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Incidence of hyperglycemia and diabetes and association with electrolyte abnormalities in pediatric solid organ transplant recipients.
Chanchlani, R, Joseph Kim, S, Kim, ED, Banh, T, Borges, K, Vasilevska-Ristovska, J, Li, Y, Ng, V, Dipchand, AI, Solomon, M, et al
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2017;(9):1579-1586
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Abstract
BACKGROUND Posttransplant hyperglycemia is an important predictor of new-onset diabetes after transplantation, and both are associated with significant morbidity and mortality. Precise estimates of posttransplant hyperglycemia and diabetes in children are unknown. Low magnesium and potassium levels may also lead to diabetes after transplantation, with limited evidence in children. METHODS We conducted a cohort study of 451 pediatric solid organ transplant recipients to determine the incidence of hyperglycemia and diabetes, and the association of cations with both endpoints. Hyperglycemia was defined as random blood glucose levels ≥11.1 mmol/L on two occasions after 14 days of transplant not requiring further treatment. Diabetes was defined using the American Diabetes Association Criteria. For magnesium and potassium, time-fixed, time-varying and rolling average Cox proportional hazards models were fitted to evaluate the association with hyperglycemia and diabetes. RESULTS Among 451 children, 67 (14.8%) developed hyperglycemia and 27 (6%) progressed to diabetes at a median of 52 days (interquartile range 22-422) from transplant. Multi-organ recipients had a 9-fold [hazard ratio (HR) 8.9; 95% confidence interval (CI) 3.2-25.2] and lung recipients had a 4.5-fold (HR 4.5; 95% CI 1.8-11.1) higher risk for hyperglycemia and diabetes, respectively, compared with kidney transplant recipients. Both magnesium and potassium had modest or no association with the development of hyperglycemia and diabetes. CONCLUSIONS Hyperglycemia and diabetes occur in 15 and 6% children, respectively, and develop early posttransplant with lung or multi-organ transplant recipients at the highest risk. Hypomagnesemia and hypokalemia do not confer significantly greater risk for hyperglycemia or diabetes in children.
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Calcium Mass Balance during Citrate Hemodialysis: A Randomized Controlled Trial Comparing Normal and Low Ionized Calcium Target Ranges.
Gubensek, J, Orsag, A, Ponikvar, R, Buturovic-Ponikvar, J
PloS one. 2016;(12):e0168593
Abstract
BACKGROUND Regional citrate anticoagulation (RCA) during hemodialysis interferes with calcium homeostasis. Optimal ionized calcium (iCa) target range during RCA and consequent calcium balance are unknown. METHODS In a randomized controlled trial (ACTRN12613001029785) 30 chronic hemodialysis patients were assigned to normal (1.1-1.2 mmol/) or low (0.95-1.05 mmol/l) iCa target range during a single hemodialysis with RCA. The primary outcome was calcium mass balance during the procedure, using a partial spent dialysate collection method; magnesium mass balance was also measured. Intact parathormone (iPTH), total calcium (tCa) and magnesium were measured before and after procedures. RESULTS Mean iCa during procedures was significantly different in the two groups (1.12±0.06 in normal and 1.06±0.07 mmol/l in low iCa group, p <0.001), resulting in different tCa (2.18±0.22 vs. 1.95±0.17, p = 0.003) after the procedure. Mean delivered calcium during the procedure was 58.3±4.8 mmol in the normal and 51.5±8.2 mmol in the low iCa group (p = 0.010), which resulted in a significantly higher mean positive calcium mass balance of 14.6±8.3 mmol (584±333 mg) per procedure in normal as compared to 7.2±8.5 mmol (290±341 mg) in low iCa group (p = 0.024). Linear mixed effects model showed a significant interaction effect of time and iCa target range group on iPTH, i.e. a significant increase in iPTH in the low as compared to normal iCa target group (p = 0.008). Magnesium mass balance was mildly negative and comparable in both groups. CONCLUSIONS Low iCa target range resulted in a significantly less positive calcium mass balance, but in a significant increase in iPTH. To achieve a more neutral calcium balance, we recommend allowing a mild hypocalcemia during hemodialysis with RCA, especially when it is used for prolonged periods.
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Electrolyte and plasma responses after pickle juice, mustard, and deionized water ingestion in dehydrated humans.
