Search Results (43)

Background/Objectives: Parenteral nutrition (PN) supports patients unable to receive nutrients via the gastrointestinal tract, but it lacks the health-promoting natural bioactive compounds found in a typical oral diet. This study aimed to develop a human serum albumin-based intravenous delivery system for lutein (an antioxidant carotenoid with vision-supportive and hepatoprotective properties) as a PN additive. Methods: An albumin–lutein nanosuspension (AlbLuteN) was synthesized using a modified nanoparticle albumin-bound (nab^TM) technology and characterized physicochemically. The nanoformulation was added to four commercial PN admixtures to assess the supplementation safety throughout the maximum infusion period. Visual inspection and measurements of fat globules larger than 5 µm (PFAT5) and the mean hydrodynamic diameter (Z-average), zeta potential, pH, osmolality, and lutein content were performed to detect potential interactions and evaluate the physicochemical stability. Results: AlbLuteN consisted of uniform particles (Z-average of 133.5 ± 2.8 nm) with a zeta potential of −28.1 ± 1.8 mV, lutein content of 4.76 ± 0.39%, and entrapment efficiency of 84.4 ± 6.3%. Differential scanning calorimetry confirmed the amorphous state of lutein in the nanosuspension. AlbLuteN was successfully incorporated into PN admixtures, without visible phase separation or significant changes in physicochemical parameters. The PFAT5 and Z-average values remained within pharmacopeial limits over 24 h. No substantial shifts in zeta potential, pH, or osmolality were observed. The lutein content remained stable, with losses below 3%. Conclusions: AlbLuteN can be safely added to representative PN admixtures without compromising their stability. This approach offers a novel strategy for intravenous lutein delivery and may contribute to improving the nutritional profile of PN. Full article

The distribution of saline-alkali water is extensive and is increasing globally each year. Fully utilizing saline-alkali water for aquaculture can help alleviate the scarcity of freshwater resources in global fisheries. As a major economic fish species, the largemouth bass (Micropterus salmoides) holds significant potential for aquaculture in saline-alkali water. In the present study, we evaluated its tolerance to different salinities (0 ppt, 6 ppt, 9 ppt, 12 ppt, 15 ppt, and 18 ppt) and investigated tissue pathology, serum biochemical indicators, enzyme activities of osmolality and antioxidant, and the relative expression of Na-K-2Cl 1a cotransporter (NKCC1a) under different saline stress (0 ppt, 6 ppt, 9 ppt, and 12 ppt). The largemouth bass 96 h mortality rate increased with increasing salinity, and the LC₅₀ for 96 h was 14.28 ppt based on the mortality results. High salinity group (12 ppt) caused gill and intestinal damage, including necrosis and cell shedding, while 6 ppt had no adverse effects, and the 9 ppt between the two salinities showed an adaptive change histologically. Serum osmolality, Na⁺, Cl⁻, and cortisol levels of the high salinity group were significantly higher than of the low salinities (p < 0.05). Similarly, Na⁺/K⁺-ATPase (NKA), Ca²⁺-Mg²⁺-ATPase (CMA), and superoxide dismutase (SOD) activities of 12 ppt peaked at 24 h (15.7 U/mgprot, 11.5 U/mgprot, and 243 U/mgprot), which is significantly different compared to the other three groups (p < 0.05). The expression of NKCC1a was significantly upregulated at 9 ppt and 12 ppt, suggesting its role in osmoregulation. Furthermore, the expression of NKCC1a in the gill is 2–4 times higher than that in the intestine. These results suggested that largemouth bass can be cultured at 6 ppt and selectively bred for tolerance at 9 ppt. NKA activity, cortisol levels, and NKCC1a expression can be used as a marker of salinity suitability. These findings provide insight into the adaptive mechanisms underlying the physiological responses to acute salinity stress and will contribute to improving aquaculture in saline waters. Full article

