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This single-center, pragmatic, multiple-crossover trial showed no difference in hospital-free days, the primary outcome, among adults treated with intravenous saline or balanced crystalloids in the ED and subsequently hospitalized outside an ICU.

Saline (0.9% sodium chloride), the fluid most commonly used to treat diabetic ketoacidosis (DKA), can cause hyperchloremic metabolic acidosis. Balanced crystalloids, an alternative class of fluids for volume expansion, do not cause acidosis and, therefore, may lead to faster resolution of DKA than saline. To compare the clinical effects of balanced crystalloids with the clinical effects of saline for the acute treatment of adults with DKA. This study was a subgroup analysis of adults with DKA in 2 previously reported companion trials-Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED) and the Isotonic Solutions and Major Adverse Renal Events Trial (SMART). These trials, conducted between January 2016 and March 2017 in an academic medical center in the US, were pragmatic, multiple-crossover, cluster, randomized clinical trials comparing balanced crystalloids vs saline in emergency department (ED) and intensive care unit (ICU) patients. This study included adults who presented to the ED with DKA, defined as a clinical diagnosis of DKA, plasma glucose greater than 250 mg/dL, plasma bicarbonate less than or equal to 18 mmol/L, and anion gap greater than 10 mmol/L. Data analysis was performed from January to April 2020. Balanced crystalloids (clinician's choice of Ringer lactate solution or Plasma-Lyte A solution) vs saline for fluid administration in the ED and ICU according to the same cluster-randomized multiple-crossover schedule. The primary outcome was time between ED presentation and DKA resolution, as defined by American Diabetes Association criteria. The secondary outcome was time between initiation and discontinuation of continuous insulin infusion. Among 172 adults included in this secondary analysis of cluster trials, 94 were assigned to balanced crystalloids and 78 to saline. The median (interquartile range [IQR]) age was 29 (24-45) years, and 90 (52.3%) were women. The median (IQR) volume of isotonic fluid administered in the ED and ICU was 4478 (3000-6372) mL. Cumulative incidence analysis revealed shorter time to DKA resolution in the balanced crystalloids group (median time to resolution: 13.0 hours; IQR: 9.5-18.8 hours) than the saline group (median: 16.9 hours; IQR: 11.9-34.5 hours) (adjusted hazard ratio [aHR] = 1.68; 95% CI, 1.18-2.38; P = .004). Cumulative incidence analysis also revealed shorter time to insulin infusion discontinuation in the balanced crystalloids group (median: 9.8 hours; IQR: 5.1-17.0 hours) than the saline group (median: 13.4 hours; IQR: 11.0-17.9 hours) (aHR = 1.45; 95% CI, 1.03-2.03; P = .03). In this secondary analysis of 2 cluster randomized clinical trials, compared with saline, treatment with balanced crystalloids resulted in more rapid resolution of DKA, suggesting that balanced crystalloids may be preferred over saline for acute management of adults with DKA. ClinicalTrials.gov Identifiers: NCT02614040; NCT02444988.

Objectives: The purpose of this study was to examine the acute effects of branched-chain amino acids (BCAAs)-containing electrolyte beverage (AE) on water–electrolyte balance, muscle damage, time to finish the final 5 km, and muscle strength compared to a standard commercially available carbohydrate–electrolyte sports beverage (CE), pure water (W), and no rehydration (N). Methods: Fourteen trained male participants (20 ± 2 years old) completed four randomized 21 km running trials. The participants were instructed to consume their drink (150 mL W, 150 mL CE, or 150 mL AE) or no rehydration (N) at 5 km, 10 km, and 15 km. Body mass and muscle strength were assessed, and blood samples were collected before and after exercise. Perceptual scales were administered during and after running. Blood electrolyte levels (sodium, potassium, and chloride) and creatine kinase (CK) concentration were analyzed. Results: The change in plasma volume with AE was significantly smaller than that with N (p < 0.05). Consuming AE maintained the best potassium balance (p < 0.05). Twenty-four hours after exercise, serum CK concentrations significantly elevated in N, W, and CE (p < 0.05), but did not reach statistical significance in the AE group (p > 0.05). Compared to N, consuming AE resulted in significantly less soreness 24 h after exercise (p < 0.05). There was no difference in time to finish the final 5 km (p > 0.05). Maximal voluntary isometric force output was significantly lower after exercise with N and W (p < 0.05) but not with CE or AE (p > 0.05). Conclusions: Consuming a BCAAs-containing sports beverage during a 21 km run can help reduce dehydration, maintain potassium balance, lower muscle damage, and prevent the decline in lower limb strength after 21 km running.