Miller, KC
Journal of athletic training. 2014;(3):360-7
Abstract
CONTEXT Some athletes ingest pickle juice (PJ) or mustard to treat exercise-associated muscle cramps (EAMCs). Clinicians warn against this because they are concerned it will exacerbate exercise-induced hypertonicity or cause hyperkalemia. Few researchers have examined plasma responses after PJ or mustard ingestion in dehydrated, exercised individuals. OBJECTIVE To determine if ingesting PJ, mustard, or deionized water (DIW) while hypohydrated affects plasma sodium (Na(+)) concentration ([Na(+)]p), plasma potassium (K(+)) concentration ([K(+)]p), plasma osmolality (OSMp), or percentage changes in plasma volume or Na(+) content. DESIGN Crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 9 physically active, nonacclimated individuals (age = 25 ± 2 years, height = 175.5 ± 9.0 cm, mass = 78.6 ± 13.8 kg). INTERVENTION(S): Participants exercised vigorously for 2 hours (temperature = 37°C ± 1°C, relative humidity = 24% ± 4%). After a 30-minute rest, a baseline blood sample was collected, and they ingested 1 mL/kg body mass of PJ or DIW. For the mustard trial, participants ingested a mass of mustard containing a similar amount of Na(+) as for the PJ trial. Postingestion blood samples were collected at 5, 15, 30, and 60 minutes. MAIN OUTCOME MEASURE(S): The dependent variables were [Na(+)]p, [K(+)]p, OSMp, and percentage change in plasma Na(+) content and plasma volume. RESULTS Participants became 2.9% ± 0.6% hypohydrated and lost 96.8 ± 27.1 mmol (conventional unit = 96.8 ± 27.1 mEq) of Na(+), 8.4 ± 2 mmol (conventional unit = 8.4 ± 2 mEq) of K(+), and 2.03 ± 0.44 L of fluid due to exercise-induced sweating. They ingested approximately 79 mL of PJ or DIW or 135.24 ± 22.8 g of mustard. Despite ingesting approximately 1.5 g of Na(+) in the PJ and mustard trials, no changes occurred within 60 minutes postingestion for [Na(+)]p, [K(+)]p, OSMp, or percentage changes in plasma volume or Na(+) content (P > .05). CONCLUSIONS Ingesting a small bolus of PJ or large mass of mustard after dehydration did not exacerbate exercise-induced hypertonicity or cause hyperkalemia. Consuming small volumes of PJ or mustard did not fully replenish electrolytes and fluid losses. Additional research on plasma responses pre-ingestion and postingestion to these treatments in individuals experiencing acute EAMCs is needed.
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Carbohydrate-electrolyte drink ingestion and skill performance during and after 2 hr of indoor tennis match play.
McRae, KA, Galloway, SD
International journal of sport nutrition and exercise metabolism. 2012;(1):38-46
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Abstract
Twenty-two tennis players were individually studied on 2 occasions. They performed a prematch skill test, a 2-hr tennis match against an equally ranked opponent, and a postmatch skill test. A carbohydrate-electrolyte (CHO-E; Lucozade Sport) or flavor-matched placebo-electrolyte (PL) beverage was administered in a double-blind fashion. During the trials, heart-rate and movement intensity were monitored, and the match was recorded for performance analysis. There were no differences in skill-test scores pre- to postmatch or between trials (154±38 pre- and 160±35 postmatch on PL, 155±36 pre- and 165±33 postmatch on CHO-E). CHO-E ingestion elevated blood glucose concentration throughout the match, and participants reported feeling more energetic (general activation) and more tense (high activation) 1 hr into the match than at baseline (p<.05). Participants in the CHO-E trial spent more time in moderate-intensity activity and less time in low-intensity activity than on PL. Performance analysis revealed that CHO-E ingestion increased overall serve success (M±SD, 68%±7% for CHO-E vs. 66%±7% for PL; p<.05) and success of first serves (65%±9% for CHO-E, 61%±7% for PL; p<.01) and serves to the advantage side (70%±9% for CHO-E, 66%±7% for PL; p<.05). Return success was greater during the second set of the match (p<.05) in the CHO-E trial. Differences in serve and return success were not associated with blood glucose response to CHO or player ability.
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Core temperature and metabolic responses after carbohydrate intake during exercise at 30 degrees C.
