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Serum Electrolytes (serum + electrolyte)
Selected AbstractsNecrotizing fasciitis: delay in diagnosis results in loss of limbINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2006Rajat Varma MD A 58-year-old man presented to the Emergency Room with a 1-day history of severe pain in the left lower extremity preceded by several days of redness and swelling. He denied any history of trauma. He also denied any systemic symptoms including fever and chills. His past medical history was significant for diabetes, hypertension, deep vein thrombosis, and Evans' syndrome, an autoimmune hemolytic anemia and thrombocytopenia, for which he was taking oral prednisone. Physical examination revealed a warm, tender, weeping, edematous, discolored left lower extremity. From the medial aspect of the ankle up to the calf, there was an indurated, dusky, violaceous plaque with focal areas of ulceration (Fig. 1). Figure 1. Grossly edematous lower extremity with well-demarcated, dusky, violaceous plaque with focal ulceration Laboratory data revealed a white blood cell count of 6.7 × 103/mm3[normal range, (4.5,10.8) × 103/mm3], hemoglobin of 11.5 g/dL (13.5,17.5 g/dL), and platelets of 119 × 103/mm3[(140,440) × 103/mm3]. Serum electrolytes were within normal limits. An ultrasound was negative for a deep vein thrombosis. After the initial evaluation, the Emergency Room physician consulted the orthopedic and dermatology services. Orthopedics did not detect compartment syndrome and did not pursue surgical intervention. Dermatology recommended a biopsy and urgent vascular surgery consultation to rule out embolic or thrombotic phenomena. Despite these recommendations, the patient was diagnosed with "cellulitis" and admitted to the medicine ward for intravenous nafcillin. Over the next 36 h, the "cellulitis" had advanced proximally to his inguinal region. His mental status also declined, and he showed signs of septic shock, including hypotension, tachycardia, and tachypnea. Vascular surgery was immediately consulted, and the patient underwent emergency surgical debridement. The diagnosis of necrotizing fasciitis was then made. Tissue pathology revealed full-thickness necrosis through the epidermis with subepidermal splitting. Dermal edema was also present with a diffuse neutrophilic infiltrate (Fig. 2). This infiltrate extended through the fat into the subcutaneous tissue and fascia. Tissue cultures sent at the time of surgery grew Escherichia coli. Initial blood cultures also came back positive for E. coli. Anaerobic cultures remained negative. Figure 2. Necrotic epidermis with subepidermal splitting. Marked dermal edema with mixed infiltrate and prominent neutrophils. Hematoxylin and eosin: original magnification, ×20 After surviving multiple additional debridements, the patient eventually required an above-the-knee amputation due to severe necrosis. [source] Increased serum phosphate levels and calcium fluxes are seen in smaller individuals after a single dose of sodium phosphate colon cleansing solution: a pharmacokinetic analysisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2009E. D. EHRENPREIS Summary Background, Sodium phosphate containing colonoscopy preparations may cause electrolyte disturbances and calcium-phosphate nephropathy. Decreased body weight is an unexplored risk factor for complications with sodium phosphate ingestion. Aim, To perform a pharmacokinetic analysis of a single dose of Fleet Phospho-Soda in smaller and larger individuals. Methods, Seven subjects weighing <55 kg (Group I) and six weighing >100 kg (Group II) consumed 45 mL Fleet Phospho-Soda. Serum electrolytes were measured. Hydration was closely maintained by monitoring weight, fluid intake and total body water. Results, Marked increases in serum phosphate were seen in Group I compared to Group II. For example, mean serum phosphate at 120 min was 7.8 ± 0.5 mg/dL in Group I and 5.1 ± 0.8 mg/dL in Group II (P < 0.001). Normalized area under the phosphate vs. time curve for Group I was 1120 ± 190 mg/dL*min and 685 ± 136 mg/dL*min for Group II (P < 0.001). Twelve-hour urine calcium was lower in Group I (16.4 ± 7.6 mg) than in Group II (39.2 ± 7.8 mg, P < 0.001). Conclusions, Increased serum phosphate occurs in smaller individuals after ingestion of sodium phosphate preparations, even with strict attention to fluid intake. Smaller body weight poses a potential risk for calcium-phosphate nephropathy. [source] Effects of 7,12-dimethylbenz(a)anthracene on growth and haematological parameters in Korean rockfish, Sebastes schlegeli (Hilgendorf)AQUACULTURE RESEARCH, Issue 5 2006Jung-Hoon Jee Abstract The objectives of the present experiment were to determine the effects on growth factors and some haematological parameters in Korean rockfish, Sebastes schlegeil, after dietary 7,12-dimethylbenz(a)anthracene (DMBA) exposure at 0.6, 1.2, 2.4 and 4.8 mg kg,1 diet for 8 weeks. The specific growth rate of the fish exposed to DMBA (,1.2 mg kg,1) showed significantly lower performance than the control. Following 8 weeks of exposure, the DMBA-exposed groups (2.4 and 4.8 mg kg,1) had a significantly higher mean hepatosomatic index. Condition factor of the fish exposed to DMBA did not show any statistically significant deviation from the control (P>0.05), although the mean values were somewhat lower than those of the control group. Observations on haematological parameters indicated DMBA treatment induced a severe anaemia. Total protein, albumin and total cholesterol concentrations decreased following exposure to DMBA at 2.4 and 4.8 mg kg,1. In contrast, serum bilirubin and blood urea nitrogen in fish exposed to DMBA increased. Significant decreases in serum electrolytes, chloride, phosphorus, magnesium and calcium, and osmolality were observed in all DMBA-treatment groups. All DMBA-treatment groups showed a significantly higher