Management of hyperkalemia in the acutely ill patient.

PURPOSE:To review the mechanisms of action, expected efficacy and side effects of strategies to control hyperkalemia in acutely ill patients. METHODS:We searched MEDLINE and EMBASE for relevant papers published in English between Jan 1, 1938, and July 1, 2018, in accordance with the PRISMA Statement using the following terms: "hyperkalemia," "intensive care," "acute kidney injury," "acute kidney failure," "hyperkalemia treatment," "renal replacement therapy," "dialysis," "sodium bicarbonate," "emergency," "acute." Reports from within the past 10 years were selected preferentially, together with highly relevant older publications. RESULTS:Hyperkalemia is a potentially life-threatening electrolyte abnormality and may cause cardiac electrophysiological disturbances in the acutely ill patient. Frequently used therapies for hyperkalemia may, however, also be associated with morbidity. Therapeutics may include the simultaneous administration of insulin and glucose (associated with frequent dysglycemic complications), β-2 agonists (associated with potential cardiac ischemia and arrhythmias), hypertonic sodium bicarbonate infusion in the acidotic patient (representing a large hypertonic sodium load) and renal replacement therapy (effective but invasive). Potassium-lowering drugs can cause rapid decrease in serum potassium level leading to cardiac hyperexcitability and rhythm disorders. CONCLUSIONS:Treatment of hyperkalemia should not only focus on the ability of specific therapies to lower serum potassium level but also on their potential side effects. Tailoring treatment to the patient condition and situation may limit the risks

Investigations of 2-Thiazoline-2-thiol as a Ligand: Synthesis and X-ray Structures of [Mn\u3csub\u3e2\u3c/sub\u3e(CO)\u3csub\u3e7\u3c/sub\u3e(\u3cem\u3eμ\u3c/em\u3e-NS\u3csub\u3e2\u3c/sub\u3eC\u3csub\u3e3\u3c/sub\u3eH\u3csub\u3e4\u3c/sub\u3e)\u3csub\u3e2\u3c/sub\u3e] and [Mn(CO)\u3csub\u3e3\u3c/sub\u3e(PPh\u3csub\u3e3\u3c/sub\u3e)(\u3cem\u3eκ\u3c/em\u3e\u3csup\u3e2\u3c/sup\u3e-NS\u3csub\u3e2\u3c/sub\u3eC\u3csub\u3e3\u3c/sub\u3eH\u3csub\u3e4\u3c/sub\u3e)]

Treatment of Mn2(CO)10 with 2-thiazoline-2-thiol in the presence of Me3NO at room temperature afforded the dimanganese complexes [Mn2(CO)7(μ-NS2C3H4)2] (1) and [Mn2(CO)6(μ-NS2C3H4)2] (2) in 51 and 34% yields, respectively. Compound 1 was quantitatively converted into 2 when reacted with one equiv of Me3NO. Reaction of 1 with triphenylphosphine at room temperature furnished the mononuclear complex [Mn(CO)3(PPh3)(κ 2-NS2C3H4)] (3) in 66% yield. All three new complexes have been characterized by elemental analyzes and spectroscopic data together with single crystal X-ray diffraction studies for 1 and 3. Compound 1 crystallizes in the orthorhombic space group Pbca with a = 12.4147(2), b = 16.2416(3), c = 19.0841(4) Å, β = 90°, Z = 8 and V = 3848.01(12) Å3 and 3 crystallizes in the monoclinic space group P 21/n with a = 10.41730(10), b = 14.7710(2), c = 14.9209(2) Å, β = 91.1760(10)°, Z = 4 and V = 2295.45(5) Å3

Genomic characterization of antibiotic resistant Escherichia coli isolated from domestic chickens in Pakistan

Poultry husbandry is important for the economic health of Pakistan, but the Pakistani poultry industry is negatively impacted by infections fro

Hyperkalemia and electrocardiogram manifestations in end-stage renal disease

Hyperkalemia is one of the more common acute life-threatening metabolic emergencies. The aim of our study is to determine the correlation and accuracy of abnormal ECG parameters as a function of serum potassium concentration in the end-stage renal disease (ESRD) population. We performed a retrospective chart review of emergency department patients presenting with ESRD and receiving emergent hemodialysis treatment. A total of 96 patients, each with five independent ED visits, provided 480 sets of ECGs and electrolytes. Of these, four ECGs were excluded for inability to interpret, leaving a total of 476 patient encounters that met all inclusion criteria. Linear regression analysis on the limited data set for serum potassium versus T/R in V2, V3, and V4, PR, and QRS found weak correlations (

An offloading method using decentralized P2P-enabled mobile edge servers in edge computing