Lyme disease (LD), caused by the spirochete Borrelia burgdorferi, is the most prevalent tick-borne disease in Europe, including Romania, where endemic areas are well documented. It has a wide range of clinical manifestations and severity, including rare neurological complications. Persistent hyponatremia is an atypical presentation of Lyme neuroborreliosis and can be associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is characterized by unregulated antidiuretic hormone release, leading to impaired water excretion, dilutional hyponatremia, and low serum osmolality. We report the case of a 16-year-old female with clinically well-tolerated, but severe, refractory hyponatremia, who was poorly responsive to intravenous sodium supplementation and fluid management. Complex investigations ruled out multiple causes of hyponatremia; neuroborreliosis was confirmed via positive Borrelia serologies, despite the absence of a suggestive history of exposure. SIADH likely symptomatology resulted from central nervous system inflammation induced by Borrelia, a mechanism rarely documented in the medical literature. Treatment with antibiotics and fluid restriction led to a gradual improvement in fluid balance and sodium homeostasis. This case emphasizes the importance of considering rare infectious causes, such as LD, in patients with unexplained SIADH, especially in endemic areas. It highlights the importance of a multidisciplinary approach in intricate, complex cases. Full article

Background: Hyponatraemia is a rare but potentially life-threatening complication of terlipressin therapy. Case history: In the current case, a 39-year-old female with decompensated liver cirrhosis (Child-Pugh C) and acute variceal bleeding experienced a precipitous decline in serum sodium—from 136 mmol/L to 115 mmol/L—within 48 h of initiating terlipressin therapy. This was accompanied by marked fluid retention, reduced urine output, and symptoms of confusion and agitation. Laboratory tests confirmed dilutional hyponatraemia, characterized by urinary sodium <20 mmol/L and urine osmolality <100 mOsm/kg, indicating excessive free water reabsorption. Outcomes: The prompt discontinuation of terlipressin, fluid restriction and the cautious administration of hypertonic sodium chloride solution (2.7% NaCl) achieved a gradual normalization of sodium levels and resolution of symptoms. Fluid balance monitoring revealed a marked diuretic response following terlipressin cessation. This case aligns with existing reports, emphasizing the dual vasopressin receptor activity of terlipressin and its capacity to induce hyponatraemia, particularly in cirrhotic patients with preserved renal function and higher baseline sodium levels. Conclusions: This case and a literature review underscored the critical need for early fluid balance monitoring to detect retention. This case highlights the importance of individualized risk assessment, multidisciplinary management, and vigilant sodium correction to avoid complications. Practical recommendations are outlined to aid clinicians in the recognition and management of terlipressin-induced hyponatraemia. Full article

Background/Objectives: Dehydration and malnutrition are common conditions in older adults. Although both are regulated by different pathways, they seem to share common risk factors, such as dysphagia and dementia. Only scarce data on their co-occurrence are published. An exploratory analysis of a multicenter prospective trial on the determinants of malnutrition to evaluate the potential association between malnutrition and dehydration in older hospitalized patients was performed. Methods: Patients underwent a comprehensive geriatric assessment, their nutritional status was evaluated using the Global Leadership Initiative on Malnutrition (GLIM) criteria, and routine laboratory tests were performed, including calculated serum osmolality. Results: A total of 454 patients were included in the analysis. Of those, 45% were classified as malnourished based on MNA-SF, and 42% according to GLIM criteria. Dehydration as determined by calculated serum osmolality was present in 32%. Multivariate binomial regression analysis revealed elevated serum creatinine (p < 0.001) and higher body mass index (BMI) (p = 0.020) as predictive factors for dehydration. Overlap between dehydration and malnutrition was present in 13% of patients; malnourished patients had no higher risk for dehydration and vice versa (p = 0.903). Conclusions: Malnutrition and dehydration are common in hospitalized older adults but do not frequently occur together. We identified that BMI and creatinine levels are significant predictors of dehydration risk among this population. Consequently, the implementation of separate screening assessments for malnutrition and dehydration is recommended to better identify and address these conditions individually. Full article

