋白对苄索氯铵法定量测定尿蛋白的干扰评价

目的评价尿血红蛋白对苄索氯铵法定量测定尿蛋白的影响。方法参照美国临床和实验室标准化协会(CLSI)的EP7-A2方案,配制不同浓度血红蛋白的尿液标本做剂量-效应试验,同时收集50例不同隐血程度的尿液标本做临床标本的偏倚试验;尿蛋白定量在DPP罗氏生化工作站采用苄索氯铵法检测,与磺基水杨酸法进行比较。结果剂量-效应试验显示,当尿血红蛋白浓度达0.2g/L时即对苄索氯铵法测定尿蛋白产生显著性干扰(P0.05);临床标本的偏倚试验显示,不同程度的隐血对苄索氯铵法测定尿蛋白产生明显的正干扰。结论重视尿隐血阳性和/或含有红细胞的尿液标本,在采用苄索氯铵法测定尿蛋白时应评价其准确性,必要时使用磺基水杨酸法进行确认。     

Straightening out the renal tubule: advances in the molecular basis of the inherited tubulopathies

Advances in the molecular genetics of inherited renal tubulopathies have allowed some insight into the normal mechanisms of tubular cation and anion reabsorption. It is now possible to view Bartter's syndrome, Gitelman's syndrome and pseudohypoaldosteronism type 1 as having genetic abnormalities which produce tubular defects that are similar to those induced by the pharmacological actions of loop diuretics, thiazide diuretics or potassium-sparing diuretics, respectively. Although these rare monogenic disorders with dramatic phenotypes seem to have little relevance to everyday clinical practice, it is possible that subtle abnormalities of the regulation of the ENaCs may play a role in low-renin forms of 'essential' hypertension. Similarly, subtle abnormalities in the function of the electroneutral sodium-(potassium)- chloride cotransporters (NKCC2 and NCCT) and the renal CLC-type chloride channels (CLC5) may be major determinants of urinary calcium excretion with roles in the pathogenesis of 'idiopathic' hypercalciuria and osteoporosis. Because of the intricate and diverse molecular mechanisms by which tubular reabsorption of water and solutes takes place in each different nephron segment, it is likely that other renal channels and transporters will be implicated in the pathogenesis of further monogenic disorders, and that these will allow additional insights into tubular functioning. Recent studies have demonstrated that in addition to abnormalities in the NKCC2 and ROMK1 genes, mutations at a third genetic locus can also cause Bartter's syndrome. Linkage studies, followed by mutational analyses have found deletions and point mutations in the gene encoding one of the TAL-specific chloride channels, CLCKB, in 17 Bartter's families. This chloride channel is similar in structure to CLC5, and is located on the long arm of chromosome 1. Importantly, there appears to be a phenotypic difference between subjects with Bartter's syndrome due to CLCKB abnormalities and those with NKCC2 or ROMK1 mutations. Despite the fact that all of these Bartter's patients had significant hypercalciuria, nephrocalcinosis was not found in any of the 17 subjects with CLCKB mutations, compared to 19 of 20 patients with NKCC2 or ROMK1 mutations. These findings have also demonstrated a key role for CLCKB as a major basolateral chloride channel involved in mTAL sodium and chloride reabsorption (Figure 2).      

Influence of protein on the determination of sodium, potassium and chloride in serum by Ektachem DT 60 with the DTE module; evaluation with special attention to a possible protein error by flame atomic emission spectrometry and ion-selective electrodes; proposals to their calibration

The reliability of the Ektachem DT 60 with the DTE module was evaluated. The precision of the determination of sodium, potassium and chloride in serum was adequate. The relative standard deviation for precision between days was Na+ 0.7%, K+ 1.5% and Cl- 1.0%. The means of the Ektachem results for 7 control sera differed from those of the reference method values by 0.9% (Na+), -0.9% (K+) and +4.4% (Cl-). Similar results were obtained for the analysis of patient sera. The influence of protein was investigated, using sera of increasing protein concentration prepared by ultracentrifugation. The results from the Ektachem corresponded to the values obtained by flame atomic emission spectrometry, even at high protein concentrations, although Ektachem measurements are performed by ion-selective electrodes without predilution. In paraproteinaemia, the Ektachem and flame atomic emission spectrometry results disagreed. Chloride determinations by Ektachem distinctly differed from measurements of the chloride concentration in total serum. It is proposed that ion-selective electrodes should be calibrated and linearized with respect to sodium chloride, in order to obtain an accurate value for the concentration of electrolyte in serum water. Concentrations are easier to interpret than "activities" for therapeutical purposes, and they can be used to define protein- and lipid-independent reference intervals for these electrolytes. With this calibration procedure, the results from ion-selective electrodes are never lower than values obtained by flame atomic emission spectrometry. The accuracy of ion-selective electrode measurements should be evaluated by applying reference methods for sodium, potassium and chloride to the ultracentrifugation supernatant of the corresponding serum. This approach can help to settle the dispute concerning the influence of protein on the residual liquid junction potential.     

Asymptomatic hyperbromidaemia detected as pseudohyperchloridaemia measured with an ion selective electrode meter

Six patients were found to have increased serum chloride concentrations when these concentrations were determined with an ion-selective electrode, but not when determined by continuous flow mercuric thiocyanate colorimetry or amperometric-coulometric titration. Their serum bromide levels of 1.8-8.0 mmol/l were much higher than those of 0.07-0.13 mmol/l in normal controls. The urinary bromide excretion, measured in two of these patients, was higher than that in normal subjects. No common symptoms or abnormalities in laboratory findings except hyperbromidaemia were found in these patients, who claimed not to have taken any drugs containing bromide. For determination of the incidence of subclinical hyperbromidaemia, the serum bromide concentrations were measured in sera of 1,323 outpatients sent to Tokushima University Hospital for routine measurements of blood chemistry over a one-month period. Five samples showed abnormally high bromide levels. It is concluded that subclinical hyperbromidaemia is not as rare as generally thought, though the aetiology of this state is unknown. Chloride determination with an ion-selective electrode can be used to screen for hyperbromidaemia, since increased levels of bromide ion result in apparently high chloride values.