Edge computing has emerged as a promising infrastructure for providing elastic resources in the proximity of mobile users. Owing to resource limitations in mobile devices, offloading several computational tasks from mobile devices to mobile edge servers is the main means of improving the quality of experience of mobile users. In fact, because of the high speeds of moving vehicles on expressways, there would be numerous candidate mobile edge servers available for them to offload their computational workload. However, the selection of the mobile edge server to be utilized and how much computation should be offloaded to meet the corresponding task deadlines without large computing bills are topics that have not been discussed much. Furthermore, with the increasing deployment of mobile edge servers, their centralized management would cause certain performance issues. In order to address these challenges, we firstly apply peer-to-peer networks to manage geo-distributed mobile edge servers. Secondly, we propose a new deadline-aware and cost-effective offloading approach, which aims to improve the offloading efficiency for vehicles and allows additional tasks to meet their deadlines. The proposed approach was validated for its feasibility and efficiency by means of extensive experiments, which are presented in this paper

Coeus: Consistent and Continuous Network Update in Software-Defined Networks:38th IEEE Conference on Computer Communications, INFOCOM 2020

Network update enables Software-Defined Networks (SDNs) to optimize the data plane performance via southbound APIs. The single update between the initial and the final network states fail to handle high-frequency changes or the burst event during the update procedure in time, leading to prolonged update time and inefficiency. On the contrary, the continuous update can respond to the network condition changes at all times. However, existing work, especially Update Algebra can only guarantee blackhole- and loop-free. The congestion-free property cannot be respected during the update procedure. In this paper, we propose Coeus, a continuous network update system while maintaining blackhole-, loop- and congestion-free simultaneously. Firstly, we establish an operation-based continuous update model. Based on this model, we dynamically reconstruct an operation dependency graph to capture unexecuted update operations and the link utilization variations. Subsequently, we develop an operation composition algorithm to eliminate redundant update commands and an operation node partition algorithm to speed up the update procedure. We prove that the partition algorithm is optimal and can guarantee the consistency. Finally, extensive evaluations show that Coeus can improve the makespan by at least 179% compared with state-of-the-art approaches when the arrival rate of update events equals to three times per second. © 2020 IEEE

Study design of real world evidence for treatment of hyperkalemia in the emergency department (REVEAL-ED): A multicenter, prospective, observational study

OBJECTIVE: Hyperkalemia affects up to 10% of hospitalized patients and, if left untreated, can lead to serious cardiac arrhythmias or death. Although hyperkalemia is frequently encountered in the emergency department (ED), and is potentially life-threatening, standard of care for the treatment is poorly defined, with little supporting evidence. The main objectives of this observational study are to define the overall burden of hyperkalemia in the ED setting, describe its causes, the variability in treatment patterns and characterize the effectiveness and safety of ED standard of care therapies used in the United States. METHODS: This is an observational study evaluating the management of hyperkalemia in the ED. Two hundred and three patients who presented to the ED with a potassium value ≥5.5 mmol/L were enrolled in the study at 14 sites across the United States. Patients were treated per standard of care practices at the discretion of the patient\u27s physician. In patients who received a treatment for hyperkalemia, blood samples were drawn at pre-specified time points and serum potassium values were recorded. The change in potassium over 4 hours and the adverse events after standard of care treatment were analyzed. RESULTS AND CONCLUSION: This article describes the background, rationale, study design, and methodology of the REVEAL-ED (Real World Evidence for Treatment of Hyperkalemia in the Emergency Department) trial, a multicenter, prospective, observational study evaluating contemporary management of patients admitted to the ED with hyperkalemia

Continuous Network Update With Consistency Guaranteed in Software-Defined Networks

Network update enables Software-Defined Networks (SDNs) to optimize the data plane performance. The single update focuses on processing one update event at a time, i.e., updating a set of flows from their initial routes to target routes, but it fails to handle continuously arriving update events in time incurred by high-frequency network changes. On the contrary, the continuous update proposed in ``Update Algebra'' can handle multiple update events concurrently and respond to the network condition changes at all times. However, ``Update Algebra'' only guarantees the blackhole-free and loop-free update. The congestion-free property cannot be respected. In this paper, we propose Coeus to achieve the continuous update while maintaining consistency, i.e., ensuring the blackhole-free, loop-free, and congestion-free properties simultaneously. Firstly, we establish the continuous update model based on the update operations in update events. With the update model, we dynamically reconstruct the operation dependency graph (ODG) to capture the relationship between update operations and link utilization variations. Then, we develop a composition algorithm to eliminate redundant operations in update events. To further speed up the update procedure, we present a partition algorithm to split the operation nodes of the ODG into a series of suboperation nodes that can be executed independently. The partition algorithm is proven to be optimal. Finally, extensive evaluations show that Coeus can improve the update speed by at least 179% and reduce redundant operations by at least 52% compared with state-of-the-art approaches when the arrival rate of update events equals three times per second. IEE