Diuretics are among the most commonly prescribed medications and, due to their mechanisms of action, electrolyte disorders are common side effects of their use. In the present work we investigated the associations between diuretics being taken and the prevalence of electrolyte disorders on admission as well as the impact of electrolyte disorders on patient outcome.In this cross sectional analysis, all patients presenting between 1 January 2010 and 31 December 2011 to the emergency room (ER) of the Inselspital, University Hospital Bern, Switzerland were included. Data on diuretic medication, baseline characteristics and laboratory data including electrolytes and renal function parameters were obtained from all patients. A multivariable logistic regression model was performed to assess the impact of factors on electrolyte disorders and patient outcome.A total of 8.5% of patients presenting to the ER used one diuretic, 2.5% two, and 0.4% three or four. In all, 4% had hyponatremia on admission and 12% hypernatremia. Hypokalemia was present in 11% and hyperkalemia in 4%. All forms of dysnatremia and dyskalemia were more common in patients taking diuretics. Loop diuretics were an independent risk factor for hypernatremia and hypokalemia, while thiazide diuretics were associated with the presence of hyponatremia and hypokalemia. In the Cox regression model, all forms of dysnatremia and dyskalemia were independent risk factors for in hospital mortality.Existing diuretic treatment on admission to the ER was associated with an increased prevalence of electrolyte disorders. Diuretic therapy itself and disorders of serum sodium and potassium were risk factors for an adverse outcome.

Context:

Hypernatremia is encountered after pituitary or hypothalamic surgery and typically is secondary to vasopressin deficiency resulting in increased free water clearance with inadequate water replacement.

Objective:

We report a type 2 diabetic patient with severe hypernatremia (Na(+) = 161 mEq/L) after hypothalamic surgery. Unexpectedly, this was accompanied by persistent urinary hypertonicity and negative total but positive electrolyte free water clearance. Main Outcome Measure: Measurement of urinary electrolytes and urea revealed that an osmotic diuresis induced by urea derived principally by breakdown of endogenous protein was causative. Body protein losses over 48 hours were estimated to exceed 2 kg of lean mass. High-dose glucocorticoid, insulin resistance, and a postsurgical catabolic stress likely contributed.

Conclusion:

In surgically severely stressed individuals, proteolysis of endogenous protein can strongly impact body water metabolism and contribute to severe hypernatremia.

OBJECTIVE:

To compare sodium and potassium levels in children as done with Blood Gas Analyzer (BGA) at point of care testing in pediatric ICU vs. that done in laboratory electrolyte analyzer.

METHODS:

This prospective method comparison study was done from February to April 2012 in Pediatric ICU of tertiary care hospital at Delhi. Sixty consecutive patients were tested during the period. Paired blood samples for venous blood gas to be tested on BGA and serum electrolytes to be tested on auto-analyzers (AA) were taken as per standard technique. Data was collected and 59 paired samples were analyzed for sodium and potassium levels. They were analyzed according to CLSI document EP15-A2 using ACB method comparison software.

RESULTS:

Mean sodium measured on the BGA was 132.8 ± 12.2 mmol/L where as measured by AA was 141.5 ± 11.1 mmol/L. The mean difference between the two was -8.76 mmol/L (p < 0.001). The difference was statistically significant in all three subgroups of hypernatremia, isonatremia and hyponatremia (p < 0.001). Potassium level in BGA was 3.53 ± 0.81 mmol/L and AA was 4.28 ± 1.05 mmol/L. The mean difference between the BGA and AA was -0.75 mmol/L (p < 0.0001). The difference was statistically significant in patients with normokalemia and hyperkalemia (p < 0.0001). The difference was non significant in patients with hypokalemia (p = 0.051).

CONCLUSIONS:

Blood gas analyzers underestimates Na + and K + values if sampling is done using liquid sodium heparin and if all other potential pre-analytical errors of testing are taken care of. The Bland Altman's analysis in the present study showed a significant systematic bias and very wide limits of agreement for both sodium and potassium, which is not clinically acceptable.

