Do Changes Occur in Hemodynamic Parameters, Hemogram, Renal Function and Serum Electrolytes during Percutaneous Nephrolithotomy? Its Correlation with Irrigation Fluid and Intravenous Fluid

Introduction: Percutaneous nephrolithotomy (PCNL) is a standard minimally invasive urological procedure for the treatment of large renal calculi. It is also associated with complications arising from absorption of irrigation fluid and intravenous fluid injection. We evaluated the changes occurring in vital and blood parameters during PCNL using 0.9% normal saline (NS) as an irrigation fluid. Materials and Methods: We prospectively studied 71 patients who underwent PCNL in our hospital between 2016 and 2018. NS (0.9%) was used as irrigation fluid in all patients. Changes in hemodynamics, hemogram, renal function tests and serum electrolytes were noted and assessed for significance using paired t-test. These changes were correlated with ASA grade, BMI, total operating time, total irrigation fluid used and total intravenous fluid used using Pearson’s correlation test. Results: A significant fall in serum creatinine was present (1.30 ± 0.96 vs. 1.24 ± 0.93) along with a rise in eGFR (85.39 ± 24.10 vs. 90.18 ± 22.58). A significant rise in serum potassium (4.34 ± 0.45 vs. 4.5 ± 0.56) and chloride levels (104.79 ± 3.51 vs. 106.69 ± 3.14) post-operatively was noted. A significant rise in pulse rate (80.84 ± 10.13 vs. 87.76 ± 13.12) and systolic blood pressure (127.67 ± 15.90 vs. 136.88 ± 19.56) post-operatively was noted. There was no significant change noted in hemoglobin, PCV, platelets and serum sodium levels. Total operating time and irrigation fluid volume showed a positive correlation with changes in eGFR, serum chloride, post-operative pulse rate and blood pressure values. Intravenous fluids volume correlated positively with changes in serum potassium, chloride, post-operative pulse rate and blood pressure values. Conclusion: High amount of irrigation fluid absorption can cause early post-operative changes in patients’ hemodynamics and blood indices. Overzealous hydration during PCNL with potassium containing fluids can also lead to hyperkalemia and hyperchloremic acidosis. Thus, early post-operative monitoring of serum electrolytes should be done in all patients after PCNL to prevent complications arising from dyselectrolytemia.

Kaolin Consumption Affects Serum Electrolytes, Glucose and Amylase Levels of Pregnant Women

Background: Geophagy is the consumption of earth materials which occurs across several cultures. For several reasons, pregnant women in many parts of West Africa including Nigeria frequently consume kaolin. This study was carried out to determine the influence of kaolin consumption on serum electrolytes, glucose and amylase levels of pregnant women attending antenatal clinic in a Teaching Hospital in the south east Nigeria. Methods: A total of eighty pregnant women recruited for this study were grouped as follows;Group 1, (30 geophagic pregnant women in the first trimester), Group 2 (30 geophagic pregnant women in the second trimester) and Group 3 (20 non-geophagic pregnant women that served as control). Subjects in Groups 1 and 2 were subdivided into three based on the quantity of kaolin consumed per week: group A (100 g/week), group B (150 g/week) and group C (200 g/week). Preliminary analysis of the calcium content of kaolin was carried out. Serum levels of potassium, sodium, chloride, bicarbonate, glucose and amylase of the subjects were determined. Results: Calcium level in kaolin was below the recommended daily intake in food. The concentrations of potassium in geophagic pregnant women who consumed 150 g and 200 g of kaolin per week were significantly (p < 0.05) lower in both 1st and 2nd trimester groups., There was a significant (p < 0.05) decrease in sodium concentration (132.2 ± 2.0) of the 2nd trimester pregnant women that consumed 200 g of kaolin per week. The concentrations of chloride and bicarbonate were not significantly (p > 0.05) affected in all the groups. Serum amylase concentration decreased significantly (p < 0.05) in the 1st and 2nd trimester pregnant women on 150 g and 200 g of kaolin per week, while the plasma glucose concentration was significantly (p < 0.05) elevated in the same groups. Conclusion: This study concludes that kaolin consumption in pregnant women may predispose to gestational diabetes, electrolytes imbalance and reduced intestinal enzymes activities.