Sodium results for urine with the Beckman electrolyte 2 ion-selective electrolyte analyzer are dependent on potassium concentration.
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Water and electrolyte changes in skeletal and cardiac muscles of rats during prolonged hypokinesia.
The objective of this study was to show that hypokinesia (diminished movement) could affect differently water and electrolyte content in muscles having minimum differences in their function and morphology. To this end, we studied water and electrolyte content in skeletal and cardiac muscles, fluid excretion, electrolyte absorption, and electrolyte levels in plasma, urine and feces of rats during prolonged hypokinesia (HK). Studies were conducted on one-hundred-twenty-six 13-weeks old male Wister rats during a pre-hypokinetic period and a hypokinesia period. Animals were equally divided into two groups: vivarium control rats (VCR) and hypokinetic rats (HKR). Hypokinetic animals were kept in small individual cages which restricted their movements in all directions without hindering food and water intake. Control rats were housed in individual cages under vivarium control conditions. Sodium (Na+) and potassium (K+) absorption, electrolyte and water content in cardiac muscles (right and left ventricle), thigh extensor (quadriceps femoris muscle) and long muscle of the back (biceps femoris muscle), urine volume, and electrolyte levels in plasma and urine and feces did not change in VCR when compared to their pre-hypokinetic levels. The absorption of Na+ and K+, water and electrolyte content in cardiac and skeletal muscles decreased significantly, while urine volume, plasma electrolyte levels and urine and fecal electrolyte excretion increased significantly in HKR compared with their pre-HK values and with their respective vivarium control (VCR). Water and electrolyte content decreased more significantly in skeletal than in cardiac muscles. Water and electrolyte levels decreased more in the thigh extensor and in the right ventricle than in the long muscle of the back, the left ventricle or the septum. Muscles suffering from higher water and electrolyte loss against the background of lower water and electrolyte content show lower water and electrolyte deposition. Lower electrolyte and water content in skeletal than in cardiac muscle shows that water and electrolyte content decreases more in skeletal than cardiac muscles. Skeletal muscle showed lower water and electrolyte content than cardiac muscle indicating that the risk for decreased muscle water and electrolyte content is inversely related to the muscle function and morphology, i.e., the more weight-bearing supporting function and morphology muscles have, the higher the risk for lower muscle water and electrolyte content. It was concluded that the greater muscle function and morphology, the lower electrolyte and water deposition, the higher water and electrolyte losses, and the lower water and electrolyte content.
Animals↗
Stunting syndrome in broilers: effect of electrolytes in drinking water on performance and intestinal glucose transport.
Posthatched naive or inoculated male broiler chicks were kept in separate rooms. An inoculum was prepared from intestines of stunting-syndrome affected broiler chicks. Tap water was supplied from 2 L cups, 1 cup per pen. In the Ist experiment, the naive chicks were provided with tap water only and the inoculated ones had free access to tap water or to an electrolyte solution. In the 2nd experiment, the naive and inoculated birds had free access to water in addition to an electrolyte solution. Supplementation was provided up to 3 weeks of age; thereafter all chicks had access to tap water only. Water or electrolyte consumption and body weight (BW) were determined. Total water intake of inoculated chicks was higher than that of naive counterparts (P<0.001). Electrolyte supplementation increased drinking (P<0.001) in inoculated birds more than in naive ones. At 1 week old the weight of the inoculated birds was about 64% of the weight of naive ones; at the age of 4 and 6 weeks it was about 74% and 86% respectively. Compensatory growth was most apparent in the inoculated chicks provided with electrolyte solution. At the age of 6 weeks, the latter exceeded the BW of the exclusively water supplied counterparts by 327 g. Electrolyte supplementation up to the age of 3 weeks had no effect on the naive counterparts. Osmolality was reduced slightly, but very significantly by inoculation; electrolyte supply had no effect on this variable. Sodium concentration in the plasma was higher in the inoculated birds. Plasma albumin was markedly reduced by inoculation on weeks 1 and 2. Whereas the inoculated chicks supplied with electrolytes resumed the level plasma albumin level of the naive chicks on week 3, an over-compensation occurred in the inoculated-water-supplied (IW) group, and they surpassed the naive chicks significantly. Blood hematocrit increased significantly with age; inoculation, age and/or electrolyte supplementation had no effect on this variable. Sodium-dependent glucose transport rates were enhanced in vesicles obtained from inoculated chicks as compared to naive ones. While electrolyte supplementation had no effect on glucose active transport in naive chicks, electrolyte supplementation decreased rates of glucose active transport in inoculated ones. These data demonstrate that electrolyte supplementation during the early age may be used to enhance the tolerance of broiler chicks to stunting-syndrome by improving food and water consumption, and subsequently growth rate during and after cessation of electrolyte supply.
