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Objective: Fluid replacement and insulin infusion are the cornerstones of treatment of diabetic ketoacidosis, but the optimal volume, rate of infusion, and electrolyte content of fluid replacement have been controversial. The aim of this study was to investigate the effects of treatment on pH, bicarbonate (HCO3), anion gap, chloride, and potassium levels as well as time to resolution of acidosis in children with diabetic ketoacidosis. Material and Methods: Ninety-six episodes with diabetic ketoacidosis between January 2015-December 2017 were evaluated. Results: The mean resolution time of acidosis was 13.4±7.1 hours. Anion gap was returned to normal in 68 (70.8%) episodes at the 4th hour of treatment with a mean of 11±4.2 mmol/L. Episodes with potassium phosphate (KPO4) replacement resulted in a faster increase in pH and a significantly shorter resolution time of acidosis (p<0.001). Acidosis persisted at the 16th hour of treatment in episodes with lower pH, lower serum bicarbonate (HCO3) and higher white blood cell (WBC) counts on admission (p<0.001, p=0.003 p=0.033, respectively). Hyperchloremia (Cl/Na ratio > 0.79) was observed in 97% of cases after 8 hours of treatment. Conclusion: Although the value of the anion gap in predicting acidosis is controversial, severe DKA episodes and high white blood cell count at admission; potassium replacement with high amounts of chloride and KCl containing fluids given during treatment have been associated with a longer recovery time of acidosis. [ABSTRACT FROM AUTHOR]

Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this systematic review demonstrated that commercial sports drinks can be suggested for effective restoration of fluid balance in dehydrated people. In part II, we perform a systematic review to compare alternative liquids, such as cow's milk, beer, and coconut water, with water for effective oral rehydration after prolonged exercise. Cochrane Library, MEDLINE via the PubMed interface, and Embase databases were searched up until June 1, 2022. Controlled experimental and observational studies involving adults and children were included when dehydration was induced by physical exercise and oral rehydration fluids were administered and compared with regular water. No additional food intake accompanied the rehydration drinks or water. Articles in all languages were included if an English abstract was available. Study design, study population, intervention, outcome measures, and study limitations were extracted from each included article. Of 3485 articles screened, 11 articles in which authors compared skim or low-fat cow's milk, coconut water, or beer (0%–5% alcohol) with water were included. Authors of 4 studies showed that drinking skim or low-fat milk, without additional food intake, led to improved volume/hydration status compared with drinking water. Authors of 3 trials showed no differences at multiple times for outcomes related to volume/hydration status after rehydration with fresh coconut water compared with water. Evidence to recommend beer (0%–5% alcohol) for rehydration is insufficient. Consuming skim or low-fat cow's milk without additional food intake as compared with water appears to improve volume/hydration status in people with exercise-induced dehydration. However, evidence is of very low certainty and should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Aim and background: Fluid resuscitation is the first-line treatment for patients with diabetic ketoacidosis (DKA). However, the optimal choice of resuscitative fluid remains controversial. This study aims to evaluate the impact of balanced electrolyte solution (BES) compared to 0.9% sodium chloride (NS) on various physiological and clinical outcomes in adult DKA patients. Materials and methods: An extensive search of electronic databases, including Embase, PubMed, Cochrane Library, Web of Science, and Google Scholar, was conducted to select studies that directly compared BES and NS in adult DKA patients. This systematic review and meta-analysis included nine studies, comprising both randomized controlled trials and retrospective studies. Combined estimates were expressed as mean differences (MDs) with 95% confidence intervals (CIs). The primary outcomes were time to resolution of DKA and length of hospital stay. The secondary outcomes were post-resuscitation chloride and bicarbonate levels and adverse events. Results: No significant difference was observed between BES and NS in the time to DKA resolution (MD: -1.63; 95% CI: -7.66-4.41; p = 0.60) or length of hospital stay (MD: -0.07; 95% CI: -0.44-0.31; p = 0.73). However, BES resulted in significantly higher post-resuscitation bicarbonate levels (MD: 1.63; 95% CI: 0.86-2.39; p < 0.001) and lower post-resuscitation chloride levels (MD: -2.37; 95% CI: -3.56 to -1.19; p < 0.001). Conclusion: The use of BES is associated with improved post-resuscitation electrolyte balance and preventing hyperchloremic metabolic acidosis in DKA patients. While BES may offer some biochemical advantages, both BES and NS are safe for treating DKA. [ABSTRACT FROM AUTHOR]

Introduction: del Nido cardioplegia was developed for immature myocardium to prevent myocardial damage by Ca+2 in traditional blood cardioplegia. But due to increased hemodilution and decreased colloid oncotic pressure it may cause myocardial edema and increased cardiac morbidity. Microplegia may have better cardioprotection in comparison to del Nido as there is less hemodilution. Material and methods: 60 patients from the age group of 1 to 14 years were divided into two groups i.e. del Nido based microplegia group and conventional del Nido group for studying two different cardioplegia technique. Data were collected and compared for intraoperative Hb, CPK-MB and Trop-I levels changes and requirement for defibrillation in intraoperative period. Demographic data, CPB time and ACC time were also collected. Results: Marked elevation in CPK-MB and Trop-I levels were seen in both groups. Statistically significant difference was seen in CPK-MB levels after 6 h of surgery where del Nido group has higher value in comparison to microplegia group. No statistical difference was seen in Trop-I levels in both groups. Strength of correlation (r) was also stronger for CPK-MB rise in association with CPB time and ACC time, in del Nido group but not for Trop-I. Significantly higher hemodilution was also seen in del Nido group after delivering cardioplegia. None of the patients required defibrillation in any group. Conclusion: Lesser hemodilution was seen in microplegia group. Significant cardioprotection is associated with use of microplegia solution in pediatric age group. [ABSTRACT FROM AUTHOR]

