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Background & Aims: Water, an essential component of body composition, appears to be a significant predictor of adverse outcomes in clinical populations, despite being frequently underexplored. Bioelectrical impedance analysis (BIA) and vector analysis (BIVA) are easy and cost-effective bedside tools for estimating body composition, particularly water content. Therefore, our study aimed to assess the impact of hydration and fluid status using both BIA and BIVA on outcomes in hospitalized patients with cancer., Methods: A prospective cohort study involving hospitalized individuals with cancer was conducted. Total body water (TBW) was estimated using BIA. Extracellular-water/TBW (ECW/TBW) and ECW/intracellular-water (ECW/ICW) ratios were calculated. BIVA ellipses vectors were constructed to enhance our analysis of hydration status. Participants were followed during their hospital stay and up to six months after discharge to assess outcomes, including in-hospital mortality, 6-month non-elective rehospitalization, and 6-month mortality., Results: TBW, ECW/TBW, ECW/ICW ratios, and BIVA plots were not associated with non-elective rehospitalization during the follow-up period. However, TBW and an elevated ECW/ICW ratio were independent predictors of in-hospital mortality [hazard ratio (HR): 1.07 (1.01; 1.13) p = 0.020; HR: 4.23 (1.69; 10.58) p = 0.002]. Elevated ratios ECW/TBW and ECW/ICW were independent predictors of 6-month mortality [HR: 1.87 (1.10; 3.21) p = 0.022; HR: 2.49 (1.37; 4.51) p = 0.003]. BIVA vectors for in-hospital and 6-month mortality shifted significantly to the right, leading to cachexia and overhydration quadrants (p < 0.05)., Conclusion: Abnormalities related to overhydration were important predictors of short- and long-term mortality in hospitalized patients with cancer., Competing Interests: Conflicts of interest APTF reports receiving grant for research from Prodiet Medical Nutrition., (Copyright © 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Magnetic resonance imaging has been used for evaluating of a brain edema in experimental animals to assess cytotoxic and vasogenic edema by the apparent diffusion coefficient (ADC) and T2 imaging. This paper brings information about the effectiveness of methylprednisolone (MP) on experimental brain edema. A total of 24 rats were divided into three groups of 8 animals each. Rats with cytotoxic/intracellular brain edema induced by water intoxication were assigned to the group WI. These rats also served as the additional control group CG when measured before the induction of edema. A third group (WIMP) was intraperitoneally administered with methylprednisolone 100 mg/kg during water intoxication treatment. The group WI+MP was injected with methylprednisolone 50 mg/kg into the carotid artery within two hours after the water intoxication treatment. We evaluated the results in four groups. Two control groups (CG, WI) and two experimental groups (WIMP, WI+MP). Rats were subjected to MR scanning 24 h after edema induction. We observed significantly increased ADC values in group WI in both evaluated areas - cortex and hippocampus, which proved the occurrence of experimental vasogenic edema, while ADC values in groups WIMP and WI+MP were not increased, indicating that the experimental edema was not developed and thus confirming the protective effect of MP. [ABSTRACT FROM AUTHOR]

Background/Aim: This study aimed to assess the clinical significance of measuring the arm skeletal muscle mass in patients with cirrhosis. Patients and Methods: Using body composition data measured with the bioimpedance analysis (BIA) method, the skeletal muscle mass index (SMI) values of the arm (arm skeletal muscle mass/height²) and leg (leg skeletal mass muscle/height²) were calculated for 353 patients with cirrhosis, and the relationships of these indices to their prognosis were assessed. In addition, overhydration of the upper and lower limbs was compared. Results: Arm SMI was significantly positively associated with the prognosis of patients with cirrhosis (p=0.0002) but leg SMI was not (p=0.0829). The rate of overhydration in the lower limbs was significantly higher than that in the upper limbs (p<0.0001). Conclusion: Arm SMI measured with the BIA method was suggested to be minimally affected by water retention, and might be clinically useful for patients with cirrhosis. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Academic Research in Nursing (JAREN) is the property of Hemsirelikte Egitim ve Arastirma Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Glycerol-induced hyperhydration (GIH) has been shown to improve fluid retention and endurance performance compared with water-induced hyperhydration. The goal of this article is to report on what is known and unknown about how glycerol-containing hyperhydration solutions (GCHSs) are processed at the stomach and intestine level, propose strategies to improve the efficacy of GIH, and provide research questions for future studies. Through statistical analyses, it is demonstrated that the effectiveness of GCHSs in increasing fluid retention is maximized when fluid ingestion is in the upper range of what is normally administered by studies (∼26 ml/kg body weight) and the duration of the protocol is no longer than the time it takes for the glycerol-fluid load to be totally or nearly completely integrated inside the body. The rate of gastric emptying and intestinal absorption of GCHSs is unknown. However, based on an analysis of indirect evidence obtained from human studies, it is proposed that most glycerol (∼80 g) and fluid (∼ 1,700 ml) ingested during a typical GIH protocol can be integrated inside the body within 60-90 min. Whether the stress associated with competition could alter these figures is unknown. Research in rats indicates that combining glycerol with glucose at a 3:1 ratio accelerates intestinal absorption of both glycerol and water, thereby potentially improving the efficacy of GIH. Human studies must be conducted to determine how GCHSs are processed by the gastrointestinal system and whether adding glucose to GCHSs could improve the technique's efficacy. [ABSTRACT FROM AUTHOR]