activity of lactate dehydrogenase and alkaline phosphatase. Serum transaminase activity after the highest level of 4.8 mg kg,1 DMBA was significantly increased. The key finding from this study is that rockfish exposed to dietary DMBA at concentrations of 1.2 and 2.4 mg kg,1 diet are likely to experience adverse impacts in growth and haematological property respectively. [source] Modified ureterosigmoidostomy (Mainz Pouch II): a nonrefluxing stented vs unstented laparoscopic porcine modelBJU INTERNATIONAL, Issue 2 2008Mitchell R. Humphreys OBJECTIVE To describe a rapid and reproducible pure laparoscopic cystectomy and nonrefluxing modified continent urinary diversion (Mainz Pouch II), and to determine whether ureteric stenting decreases ureteric obstruction after surgery. MATERIALS AND METHODS After institutional review and approval, six female pigs (51,55 kg) had a laparoscopic cystectomy and urinary diversion using a modified Mainz Pouch II. Imbricating bowel over the extra-intestinal ureteric segment created the nonrefluxing mechanism. All pigs had the same bowel preparation before a standard four-port transperitoneal laparoscopic procedure, but three pigs received bilateral J ureteric stents and three did not. Body weights, radiographic imaging, serum electrolytes and renal function were monitored during the 6-week survival period. RESULTS One stented pig developed bilateral pyelonephritis, renal obstruction and was killed. Including this pig, four of 12 renal units were obstructed, occurring more often in the stented pigs. There were no significant differences between the serum electrolytes before and after surgery or between the stented or unstented pigs. The surgery was quicker as experience increased. No pig developed hyperchloraemic metabolic acidosis. The nonrefluxing modification appeared to be effective, as reflux was only present in one renal unit. CONCLUSIONS Laparoscopic ureterosigmoidostomy, specifically the modified Mainz Pouch II, represents a viable and reasonable continent urinary diversion. The results suggest that there was no benefit in stenting in this pig model. [source] Fluid shifts during cardiopulmonary bypass with special reference to the effects of hypothermiaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2000J. K. Heltne Background Generalized overhydration, oedema and organ dysfunction occurs in patients undergoing open heart surgery using cardiopulmonary bypass (CPB) and hypothermia. Inflammatory reactions induced by contact between blood and the foreign surfaces of the extracorporeal circuit are commonly held responsible for the disturbances in fluid balance (,capillary leak syndrome'). Using the CPB circuit reservoir as a fluid gauge (measuring continuous extracorporeal blood volume), fluid shifts between the intravascular and the extravascular space, and differences between normothermic and moderately hypothermic CPB, were examined. Methods Piglets were placed on CPB (thoracotomy) under general anaesthesia. In the normothermic group (n = 7) the core temperature was kept at 38°C before and during 2 h on CPB, whereas in the hypothermic group (n = 7) the temperature was lowered to 29°C during bypass. In addition to accurate recording of fluid during operation, the extracorporeal blood volume was kept constant by maintaining a certain blood level in the CPB circuit's reservoir. Acetated Ringer was used as priming solution in the CPB, as maintenance fluid and for adding fluid to the reservoir if necessary. Results Cardiac output, serum electrolytes and arterial blood gases were all similar in the two groups. Haematocrit fell significantly following the start of CPB in both groups. The reservoir fluid level fell markedly in both groups necessitating fluid supplementation. This extra fluid requirement was transient in the normothermic group, but persisted in hypothermic animals. At the end of 2 h of CPB the hypothermic animals had received seven times more extra fluid than the normothermic pigs. Conclusion There were strong indications of a greater fluid extravasation induced by hypothermia. The model described, using the PBC circuit reservoir as a fluid gauge, provides the opportunity for further study of fluid volume shifts, their causes and potential ways to manipulate fluid pathophysiology related to hypothermia and to PBC. © 2000 British Journal of Surgery Society Ltd [source] Afebrile benign convulsions with mild gastroenteritis: a new entity?ACTA NEUROLOGICA SCANDINAVICA, Issue 2 2009A. Verrotti Afebrile seizures in children usually necessitate investigations in order to determine the etiology and estimate the prognosis. Recently, convulsions that are described as benign but afebrile have been documented in children, in association with diarrhea, and are now recognized as a distinct entity. Benign afebrile seizures with mild gastroenteritis are defined as convulsions accompanying symptoms of mild diarrhea without dehydration or electrolyte derangement and without fever before and after the seizures in healthy children without meningitis, encephalitis or encephalopathy. The convulsions are short, symmetrical, generalized tonic,clonic seizures, occurring in clusters. Laboratory studies (full blood count, blood glucose, creatinine, serum electrolytes, cerebrospinal fluid, bacterial and viral cultures) are usually normal, and other investigations (neuroimaging and electroencephalogram) are not necessary. Prognosis is always favorable (normal psychomotor development, no recurrences of seizures), and anticonvulsant therapy is not warranted. Recognition of this benign infantile convulsion avoids extensive evaluation and long-term anticonvulsant therapy; physicians may reassure the parents regarding the lack of long-term sequelae. In conclusion, this type of seizure seems to be a new entity, but it awaits a correct place in the large group of infantile convulsion disorders. [source] | ||||||||||