Objective Several studies have examined the relationships between dietary potassium and sodium and hypertension, but few have evaluated the association between serum potassium or sodium and risk of incident hypertensi...Objective Several studies have examined the relationships between dietary potassium and sodium and hypertension, but few have evaluated the association between serum potassium or sodium and risk of incident hypertension. We therefore investigated the associations between serum potassium and sodium and risk of incident hypertension in a Chinese community-based population. Methods A total of 839 normotensive individuals without cardiovascular disease from the Chinese Multi-Provincial Cohort Study who took part in the baseline examination in 2007-2008 and the follow-up survey in 2012-2013 were included in this study. Odds ratios （OR） and 95% confidence intervals （95%CI） for baseline serum potassium and sodium in relation to the risk of new-onset hypertension were evaluated using multivari- ate logistic regression models. Results During five years of follow-up, 218 （26.0%） individuals progressed to hypertension. Logistic re- gression adjusting for multiple confounders showed that every 1 mEq/L increment in baseline serum potassium level was associated with a 75% increased risk of hypertension （OR： 1.75; 95%CI： 1.01-3.04; P = 0.04）. Compared with adults with serum potassium level of 4.20-4.79 mEq/L, adults with level 〉 4.80 mEq/L had an 84% increased risk of hypertension （OR： 1.84; 95%CI： 1.14-2.96; P = 0.01）. There was no significant association between serum sodium and risk of hypertension （OR： 0.96; 95%CI： 0.89-1.04; P = 0.33）. Conclusions Base- line serum potassium level, but not baseline serum sodium level, was positively related to the risk of incident hypertension in the Chinese population.展开更多
Casals et al have reported an inverse correlation between serum phosphate and body weight after administration of sodium phosphate at a dose of 60 g. Our group has already described the relationship between body weigh...Casals et al have reported an inverse correlation between serum phosphate and body weight after administration of sodium phosphate at a dose of 60 g. Our group has already described the relationship between body weight and hyperphosphatemia with these preparations, although our study was not quoted by Casals. We performed a pharmacokinetic study involving 13 volunteers who were divided into two groups on the basis of body weight： group I consisting of seven women with a median weight of 60 kg and group Ⅱ consisting of five men and one woman with a median weight of 119.2 kg. Group Ⅰdeveloped higher peak phosphate levels and maintained these levels above the subjects in Group Ⅱ for a prolonged time period despite adequate hydration being ensured with frequent monitoring of weight, fluid intake and total body weight. Our studydemonstrated that adequate hydration does not protect against the secondary effects of hyperphosphatemia. In the study by Casais et al, 66% of the study subjects were women, the correlation between serum phosphate and gender in their data also appears to be important. Women are at higher risk of acute phosphate nephropathy due to a diminished volume of distribution of the high dose of ingested phosphate. Decreased volume of distribution in women is due to diminished body weight. This is further compounded by decreased creatinine clearance in females.展开更多
Objective To explore the effect of allocryptopine （All） on the Late sodium current （INa,Late） of atrial myocytes in spontaneously hyper- tensive rats （SHR）. Method The enzyme digestion method was used to separat...Objective To explore the effect of allocryptopine （All） on the Late sodium current （INa,Late） of atrial myocytes in spontaneously hyper- tensive rats （SHR）. Method The enzyme digestion method was used to separate single atrial myocytes from SHR and Wistar-Kyoto rat （WKY） rats. INa,Late was record by patch-clamp technique and the effect of All on the current was evaluated. Results Comparing with WKY cells, markedly increasing of INa,Late current in SHR myocytes was found from 0.24 ± 0.02 pA/pF of WKY cells to 1.73± 0.04 pA/pF of SHR cells （P 〈 0.01, n = 15）. After treament with 30 μmol/L All; the current densities was reduced to 0.92 ± 0.03 pA/pF. The ratio of INa,Late/INa,peak of WKY and SHR were 0.09% ± 0.01% and 0.71% ± 0.02%, INa, Late/INa,peak of SHR was reduced to 0.37% ± 0.02% by 30 μmol/L All （P 〈 0.01, n = 15）. We also determined the effect of All on the gating mechanism of the INa,Late in the SHR cells. It was found that All decreased the INa,Late by alleviating the inactivation of the channels and increasing the window current of sodium channel. Conclusion Increased INa,Late in SHR atrial myocytes and the prolonged APD were inhibited by All coming from Chinese herb medicine.展开更多
Ascites is the most common complication related to cirrhosis and is associated with increased morbidity and mortality.Ascites is a consequence of the loss of compensatory mechanisms to maintain the overall effective a...Ascites is the most common complication related to cirrhosis and is associated with increased morbidity and mortality.Ascites is a consequence of the loss of compensatory mechanisms to maintain the overall effective arterial blood volume due to worsening splanchnic arterial vasodilation as a result of clinically significant portal hypertension.In order to maintain effective arterial blood volume,vasoconstrictor and antinatriuretic pathways are activated,which increase overall sodiumand fluid retention.As a result of progressive splanchnic arterial vasodilation,intestinal capillary pressure increases and results in the formation of protein-poor fluid within the abdominal cavity due to increased capillary permeability from the hepatic sinusoidal hypertension.In some patients,the fluid can translocate across diaphragmatic fenestrations into the pleural space,leading to hepatic hydrothorax.In addition,infectious complications such as spontaneous bacterial