The authors determined, through a meta-analytic approach, whether glycerol-induced hyperhydration (GIH) enhances fluid retention and increases endurance performance (EP) significantly more than water-induced hyperhydration (WIH). Collectively, studies administered 23.9 ± 2.7 mL of fluid/kg body weight (BW) with 1.1 ± 0.2 g glycerol/kg BW, and hyperhydration was measured 136 ± 15 min after its onset. Compared with WIH, GIH increased fluid retention by 7.7 ± 2.8 mL/kg BW (P < 0.01; pooled effect size [PES]: 1.64 ± 0.80, P < 0.01, N = 14). The use of GIH was associated with an improvement in EP of 2.62% ± 1.60% (P = 0.047; PES: 0.35 ± 0.13, P = 0.014, N = 4). Unarguably, GIH significantly enhances fluid retention better than WIH. Because of the dearth of data, the effect of GIH on EP must be further investigated before more definitive conclusions can be drawn as to its ergogenic property. [ABSTRACT FROM AUTHOR]

The article presents information on the Medical and Anti-Doping Commission of the International Association of Athletics Federations' (IAAF) updated nutrition guidelines for athletes. According to the consensus statement, it is advantageous for athletes to create a drinking and eating plan in order meet their fluid and energy needs. The article discusses the IAAF 2007 Consensus Meeting, appropriate levels of carbohydrate and protein intake, timing of snacks and meals, hyperhydration, food choices, and dietary supplements.

Examines the effect of glycerol ingestion on fluid homeostasis, thermoregulation and metabolism during rest and exercise. Osmolality of plasma and urine at rest and during 90 minutes of bicycle exercise; Muscle metabolite concentrations before and after 90 minutes of bicycle exercise; Mechanisms for glycerol-induced hyperhydration.

Introduction. Water intoxication is a well-recognized cause of symptomatic hyponatremia, whose often fatal consequences are described in a wide variety of conditions such as psychiatric disorders, metabolic dysfunctions, child abuse, drug abuse and several medical procedures. The case. We here report a rare case of a 67-year-old woman with severe acute hyponatremia due to an excessive voluntary water intake - 14 litres in two days - following a chiropractic prescription. The patient developed sudden severe symptoms, including water retention, sensory alteration, altered mental status and tonic-clonic seizures. She was thus admitted to the Intensive Care Unit with a diagnosis of coma due to electrolyte alterations following water intoxication. Conclusion. The evaluation, in the present case, of the medicolegal implications related to malpractice involving a practitioner of Complementary and Alternative Medicine, led to the admission of a professional liability of the chiropractor. [ABSTRACT FROM AUTHOR]

Dipsogenic diabetes insipidus (DDI) is a subtype of primary polydipsia (PP), which occurs mostly in healthy people without psychiatric disease. In contrast, PP is characterized by a polyuria polydipsia syndrome (PPS) associated with psychiatric illness. However, the pathogenesis of DDI is not well established and remains unexplored. In order to diagnose DDI, the patient should exhibit excessive thirst as the main symptom, in addition to no history of psychiatric illness, polyuria with low urine osmolality, and intact urine concentrating ability. Treatment options for DDI remain scarce. On this front, there have been two published case reports with successful attempts at treating DDI patients. The noteworthy commonalities in these reports are that the patient was diagnosed with frequent excessive intake of water due to a belief that drinking excess water would have pathologic benefits. It could therefore be hypothesized that the increasing trend of excessive fluid intake in people who are health conscious could also contribute to DDI. Hence, this review provides an overview of the pathophysiology, diagnosis, and treatment, with a special emphasis on habitual polydipsia and DDI.

Introduction: Transurethral resection of the prostate (TURP) syndrome is iatrogenic state of water intoxication after transurethral resection of the prostate, an endoscopic procedure in urology. Neurological changes, heart failure and respiratory failure, followed with hyper or hypotension and hypoxia and acidemia, are dominant signs in clinical presentation of the TURP syndrome. For the last decade, better understanding of TURP syndrome pathophysiology and development of preventive measures, led to decrease incidence of the TURP syndrome. The present incidence of TURP syndrome is below 1 %. Case report: We are presenting case of severe TURP syndrome developed during endoscopic two hours long urologie procedure. TURP syndrome was manifested with serious neurologic disturbance which has expanded to coma and epileptic seizures, followed with hemodynamic instability requiring inotropic and vasopressor support. Severe hyponatremia (serum Na+102 mmol/l) was dominant biochemical finding. We are presenting therapy approach to the patient with severe form of TURP syndrome followed by patient health condition improvement. Conclusion: TURP syndrome is iatrogenic potentially life threatening condition, which may be presented during or after intervention. With constant patient monitoring symptoms of TURP syndrome can be early recognized and with adequate therapy potential complications can be avoided.