Animals↗
Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study.
INTRODUCTION: Electrolyte disorders are an important cause of ventricular and supraventricular arrhythmias as well as various other complications in the intensive care unit. Patients undergoing cardiac surgery are at risk for development of tachyarrhythmias, especially in the period during and immediately after surgical intervention. Preventing electrolyte disorders is thus an important goal of therapy in such patients. However, although levels of potassium are usually measured regularly in these patients, other electrolytes such as magnesium, phosphate and calcium are measured far less frequently. We hypothesized that patients undergoing cardiac surgical procedures might be at risk for electrolyte depletion, and we therefore conducted the present study to assess electrolyte levels in such patients. METHODS: Levels of magnesium, phosphate, potassium, calcium and sodium were measured in 500 consecutive patients undergoing various cardiac surgical procedures who required extracorporeal circulation (group 1). A total of 250 patients admitted to the intensive care unit following other major surgical procedures served as control individuals (group 2). Urine electrolyte excretion was measured in a subgroup of 50 patients in both groups. RESULTS: All cardiac patients received 1 l cardioplegia solution containing 16 mmol potassium and 16 mmol magnesium. In addition, intravenous potassium supplementation was greater in cardiac surgery patients (mean +/- standard error: 10.2 +/- 4.8 mmol/hour in cardiac surgery patients versus 1.3 +/- 1.0 in control individuals; P < 0.01), and most (76% versus 2%; P < 0.01) received one or more doses of magnesium (on average 2.1 g) for clinical reasons, mostly intraoperative arrhythmia. Despite these differences in supplementation, electrolyte levels decreased significantly in cardiac surgery patients, most of whom (88% of cardiac surgery patients versus 20% of control individuals; P < 0.001) met criteria for clinical deficiency in one or more electrolytes. Electrolyte levels were as follows (mmol/l [mean +/- standard error]; cardiac patients versus control individuals): phosphate 0.43 +/- 0.22 versus 0.92 +/- 0.32 (P < 0.001); magnesium 0.62 +/- 0.24 versus 0.95 +/- 0.27 (P < 0.001); calcium 1.96 +/- 0.41 versus 2.12 +/- 0.33 (P < 0.001); and potassium 3.6 +/- 0.70 versus 3.9 +/- 0.63 (P < 0.01). Magnesium levels in patients who had not received supplementation were 0.47 +/- 0.16 mmol/l in group 1 and 0.95 +/- 0.26 mmol/l in group 2 (P < 0.001). Urinary excretion of potassium, magnesium and phosphate was high in group 1 (data not shown), but this alone could not completely account for the observed electrolyte depletion. CONCLUSION: Patients undergoing cardiac surgery with extracorporeal circulation are at high risk for electrolyte depletion, despite supplementation of some electrolytes, such as potassium. The probable mechanism is a combination of increased urinary excretion and intracellular shift induced by a combination of extracorporeal circulation and decreased body temperature during surgery (hypothermia induced diuresis). Our findings may partly explain the high risk of tachyarrhythmia in patients who have undergone cardiac surgery. Prophylactic supplementation of potassium, magnesium and phosphate should be seriously considered in all patients undergoing cardiac surgical procedures, both during surgery and in the immediate postoperative period. Levels of these electrolytes should be monitored frequently in such patients.
Adult↗
Treatment of electrolyte disorders in adult patients in the intensive care unit.