peritonitis can occur.Eventually,as the liver disease progresses related to higher portal pressures,loss of a compensatory cardiac output and further splanchnic vasodilation,kidney function becomes compromised fromworsening renal vasoconstriction as well as the development of impaired solute-free water excretion and severe sodium retention.Thesemechanisms then translate into significant clinical complications,such as refractory ascites,hepatorenal syndrome and hyponatremia,and all are linked to increased short-termmortality.Currently,liver transplantation is the only curative option for this spectrumof clinical manifestations but ongoing research has led to further insight on alternative approaches.This review will further explore the current understanding on the pathophysiology andmanagement of ascites as well as expand on two advanced clinical consequences of advanced liver disease,refractory ascites and hyponatremia.展开更多
The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic aci...The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic acid-base bal- ance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume （〉2 L） saline infusion in healthy adults induces hyperohloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload （80 ml/kg） in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger （NHE） and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemody- namics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising 02 delivery to the renal perenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, in- creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin- testinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.展开更多
As a common urea-cycle disorder, ornithine transcarbamylase deficiency(OTCD) disables the conversion of ammonia into non-toxic urea, and its subsequent excretion results in hyperammonemia. We reported a 28-year-old wo...As a common urea-cycle disorder, ornithine transcarbamylase deficiency(OTCD) disables the conversion of ammonia into non-toxic urea, and its subsequent excretion results in hyperammonemia. We reported a 28-year-old woman who was diagnosed with OTCD during her first pregnancy. She was treated with arginine, citrulline and sodium benzoate for complications associated with hyperammonemia, and her protein intake was restricted. The patient’s condition was stabilized, and she delivered a baby boy via cesarean section. However, the baby died 2d later. During her second pregnancy, prenatal screening suggested that the fetus had OTCD, and an induced abortion was performed. During her third pregnancy, fetal OTCD was ruled out, and the patient was treated with oral sodium benzoate. Her blood ammonia level was stabilized, and a baby boy was successfully delivered via cesarean section. This case described the treatment process of the pregnant patient with OTCD, and the safety and efficacy of sodium benzoate were evaluated. Collectively, our findings provided the experience and evidence for the drug selection and treatment of these rare diseases.展开更多
文摘Objective Several studies have examined the relationships between dietary potassium and sodium and hypertension, but few have evaluated the association between serum potassium or sodium and risk of incident hypertension. We therefore investigated the associations between serum potassium and sodium and risk of incident hypertension in a Chinese community-based population. Methods A total of 839 normotensive individuals without cardiovascular disease from the Chinese Multi-Provincial Cohort Study who took part in the baseline examination in 2007-2008 and the follow-up survey in 2012-2013 were included in this study. Odds ratios （OR） and 95% confidence intervals （95%CI） for baseline serum potassium and sodium in relation to the risk of new-onset hypertension were evaluated using multivari- ate logistic regression models. Results During five years of follow-up, 218 （26.0%） individuals progressed to hypertension. Logistic re- gression adjusting for multiple confounders showed that every 1 mEq/L increment in baseline serum potassium level was associated with a 75% increased risk of hypertension （OR： 1.75; 95%CI： 1.01-3.04; P = 0.04）. Compared with adults with serum potassium level of 4.20-4.79 mEq/L, adults with level 〉 4.80 mEq/L had an 84% increased risk of hypertension （OR： 1.84; 95%CI： 1.14-2.96; P = 0.01）. There was no significant association between serum sodium and risk of hypertension （OR： 0.96; 95%CI： 0.89-1.04; P = 0.33）. Conclusions Base- line serum potassium level, but not baseline serum sodium level, was positively related to the risk of incident hypertension in the Chinese population.
文摘Casals et al have reported an inverse correlation between serum phosphate and body weight after administration of sodium phosphate at a dose of 60 g. Our group has already described the relationship between body weight and hyperphosphatemia with these preparations, although our study was not quoted by Casals. We performed a pharmacokinetic study involving 13 volunteers who were divided into two groups on the basis of body weight： group I consisting of seven women with a median weight of 60 kg and group Ⅱ consisting of five men and one woman with a median weight of 119.2 kg. Group Ⅰdeveloped higher peak phosphate levels and maintained these levels above the subjects in Group Ⅱ for a prolonged time period despite adequate hydration being ensured with frequent monitoring of weight, fluid intake and total body weight. Our studydemonstrated that adequate hydration does not protect against the secondary effects of hyperphosphatemia. In the study by Casais et al, 66% of the study subjects were women, the correlation between serum phosphate and gender in their data also appears to be important. Women are at higher risk of acute phosphate nephropathy due to a diminished volume of distribution of the high dose of ingested phosphate. Decreased volume of distribution in women is due to diminished body weight. This is further compounded by decreased creatinine clearance in females.