PULMONARY OEDEMA/ARDS ulmonary edema is a potential cause of hypoxia in the perioperative patient. The accumulation of excessive alveolar fluid results in hypoxia due to interference with diffusion across the alveolar capillary membrane. Frothy (sometimes blood-stained) sputum may be expectorated or observed in the endotracheal tube. the abnormal accumulation of fluid in the interstitial or alveolar spaces of the lung can be explained on the basis of a disturbance in the normal Starling equation1. It involves changes in hydrostatic or oncotic pressure across the alveolar membrane or in the permeability of the alveolar membrane such that fluid moves across from the capillaries into the alveolar space. P

Hyponatremia due to water intoxication is frequently observed in patients with chronic schizophrenia. We herein present a 49-year-old man who developed schizophrenia at the age of 23 and had been admitted to the closed ward of our hospital for 7 years. He was found by a round nurse standing at the bedside, covering both ears with his hands and making groaning noises. He was disoriented and immediately after being returned to bed, a general tonic-clonic seizure occurred. Severe hyponatremia (Na 104 mEq/L) was noted and intravenous sodium correction was started. A few hours later, due to glossoptosis and massive vomiting, ventilation got worse to the point where he had to be put on a ventilator. On the following day, he developed aspiration pneumonia and antimicrobial treatment was started. In addition, a blood sample taken 36 hours later revealed an extensive elevation of creatine kinase (41,286 U/L), pointing to a possibility of rhabdomyolysis as a complication. Subsequently, the general condition gradually improved with antimicrobial therapy and sodium correction. He eventually recovered without any complications including central pontine myelinolysis. He had no history of polydipsia before this event but it was later found that esophageal stricture triggered complusive fluid intake, resulting in acute hyponatremia, seizure, aspiration pneumonia and rhabdomyolysis. A brief discussion will be provided on the issues surrounding hyponatremia, rhabdomyolysis and schizophrenia., (Copyright © 1964–2023 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States.)

The distribution volume of uric acid is affected by the amount of extracellular water (ECW), while urea distribution volume can be considered as total body water (TBW). Thus, the ratio of distribution volumes of uric acid and urea can be paralleled to and be considered as the proxy of ECW/TBW. A total of 108 patients at our facility was included. The uric acid and urea distribution volume ratio (UUVdR) calculated from the single-pool model, which was measured within 1 month of the time when the bioimpedance index was measured. ECW/TBW at the end of the HD session was measured by InBody S10. We investigated the association between the UUVdR and the ECW/TBW values and the factors affecting the residuals of the regression equation. We also evaluated the predictive ability of overhydration or dehydration in randomly selected two groups, i.e., the training group and the validation group. ECW/TBW correlated highly with UUVdR. Multivariate analysis demonstrated that only creatinine and ECW/TBW were significantly associated with regression residuals. The cutoff values of UUVdR for overhydration and dehydration were 0.666 and 0.579, respectively, in the training group. Their AUC were 0.872 and 0.898, respectively. The sensitivity and specificity values in the validation group were 0.571 and 0.868 for overhydration, and 0.444 and 0.953 for dehydration, respectively. UUVdR might be a proxy of hydration status in hemodialysis patients. It may be possible to predict hydration status without dedicated devices in the epidemiological study., (© 2022. The Japanese Society for Artificial Organs.)

Background and Objectives : Early improvements to graft function are crucial for good outcomes in kidney transplantation (kTx). Various factors can influence early graft function. This study aimed to evaluate the pre- and post-transplant hydration statuses of kTx recipients using bioimpedance analysis (BIA) and lung ultrasonography (LUS) and to investigate the hydration status' relationship with the function of the transplanted kidney during the first year after transplantation. Materials and Methods : This observational prospective cohort study included deceased kidney recipients transplanted in the Hospital of the Lithuanian University of Health Sciences between September 2016 and January 2023. BIA and LUS were performed before transplantation, on days 3 and 7, and at discharge. Data on recipient and donor clinical characteristics were collected. Graft function was evaluated according to the serum creatinine reduction ratio and the need for dialysis. Hydration status was evaluated by calculating B-lines (BL) on LUS and the ratio of extracellular/total body water on BIA. Results : Ninety-eight kTx recipients were included in the study. Patients with immediate graft function (IGF) were compared to those with slow or delayed graft function (SGF + DGF). Recipients in the SGF + DGF group had a higher sum of BL on LUS before transplantation. After transplantation in early postoperative follow-up, both groups showed hyperhydration as determined by BIA and LUS. After one year, recipients with no BL before transplantation had better graft function than those with BL. Logistic regression analysis showed that having more than one BL in LUS was associated with a 2.5 times higher risk of SGF or DGF after transplantation. Conclusions : This study found that lung congestion detected by LUS before kTx was associated with slower graft recovery and worse kidney function after 1 year. Meanwhile, the hyperhydration status detected by BIA analysis did not correlate with the function of the transplanted kidney.