The physiological and performance effects of carbohydrate-electrolyte gels consumed before the 30min extra-time period of prolonged soccer-specific exercise were investigated. Randomised, double-blind, crossover. Eight English Premier League academy soccer players performed 120min of soccer-specific exercise on two occasions while consuming fluid-electrolyte beverages before exercise, at half-time and 90min. Carbohydrate–electrolyte (0.7±0.1gkg−1 BM) or energy-free placebo gels were consumed ∼5min before extra-time. Blood samples were taken before exercise, at half-time and every 15min during exercise. Physical (15-m and 30-m sprint speed, 30-m sprint maintenance and countermovement jump height) and technical (soccer dribbling) performance was assessed throughout each trial. Carbohydrate–electrolyte gels improved dribbling precision (+29±20%) and raised blood glucose concentrations by 0.7±0.8mmoll−1 during extra-time (both p<0.01). Supplementation did not affect sprint velocities (15m and 30m), 30-m sprint maintenance or dribbling speed as reductions compared to 0–15min values occurred at 105–120min irrespective of trial (all p<0.05). Plasma osmolality and blood sodium concentrations increased post-exercise vs. the opening 15min (p<0.05) but no effect of supplementation existed. Selected markers of physical performance (jump height, 30-m sprint velocity and 30-m repeated sprint maintenance) also reduced by >3% during half-time (all p<0.05). Carbohydrate–electrolyte gel ingestion raised blood glucose concentrations and improved dribbling performance during the extra-time period of simulated soccer match-play. Supplementation did not attenuate reductions in physical performance and hydration status that occurred during extra-time.

Electrolytes (sodium, potassium, calcium, magnesium, chloride, phosphate) are required in specific amounts for proper functioning of the human body. Although the body has different organ systems, such as the kidneys, that regulate electrolyte levels in the blood, electrolyte abnormalities occur frequently in people with eating disorders. The objective of this review will be to examine the association between electrolyte imbalances and adverse outcomes in people with eating disorders. A systematic review of studies on eating and electrolyte disorders shall be conducted. Electronic searches shall be done in the Ovid MEDLINE, EMBASE, and PsycINFO databases. Selected studies shall include randomized control trials (RCTs), non-randomized controlled trials, and cross-sectional studies published in English or French. Quality appraisal of studies and a narrative synthesis of extracted data shall be conducted. This review will synthesize existing evidence on electrolyte abnormalities in people with eating disorders. It will identify the type of electrolyte imbalances, their impact, and outcomes in people with eating disorders. We anticipate that information that will be useful to policy makers and clinicians in designing better policies to prevent eating disorders and or manage people with eating disorders shall be elucidated in this study. The final manuscript will be submitted for publication in a journal. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number CRD42023477497.

This study investigated the influence of carbohydrate supplementation on skill performance throughout exercise that replicates soccer match-play. Experimentation was conducted in a randomised, double-blind and cross-over study design. After familiarization, 15 professional academy soccer players completed a soccer match simulation incorporating passing, dribbling and shooting on two separate occasions. Participants received a 6% carbohydrate–electrolyte solution (CHO) or electrolyte solution (PL). Precision, success rate, ball speed and an overall index (speed-precision-success; SPS) were determined for all skills. Blood samples were taken at rest, immediately before exercise, every 15min during exercise (first half: 15, 30 and 45min; second half: 60, 75 and 90min), and 10min into the half time (half-time). Carbohydrate supplementation influenced shooting (time×treatment interaction: p<0.05), where CHO attenuated the decline in shot speed and SPS index. Supplementation did not affect passing or dribbling. Blood glucose responses to exercise were influenced by supplementation (time×treatment interaction: p<0.05), where concentrations were higher at 45min and during half-time in CHO compared with PL. Blood glucose concentrations reduced by 30±1% between half-time and 60min in CHO. Carbohydrate supplementation attenuated decrements in shooting performance during simulated soccer match-play; however, further research is warranted to optimise carbohydrate supplementation regimes for high-intensity intermittent sports.