Background/Objectives: Different beverages may vary in their effectiveness at quenching thirst. This study aims to explore the impact of pre-exercise consumption of different types of beverages on thirst relief, providing scientific evidence to guide the selection of the most suitable beverage type. Methods: A randomized crossover design was used, recruiting 13 healthy male college students as participants. Each participant completed five exercise trials, with a 7-day interval between trials. In random order, participants consumed 6 mL/kg body weight of water, carbonated beverage, juice, electrolyte drink, or tea before exercise in each trial. Blood, saliva, and urine samples were collected before and after exercise; body weight was measured, and thirst sensation was recorded. Results: Body weight significantly decreased in all groups post-exercise (p < 0.05), with no significant differences between the beverage groups (p > 0.05). Post-exercise, serum Na⁺ concentrations significantly decreased in all beverage groups, with the electrolyte drink group showing a significantly different change compared to the other groups (p < 0.05). Serum K⁺ concentrations significantly increased post-exercise only in the electrolyte drink group (p < 0.05). No consistent trend was observed in the changes in serum Ca²⁺ concentrations before and after exercise. Serum Cl⁻ concentrations post-exercise were significantly lower than pre-exercise in all groups except the electrolyte drink group (Group E) (p < 0.05). All five hydration protocols resulted in a decrease in plasma volume. There was no consistent pattern in the changes in urine osmolality before and after exercise. Salivary osmolality significantly increased post-exercise in all groups (p < 0.05). In terms of subjective thirst, the water supplementation group had the highest score. Conclusions: This study indicates that electrolyte drinks are more effective in maintaining physiological balance, while water is most effective in alleviating subjective thirst. The impact of different beverages on subjective thirst did not fully align with changes in physiological markers, suggesting that future research should comprehensively evaluate the relationship between subjective sensations and physiological changes. Full article

Background and Aims: Dehydration is a prevalent and costly healthcare concern, linked to heightened risks of acute kidney injury and in-hospital mortality. Despite its significance, limited evidence exists regarding its prevalence and correlation with renal function decline in apparently healthy individuals. This retrospective cohort study aimed to investigate the prevalence and association of dehydration with renal function decline and the development or progression of chronic kidney disease (CKD) in the general population. Methods: The medical records of subjects undergoing annual health check-ups from 2016 to 2019 at a single center in Taiwan were analyzed, and those with CKD stage V, insufficient data, or an increased estimated glomerular filtration rate (eGFR) were excluded. Serum osmolality, eGFR, and relevant parameters were measured. Logistic regression and Kaplan–Meier analyses were used to assess associations between osmolality and CKD-related outcomes. Results: Among the 4449 eligible subjects, those in the higher osmolality quartiles had an elevated risk of CKD or CKD progression. Multivariate analyses identified age, systolic blood pressure, serum osmolality, uric acid, proteinuria, and a history of diabetes as independent risk factors, with high-density lipoprotein being protective. Cumulative incidence curves demonstrated a significant increase in the risk of CKD with increasing osmolality levels. Restricted cubic spline analyses confirmed a nonlinear relationship between osmolality and CKD risk. Conclusions: Elevated serum osmolality independently predicted renal function decline and CKD development in apparently healthy individuals, and this effect persisted after adjusting for established risk factors. Our findings underscore the importance of addressing dehydration as a modifiable risk factor for CKD. Full article

(1) Background: Pituitary adenomas are benign tumors comprising about 18% of all intracranial tumors, and they often require surgical intervention. Differentiating pituitary tissue from adenoma during surgery is crucial to minimize complications. We hypothesized that using ICG dye would reduce the hormonal complication rates. (2) Methods: A prospective randomized study (February 2019–October 2023) included 34 patients with non-functional macroadenomas of the pituitary gland randomly assigned to receive intraoperative ICG or be in the control group. All underwent endoscopic endonasal transsphenoidal surgery. Pituitary function was assessed preoperatively, immediately postoperatively, and 3–6 months postoperatively. Adenohypophysis function was evaluated with hormonal tests (Cosyntropin stimulation test, TSH, fT3, fT4, prolactin, IGF-1, FSH, LH, and testosterone in men) and neurohypophysis function with fluid balance, plasma and urine osmolality, and serum and urinary sodium. (3) Results: Of the 34 patients (23 men, 11 women; average age 60.9 years), 5.9% in the ICG group developed diabetes insipidus postoperatively, compared to 23.5% in the control group. Adenohypophysis function worsened in 52.9% of the ICG group and in 35.3% of the control group. (4) Conclusions: Our study did not confirm the benefits of using ICG in these surgeries. Further research with a larger sample is needed. Full article