Background: Hyponatremia during labor and delivery may result in severe maternal and neonatal sequelae. Our aim was to describe the direct effect of hyponatremia in labor on pregnancy outcome.Methods: A case series of parturients diagnosed with hyponatremia during labor and their neonates. Clinical presentation, laboratory workup, and maternal and neonatal outcomes are presented.Results: Four parturients and their corresponding six neonates were diagnosed with hyponatremia. Of these, two cases were caused by water intoxication and two were preeclampsia induced. While two were identified due to maternal or neonatal symptoms, two were diagnosed by routine laboratory testing. In all cases, low maternal sodium resulted in similarly low neonatal sodium. Neonatal symptoms included respiratory distress syndrome (RDS), lethargy, and jaundice.Conclusion: Psychogenic drinking during labor and preeclampsia may predispose to maternal hyponatremia, resulting in neonatal hyponatremia. Early recognition and treatment can prevent further maternal deterioration and adverse neonatal sequelae. [ABSTRACT FROM AUTHOR]

Copyright of Zentralblatt fuer Arbeitsmedizin, Arbeitsschutz und Ergonomie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Importance: Immersion pulmonary edema (IPE) is a rare but important complication associated with surface swimming and underwater diving. It tends to reoccur and can be fatal. It is not very well-known to clinicians involved in the care of individuals participating in aquatic activities. We performed a systematic review of immersion pulmonary edema to describe the condition and provide guidelines for its management. Evidence review: We searched PubMed to identify case reports and studies using the MeSH terms "immersion," "pulmonary edema," "cold-induced," "exercise," "hemodynamics," "water immersion," "cardiovascular response," alone and in combinations. We identified 121 relevant articles including 54 case reports. We reviewed in detail 24 studies and all 54 case reports. Findings: The incidence of IPE is estimated to be around 1.1– 1.8%. The risk factors for IPE include age >50 years, female sex, overhydration before exercise, tight wetsuits, cold water exposure and physically trained individuals such as endurance athletes. Individuals with pre-existing heart disease are at increased risk, however, IPE is seen even in healthy individuals. Symptoms such as cough, sputum production, hemoptysis and shortness of breath can occur immediately after immersion. Combination of water immersion, cold exposure, and exercise lead to an increase in pulmonary capillary pressures and eventual pulmonary capillary stress failure that leads to the flooding of alveolar spaces and edema. Conclusion and relevance: Clinicians should be aware of IPE to avoid overestimating the severity of coronary or valvular conditions sometimes coincidentally present in IPE victims. Management is usually supportive. Functional and clinical recovery usually happens spontaneously within 24 h to 2 days, with or without diuretic therapy and a beta-adrenergic agonist. IPE can be recurrent and fatal, hence subjects with a history of IPE should undergo extensive cardiopulmonary investigation and should avoid cold water and physically demanding swimming events or avoid immersion activities. [ABSTRACT FROM AUTHOR]

Abstract Cerebral edema in ischemic stroke can lead to increased intracranial pressure, reduced cerebral blood flow and neuronal death. Unfortunately, current therapies for cerebral edema are either ineffective or highly invasive. During the development of cytotoxic and subsequent ionic cerebral edema water enters the brain by moving across an intact blood brain barrier and through aquaporin-4 (AQP4) at astrocyte endfeet. Using AQP4-expressing cells, we screened small molecule libraries for inhibitors that reduce AQP4-mediated water permeability. Additional functional assays were used to validate AQP4 inhibition and identified a promising structural series for medicinal chemistry. These efforts improved potency and revealed a compound we designated AER-270, N-[3,5-bis (trifluoromethyl)phenyl]-5-chloro-2-hydroxybenzamide. AER-270 and a prodrug with enhanced solubility, AER-271 2-{[3,5-Bis(trifluoromethyl) phenyl]carbamoyl}-4-chlorophenyl dihydrogen phosphate, improved neurological outcome and reduced swelling in two models of CNS injury complicated by cerebral edema: water intoxication and ischemic stroke modeled by middle cerebral artery occlusion. Highlights • High throughput screening of small molecule libraries reveals an inhibitor of Aquaporin-4. • Medicinal chemistry leads to development of AER-270 and IV prodrug AER-271, selective partial antagonist of Aquaporin-4. • Aquaporin-4 inhibitor AER-270 prevents cerebral edema and improves survival in a mouse model of water intoxication. • Aquaporin-4 inhibitor AER-271 reduces cerebral edema and improves neurological outcomes in rodent ischemic stroke models. [ABSTRACT FROM AUTHOR]

Induction of cellular cerebral edema (CE) was achieved by a standard method of water intoxication which consisted of fractionated intraperitoneal administration of distilled water (DW) together with the injection of desmopressin (DP). Using metabolic cage, fluid and food balance was studied in two groups of eight animals: group C - control; group CE - cellular edema induced by water intoxication. For each rat the intake (food pellets and water) and excretion (solid excrements and urine) were recorded for 48 h together with the initial and final body weight. CE animals consumed significantly less food, drank less water and eliminated the smallest amount of excrements. The induction of cellular cerebral edema was accompanied with a significant loss of body weight (representing on average 13 % of the initial values) mainly due to a reduction of food intake. This phenomenon has not yet been reported. [ABSTRACT FROM AUTHOR]