Acetazolamide is a mild diuretic and a respiratory stimulant. It is used to treat periodic breathing at high altitude. To determine the therapeutic efficacy of acetazolamide on central sleep apnea associated with heart failure. Twelve male patients with stable systolic heart failure whose initial polysomnograms showed more than 15 episodes per hour of apnea and hypopnea participated in the study. The patients were randomized to a double-blind cross-over protocol with acetazolamide or placebo, taken 1 h before bedtime for six nights with 2 wk of washout. Polysomnography, pulmonary function tests, arterial blood gases, and left ventricular ejection fraction were obtained initially along with a sleep questionnaire, history, and physical examination. Baseline measurements were repeated at the end of each arm. There were no significant differences between parameters at baseline and placebo. In comparing placebo with acetazolamide, the hourly number of episodes of central apnea (49 +/- 28 vs. 23 +/- 21 [mean +/- SD]; p = 0.004) and the percentage of total sleep time spent below an arterial oxyhemoglobin saturation of 90% (19 +/- 32 vs. 6 +/- 13%; p = 0.01) decreased significantly. Acetazolamide improved subjective perception of overall sleep quality (p = 0.003), feeling rested on awakening (p = 0.007), daytime fatigue (p = 0.02), and falling asleep unintentionally during daytime (p = 0.002). In patients with heart failure, administration of a single dose of acetazolamide before sleep improves central sleep apnea and related daytime symptoms.

Fluid overload is a potential complication of hysteroscopic procedures with the possibility of dangerous electrolyte changes. This prospective randomized controlled trial aimed to compare perioperative outcomes and changes in electrolytes after hysteroscopic procedures between the manual infusion (MI) and the pump infusion (PI) methods for distending media infusion. One hundred consecutive women who had hysteroscopic procedures between December 2013 and February 2017 were recruited and randomly allocated to either the MI or PI group. The PI group was associated with an increased volume of infused fluid and collected fluid compared with the volumes of the MI group. Almost all serum electrolyte levels differed significantly between the baseline and postoperative values in both groups; however, no significant differences were noted between the groups. The change in potassium level was positively correlated with the volume of fluid deficit (Spearman’s rho = 0.24, P = 0.03), whereas the change in calcium level was negatively correlated with the volume of fluid deficit (Spearman’s rho = −0.26, P = 0.046). With no between-group differences in the changes in the other perioperative parameters and electrolytes, the MI method can be a good alternative for delivering distending media for hysteroscopic procedures.

Malnourished HIV-infected patients starting antiretroviral therapy (ART) are at high risk of early mortality, some of which may be attributed to altered electrolyte metabolism. We used data from a randomised controlled trial of electrolyte-enriched lipid-based nutritional supplements to assess the association of baseline and time-varying serum phosphate and K concentrations with mortality within the first 12 weeks after starting ART. Baseline phosphate results were available from 1764 patients and there were 9096 subsequent serum phosphate measurements, a median of 6 per patient. For serum K there were 1701 baseline and 8773 subsequent measures, a median of 6 per patient. Abnormally high or low serum phosphate was more common than high or low serum K. Controlling for other factors found to affect mortality in this cohort, low phosphate which had not changed from the previous time interval was associated with increased mortality; the same was not true for high phosphate or for high or low K. Both increases and decreases in serum electrolytes from the previous time interval were generally associated with increased mortality, particularly in the electrolyte-supplemented group. The results suggest that changes in serum electrolytes, largely irrespective of the starting point and the direction of change, were more strongly associated with mortality than were absolute electrolyte levels. Although K and phosphate are required for tissue deposition during recovery from malnutrition, further studies are needed to determine whether specific supplements exacerbate physiologically adverse shifts in electrolyte levels during nutritional rehabilitation of ill malnourished HIV patients.

Severe Acute Malnutrition [SAM] is a leading cause of pediatric morbidity and mortality, particularly in low-resource settings. Electrolyte disturbances significantly influence treatment outcomes but are often underemphasized in clinical protocols. Understanding these disturbances and their impact on recovery is critical to improving management strategies and survival rates among children with SAM. To assess serum electrolyte and their association with treatment outcomes among children with SAM. A prospective cohort study was conducted among 110 under five children who were admitted with SAM in Woldia comprehensive specialized Hospital, Ethiopia. Serum electrolytes were measured at admission using standard laboratory procedures. multinomial logistic regression was employed to evaluate predictors of treatment outcomes, categorized as recovery, default, transferred out, and died. Of the 110 participants, 85.5% were transferred out after improvement, 8.2% died, and 6.4% defaulted. Hyponatremia, observed in 55.5% of study participants, was the strongest predictor of mortality with 77.8% of children who died having sodium levels below 135 mmol/L. Serum electrolyte disturbances significantly influence treatment outcomes in children with SAM, with hyponatremia being the most critical predictors of mortality. Integrating electrolyte management into SAM protocols and addressing comorbidities can enhance recovery rates and reduce mortality.