Kidney transplantation is preferred for end-stage renal disease. The current gold standard for kidney preservation is static cold storage (SCS) at 4 °C. However, SCS contributes to renal graft damage through ischemia–reperfusion injury (IRI). We previously reported renal graft protection after SCS with a hydrogen sulfide donor, sodium thiosulfate (STS), at 4 °C. Therefore, this study aims to investigate whether SCS at 10 °C with STS and Hemopure (blood substitute), will provide similar protection. Using in vitro model of IRI, we subjected rat renal proximal tubular epithelial cells to hypoxia–reoxygenation for 24 h at 10 °C with or without STS and measured cell viability. In vivo, we preserved 36 donor kidneys of Lewis rats for 24 h in a preservation solution at 10 °C supplemented with STS, Hemopure, or both followed by transplantation. Tissue damage and recipient graft function parameters, including serum creatinine, blood urea nitrogen, urine osmolality, and glomerular filtration rate (GFR), were evaluated. STS-treated proximal tubular epithelial cells exhibited enhanced viability at 10 °C compared with untreated control cells (p < 0.05). Also, STS and Hemopure improved renal graft function compared with control grafts (p < 0.05) in the early time period after the transplant, but long-term function did not reach significance. Overall, renal graft preservation at 10 °C with STS and Hemopure supplementation has the potential to enhance graft function and reduce kidney damage, suggesting a novel approach to reducing IRI and post-transplant complications. Full article

Background: Tolvaptan sodium phosphate (Samtas^®; Otsuka Pharmaceutical, Tokyo, Japan) is a novel intravenous aquaretic diuretic aimed at individuals experiencing advanced congestion refractory to conventional diuretics and having difficulty with oral intake. Despite its potential, the true efficacy and practicality of this compound within real-world clinical settings remain obscure. Methods: A retrospective analysis of clinical data was conducted, examining trends among consecutive in-hospital patients diagnosed with congestive heart failure who underwent treatment with tolvaptan sodium phosphate at a prominent academic medical center between June 2022 and June 2023. Results: Twenty-one patients were enrolled (median age: 75 years, serum N-terminal pro B-type natriuretic peptide: 8941 pg/mL). Among them, 14 patients (67%) received non-invasive/invasive positive-pressure ventilation, and 17 patients (81%) concurrently received intravenous inotropes. Subsequent to the initiation of tolvaptan sodium phosphate treatment, a significant increase in urine volume was observed on the following day (p = 0.036). Urine osmolality decreased from 356 (318, 443) at baseline to 247 (176, 333) mOsm/kg after 4 h (p = 0.002). No occurrences of hypernatremia were recorded during the therapeutic period. Notably, two patients transitioned from tolvaptan sodium phosphate treatment to continuous hemodiafiltration due to insufficient efficacy. Conclusions: In routine clinical practice, intravenous tolvaptan sodium phosphate exhibits potential efficacy and practicability in the majority of congestive heart failure patients exhibiting refractory congestion, unstable hemodynamics, and challenges with oral intake. Full article