The health and performance of ultra-endurance athletes is dependent on avoidance of performance limiting hypohydration while also avoiding the potentially fatal consequences of exercise-associated hyponatremia due to overhydration. In this work, key factors related to maintaining proper hydration during ultra-endurance activities are discussed. In general, proper hydration need not be complicated and has been well demonstrated to be achieved by simply drinking to thirst and consuming a typical race diet during ultra-endurance events without need for supplemental sodium. As body mass is lost from oxidation of stored fuel, and water supporting the intravascular volume is generated from endogenous fuel oxidation and released with glycogen oxidation, the commonly promoted hydration guidelines of avoiding body mass losses of >2% can result in overhydration during ultra-endurance activities. Thus, some body mass loss should occur during prolonged exercise, and appropriate hydration can be maintained by drinking to the dictates of thirst. [ABSTRACT FROM AUTHOR]

Abstract This paper reports a study, performed by in-situ synchrotron X-ray powder diffraction, of the high-pressure behavior of zeolite L. The experiments were performed using both penetrating (methanol: ethanol: water mixture, m.e.w.) and non-penetrating (silicon oil, s.o.) pressure transmitting media (PTM) to study the compressibility and the possible pressure-induced hydration (PIH) of this synthetic zeolite, technologically relevant as host-guest system exploited in numerous application fields. The experiments were performed from P amb to 6.2 and 6.3 GPa in s.o. and m.e.w., respectively. The crystal structure refinements were performed up to 6.3 GPa and 3.1 GPa for the patterns collected in m.e.w. and s.o., respectively, while the unit cell parameters were determined in the whole pressure range for both media. A strong PIH effect is evident when zeolite L is compressed in m.e.w. and the over-hydration is essentially ascribable to the filling of most the H 2 O sites, to the appearance of a new H 2 O site and to the partially filling of the K sites. The over-hydration starts at a very low pressure (0.5 GPa) and the maximum H 2 O content can be estimated in 31.1 H 2 O molecules, against the original value of 18. The PIH is completely reversible upon P release. The main difference between the compression behavior of zeolite L in the two media is the higher compressibility in the non-penetrating one, evidenced by ΔV = − 6.3% and −9.9% in m.e.w. and s.o, respectively. Our data are consistent with the general behavior of zeolites compressed with penetrating media, when the intrusion of H 2 O molecules hinders the effects of the applied pressure. The results of this work are compared with those obtained on a K-gallosilicate with LTL topology, where PIH induces the formation of H 2 O nanotubes inside the zeolite channel. Graphical abstract Image 1 Highlights • A strong PIH effect is evident when zeolite L is compressed in m.e.w. • Filling of most the water sites and the appearance of a new water site is observed. • The maximum water content can be estimated in 31.1 water molecules. • The PIH is completely reversible upon P release. • Higher compressibility in the non-penetrating medium is observed. [ABSTRACT FROM AUTHOR]

Although dehydration is a serious condition associated with significant morbidity and mortality in palliative care patients, as in any other patient group, treatment remains controversial. A narrative review of the causes of dehydration during end of life was conducted paying special attention to the nature of terminal dehydration. A comprehensive search of the literature was performed to identify relevant articles published in English and German languages between 1960 and 2018. Currently available options for bed-side evaluation and therapeutic approaches were critically appraised and areas of future research are emphasized. The following inferences can be derived: 1) the available evidence does not support a clear decision in favor or against fluid therapy during the dying phase. 2) There is inadequate precision of the term end of life care (ELC) and insufficient differentiation between modes of dehydration of palliative care patients. 3) Evaluation of dehydration based on its clinical appearance is considered the method of choice compared to invasive procedures. 4) Detailed clinical assessment of symptom reversibility in terminal dehydration by an appropriate fluid challenge is mandatory in the decision-making process. 5) If despite adequate rehydration measures, complete reversibility of the clinical picture of dehydration can no longer be achieved since organ systems are gradually deteriorating, the cessation of clinically assisted hydration (CAH) can be considered. 6) If symptoms of dehydration are reversible after fluid challenge and no other patient wishes to the contrary are known, fluid management should be continued in the context of symptom control. 7) Hyperhydration represents a considerable threat during fluid management that needs to be prevented by noninvasive monitoring procedures. In conclusion, if CAH is applied as a part of ELC the hydration status needs to be individually appraised and all therapeutic measures constantly need to be adapted to the findings of diligent monitoring procedures. [ABSTRACT FROM AUTHOR]

Background and purpose: Diphenylarsinic acid (DPAA) intoxication caused by drinking contaminated well water was found in Kamisu, Japan. The symptoms indicated cerebellar–brainstem and temporo‐occipital involvement. However, it remains unclear how it affects the human brain. To elucidate the effect of DPAA on the human brain, we analyzed cerebral blood flow (CBF) data after the drinking of DPAA‐contaminated water was stopped and investigated the correlation between DPAA exposure level and CBF by single‐photon emission computed tomography (CBF‐SPECT). Methods: The DPAA‐exposed inhabitants (n = 78) were divided into 35 symptomatic and 43 asymptomatic subjects and compared with 38 healthy controls. The DPAA concentration in nails or hair and well water was measured using a high‐performance liquid chromatography system and coupled plasma mass spectrometry after adequate extraction treatment. CBF‐SPECT data, obtained within 1 year after the drinking of contaminated well water was stopped, were analyzed by statistical parametric mapping. We also examined the relationship between variations in CBF‐SPECT signals and variations in DPAA concentrations in the hair or nails of the subjects. Results: Compared with control subjects, CBF in symptomatic DPAA‐exposed subjects was significantly lower in the occipital lobe, including the cuneus and inferior occipital gyri. The DPAA concentration in the nails or hair of subjects was inversely and significantly related to their CBF. Conclusion: These data suggest that CBF‐SPECT may be useful as a clinical marker to infer the effect of accumulated DPAA on the brain. [ABSTRACT FROM AUTHOR]