PURPOSE: The treatment of electrolyte disorders in adult patients in the intensive care unit (ICU), including guidelines for correcting specific electrolyte disorders, is reviewed. SUMMARY: Electrolytes are involved in many metabolic and homeostatic functions. Electrolyte disorders are common in adult patients in the ICU and have been associated with increased morbidity and mortality, as has the improper treatment of electrolyte disorders. A limited number of prospective, randomized, controlled studies have been conducted evaluating the optimal treatment of electrolyte disorders. Recommendations for treatment of electrolyte disorders in adult patients in the ICU are provided based on these studies, as well as case reports, expert opinion, and clinical experience. The etiologies of and treatments for hyponatremia hypotonic and hypernatremia (hypovolemic, isovolemic, and hypervolemic), hypokalemia and hyperkalemia, hypophosphatemia and hyperphosphatemia, hypocalcemia and hypercalcemia, and hypomagnesemia and hypermagnesemia are discussed, and equations for determining the proper dosages for adult patients in the ICU are provided. Treatment is often empirical, based on published literature, expert recommendations, and the patient's response to the initial treatment. Actual electrolyte correction requires individual adjustment based on the patient's clinical condition and response to therapy. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders in order to provide the optimal therapy to patients. CONCLUSION: Treatment of electrolyte disorders is often empirical, based on published literature, expert opinion and recommendations, and patient's response to the initial treatment. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders to provide optimal therapy for patients.
Adult↗
The effects of dietary minerals and electrolytes on the growth and physiology of the young chick.
The effects of the mineral elements, calcium and available phosphorus (aP), and the electrolytes, sodium, potassium and chloride in the diet on the growth and physiology of male broiler-type chickens were investigated. The concepts of total dietary cation-anion and electrolyte (Na + K - Cl, meq/kg) balance were compared for their ability to describe observed growth and various parameters to 42 d of age. There were 12 dietary treatments; each was given to four replicates of 32 birds housed in a deep-litter, environmentally controlled shed. Diets were nutritionally adequate and were based on practical ingredients. Total cation-anion balance was varied from 327 to 700 meq/kg and electrolyte balance, from -29 to 553 meq/kg. Results showed that total dietary cation-anion balance did not describe the growth of chickens as well as electrolyte balance. Low (less than 180 meq/kg) or high (greater than 300 meq/kg) electrolyte balance in a diet led to depressed liveweight at 42 d of age. There was an optimum electrolyte balance from 250 to 300 meq/kg. The extent of liveweight depression from feeding diets with an electrolyte balance greater than 300 meq/kg depended on the type of cation added to the diet (Na or K): the range of the Na:K ratio for optimum growth was 0.5-1.8. Acid-base balance was influenced mainly by a diet with a low electrolyte balance (-29 meq/kg). Plasma ion levels (Ca, inorganic P, Mg, Na, K, Cl) were unaffected by dietary treatment, except that high dietary calcium reduced plasma inorganic P levels. Increasing calcium from 1.30 to 1.74% reduced liveweight at 42 d of age by 5%, but subsequent increases up to 2.30% Ca had relatively minor effects. Liveweight tended to be lower for birds fed a diet containing 1.30% Ca and 0.81% aP compared to 0.45% aP with 1.30% Ca. Total cation-anion balance cannot be used in preference to dietary electrolyte balance to describe growth of broiler chickens. However, even though there was a good relationship between growth and dietary electrolyte balance, there were specific cation effects (Na and K) independent of electrolyte balance.
Acid-Base Equilibrium↗
Distinct difference in ionic transport behavior in polymer electrolytes depending on the matrix polymers and incorporated salts.