Horswill, CA, Stofan, JR, Lovett, SC, Hannasch, C
Journal of athletic training. 2008;(6):585-91
Abstract
CONTEXT Carbohydrate ingestion has recently been associated with elevated core temperature during exercise in the heat when testing for ergogenic effects. Whether the association holds when metabolic rate is controlled is unclear. Such an effect would have undesirable consequences for the safety of the athlete. OBJECTIVE To examine whether ingesting fluids containing carbohydrate contributed to an accelerated rise in core temperature and greater overall body heat production during 1 hour of exercise at 30 degrees C when the effort was maintained at steady state. DESIGN Crossover design (repeated measures) in randomized order of treatments of drinking fluids with carbohydrate and electrolytes (CHO) or flavored-water placebo with electrolytes (PLA). The beverages were identical except for the carbohydrate content: CHO = 93.7 +/- 11.2 g, PLA = 0 g. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Nine physically fit, endurance-trained adult males. INTERVENTION(S): Using rectal temperature sensors, we measured core temperature during 30 minutes of rest and 60 minutes of exercise at 65% of maximal oxygen uptake (Vo(2) max) in the heat (30.6 degrees C, 51.8% relative humidity). Participants drank equal volumes (1.6 L) of 2 beverages in aliquots 30 minutes before and every 15 minutes during exercise. Volumes were fixed to approximate sweat rates and minimize dehydration. MAIN OUTCOME MEASURE(S): Rectal temperature and metabolic response (Vo(2), heart rate). RESULTS Peak temperature, rate of temperature increase, and metabolic responses did not differ between beverage treatments. Initial hydration status, sweat rate, and fluid replacement were also not different between trials, as planned. CONCLUSIONS Ingestion of carbohydrate in fluid volumes that minimized dehydration during 1 hour of steady-state exercise at 30 degrees C did not elicit an increase in metabolic rate or core temperature.
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Serum electrolyte concentrations and hydration status are not associated with exercise associated muscle cramping (EAMC) in distance runners.
Schwellnus, MP, Nicol, J, Laubscher, R, Noakes, TD
British journal of sports medicine. 2004;(4):488-92
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Abstract
OBJECTIVES To determine whether acute exercise associated muscle cramping (EAMC) in distance runners is related to changes in serum electrolyte concentrations and hydration status. METHODS A cohort of 72 runners participating in an ultra-distance road race was followed up for the development of EAMC. All subjects were weighed before and immediately after the race. Blood samples were taken before the race, immediately after the race, and 60 minutes after the race. Blood samples were analysed for glucose, protein, sodium, potassium, calcium, and magnesium concentrations, as well as serum osmolality, haemoglobin, and packed cell volume. Runners who suffered from acute EAMC during the race formed the cramp group (cramp, n = 21), while runners with no history of EAMC during the race formed the control group (control, n = 22). RESULTS There were no significant differences between the two groups for pre-race or post-race body weight, per cent change in body weight, blood volume, plasma volume, or red cell volume. The immediate post-race serum sodium concentration was significantly lower (p = 0.004) in the cramp group (mean (SD), 139.8 (3.1) mmol/l) than in the control group (142.3 (2.1) mmol/l). The immediate post-race serum magnesium concentration was significantly higher (p = 0.03) in the cramp group (0.73 (0.06) mmol/l) than in the control group (0.67 (0.08) mmol/l). CONCLUSIONS There are no clinically significant alterations in serum electrolyte concentrations and there is no alteration in hydration status in runners with EAMC participating in an ultra-distance race.
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A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda.
Aronchick, CA, Lipshutz, WH, Wright, SH, Dufrayne, F, Bergman, G
Gastrointestinal endoscopy. 2000;(3):346-52
Abstract
BACKGROUND Currently available aqueous purgatives used before colonoscopy are poorly tolerated. We designed a tableted sodium phosphate purge that we believe will yield much greater patient acceptance. METHODS A total of 305 outpatients undergoing routine diagnostic colonoscopy were randomized to one of three preparation groups: Colyte (100 patients), Fleet Phospho-Soda (106 patients), or sodium phosphate tablets (99 patients). Endoscopists were blinded to the type of preparation administered and answered a questionnaire regarding preparation quality. Patients answered a questionnaire designed to analyze tolerability. Adverse events were closely followed and recorded. RESULTS There were no significant differences in quality of preparation across the groups (80% excellent or good, 4% repreparation). Although hypocalcemia (4 of 71), hypokalemia (18 of 68), and hyperphosphatemia (39 of 69) were observed in patients receiving the tablets, no adverse events occurred. Patients preferred taking the tablets over Colyte and Fleet Phospho-Soda. CONCLUSION The evaluation of a novel delivery system of a sodium phosphate purge is described. Intended for use before colonoscopy, it circumvents the poor taste and excessive volume of ingestion that are aversive to patients. The tableted purgative is equally effective, safe, and greatly preferred over the existing aqueous preparations. This may improve patient compliance with recommendations for screening colonoscopy.