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Severe cases can involve fluid loss , electrolyte abnormalities , hemodynamic instability , seizures , and even death if managed improperly , especially when co-occurring medical or psychiatric problems are present NIH review

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Scand J Gastroenterol 27(4):270274 Pals KL, Chang RT, Ryan AJ, Gisolfi CV (1997) Effect of running intensity on intestinal permeability

even brief temperature fluctuations can shorten a solutions usable life more than steady refrigeration at a slightly less-than-ideal setting would