Abstract Nitrate pollution has emerged as a problem of great importance because in recent years, the levels of nitrate in soil and groundwater have increased, mainly through anthropogenic activities, such as the use of fertilizers in agriculture, domestic wastewater and septic tanks, industrial waste and deforestation. In animals, nitrate reduction to nitrite (NO 2) and nitric oxide (NO) promote the formation of methemoglobin in the blood and the generation of highly reactive intermediates that induce oxidative stress in target organs. Exposition to nitrates has been associated with methemoglobinemia, reproductive toxicity, metabolic and endocrine alterations and cancer. This study analyzed acute intoxication with sodium nitrate (NaNO 3) in male Wistar rats, aged 12–16 weeks. Four groups with n = 10 rats each were formed: group 1 was the control, and group 2, group 3 and group 4 were treated for 10 days with intragastric doses of 19, 66 and 150 mg/kg/d NaNO 3 , respectively. Hematological, metabolic and histological biomarkers in the liver were analyzed. The results showed high percentages of methemoglobin, an increase in NO 2 in the plasma and an accumulation in the liver. Moreover, there were high counts of white blood cells and platelets in all treated groups. Additionally, there was an increase in the spleen weight in group 4. High levels of glucose, triglycerides, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were observed and were significantly increased in groups 3 and 4. For oxidative stress biomarkers, there were increases in Thiobarbituric Acid Reactive Substances (TBARS), total GSH and SOD activity, mainly in group 4. Changes in mitochondrial activity were not significant. Histopathological analyses of the liver showed inflammation, infiltration of mononuclear cells, steatosis, ischemia and necrosis, and these findings were more evident at high doses of NaNO 3 in which high of S-nitrosylation were found. In conclusion, NaNO 3 was reduced to NO 2 , thereby inducing methemoglobinemia, whereas other reactive species generated oxidative stress, causing hematological and metabolic alterations and injury to the liver. Graphical abstract fx1 Highlights • Subacute intoxication with NaNO 3 increases the level of NO 2 in the plasma and the percentage of methemoglobin in Wistar rats. • Short term exposition to NaNO 3 causes alterations in white blood cell and platelet counts. • An increase in the dose of NaNO 3 also increases the TBARS and S-nitrosylation levels and triggers the antioxidant response. • Inflammation, steatosis, ischemia and necrosis in the liver were found at a high dose, namely, 150 m/kg/d NaNO 3. [ABSTRACT FROM AUTHOR]

Background and aims: Diabetes mellitus (DM) is a significant public health issue, being one of the major contributors to morbidity and mortality in the modern societies. Chronic hyperglycemia produces significant physiological, biochemical, and histological changes in the affected organisms. This study aims to evaluate the markers of endogenous intoxication in rats with diabetes mellitus combined with carrageenan-induced enterocolitis. Materials and methods: Diabetes mellitus was induced by a single intraperitoneal administration of streptozotocin (Sigma Aldrich, USA, at a dose of 60 mg/kg body weight). Carrageenan-induced enterocolitis was modeled by giving the animals free access to 1.0 % solution of carrageenan in drinking water for 1 month. The syndrome of endogenous intoxication was assessed by quantification of low and medium molecular weight substances in blood plasma, red blood cell suspension and urine using extraction-spectrophotometric method. Results: The increase in endogenous intoxication in streptozotocin-induced diabetes combined with chronic enterocolitis can mainly be attributed to the catabolic pool of blood plasma substances of low and medium molecular weight. The index of distribution of low- and medium-molecular-weight substances between blood plasma proteins and glycocalyx of erythrocytes in the experimental groups increased simultaneously with the quantities of investigated fractions in the erythrocyte suspension measured at the wavelengths of 242, 254 and 280 nm. Conclusions: We observed upsurge of endogenous intoxication markers in the rats with diabetes mellitus. Endotoxicosis became even more evident in the rats with diabetes mellitus combined with carrageenan-induced enterocolitis. [ABSTRACT FROM AUTHOR]

K6.16Na0.16Ca0.07Mg0.03(H2O)19.2|[Al6.45Si29.55O72] (space group C2/m, a = 17.6490(3) Å, b = 17.9982(2) Å, c = 7.39329(12) Å, β = 116.0655(19)°, V = 2109.63(5) Å3, Z = 1) is studied by the single crystal X-ray diffraction analysis under ambient conditions and also upon compression to 4 GPa in penetrating (water-containing) and non-penetrating (paraffin) media. Compression of Ksubstituted clinoptillolite in a water:ethanol (1:1) mixture results in its additional hydration: inclusion of 2.2 additional H2O molecules into the structure at the initial stage. Upon further compression the H2O concentration increases by two molecules. This is caused by additional occupancy of partially vacant H2O sites. The cation environment practically does not change during overhydration. Changes in the coordination polyhedra of cations during compression in paraffin are reduced to a small (0.02-0.1 Å) decrease in bond lengths. Distinctions in the degree of hydration of the K-form upon compression in penetrating and non-penetrating media are manifested in the features of the compressibility of the compound. [ABSTRACT FROM AUTHOR]