Adequate water intake and optimal hydration status during pregnancy are crucial for maternal and infant health. However, research on water intake by pregnant women in China is very limited. This study mainly aimed to observe the daily total water intake (TWI) of pregnant women and its different sources and to investigate the relationship between their water intake and hydration biomarkers. From October to November 2020, a convenience sample of pregnant women in the second trimester (n = 21) was recruited. Under conditions close to daily life, they undertook a 3-day metabolic trial. Each participant was provided with sufficient bottled water, and the weight of what they drank each time was measured. The intake of other beverages and foods was measured using a combination of weighing and duplicate portion method. Fasting venous blood and 24 h urine samples were collected and analyzed for the hydration biomarkers, including the serum/urine osmolality, urine pH, urine specific gravity, and the concentrations of major electrolytes in urine and serum. The results showed that the mean daily TWI was 3151 mL, of which water from beverages and foods accounted for 60.1% and 39.9%, respectively. The mean total fluid intake (TFI) was 1970 mL, with plain water being the primary contributor (68.7%, r = 0.896). Among the participants, 66.7% (n = 14, Group 1) met the TWI recommendation set by the Chinese Nutrition Society. Further analysis revealed that the TFI, water from beverages and foods, plain water, and milk and milk derivatives (MMDs) were significantly higher in Group 1 than those who did not reach the adequate intake value (Group 2) (p < 0.05). The results of hydration biomarkers showed that the mean 24 h urine volume in Group 1 was significantly higher than that in Group 2 (p < 0.05), while the 24 h urine osmolality, sodium, magnesium, phosphorus, chloride, and creatinine concentrations in Group 1 were significantly lower than those in Group 2 (p < 0.05). However, no significant differences were observed in serum biomarkers. Partial correlation analysis showed that TWI was moderately positively correlated with 24 h urine volume (r = 0.675) and negatively correlated with urine osmolality, sodium, potassium, magnesium, calcium, phosphorus, and chloride concentrations (r = from−0.505 to −0.769), but it was not significantly correlated with serum biomarkers. Therefore, under free-living conditions, increasing the daily intake of plain water and MMDs is beneficial for pregnant women to maintain optimal hydration. The hydration biomarkers in urine are more accurate indicators of water intake and exhibit greater sensitivity compared to serum biomarkers. These findings provide a scientific basis for establishing appropriate water intake and hydration status for pregnant women in China. Full article

This paper focuses on hyperglycemic hyperosmolar syndrome (HHS), a unique hyperglycemic state requiring divergent diagnosis and treatment approaches from diabetic ketoacidosis (DKA) despite some shared characteristics. We introduce the mnemonic DI-FF-ER-EN-CE-S to encapsulate unique HHS management and complications. ‘DI’ emphasizes the need to delay and decrease initial insulin therapy until serum glucose decline is managed by fluid resuscitation alone. ‘FF’ stresses the importance of double fluid replacement compared to DKA due to severe dehydration and ‘ER’ electrolyte replacement due to profound losses and imbalances. ‘EN’ denotes the potential for encephalopathy and the requirement for a controlled serum osmolality reduction. ‘CE’ indicates cerebral edema, a rare complication in HHS. ‘S’ signifies systemic multiorgan failure. We categorize the associated risks into three mnemonic groups: the 3Rs (renal failure, respiratory distress, rhabdomyolysis), the 3Hs (heart failure, hypercoagulation, hyperthermia), and AP (arrhythmias, pancreatitis) to facilitate awareness and screening of HHS. Full article