Two different electrolyte salts, lithium bis(trifluoromethanesulfonyl)imide (LiTFSI), and a room temperature ionic liquid, 1-ethyl-3-methylimidazolium bis(trifluoromethanesulfonyl)imide (EMITFSI), were incorporated into network polymers to obtain ion-conductive polymer electrolytes. Network polymers of poly(ethylene oxide-co-propylene oxide) (P(EO/PO)) and poly(methyl methacrylate) (PMMA) were chosen as matrixes for LiTFSI and EMITFSI, respectively. Both of the polymer electrolytes were single-phase materials and were completely amorphous. Ionic conductivity of the polymer electrolytes was measured over a wide temperature range, with the lowest temperatures close to or below the glass transition temperatures (Tg). The Arrhenius plots of the conductivity for both of the systems exhibited positively curved profiles and could be well fit to the Vogel-Tamman-Fulcher (VTF) equation. The conductivity of the PMMA/EMITFSI electrolytes was higher at most by 3 orders of magnitude than that of the LiTFSI/P(EO/ PO) electrolytes at ambient temperature. When the ideal glass transition temperature, T0 (one of the VTF fitting parameters), was compared with the Tg, a difference in the ionic conduction was apparent in these systems. In the P(EO/PO)/LiTFSI electrolytes, the T0 and Tg increased in parallel with salt concentration and the T0 was lower than the Tg by ca. 50 degrees C. On the contrary, the difference between the T0 and the Tg increased with increasing content of PMMA in the PMMA/EMITFSI electrolytes, with the observed difference in the concentration range studied reaching up to ca. 100 degrees C. The conductivity at the Tg, sigma(Tg), for the LiTFSI/P(EO/PO) electrolytes was on the order of 10(-14-)10(-13) S cm(-1) and increased with increasing salt concentration, whereas that for the PMMA/EMITFSI polymer electrolytes reached 10(-7) S cm(-1) when the concentration of PMMA was high. The ion transport mechanism was discussed in terms of the concepts of coupling/decoupling and strong/fragile for the two different polymer electrolytes.
Journal Article↗
Effect of oral administration of electrolyte pastes on rehydration of horses.
OBJECTIVE: To determine whether the composition of electrolyte pastes formulated for oral administration influences voluntary water intake (WI) by horses recovering from furosemide-induced dehydration. ANIMALS: 6 horses. PROCEDURES: Voluntary WI, body weight, and blood and urine constituents were measured before and after induction of dehydration by furosemide administration and overnight withholding of water; these same variables also were measured during a 36-hour rehydration period. Each horse was evaluated 4 times with random application of 4 treatments (electrolyte pastes) that provided 0.5 g of KCl/kg of body weight, 0.5 g of NaCl/kg, 0.25 g of NaCl and 0.25 g of KCl/kg, or no electrolytes (control treatment). Electrolyte pastes were administered 3 times (4, 8, and 12 hours after start of the rehydration period). RESULTS: Administration of all electrolyte pastes resulted in significantly greater voluntarily WI, compared with the control treatment, and was accompanied by significantly greater recovery of body weight when NaCl was a component of the paste. Administration of NaCl and NaCl-KCl pastes tended to produce a state of transient hyperhydration; however, electrolyte administration also resulted in significantly greater urine production and electrolyte excretion during the final 24 hours of the rehydration period. Adverse effects of oral administration of hypertonic electrolyte pastes were not observed. CONCLUSIONS AND CLINICAL RELEVANCE: Oral administration of electrolyte pastes to dehydrated horses increases voluntary WI and improves rehydration during the rehydration period. Rehydration is more rapid and complete when NaCl is a component of the electrolyte paste.
Animals↗
Effect of glutamine or glycine containing oral electrolyte solutions on mucosal morphology, clinical and biochemical findings, in calves with viral induced diarrhea.
Twenty-one diarrheic calves were randomly assigned to 1 of 3 oral electrolyte treatments. The treatments were either a conventional oral electrolyte containing glycine (40 mmol/L) as the amino acid, an oral electrolyte in which glutamine (40 mmol/L) replaced glycine or an electrolyte in which high concentrations of glutamine (400 mmol/L) replaced glycine. The calves were monitored while on trial and at the end of the treatment they were euthanized and a necropsy was immediately performed. Calves fed the high glutamine electrolyte had more treatment failures (2/7 versus 0/7 for each of the other 2 treatments). There was a significant effect of type of electrolyte on fecal consistency. Calves fed the glycine containing electrolyte had the most solid feces. Duodenal villus height was significantly affected by the type of electrolyte: values (mean +/- 1 SEM) were 0.61 +/- 0.09, 0.46 +/- 0.05, and 0.59 +/- 0.07 mm for high glutamine, low glutamine and glycine electrolytes respectively. There was no significant difference in small intestinal surface area between groups. High glutamine treated calves had the greatest capacity to absorb xylose from the small intestine but this difference was not statistically significant. Overall, this trial does not suggest that substituting glutamine for glycine in oral electrolyte solutions improves treatment of diarrheic calves or speeds mucosal healing.