Background Accurate volume status evaluation and differentiation of cardiac and non-cardiac components of overhydration (OH) are fundaments of optimal haemodialysis (HD) management. Methods This study, by combining bioimpedance measurements, cardiovascular biomarkers and echocardiography, aimed at dissecting OH into its major functional components, and prospectively tested the association between cardiac and non-cardiac components of OH with mortality. In the first part, we validated soluble CD146 (sCD146) as a non-cardiac biomarker of systemic congestion in a cohort of 30 HD patients. In the second part, we performed a prospective 1-year follow-up study in an independent cohort of 144 HD patients. Results sCD146 incrementally increased after the short and long intervals after HD (+53 ng/mL, P = 0.006 and  +91 ng/mL, P < 0.001), correlated with OH as determined by bioimpedance and well-diagnosed OH (area under the receiver operating characteristics curve 0.72, P = 0.005). The prevalence of OH was lower for low-sCD146 and low-BNP patients (B-type natriuretic peptide, 29%) compared with subjects with either one or both biomarkers elevated (65–74%, P < 0.001). Notably, most low-BNP but high-sCD146 subjects were overhydrated. Systolic dysfunction was 2- to 3-fold more prevalent among high-BNP compared with low-BNP patients (44–68% versus 21–23%, chi-square P < 0.001), regardless of sCD146. One-year all-cause mortality was markedly higher in patients with high-BNP (P = 0.001) but not with high-sCD146. In multivariate analysis, systolic dysfunction and BNP, but not OH, were associated with lower survival. Conclusions The combination of BNP and sCD146 dissects OH into functional components of prognostic value. OH in HD patients is associated with higher mortality only if resulting from cardiac dysfunction. [ABSTRACT FROM AUTHOR]

Objective: Hemodialysis (HD) patients are exposed to dysregulated fluid balance which can lead to overhydration. Poor sleep quality and excessive daytime sleepiness are particularly common in these patients, however the relationship between fluid status and sleep quality and daytime sleepiness has not yet been studied. Therefore, the aim of this study is to evaluate the correlations between fluid status and sleep quality and daytime sleepiness in HD patients.Method: This cross-sectional study included 115 HD patients and 30 healthy control subjects from the HD center of Shanghai Ninth People's Hospital. Fluid compartments [total body water (TBW)], extracellular water (ECW)] and overhydration index (OH) were analyzed by multifrequency bio-impedance (BCM). Overhydration was defined as OH/ECW≥7%. HD patients were divided into an overhydration group and non overhydration group according to OH/ECW. Sleep quality was assessed by the Chinese version of the Pittsburgh Sleep Quality Index (PSQI), and excessive daytime sleepiness was evaluated by the Epworth Sleepiness Scale (ESS).Results: The prevalence rate of fluid overload in HD patients was 65.2%. Poor sleep quality (PSQI≥5) and excessive daytime sleepiness (ESS≥11) were significantly higher in HD patients compared with the healthy controls [6 (3, 10) vs.2.11 ± 1.59, p = 0.000; 3 (0, 6) vs.1.68 ± 1.07, p = 0.045]. Furthermore, the PSQI scores were higher in HD patients with overhydration (7.8 ± 4.5 vs. 4.8 ± 3.2, p = 0.000). The component scores 1, 2, 3 and 5 of the PSQI showed significant differences between the overhydration and non overhydration groups. The ESS scores did not show differences between the two groups (3.9 ± 4.1 vs. 3.3 ± 3.5, p = 0.508). OH was correlated with Systolic BP and Diastolic BP, and additionally was an independent predictor of poor sleep quality.Conclusion: Fluid overload is significantly linked with poor quality of sleep in HD patients, however there is no association with excessive daytime sleepiness. Our study provides new insight into possible treatment strategies. Future studies should examine the effects of optimizing fluid status on quality of sleep. [ABSTRACT FROM AUTHOR]

Background: Overhydration is common among peritoneal dialysis (PD) patients and can affect PD-related outcomes. This paper aims to systematically investigate whether bioimpedance-assessed overhydration is a predictor for mortality and technique failure in PD patients. Methods: We conducted a systematic review and meta-analysis of cohort studies on overhydration and prognosis in PD patients, strictly complying with the Preferred Reporting Items for Systematical Reviews and Meta-analyses. Results: Eight articles met the selection criteria and 5 studies were included in the meta-analysis. Meta-analyses-revealed overhydration, defined as a high ratio of extracellular water/total body water (ECW/TBW), was significantly associated with higher risk for all-cause mortality and technique failure. Other higher dichotomized overhydration indicators and continuous hydration variables all indicated overhydration as a significant risk factor for all-cause mortality. Conclusion: Overhydration, defined by a higher ratio of ECW/TBW, might be an independent predictor for all-cause mortality and technique failure among PD patients. However, more studies are needed to confirm this conclusion. Video Journal Club 'Cappuccino with Claudio Ronco' at https://www.karger.com/Journal/ArticleNews/223997?​sponsor=52 [ABSTRACT FROM AUTHOR]

