Electrolyte, Acid–Base, and Mineral Metabolism Disorders: Pathophysiology, Outcomes, and Treatment

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (31 July 2020) | Viewed by 16158

Special Issue Editors


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Guest Editor

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Guest Editor
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Interests: artificial Intelligence; machine learning; meta-analysis; acute kidney injury; clinical nephrology; kidney transplantation
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Special Issue Information

Dear Colleagues,

Electrolyte, acid–base, and mineral metabolism disorders are common in both outpatient and inpatient settings, independently associated with both short- and long-term mortality. Uncorrected electrolyte abnormalities may result in life-threatening consequences. The prevalence of hyponatremia, the most common electrolyte disorder, has been reported as high as 30% among hospitalized patients. An abrupt decrease in serum sodium can cause significant cerebral edema, leading to lethargy, seizures, coma, or mortality. Furthermore, hyperkalemia is also a common condition occurring in up to 10% of hospitalized patients. If hyperkalemia is left untreated, a sine-wave pattern, idioventricular rhythms, and asystolic cardiac arrest may develop.

Despite advances in medicine, electrolyte, acid–base, and mineral metabolism disorders remain very common and are associated with increased mortality. Hence, additional studies are essential in the fields of electrolyte, acid–base, and mineral metabolism research.

In this Special Issue, we are making a call to action to stimulate researchers and clinicians to submit their invaluable studies of electrolyte, acid–base, and mineral metabolism disorders, conducted in both fundamental and clinical research, that will provide additional knowledge and skills in the field of electrolyte research, with the ultimate aim of improving patient outcomes. Original investigations and review articles are especially welcome.  

Potential topics include, but are not limited to, the following:

-Electrolyte imbalance in critically ill patients;

-Diagnosing acute acid–base disorders;

-Assessment of acid–base balance: Stewart's approach;

-Management of hyponatremia in the ICU;

-Diagnosis and treatment of hypernatremia;

-Pathophysiology and management of hypokalemia: a clinical perspective;

-Updates in hyperkalemia: outcomes and therapeutic strategies;

-Diagnosis and management of hypocalcemia;

-Hypercalcemia—presentation and management;

-Hypomagnesemia: a clinical perspective;

-Analysis of hypermagnesemia and hypomagnesemia;

-Chloride-restrictive fluid administration and incidence of acute kidney injury;

-Serum chloride as a novel marker for prognostic information of mortality in congestive heart failure;

-Metabolic acidosis: pathophysiology, diagnosis, and management;

-Lactic acidosis: clinical implications and management strategies;

- Metabolic alkalosis—bedside and bench.

Dr. Charat Thongprayoon
Dr. Wisit Cheungpasitporn
Guest Editors

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Keywords

  • sodium
  • potassium
  • calcium
  • bicarbonate
  • magnesium
  • chloride
  • phosphate
  • acidosis
  • alkalosis
  • risk factors
  • outcomes
  • predictors

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Published Papers (4 papers)