基金This work was supported by the grant from the National Natural Science Foundation of China （grant number. No： 81030002,81170177, 81100215, 81373835）.
文摘Objective To explore the effect of allocryptopine （All） on the Late sodium current （INa,Late） of atrial myocytes in spontaneously hyper- tensive rats （SHR）. Method The enzyme digestion method was used to separate single atrial myocytes from SHR and Wistar-Kyoto rat （WKY） rats. INa,Late was record by patch-clamp technique and the effect of All on the current was evaluated. Results Comparing with WKY cells, markedly increasing of INa,Late current in SHR myocytes was found from 0.24 ± 0.02 pA/pF of WKY cells to 1.73± 0.04 pA/pF of SHR cells （P 〈 0.01, n = 15）. After treament with 30 μmol/L All; the current densities was reduced to 0.92 ± 0.03 pA/pF. The ratio of INa,Late/INa,peak of WKY and SHR were 0.09% ± 0.01% and 0.71% ± 0.02%, INa, Late/INa,peak of SHR was reduced to 0.37% ± 0.02% by 30 μmol/L All （P 〈 0.01, n = 15）. We also determined the effect of All on the gating mechanism of the INa,Late in the SHR cells. It was found that All decreased the INa,Late by alleviating the inactivation of the channels and increasing the window current of sodium channel. Conclusion Increased INa,Late in SHR atrial myocytes and the prolonged APD were inhibited by All coming from Chinese herb medicine.
文摘Ascites is the most common complication related to cirrhosis and is associated with increased morbidity and mortality.Ascites is a consequence of the loss of compensatory mechanisms to maintain the overall effective arterial blood volume due to worsening splanchnic arterial vasodilation as a result of clinically significant portal hypertension.In order to maintain effective arterial blood volume,vasoconstrictor and antinatriuretic pathways are activated,which increase overall sodiumand fluid retention.As a result of progressive splanchnic arterial vasodilation,intestinal capillary pressure increases and results in the formation of protein-poor fluid within the abdominal cavity due to increased capillary permeability from the hepatic sinusoidal hypertension.In some patients,the fluid can translocate across diaphragmatic fenestrations into the pleural space,leading to hepatic hydrothorax.In addition,infectious complications such as spontaneous bacterial peritonitis can occur.Eventually,as the liver disease progresses related to higher portal pressures,loss of a compensatory cardiac output and further splanchnic vasodilation,kidney function becomes compromised fromworsening renal vasoconstriction as well as the development of impaired solute-free water excretion and severe sodium retention.Thesemechanisms then translate into significant clinical complications,such as refractory ascites,hepatorenal syndrome and hyponatremia,and all are linked to increased short-termmortality.Currently,liver transplantation is the only curative option for this spectrumof clinical manifestations but ongoing research has led to further insight on alternative approaches.This review will further explore the current understanding on the pathophysiology andmanagement of ascites as well as expand on two advanced clinical consequences of advanced liver disease,refractory ascites and hyponatremia.
文摘The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic acid-base bal- ance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume （〉2 L） saline infusion in healthy adults induces hyperohloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload （80 ml/kg） in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger （NHE） and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemody- namics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising 02 delivery to the renal perenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, in- creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin- testinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.
基金Clinical Trial of Xinhua Hospital(Grant No.15LC11)。
文摘As a common urea-cycle disorder, ornithine transcarbamylase deficiency(OTCD) disables the conversion of ammonia into non-toxic urea, and its subsequent excretion results in hyperammonemia. We reported a 28-year-old woman who was diagnosed with OTCD during her first pregnancy. She was treated with arginine, citrulline and sodium benzoate for complications associated with hyperammonemia, and her protein intake was restricted. The patient’s condition was stabilized, and she delivered a baby boy via cesarean section. However, the baby died 2d later. During her second pregnancy, prenatal screening suggested that the fetus had OTCD, and an induced abortion was performed. During her third pregnancy, fetal OTCD was ruled out, and the patient was treated with oral sodium benzoate. Her blood ammonia level was stabilized, and a baby boy was successfully delivered via cesarean section. This case described the treatment process of the pregnant patient with OTCD, and the safety and efficacy of sodium benzoate were evaluated. Collectively, our findings provided the experience and evidence for the drug selection and treatment of these rare diseases.