Animals↗
Effect of cation and anion of an electrolyte on apparent molar volume, isentropic compressibility and refractive index of glycine in aqueous solutions.
Experiments at 298.15 K have been performed to measure the density, velocity of sound and refractive index in three water+glycine+electrolyte systems. The electrolytes studied were KCl, KNO3 and NaNO3. The values of apparent molar volume and isentropic compressibility of glycine in aqueous electrolyte solutions were calculated from the measured data. The results obtained in this study and those reported previously for water+glycine+NaCl system have been comparatively studied. The results show that the nature of both the cation and the anion of an electrolyte influence the behaviour of glycine in aqueous solutions. For all four electrolytes studied, the comparison shows a positive volume transfer for glycine from an electrolyte solution to a more concentrated solution of the same electrolyte. The results also show a negative apparent isentropic compressibility for glycine in the presence of the electrolytes studied. These effects indicate that the volume of a glycine molecule is larger in solutions with higher electrolyte concentration and the water molecules around the glycine molecules are less compressible than the water molecules in the bulk solution. These effects were attributed to the doubly charged behaviour of glycine and to the formation of physically bonded ion-pairs between the charged groups of glycine and the cation and the anion of the electrolyte.
Journal Article↗
Effects of electrolyte and glycerol supplementation on recovery from endurance exercise.
Incomplete recovery from endurance exercise after an overnight rest period is reflected by persisting weight loss and an elevated plasma aldosterone concentration, even in successful competitors. To determine whether supplementation with high doses of electrolytes, with or without glycerol, enhances recovery, the following were measured in 6 Arabian horses before and after completion of a 60 km treadmill exercise test simulating an endurance ride and after 12, 24, 48, and 72 h of recovery: bodyweight; plasma osmolality; plasma concentrations of protein, electrolytes, aldosterone and cortisol; and urine and faecal electrolyte concentrations. Before and during the exercise test, horses were supplemented with a total of 2.4 ml/kg bwt of water (W); 0.2 g/kg bwt KCl and 0.4 g/kg bwt NaCl in 2.4 ml/kg bwt of water (E); or 0.2 g/kg bwt KCl and 0.4 g/kg bwt NaCl in 2.4 ml/kg bwt (3 g/kg bwt) of glycerol (GE). Although weight loss after completion of the simulated ride was greater (P < 0.01) for W (3.2%) than for E and GE (1.0 and 0.9%, respectively), horses supplemented with E or GE experienced further weight loss by 24 h after the simulated ride (2.2 and 2.1% for E and GE, respectively) while bodyweight with W remained unchanged (3.0%) from the finish value. After 48 h of recovery, bodyweight was not different from the starting values with E and GE but remained decreased (P < 0.01) with W throughout the recovery period (2.2% persisting weight loss after 72 h of recovery). Plasma osmolality and plasma Na+ and Cl- concentrations increased (P < 0.01) and plasma protein concentration decreased (P < 0.01) after the exercise test with E and GE but were unchanged with W. Plasma osmolality and protein and electrolyte concentrations returned to pre-exercise values within 12 h of recovery with the exception of a persistent increase in plasma Na+ concentration with GE. The greatest plasma aldosterone concentration was measured after 12 h of recovery with W (1357 pmol/l) and was greater (P < 0.02) than that with E and GE (24 and 304 pmol/l, respectively). Urine production during the simulated ride increased (P < 0.01) with GE and resulted in loss of approximately 20% and essentially 100% of supplemented Na+ and K+, respectively. In contrast, electrolyte losses in faeces were unaffected by electrolyte or glycerol supplementation. In conclusion, supplementation with high doses of electrolytes as hypertonic oral pastes attenuated weight loss during a simulated endurance ride (by enhancing voluntary water intake); however, it did not prevent development of significant weight loss during the initial 24 h of recovery. Glycerol administration resulted in no benefits, and actually increased urine electrolyte losses, in comparison to supplementation with electrolytes alone.
