The aim was to investigate triggering factors and insulin pump usage (continuous subcutaneous insulin infusion, CSII) at diabetic ketoacidosis (DKA). Data from 1999 and 2000 were collected retrospectively from Sweden. In 1999 and 2000, 7.4 and 11.0%, respectively, of children with diabetes used CSII. One hundred and forty-two episodes of DKA (pH
101 patients were treated for acute acetylsalicylic acid (ASA) poisoning in the Nephrological Unit Trondheim between 1971-1975. On admission 33 of them had a serum salicylic acid (SA) concentration greater than 400 microgram/ml (mean 588 +/- 40 microgram/ml). This group was compared with a group of 11 children less than 5 years old with ASA poisoning and a mean serum SA on admission of 550 +/- 34 microgram/ml. Blood pH on admission was normal or elevated in all patients more than 12 years old (mean 7.43 +/- 0.01), whereas 7 of the 11 children suffered from metabolic acidosis. The results of forced alkaline diuresis produced by loop diuretics (bumetanide, furosemide) in ASA poisoned patients older than 12 years are reported. The mean T 1/2 of SA was 9.6 h in the treated group as compared to 18-22 h in untreated patients. There was no apparent difference between the diuretic effect of bumetanide and furosemide.
To measure blood IL-6, IL-10, creatinine levels, calcium, sodium and potassium in blood and saliva, melatonin in urine of patients with acute coronary syndrome without ST segment elevation for the prediction of the clinical course at the post-hospital stage.
The study included 93 patients with complicated (n = 46) and uncomplicated (n = 47) coronary syndrome without ST segment elevation. Blood IL-6, IL-1, creatinine levels, calcium, sodium and potassium in blood and saliva, melatoni n in urine were determined on days 1-3 after hospitalization. 6-hydroxymelatonin was measured by HPLC in urine collected between 23 p.m. and 8 a.m., melatonin i in urine collected between 8 a.m. and 23 p.m.
Complicated coronary syndrome was associated with increased levels of melatonin (night), blood IL-10 and Na, salivary, Na and Ca while the uncomplicated condition with increased blood melatonin (daytime), IL-6, creatinine, Ca, Na, K, and salivary K. 90 patients were followed up within 12 months after discharge. End-points developed in 36 (40%) of them. Logistic analysis yielded variables and 2 logistic regression equations The data on night melatonin +5 and +4 were included in ROC analysis. The night melatonin +5 values over 0.7453 were associated with increased risk of complications in the post-hospital period (6 months) and values of 0.7453 or lower with the enhanced probability of uncomplicated clinical course. Prognostic sensitivity was estimated at 90%, specificity at -54.39%. The night melatonin +4 values over 0.2903 were associated with increased risk of complications in the post-hospital period (12 months) and values of 0.2903 or lower with the enhanced probability of uncomplicated clinical course. Prognostic sensitivity was estimated at 77.8%, specificity at -59.26%.
The night melatonin +5 and +4 models can be used to predict the clinical course of acute coronary syndrome during 6 and 12 months of the post-hospitalization period.
Severe hypokalaemia can aggravate arrhythmia tendency and prognosis, but less is known about risk of mild hypokalaemia, which is a frequent finding. We examined the associations between mild hypokalaemia and ambulatory cardiac arrhythmias and their prognosis.
Subjects from the cohort of the 'Copenhagen Holter Study' (n = 671), with no history of manifest cardiovascular (CV) disease or stroke, were studied. All had laboratory tests and 48-h ambulatory electrocardiogram (ECG) recording. The median follow-up was 6.3 years. p-Potassium was inversely associated with frequency of premature ventricular complexes (PVCs) especially in combination with diuretic treatment (r = -0.22, P = 0.015). Hypokalaemia was not associated with supraventricular arrhythmias. Subjects at lowest quintile of p-potassium (mean 3.42, range 2.7-3.6 mmol/L) were defined as hypokalaemic. Cardiovascular mortality was higher in the hypokalaemic group (hazard ratio and 95% confidence intervals: 2.62 (1.11-6.18) after relevant adjustments). Hypokalaemia in combination with excessive PVC worsened the prognosis synergistically; event rates: 83 per 1000 patient-year in subjects with both abnormalities, 10 and 15 per 1000 patient-year in those with one abnormality, and 3 per 1000 patient-year in subjects with no abnormality. One variable combining hypokalaemia with excessive supraventricular arrhythmias gave similar results in univariate analysis, but not after multivariate adjustments.