Electrolyte disorders have been studied mainly in hospitalized patients, whereas data in the general population are limited. The aim of this study was to determine the prevalence and risk factors of common electrolyte disorders in older subjects recruited from the general population.A total of 5179 subjects aged 55 years or more were included from the population-based Rotterdam Study. We focused on hyponatremia, hypernatremia, hypokalemia, hyperkalemia, and hypomagnesemia. Multivariable logistic regression was used to study potential associations with renal function, comorbidity, and medication. The adjusted mortality also was determined for each electrolyte disorder.A total of 776 subjects (15.0%) had at least 1 electrolyte disorder, with hyponatremia (7.7%) and hypernatremia (3.4%) being most common. Diabetes mellitus was identified as an independent risk factor for hyponatremia and hypomagnesemia, whereas hypertension was associated with hypokalemia. Diuretics were independently associated with several electrolyte disorders: thiazide diuretics (hyponatremia, hypokalemia, hypomagnesemia), loop diuretics (hypernatremia, hypokalemia), and potassium-sparing diuretics (hyponatremia). The use of benzodiazepines also was associated with hyponatremia. Hyponatremic subjects who used both thiazides and benzodiazepines had a 3 mmol/L lower serum sodium concentration than subjects using 1 or none of these drugs (P < .001). Hyponatremia and hypomagnesemia were independently associated with an increased mortality risk.Electrolyte disorders are common among older community subjects and mainly associated with diabetes mellitus and diuretics. Subjects who used both thiazides and benzodiazepines had a more severe degree of hyponatremia. Because even mild electrolyte disorders were associated with mortality, monitoring of electrolytes and discontinuation of offending drugs may improve outcomes.

Under normal physiological conditions, our body fluids and electrolytes are protected in complete balance in a wonderful, flawless design. Even small deviations occurring in this equilibrium may lead to impairments, which can end in death. Especially in fairly common sodium metabolism disorders, it is the responsibility of the clinician to determine, according to the patient's history and her physical examination of him, whether there is an excess or depletion of volume, and to arrange subsequent treatment. Serum sodium levels of 120, 140, or 150 mEq/L alone should be meaningless to the physician in relation to total body sodium and water content because either hyponatremia or hypernatremia can occur while the patient is hypovolemic, euvolemic, or hypervolemic. For example, administering hypertonic or isotonic saline treatment to a patient with hypervolemic hyponatremia in order to correct the sodium will clinically lead to both an increase in edema and a worsening of the hyponatremia. Treatment of hypo- and hypernatremia must be adjusted separately for each patient based on his age, presence of comorbid conditions, and the speed of development of the severity of clinical signs and symptoms. Adjustments either executed too slowly or too quickly will increase mortality or morbidity. For every patient presenting unexplained symptoms of the muscular, skeletal, or neurological systems, including confusion, making the first priority the conduction of electrolyte analyses and the correctly managed effective treatment of excesses or deficiencies may save lives and will certainly save time and money that would otherwise have been spent unnecessarily.

The present study was carried out in the department of Neurology and Medicine, Mymensingh Medical College Hospital, Bangladesh during the period of January 2009 to December 2010 to see the electrolyte changes in stroke. The serum concentration of Na⁺, K⁺, and Cl⁻ were measured in 110 cases during acute period of stroke (55 ischemic and 55 haemorrhagic strokes). Data were analyzed by computer with SPSS programme using 't' test and chi square test. In haemorrhagic stroke, out of 55 patients 29(52.72%) had abnormal sodium level, of them 23(41.8%) had hyponatremia, 6(10.9%) had hypernatremia. In contrast in ischemic stroke 23(41.80%) out of 55 had abnormal sodium level, of them 21(38%) had hyponatremia. The result showed that hyponatremia is almost equally common in both haemorrhagic and ischaemic group without significant difference (p>0.05). The study also revealed that hyponatremia is more common than hypernatremia in both groups. Mean ± SD of age of the haemorrhagic group was 60.80 ± 15.97 while the age of ischaemic group was 59.89 ± 15.84 years. Male, female ratio in haemorrhagic and ischaemic group 1:0.62 and 1:0.89 respectively. Mean ± SD of serum Na⁺, K⁺, Cl⁻ in haemorrhagic group were 136.18 ± 10.5, 3.83 ± 0.65, 97.96 ± 16.74 mmol/L, in ischaemic group 135.08 ± 9.08, 4.00 ± 0.75, 100.27 ± 8.39 mmol/L. The result showed no significant difference in haemorrhagic and ischemic stroke. Hyponatremia, hypokalamia and hyperchloredemia were more common than hypernatremia, hyperkalamia and hyperchloredemia. In haemorrhagic stroke, out of 55 patients, 21(38.18%) had abnormal potassium level, of them 19(34.55%) had hypokalemia, 2(3.63%) had hyperkalemia. In contrasts, in ischemic stroke, 15 out of 55(27.22%) had abnormal potassium level. Of them 12(21.81%) had hypokalemia and 3(5.45%) had hyperkalemia. The finding showed that hypokalemia is almost equally common in both haemorrhagic and ischaemic group without significant difference. The study also revealed that hypokalemia is more common than hyperkalemia in both groups. In haemorrhagic stroke, out of 55 patients 33(60%) had abnormal chloride level. Of them 20(36.4%) had hypochrloridemia, 13(23%) had hyperchrloridemia, in contrast, in ischemic stroke, 40 out of 55(60%) had abnormal chloride level, of them 22(40%) had hypochrloridemia and 18(32.7%) had hyperchrloridemia. The result showed that changes in chloride level after haemorrhagic and ischemic stroke are similar. The result showed hypochrloridemia is more common than hyperchrloridemia in both groups.