Animal Feed↗
Rational ordering of serum electrolytes: development of clinical criteria.
The purpose of this study was to determine the frequency of electrolyte abnormalities in emergency department patients, to assess the proportion of these abnormalities affecting patient outcome, and to develop a set of clinical criteria to allow selective ordering of serum electrolytes. The ordering physicians completed questionnaires describing the clinical presentations of 1,031 patients on whom electrolytes were requested. For every patient with abnormal electrolyte values, the chart was reviewed to ascertain whether this was a clinically significant electrolyte abnormality (CSEA). The clinicians' responses to the questionnaires were used to construct a clinical criteria set predictive of CSEAs. Five hundred forty-five patients (52.9%) had one or more abnormal electrolytes, but only 161 patients (15.6%) had CSEAs. A set of ten clinical criteria detected 159 of 161 CSEAs (98.8% sensitivity) and would have avoided the ordering of electrolytes in 262 cases (29.9% specificity). At a cost to the patient of $20 per set of electrolytes ordered, detection of 159 CSEAs using the clinical criteria would cost $96.73 per CSEA detected. Detection of the additional two CSEAs by ordering electrolytes on all patients in the series would cost an additional $5,240. If the accuracy of these clinical criteria is confirmed in other settings, they may be useful guidelines for reducing laboratory charges without compromising patient care.
Adolescent↗
The usefulness of serum electrolytes in the evaluation of acute adult gastroenteritis.
Acute gastrointestinal disorders are among the most common problems encountered by the emergency physician. Serum electrolytes are commonly ordered in the evaluation of patients with gastroenteritis. We retrospectively reviewed the charts of all 281 patients with a discharge diagnosis of acute gastroenteritis seen in our emergency department during a recent six-month period. Electrolytes were ordered on 207 of these patients, and the time spent in the ED was three to four times longer for patients on whom electrolytes were ordered. Of these 207, 24 (11%) had electrolyte abnormalities, but only two (1%) had clinically significant electrolyte abnormalities, which were defined as values that affected patient treatment or disposition. On presentation, 56 patients (27%) had orthostatic vital sign changes (defined as a pulse increase of 30 or more on standing). Five (10%) had electrolyte abnormalities. None of the abnormalities were clinically significant. Eleven patients (5%) were hospitalized. One patient had electrolyte abnormalities that were not the cause of hospitalization. No patients with uncomplicated gastroenteritis alone had clinically significant electrolyte abnormalities. We conclude that there is no justification for the routine ordering of serum electrolytes on the adult patient with acute gastroenteritis.
Acute Disease↗
Electrolyte disturbances in patients with chronic, stable asthma: effect of therapy.
OBJECTIVE: To determine the prevalence of electrolyte disturbances in patients with chronic, stable asthma, and to assess whether the therapeutic agents used to treat chronic asthma have an effect on abnormal electrolyte levels. DESIGN: Prospective, hospital-based, cross-sectional study. SETTING: University teaching hospital in Jeddah, Saudi Arabia. PATIENTS: Patients with chronic, stable asthma. METHOD: Ninety-three consecutive patients with chronic, stable asthma were involved in the study. On the day of the visit to the asthma clinic, particulars such as age, sex, duration of asthma, and details of drug therapy were obtained from each asthmatic patient. Serum potassium, magnesium, phosphorus, calcium, and sodium levels were measured. Normal values were as follows: potassium, 3.5 to 5 mmol/L; magnesium, 0.74 to 1.2 mmol/L; phosphorus, 0.8 to 1.4 mmol/L; and calcium, 2.1 to 2.6 mmol/L. RESULTS: Electrolyte disturbances were found in 43% of the patients; 85% of the patients had one electrolyte disturbance, 10% had two electrolyte disturbances, and 5% had three electrolyte disturbances. The highest proportions were for magnesium (26.9%) and phosphorus (15.1%) [serum levels were 0.69 +/- 0.04 mmol/L and 0.64 +/- 0.09 mmol/L, respectively], the lowest proportions were for potassium (5.4%) and sodium (4.3%) [serum levels were 3.3 +/- 0.01 mmol/L and 133 +/- 0.01 mmol/L, respectively], and no patient had a calcium disturbance. Logistic regression analysis showed no statistically significant association between the therapy used and electrolyte disturbances. CONCLUSION: Hypomagnesemia and hypophosphatemia were found to be the two most common electrolyte disturbances in patients with chronic, stable asthma. Therapeutic agents used to treat patients with chronic asthma have no effect on abnormal electrolyte levels. The underlying cause still remains unclear.