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Research

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10 pages, 758 KiB  
Article
Progression to Severe Hypernatremia in Hospitalized General Medicine Inpatients: An Observational Study of Hospital-Acquired Hypernatremia
by Ramessh Ranjan, Stacey C.-Y. Lo, Stephanie Ly, Visakan Krishnananthan and Andy K.H. Lim
Medicina 2020, 56(7), 358; https://doi.org/10.3390/medicina56070358 - 17 Jul 2020
Cited by 9 | Viewed by 4572
Abstract
Background and objectives: Hypernatremia can be community or hospital-acquired, and there may be specific factors unique to the hospital environment, such as intravenous fluid treatment, which contribute to hypernatremia. The aim of this study was to determine the factors associated with the progression [...] Read more.
Background and objectives: Hypernatremia can be community or hospital-acquired, and there may be specific factors unique to the hospital environment, such as intravenous fluid treatment, which contribute to hypernatremia. The aim of this study was to determine the factors associated with the progression from moderate to severe hospital-acquired hypernatremia among patients admitted under general medicine. Materials and Methods: In this retrospective, single-center cohort study (2012 to 2017), we used ICD-10 coding and medical records to identify adult patients who developed moderate hypernatremia and followed them for progression to severe hypernatremia. We profiled the serum biochemistry and the volume and composition of prescribed intravenous fluids. We applied logistic regression to determine the factors associated with the progression to severe hypernatremia, using the patients with moderate hypernatremia as reference. Results: Of the 180 medical inpatients (median age of 81 years) with moderate hospital-acquired hypernatremia, 9.4% progressed to severe hypernatremia. Normal saline comprised 76% of intravenous fluid volume administered prior to onset of moderate hypernatremia. After the onset, 38% of fluid volume prescribed remained normal saline. The factors independently associated with progression to severe hypernatremia included chronic kidney disease stage (odds ratio 2.38, 95% CI: 1.26–4.50, P = 0.008) and serum creatinine increase (per 10 µmol/L, OR 1.29, 95% CI: 1.07–1.57, P = 0.009). Conclusions: Patients with chronic kidney disease and acute kidney injury may have an increased risk of severe hospital-acquired hypernatremia. Full article
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10 pages, 915 KiB  
Article
Serum Potassium Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients
by Charat Thongprayoon, Wisit Cheungpasitporn, Sorkko Thirunavukkarasu, Tananchai Petnak, Api Chewcharat, Tarun Bathini, Saraschandra Vallabhajosyula, Michael A. Mao and Stephen B. Erickson
Medicina 2020, 56(5), 236; https://doi.org/10.3390/medicina56050236 - 14 May 2020
Cited by 9 | Viewed by 2883
Abstract
Background and Objectives: The optimal range of serum potassium at hospital discharge is unclear. The aim of this study was to assess the relationship between discharge serum potassium levels and one-year mortality in hospitalized patients. Materials and Methods: All adult hospital survivors between [...] Read more.
Background and Objectives: The optimal range of serum potassium at hospital discharge is unclear. The aim of this study was to assess the relationship between discharge serum potassium levels and one-year mortality in hospitalized patients. Materials and Methods: All adult hospital survivors between 2011 and 2013 at a tertiary referral hospital, who had available admission and discharge serum potassium data, were enrolled. End-stage kidney disease patients were excluded. Discharge serum potassium was defined as the last serum potassium level measured within 48 h prior to hospital discharge and categorized into ≤2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, 4.5–4.9, 5.0–5.4 and ≥5.5 mEq/L. A Cox proportional hazards analysis was performed to assess the independent association between discharge serum potassium and one-year mortality after hospital discharge, using the discharge potassium range of 4.0–4.4 mEq/L as the reference group. Results: Of 57,874 eligible patients, with a mean discharge serum potassium of 4.1 ± 0.4 mEq/L, the estimated one-year mortality rate after discharge was 13.2%. A U-shaped association was observed between discharge serum potassium and one-year mortality, with the nadir mortality in the discharge serum potassium range of 4.0–4.4 mEq/L. After adjusting for clinical characteristics, including admission serum potassium, both discharge serum potassium ≤3.9 mEq/L and ≥4.5 mEq/L were significantly associated with increased one-year mortality, compared with the discharge serum potassium of 4.0–4.4 mEq/L. Stratified analysis based on admission serum potassium showed similar results, except that there was no increased risk of one-year mortality when discharge serum potassium was ≤3.9 mEq/L in patients with an admission serum potassium of ≥5.0 mEq/L. Conclusion: The association between discharge serum potassium and one-year mortality after hospital discharge had a U-shaped distribution and was independent of admission serum potassium. Favorable survival outcomes occurred when discharge serum potassium was strictly within the range of 4.0–4.4 mEq/L. Full article
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10 pages, 310 KiB  
Article
Predictors of Hyperuricemia after Kidney Transplantation: Association with Graft Function
by Inese Folkmane, Lilian Tzivian, Elizabete Folkmane, Elina Valdmane, Viktorija Kuzema and Aivars Petersons
Medicina 2020, 56(3), 95; https://doi.org/10.3390/medicina56030095 - 25 Feb 2020
Cited by 5 | Viewed by 2376
Abstract
Background and objectives: In kidney transplant recipients (KTR), hyperuricemia (HU) is a commonly-observed phenomenon, due to calcineurin inhibitors and reduced kidney graft function. Factors predicting HU, and its association with graft function, remains equivocal. Materials and Methods: We conducted a retrospective [...] Read more.
Background and objectives: In kidney transplant recipients (KTR), hyperuricemia (HU) is a commonly-observed phenomenon, due to calcineurin inhibitors and reduced kidney graft function. Factors predicting HU, and its association with graft function, remains equivocal. Materials and Methods: We conducted a retrospective longitudinal study to assess factors associated with HU in KTR, and to determine risk factors associated with graft function, measured as glomerular filtration rate (GFR). Moreover, GFR > 60 mL/min/1.73 m2 was considered normal. HU was defined as a serum uric acid level of > 416 μmol/L (4.70 mg/dL) in men and >357 μmol/L (4.04 mg/dL) in women, or xanthine-oxidase inhibitor use. We built multiple logistic regression models to assess predictors of HU in KTR, as well as the association of demographic, clinical, and biochemical parameters of patients with normal GFR after a three-year follow-up. We investigated the effect modification of this association with HU. Results: There were 144 patients (mean age 46.6 ± 13.9), with 42.4% of them having HU. Predictors of HU in KTR were the presence of cystic diseases (OR = 9.68 (3.13; 29.9)), the use of diuretics (OR = 4.23 (1.51; 11.9)), and the male gender (OR = 2.45 (1.07; 5.56)). Being a younger age, of female gender, with a normal BMI, and the absence of diuretic medications increased the possibility of normal GFR. HU was the effect modifier of the association between demographic, clinical, and biochemical factors and a normal GFR. Conclusions: Factors associated with HU in KTR: Presence of cystic diseases, diuretic use, and male gender. HU was the effect modifier of the association of demographic, clinical, and biochemical factors to GFR. Full article

