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The Impact of Severe Obesity on Electrolyte Imbalance and its Potential Effects on the Sodium/Potassium-ATPase Pump Regulation

Cristian Milla Matute, MD, Maria C Fonseca, MD, Carlos Rivera, MD, David Romero Funes, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul Rosenthal. Cleveland Clinic Florida

INTRODUCTION: Sodium/Potassium-ATPase (Na+/K+-ATPase) is a membrane protein responsible for the active transport of sodium and potassium ions across the plasma membranes on eukaryotes. Recent studies have shown that obesity, among other complications, induces an aberrant activity of Na+/K+-ATPase, causing extracellular and intracellular ions imbalance. Hyperinsulinemia, leptin resistance, and hyperandrogenism are factors that play a key role in Na+/K+-ATPase expression and regulation. The aim of this study is to analyze our bariatric patient population with electrolyte disturbances before and after surgery.

METHODS: After IRB approval, we retrospectively reviewed the electronic records of all patients that underwent bariatric surgery at Cleveland Clinic Florida between the years 2003 and 2017. Inclusion criteria were BMI>35, serum sodium and potassium measurements pre-operatively and post-operatively at 3 months follow up. Patients with comorbidities under pharmacological treatment and/or hormonal replacement therapy were excluded from this study. SPSS software was used to apply a t-test for means.

RESULTS: From a total of 5,373 patients reviewed, 22.5% (n=1,558) patients met the inclusion criteria. This patient population was predominantly female 77.8% (N: 1,212), the most prevalent procedure was RNYGB 61% (N: 950), the mean age was 54y±13. The mean BMI was 44±8 kg/m2 at the time of the procedure and 32±9 kg/m2 at 3 months follow up. We identified 37% (n=589) of patients with serum electrolyte imbalance preoperatively versus 3.1% (n=47) postoperatively at three months follow up. Before surgery 18% (n=106) patients had hypokalemia, 17.6 (n=104) hyperkalemia, 56.8% (n=335) patients had hyponatremia and 6.6% (n=39) had hypernatremia. At 3 months follow up after surgery a total of 21.2% (n=10) had hypokalemia, 34% (n=16) hyperkalemia, 17% (n=8) patients had hyponatremia and 27.6% (n=13) had hypernatremia.

CONCLUSIONS: Electrolytes disturbances are just one of the multiple manifestations of Na+/K+-ATPase pump impaired activity in patients with severe obesity. The prevalence of obese electrolytes disturbance is higher than in the general population. Rapid weight loss after bariatric interventions showed a significant improvement of serum electrolytes levels. However multiple factors might be related to these changes. Further studies with the inclusion of more variables should be performed in order to better understand these findings.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95287

Program Number: P049

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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