Adult↗
Electrolyte and acid-base disturbances in the management of leukemia.
Electrolyte disturbances in leukemia can be the result of the disease process or drug therapy. One group of electrolyte abnormalities is related to the stage of the leukemic process. Included in this group are newly diagnosed patients who may show elevated serum potassium, phosphorus, and magnesium--a result of their release from malignant cells after cytotoxic therapy or their accumulation due to urate nephropathy. Patients in remission usually have normal serum electrolyte concentrations, but acute leukemia patients during relapse may have hypokalemia, hypophosphatemia, and hypomagnesemia. This imbalance may be related to cellular uptake of these electrolytes in the presence of inadequate dietary intake. Other factors contributing to electrolyte derangements, and related to the leukemic process, include hyponatremia and hypochloremia secondary to the SIADH, hypokalemia in acute monocytic or acute myelomonocytic leukemia due to lysozyme-induced tubular damage, hypercalcemia possibly secondary to leukemic infiltration of bone or parathyroid glands (with PTH release), or production of a PTH-like substance by leukemic cells. Nonspecific factors related to the disease process which may aggravate the electrolyte imbalance include gastrointestinal loss through nausea, vomiting, and malnutrition. The drug-related electrolyte abnormalities include cyclophosphamide- and vincristine-induced SIADH; decreased serum sodium, chloride, potassium, and calcium concentrations as a result of polymyxin B nephrotoxicity; hypokalemia and hypomagnesemia secondary to amphotericin B; hypocalcemia, hypophosphatemia, and hyperphosphaturia due to L-asparaginase-induced hypoparathyroidism; hypokalemia due to a nonreabsorbable anion effect of antibiotics in the distal tubule or changes in membrane ionic transport of all cells by large doses of antibiotics. Electrolyte disturbance in leukemia thus have a multifactorial pathogenesis which can best be delineated according to the stage of the leukemic process and the drugs being used. Recognition of the cause or causes in a particular patient is essential for an effective approach to management. This review emphasizes the need for routine measurement of serum electrolytes during all phases of the leukemic process.
Acid-Base Imbalance↗
Electrolyte addition to nonionic contrast media. Cardiac effects during experimental coronary arteriography.
Although the incidence of serious adverse effects is low during clinical coronary arteriography, life-threatening cardiovascular complications occasionally occur. Ventricular fibrillation (VF) is most often seen during contrast media (CM) injection through a wedged catheter. A simulated wedged catheter model in dogs has therefore been developed. Further, patients with heart failure are at greater risk for CM-related side effects during coronary arteriography. Thus, an acute ischemic heart failure model has been used. The present thesis was designed to investigate the cardiac electrophysiologic and hemodynamic effects of CM during selective coronary arteriography in normal and failing hearts, and in particular the role of electrolyte addition to nonionic CM. The risk of spontaneously induced VF and the arrhythmogenic mechanisms were studied when using iso-osmolal and low-osmolal CM having different contents of electrolytes, and after pretreatment with antiarrhythmic drugs. Further, effects of adding electrolytes to nonionic CM during single and fast repeated injections in normal and failing hearts were studied. Also possible effects of oxygenating CM were studied. CM injection in a wedged catheter situation had a high risk for VF. Probably, VF was due to induced regional electrophysiologic changes in ventricular activation and repolarization. Pretreatment with antiarrhythmic drugs did not prevent VF. However, addition of low concentrations of electrolytes to nonionic CM reduced the risk for VF in a wedged catheter situation. The results indicate that side-effects of CM during coronary arteriography are related mainly to the passive washout of cardiac electrolytes. Electrolyte shifts during coronary arteriography may change the myocardial Na/Ca balance and cellular calcium control. The nonionic, iso-osmolal CM iodixanol, with a balanced content of sodium and calcium and the low-osmolal, nonionic CM iohexol, also with a balanced content of electrolytes, had about the same low risk for inducing VF and presented a much lower risk for inducing VF than did iohexol and ioxaglate in a wedged catheter situation. Single injection of iohexol with a balanced eletrolyte addition induced only minimal electro-physiologic changes and was well tolerated hemodynamically. Repeated intracoronary CM injections during ischemic heart failure were associated with similar additive electrophysiologic and hemodynamic changes as when using iohexol without electrolyte supplement. Oxygenated and nonoxygenated CM presented the same risk for inducing VF. Only minor electrophysiologic and hemodynamic differences could be detected during wedged catheter injection. In conclusion, addition of key electrolytes to nonionic CM can reduce the risk of cardiac complications during coronary arteriography. Oxygenation of CM does not seem to significantly further reduce the risk.