Objective: Nutritional rehabilitation and weight restoration are often critical for the treatment of eating disorders (ED), yet are restricted by the potential risk of refeeding syndrome (RFS). The primary objective was to determine the incidence of RFS. Secondary objectives were to explore predictive factors of RFS and describe its impact on treatment goals for patients with ED. Method: This retrospective observational study reviewed the nutrition management for patients admitted to a quaternary hospital for ED treatment from 2018 to 2020. Data were collected during the first 4 weeks of admission and included anthropometry, energy prescription, incidence and severity of RFS, and electrolyte and micronutrient prescription. Outcomes included incidence of RFS, energy prescription and advancement, and weight change. Results: Of 423 ED admissions, 217 patients (median [interquartile range, IQR] age 25 [21–30.5] years; 210 [97%] female) met inclusion criteria. Median (IQR) body mass index (BMI) on admission was 15.5 (14.1–17.3) kg/m2. The mean (standard deviation) length of admission was 35 (7.3) days. Median (IQR) initial energy prescription was 1500 (930–1500) kcal/day. Seventy‐three (33%) patients developed RFS; 34 (16%) mild, 27 (12%) moderate, and 12 (5%) severe. There was no association between RFS severity and admission BMI, energy prescription, or prescription of prophylactic electrolytes or micronutrients. Lower admission weight was associated with RFS (odds ratio 0.96, 95% confidence interval [0.93–1.00], p =.035). Less than half of the participants met the weight gain target (>1 kg per week) in the first 3 weeks of admission. Discussion: The incidence of severe RFS was low in this cohort and was associated with lower admission weight. Public Significance: This study is one of the largest studies to utilize consensus‐defined criteria to diagnose RFS among adult patients admitted for treatment of an ED. This population is still considered to be at risk of RFS and will require close monitoring. The results add to the growing body of research that restriction of energy prescription to prevent RFS may not require the level of conservatism traditionally practiced. [ABSTRACT FROM AUTHOR]

Oral rehydration therapy is a proven and cost-effective treatment for calves suffering from diarrhoea. The key components of an efficient oral electrolyte product are adequate concentrations of sodium, chloride and potassium, an energy source like glucose or glycine to facilitate water absorption, and sufficient concentrations of alkalinising substances to correct metabolic acidosis. A thorough understanding of the composition of commercial oral electrolyte solutions is important for practitioners to make informed treatment recommendations. Continued milk feeding is another cornerstone in the resuscitation of diarrhoeic calves since withholding milk can exacerbate dehydration and malnourishment. [ABSTRACT FROM AUTHOR]

The article presents a case study highlighting the emergence of hyperglycaemic hyperosmolar state (HHS) in adolescents, previously considered exclusive to adults. Topics include the clinical presentation, management, and outcomes of HHS in adolescents, along with an overview of its epidemiology and pathophysiology.

Fluid and electrolyte therapy in childhood diabetic ketoacidosis (DKA) management has been controversial. Previous National Institute for Health and Care Excellence (NICE) 2015 guidance advocated a restricted fluid regimen while more recent guidelines have advocated a more liberal approach to fluid replacement in DKA. At the core of the debate is the need to avoid developing cerebral oedema as a complication. Although subtle asymptomatic cerebral oedema is common in children presenting in DKA, clinically apparent cerebral oedema is rare and has been reported in approximately 0.5%-1% of DKA cases in children. Recent research evidence has shown that there was no clear evidence of a difference in rates of clinically apparent cerebral injury in children in DKA managed with a range of fluid volumes and rates of rehydration. In view of this, NICE has updated its guideline. In this paper, we review literature evidence underpinning the current understanding of the pathophysiology of cerebral oedema in children and discuss the rationale for the new NICE guidance., (© 2021 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)

Abstract: Although antiepileptic drugs are often effective in the control of seizures, some patients show little or no improvement. As alternative treatments, different dietary modifications were shown to be beneficial for patients with poor tolerance for AEDS. Previous reports have shown that rice-based oral electrolyte hydration therapy is effective in seizure control in patients with refractory absence seizures. In the present study, using an animal model of absence epilepsy, we showed that the occurrence of spike-and-wave discharges significantly decreases upon switching to electrolyte therapy. We also showed that consumption of solution with the same osmolarity as rice-based oral electrolyte solution leads to a decrease in the number of spike-and-wave discharges per hour. We suggest that the antiepileptic effect of rice-based oral electrolyte hydration therapy can be at least in part due to hyperosmolarity of the ingested solution. [Copyright &y& Elsevier]