In middle-aged and elderly subjects with no manifest heart disease, mild hypokalaemia is associated with increased rate of ventricular but not supraventricular arrhythmias. Hypokalaemia interacts synergistically with increased ventricular ectopy to increase the risk of adverse events.
The purpose of the present study was to evaluate the relationship of aldosterone to blood pressure and left ventricular size in black American (n=109) and white French Canadian (n=73) patients with essential hypertension. Measurements were obtained with patients off antihypertensive medications and included 24-hour blood pressure monitoring, plasma renin activity and aldosterone, and an echocardiogram. Compared with the French Canadians, the black Americans had higher body mass indexes, higher systolic blood pressures, attenuated nighttime reduction of blood pressure, and lower serum potassium concentrations (P:
Postoperative atrial fibrillation is a common complication to cardiac surgery. Na,K-ATPase is of major importance for the resting membrane potential and action potential. The purpose of the present study was to evaluate the importance of Na,K-ATPase concentrations in human atrial biopsies and plasma potassium concentrations for the development of atrial fibrillation.
Atrial myocardial biopsies were obtained from 67 patients undergoing open chest cardiac surgery. Na,K-ATPase was quantified using vanadate-facilitated 3H-ouabain binding. Plasma potassium concentration was measured with ion-selective electrode.
In patients with preoperative sinus rhythm, 3H-ouabain-binding site concentration was 16% higher in patients developing postoperative atrial fibrillation compared to patients maintaining sinus rhythm [302 +/- 15 pmol/g wet weight (n = 20) vs. 261 +/- 11 mmol/g wet weight (n = 33), p = 0.03]. Also with multivariable analysis, 3H-ouabain-binding site concentration was significantly associated with the development of atrial fibrillation. High increase in plasma potassium concentration during the perioperative period and surgery was associated with postoperative atrial fibrillation.
The present study supports the increasing evidence of dysregulation of the potassium homeostasis as an important factor in the development of cardiac arrhythmias. High atrial Na,K-ATPase and sudden plasma potassium concentration increase may contribute to precipitate atrial fibrillation.
In order to investigate the relevance of the currently used lower reference limit for S-Potassium in Danish hospital laboratories, analytical bias in the measurement of S-Potassium was compared with the lower reference limit in each of 52 Danish hospital laboratories. The acceptable bias range was estimated according to Gowans et al on the basis of the result of two different reference sample groups. The estimated acceptable 0.95 bias range was 0.24 mmol/L, so the observed bias range of 0.23 mmol/L was within this limit. As all preanalytical errors tend to increase the measured S-Potassium, all acceptable bias should be in the direction of decreasing the measured value. It can be concluded that analytical performance allows for more uniform (even common) reference interval(s) in all Danish and perhaps Nordic hospital laboratories, provided that preanalytical errors can be controlled.
In Canada, there are an estimated 400 home parenteral nutrition (HPN) patients. In 2006, a registry was created to gather patient outcome information. The aim of this study was to validate the registry and report on HPN patient outcomes.
Several demographic, clinical parameters were collected. For the validation, paired t test and intraclass correlation coefficient (ICC) were used to assess agreement between repeat entries. For the outcome report, paired t test was used to assess changes, and survival analysis was performed using the Kaplan-Meier method. Results are expressed as mean ± SEM.
On validation, there was high correlation/agreement (P