Background: Sports-related concussion is a relevant risk of contact sports, with several million cases per year worldwide. Prompt identification is crucial to prevent complications and late effects but may be impeded by an overlap with dehydration-associated impairment of cognitive function. Researchers have extensively studied the effects of pronounced dehydration in endurance sports, especially in the heat. However, little is known about the effects of isolated and mild dehydration. Methods: Healthy recreational athletes underwent a standardized fluid deprivation test. Hypohydration was assessed by bioelectrical impedance analysis (BIA) and laboratory testing of electrolytes and retention parameters. Participants underwent cardiopulmonary exercise testing (CPET) with a cycle ramp protocol. Each participant served as their own control undergoing CPET in a hypohydrated [HYH] and a euhydrated [EUH] state. Effects were assessed using a shortened version of Sport Concussion Assessment Tool 3 (SCAT3). Results: Fluid deprivation caused a mild (2%) reduction in body water, resulting in a calculated body mass loss of 0.8% without alterations of electrolytes, serum-osmolality, or hematocrit. Athletes reported significantly more (1.8 ± 2.2 vs. 0.4 ± 0.7; p < 0.01) and more severe (4.4 ± 6.2 vs. 1.0 ± 1.9; p < 0.01) concussion-like symptoms in a hypohydrated state. Balance was worse in HYH by trend with a significant difference for tandem stance (1.1 ± 1.3 vs. 0.6 ± 1.1; p = 0.02). No relevant differences were presented for items of memory and concentration. Conclusions: Mild dehydration caused relevant alterations of concussion-like symptoms and balance in healthy recreational athletes in the absence of endurance exercise or heat. Further research is needed to clarify the real-life relevance of these findings and to strengthen the differential diagnosis of concussion. Full article

Background: Heat induces a thermoregulatory strain that impairs cardiopulmonary exercise capacity. The aim of the current study is to elucidate the effect of isolated dehydration on cardiopulmonary exercise capacity in a model of preparticipating hypohydration. Methods: Healthy recreational athletes underwent a standardised fluid deprivation test. Hypohydration was assessed by bioelectrical impedance analysis (BIA) and laboratory testing of electrolytes and retention parameters in the blood and urine. The participants underwent cardiopulmonary exercise testing (CPET) with a cycle ramp protocol. Each participant served as their own control undergoing CPET in a hypohydrated [HYH] and euhydrated [EUH] state. Results: Fluid deprivation caused a mild (2%) but significant reduction of body water (38.6 [36.6; 40.7] vs. 39.4 [37.4; 41.5] %; p < 0.01) and an increase of urine osmolality (767 [694; 839] vs. 537 [445; 629] mosm/kg; p < 0.01). Hypohydration was without alterations of electrolytes, serum osmolality or hematocrit. The oxygen uptake was significantly lower after hypohydration (−4.8%; p = 0.02 at ventilatory threshold1; −2.0%; p < 0.01 at maximum power), with a corresponding decrease of minute ventilation (−4% at ventilatory threshold1; p = 0.01, −3.3% at maximum power; p < 0.01). The power output was lower in hypohydration (−6.8%; p < 0.01 at ventilatory threshold1; −2.2%; p = 0.01 at maximum power). Conclusion: Isolated hypohydration causes impairment of workload as well as peak oxygen uptake in recreational athletes. Our findings might indicate an important role of hypohydration in the heat-induced reduction of exercise capacity. Full article

Hyponatremia (hypo-osmolality) is a disorder of water homeostasis due to abnormal renal diluting capacity. The body limits the degree to which serum sodium concentration falls through a mechanism called “vasopressin escape”. Vasopressin escape is a process that prevents the continuous decrease in serum sodium concentration even under conditions of sustained high plasma vasopressin levels. Previous reports suggest that aldosterone may be involved in the vasopressin escape mechanism. The abilities of aldosterone synthase (Cyp11b2) knockout and wild-type mice to escape from vasopressin were compared. Wild-type mice escaped while the aldosterone synthase knockout mice did not. Both the water channel aquaporin 2 (AQP2) and the urea transporter UT-A1 protein abundances were higher in aldosterone synthase knockout than in wild-type mice at the end of the escape period. Vasopressin escape was also blunted in rats given spironolactone, a mineralocorticoid receptor blocker. Next, the role of the phosphatase, calcineurin (protein phosphatase 2B, PP2B), in vasopressin escape was studied since aldosterone activates calcineurin in rat cortical collecting ducts. Tacrolimus, a calcineurin inhibitor, blunted vasopressin escape in rats compared with the control rats, increased UT-A1, AQP2, and pS256-AQP2, and decreased pS261-AQP2 protein abundances. Our results indicate that aldosterone regulates vasopressin escape through calcineurin-mediated protein changes in UT-A1 and AQP2. Full article