Jianbo Lai,1 Qiaoqiao Lu,1 Yi Xu,1,2 Shaohua Hu1,2 1Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2The Key Laboratory of Mental Disorder’s Management in Zhejiang Province, Hangzhou, People’s Republic of China Abstract: This study presents a case of severe water intoxication in a female patient with delusional infestation. Self-induced excessive water ingestion is a rare medical condition, which has not been reported in patients with delusional infestation yet. The patient in this case study was a 60-year-old Chinese woman, who was admitted to our hospital because of a feeling of skin infestation. She suffered from loss of consciousness and generalized tonic–clonic seizure after drinking 12 L of water during bowel cleansing before colonoscopy. Sufficient laboratory and imaging examinations were performed to exclude other possible causes of severe hyponatremia, such as hypothyroidism, diabetes insipidus, and syndrome of inappropriate antidiuretic hormone. Besides, the cystic lesion in the posterior pituitary revealed by cranial magnetic resonance imaging was not accountable for her delusional symptoms as well as excessive drinking behavior. Her delusional symptoms were in complete remission with a combination of risperidone and aripiprazole. However, nearly 3 months after discharge, this patient suffered from depressed mood and was diagnosed with depressive syndrome, and even attempted suicide. This case highlights the possibility of self-induced water intoxication in patients with delusional infestation, inevitably adding to the complexity of the disease, and indicates the necessity of precautions for secondary psychotic or mood problems after symptomatological remission. Keywords: delusional infestation, depressive syndrome, suicide, water intoxication

Primary polydipsia (PP) has been defined as excessive intake of fluids. However, the pathogenesis of PP remains unexplored. Different theories include a dysfunction in the thirst mechanism, involvement of the hippocampus, stress-reducing behaviour and lesion occurrences in specific areas of the brain. Most studies have been performed in the psychiatric setting, indicating that PP coincides with schizophrenia, anxiety disorder and depression. However, an increasing number of case reports emphasise the incidence of PP in non-psychiatric patients. As often recommended by healthcare professions and in life-style programmes, the phenomenon of excessive fluid intake appears to be growing, especially in health-conscious and active people. PP is part of the polyuria-polydipsia syndrome, so the differential diagnosis diabetes insipidus (central or nephrogenic) must be excluded. The gold standard when differentiating between these disorders has been the water deprivation test. However, new options for distinguishing between these entities have been proposed e.g., measurement of copeptin, a reliable surrogate marker of the hormone arginine vasopressin (AVP). The major risk of excessive drinking is the development of hyponatraemia and the ensuing complications. In patients with PP, factors reducing the renal excretory capacity of the kidney such as acute illness, medications or low solute intake may accumulate in hyponatraemia. Treatment options for PP remain scarce. Different medication and behavioural therapy have been investigated, but never on a large scale and rarely in non-psychiatric patients. This review provides an overview of the pathophysiology, characteristics, complications, and outcomes of patients with PP in the medical and psychiatric patient.

Hypotonic hyponatremia by primary polydipsia can cause severe neurologic complications due to cerebral edema. A 10-year-and-4-month-old boy with a psychiatric history of intellectual disability and behavioral disorders who presented with chief complaints of seizure and mental change showed severe hypotonic hyponatremia with low urine osmolality (serum sodium, 101 mmol/L; serum osmolality, 215 mOsm/kg; urine osmolality, 108 mOsm/kg). The patient had been polydipsic for a few months prior, and this had been worse in the previous few days. A diagnosis of hypotonic hyponatremia caused by primary polydipsia was made. The patient was in a coma, and developed respiratory arrest and became brain death shortly after admission, despite the treatment. The initial brain magnetic resonance imaging showed severe brain swelling with tonsillar and uncal herniation, and the patient was declared as brain death. It has been reported that antidiuretic hormone suppression is inadequate in patients with chronic polydipsia, and that this inadequate suppression of antidiuretic hormone is aggravated in patients with acute psychosis. Therefore, hyponatremia by primary polydipsia, although it is rare, can cause serious and life-threatening neurologic complications.

Hyponatremia is one of the most common electrolyte disorders in emergency departments and hospitalized patients. Serum sodium concentration is controlled by osmoregulation and volume regulation. Both pathways are regulated via the release of antidiuretic hormone (ADH). Syndrome of inappropriate release of ADH (SIADH) may be caused by neoplasms or pneumonia but may also be triggered by drug use or drug abuse. Excessive fluid intake may also result in a decrease in serum sodium concentration. Rapid alteration in serum sodium concentration leads to cell swelling or cell shrinkage, which primarily causes neurological symptoms. The dynamics of development of hyponatremia and its duration are crucial. In addition to blood testing, a clinical examination and urine analysis are essential in the differential diagnosis of hyponatremia., (© 2023. The Author(s).)