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18 pages, 1599 KiB  
Review
Risk Factors and Management of Osteoporosis Post-Transplant
by Karthik Kovvuru, Swetha Rani Kanduri, Pradeep Vaitla, Rachana Marathi, Shiva Gosi, Desiree F. Garcia Anton, Franco H. Cabeza Rivera and Vishnu Garla
Medicina 2020, 56(6), 302; https://doi.org/10.3390/medicina56060302 - 19 Jun 2020
Cited by 26 | Viewed by 5137
Abstract
Bone and mineral disorders are common after organ transplantation. Osteoporosis post transplantation is associated with increased morbidity and mortality. Pathogenesis of bone disorders in this particular sub set of the population is complicated by multiple co-existing factors like preexisting bone disease, Vitamin D [...] Read more.
Bone and mineral disorders are common after organ transplantation. Osteoporosis post transplantation is associated with increased morbidity and mortality. Pathogenesis of bone disorders in this particular sub set of the population is complicated by multiple co-existing factors like preexisting bone disease, Vitamin D deficiency and parathyroid dysfunction. Risk factors include post-transplant immobilization, steroid usage, diabetes mellitus, low body mass index, older age, female sex, smoking, alcohol consumption and a sedentary lifestyle. Immunosuppressive medications post-transplant have a negative impact on outcomes, and further aggravate osteoporotic risk. Management is complex and challenging due to the sub-optimal sensitivity and specificity of non-invasive diagnostic tests, and the underutilization of bone biopsy. In this review, we summarize the prevalence, pathophysiology, diagnostic tests and management of osteoporosis in solid organ and hematopoietic stem cell transplant recipients. Full article
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