Because of the potential side effects of heparin, methods of regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) have been gaining wider acceptance with the development of simplified and safer protocols. Advantages of RCA include the avoidance of systemic anticoagulation and heparin-induced thrombocytopenia. The disadvantage is that citrate can add complexity and labor intensity to CRRT. Frequent monitoring of electrolytes, ionized calcium, and acid-base status is required, due to the potential for hypernatremia, metabolic alkalosis, and systemic ionized hypocalcemia. If properly monitored, complications associated with RCA are uncommon. A variety of methods of delivering RCA are described in the literature. Overall, studies of RCA, as compared to unfractionated heparin, report better filter survival times and less bleeding. In this section, we summarize the characteristics of citrate as an anticoagulant and provide an update of citrate use in CRRT.

Thyroid hormone is a central regulator of body functions. Disorders of thyroid function are considered to be a cause of electrolyte disorders. Only few data on the association between thyroid function and electrolyte disorders exists.In the present retrospective analysis data from all patients admitted to the Department of Emergency Medicine of a university hospital who had measurements of thyroid function (TSH, fT(3), fT(4)) and electrolytes were included.9,012 patients with measurement of TSH and electrolytes were available. 86% of patients had normal, 4% suppressed and 10% elevated TSH. Serum sodium was significantly lower in patients with high TSH levels (p <0.01). There was a significant correlation between serum TSH and phosphate level (p <0.05). Phosphate levels were higher in patients with elevated TSH than in patients with normal TSH (p <0.01). Serum calcium and magnesium correlated significantly with TSH (p <0.05). fT(3) levels correlated significantly with calcium (p <0.05). Hyponatraemia was present in 14% of patients with high TSH and was significantly more common than in the group with normal TSH levels of which 9% had hyponatraemia (p <0.01). Hypokalaemia was more common in the group with elevated TSH than in those with normal TSH (14 versus 11%, p = 0.016). Hyperkalaemia was more common in the group with high TSH levels (7%) than in those with normal TSH (7 vs. 4%, p <0.01).An association between thyroid function and electrolyte disorders seems to exist, although it is probably only relevant in marked hypo-/hyperthyroidism.

This study was carried out to investigate the effect of Aloe vera extract (AvE) on serum electrolytes, urea, and creatinine as indices of renal function in Sprague-Dawley rats. Twelve male Sprague-Dawley rats weighing between 80 and 130 g were used. Rats were divided into two groups: The control and the test groups (n=6). The test group received 1 ml of AvE daily for 28 days. Both the groups fed on standard rat chow and water ad libitum. The results showed a decrease in serum levels of sodium, and potassium, but an increase in the serum levels of bicarbonate, urea, and creatinine in the test group. The changes seen were, however, statistically insignificant, except for the serum levels of sodium and creatinine (P<0.05). It is thus concluded that AvE impairs renal handling of electrolytes with consequent hyponatremia and hypercreatinemia. However, this might be of therapeutic value in conditions associated with hypernatremia.

Understanding hypernatremia is at times difficult for many clinicians. However, hypernatremia can often be deciphered easily with some basic understanding of water and sodium balance. Here, the basic pathophysiological abnormalities underlying the development of sodium disorders are reviewed, and case examples are given. Hypernatremia often arises in the hospital, especially in the intensive care units due to the combination of (1) not being able to drink water; (2) inability to concentrate the urine (most often from having kidney failure); (3) osmotic diuresis from having high serum urea concentrations, and (4) large urine or stool outputs.