Animals↗
Effects of Electrolytes on the Transport Phenomena in a Cation-Exchange Membrane.
The effect of electrolyte solutions on the characteristics of the current-voltage (I-V) curve in a cation-exchange membrane (CMX membrane, Tokuyama Soda, Inc.) was studied based on the concentration polarization and electroconvection theory. The study includes the limiting current density (LCD), plateau length, and the ratio of resistance of region III to region I of the I-V curve (R(3rd)/R(1st)). Different electrolyte solutions, HCl, LiCl, NaCl, KCl, CaCl(2), MgCl(2), and AlCl(3), were used in this study. The LCD values of the electrolytes were correlated with the diffusion coefficient of the cation (D(+)) and valence of the cation and anion (z(+), z(-)). Except for the HCl solution, the LCD values of the electrolytes increased linearly with D(+)(1-z(+)/z(-)), implying that the current in this region was governed by the concentration polarization phenomena. The deviation of the HCl solution from the linearity is due to a particular transport mechanism of the proton called the Grotthuss-type transport. The differences in the plateau length and the resistance ratio, R(3rd)/R(1st), with the electrolytes were explained by the Péclet number (Pe) representing a transport pattern in the electroconvection theory. The Péclet number is proportional to the Stokes radius of an ion. An electrolyte with a large Stokes radius has a shorter plateau length and a lower ratio of R(3rd)/R(1st) than those of an electrolyte with a small Stokes radius. Water-splitting measurements for the different electrolyte solutions in the CMX membrane revealed that the contribution of water splitting to the overlimting current was insignificant regardless of the electrolytes used in this study. However, when metal hydroxides, such as Al(OH)(3), formed on the surface of the membrane, significant water splitting was observed. Copyright 2001 Academic Press.
Journal Article↗
In-situ FTIR investigations on the reduction of vinylene electrolyte additives suitable for use in lithium-ion batteries.
Lithium-ion batteries operate beyond the thermodynamic stability of the aprotic organic electrolyte used and electrolyte decomposition occurs at both electrodes. The electrolyte must therefore be composed in a way that its decomposition products form a film on the electrodes which stops the decomposition reactions but is still permeable to the Li(+) cations which are the charge carriers. At the graphite anode, this film is commonly referred to as a solid electrolyte interphase (SEI). Aprotic organic compounds containing vinylene groups can form an effective SEI on a graphitic anode. As examples, vinyl acetate (VA) and acrylonitrile (AN) have been investigated by in-situ Fourier transform infrared (FTIR) spectroscopy in a specially developed IR cell. The measurements focus on electrolyte decomposition and the mechanism of SEI formation in the presence of VA and AN. We conclude that cathodic reduction of the vinylene groups (i.e., via reduction of the double bond) in the electrolyte additives is the initiating and thus a most important step of the SEI-formation process, even in an electrolyte which contains only a few percent (i.e. electrolyte additive amounts) of the compound. The possibility of electropolymerization of the vinylene monomers in the battery electrolytes used is critically discussed on the basis of the IR data obtained.
Journal Article↗