RESUMO
BACKGROUND AND AIMS: Potassium-wasting (loop diuretics [LD]) and potassium-sparing (spironolactone) medications used for heart failure (HF) may alter renal potassium handling and confound the use of twenty-four-hour (24-h) urine collections as a surrogate marker for potassium intake, an effect that has been observed with dietary sodium assessment. The objective was to determine the strength of association between 24-h urine collections and weighed food records in assessing potassium intake in HF patients stratified by LD usage and spironolactone usage. METHODS AND RESULTS: Stable outpatients with HF simultaneously completed two 24-h urine collections and two weighed food records on consecutive days. Analyses compared patients stratified by LD and/or spironolactone use. Pearson's correlation and the Bland-Altman method of agreement assessed the relationship between the techniques. Overall, 109 patients (61 ± 11 yrs, 74% male) were included. The mean difference in dietary potassium estimated between 24-h urine collections and food records was -353 ± 1043 mg (p < 0.01) for all patients, with no differences between measures among subgroups. The association between the two methods was r = 0.551 (95% CI, 0.373 to 0.852, p < 0.001) for LD users; r = 0.287 (95% CI, 0.01 to 0.570, p = 0.050) for LD non-users; r = 0.321 (95% CI, 0.13 to 0.798, p = 0.043) for spironolactone users, and; r = 0.534 (95% CI, 0.331 to 0.747, p < 0.001) for spironolactone non-users. There were no significant mean biases identified as part of the Bland-Altman analysis. CONCLUSION: Among HF patients, potassium-wasting and potassium-sparing medications do not influence the agreement between the two methods in the assessment of potassium intake.
Assuntos
Registros de Dieta , Insuficiência Cardíaca/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Avaliação Nutricional , Potássio na Dieta/administração & dosagem , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Espironolactona/uso terapêutico , Idoso , Feminino , Absorção Gastrointestinal/efeitos dos fármacos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/urina , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Potássio na Dieta/urina , Valor Preditivo dos Testes , Eliminação Renal/efeitos dos fármacos , Reprodutibilidade dos Testes , Inibidores de Simportadores de Cloreto de Sódio e Potássio/efeitos adversos , Espironolactona/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Urinálise , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
Electrolyte concentration in sweat depends on environmental context and physical condition but also on the pathophysiological status. Sweat analyzers may be therefore the future way for biological survey although how sweat electrolyte composition can reflect plasma composition remains unclear. We recruited 10 healthy subjects and 6 patients to have a broad range of plasma electrolyte concentrations (chloride, potassium and sodium) and pH. These variables were compared to those found in sweat produced following cycling exercise or pilocarpine iontophoresis, a condition compatible with operating a wearable device. We found no correlation between plasma and sweat parameters when exercise-induced sweat was analyzed, and we could identify a correlation only between plasma and sweat potassium concentration (R = 0.78, p < 0.01) when sweat was induced using pilocarpine iontophoresis. We tested measurement repeatability in sweat at 24hr-interval for 3 days in 4 subjects and found a great intra-individual variability regarding all parameters in exercise-induced sweat whereas similar electrolyte levels were measured in pilocarpine-induced sweat. Thus, electrolyte concentration in sweat sampled following physical activity does not reflect concentration in plasma while pilocarpine iontophoresis appears to be promising to reproducibly address sweat electrolytes, and to make an indirect evaluation of plasma potassium concentration in chronic kidney disease and arrhythmia.
Assuntos
Iontoforese , Pilocarpina/administração & dosagem , Potássio/sangue , Suor/metabolismo , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Adulto , Idoso , Arritmias Cardíacas/metabolismo , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/metabolismoRESUMO
PURPOSE: The adherence to and effectiveness and safety of a timed, electronic, assessment-driven potassium-replacement protocol (TARP) were compared with an electronic nurse-driven replacement protocol (NRP) are reported. METHODS: A retrospective observational study was conducted in a community hospital evaluating protocol adherence, effectiveness, and safety for 2 potassium-replacement protocols. All adults on medical units with an order for potassium replacement per protocol during the 3-month trial periods were reviewed. All patients requiring potassium replacement per protocol were included in the analysis. Adherence to the protocol was assessed by evaluating the dose of potassium administered and performance of reassessments. Effectiveness of the protocol was assessed by evaluating the time to achieve target potassium levels. Safety was assessed by evaluating the route of administration and occurrence of hyperkalemia. RESULTS: A total of 300 patients treated using potassium-replacement protocols required potassium replacement during the study period, with 148 patients in the NRP group requiring 491 instances of potassium replacement. In the TARP group a total of 564 instances requiring potassium replacement corresponded to 152 patients. Of the 491 instances requiring replacement in the NRP group, the correct dose was administered and reassessment performed 117 times (23.8%). Overall adherence (p < 0.05), correct dose given (p < 0.05), average time from blood draw to potassium replacement (p < 0.0001), use of oral replacement (p < 0.05), and time to achieve target potassium level within 12 hours (p < 0.05) were significantly improved in the TARP group. CONCLUSION: The TARP improved the effectiveness and safety of potassium-replacement therapy over the traditional NRP without negatively affecting timeliness of care.
Assuntos
Protocolos Clínicos , Monitoramento de Medicamentos/métodos , Prescrição Eletrônica , Hidratação/métodos , Potássio/sangue , Monitoramento de Medicamentos/instrumentação , Feminino , Hidratação/instrumentação , Hospitais Comunitários/métodos , Humanos , Masculino , Potássio/administração & dosagem , Estudos Retrospectivos , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Equilíbrio Hidroeletrolítico/fisiologiaRESUMO
INTRODUCTION: The relationship between hypertension and fluid overload in pre-dialysis CKD patients need to be elucidated. Current study aimed to find relationship between fluid overload and hypertension along with prescribed diuretic therapy using bioimpedance spectroscopy (BIS). METHODOLOGY: A prospective observational study was conducted by inviting pre-dialysis CKD patients. Fluid overload was assessed by BIS. RESULTS: A total of 312 CKD patients with mean eGFR 24.5 ± 11.2 ml/min/1.73 m2 were enrolled. Based on OH value ≥7 %, 135 (43.3 %) patients were hypervolemic while euvolemia was observed in 177 (56.7 %) patients. Patients were categorized in different regions of hydration reference plot (HRP) generated by BIS i.e., 5.1 % in region-N (normal BP and fluid status), 20.5 % in region I (hypertensive with severe fluid overload), 29.5 % in region I-II (hypertensive with mild fluid overload), 22 % in region II (hypertensive with normohydration), 10.2 % in region III (underhydration with normal/low BP) and 12.5 % in region IV (normal BP with severe fluid overload). A total of 144 (46 %) patients received diuretics on basis of physician assessment of BP and edema. Maximum diuretics 100 (69.4 %) were prescribed in patients belonging to regions I and I-II of HRP. Interestingly, a similar number of diuretic prescriptions were observed in region II (13 %) and region IV (12 %). Surprisingly, 7 (4.9 %) of patients in region III who were neither hypervolemic nor hypertensive were also prescribed with diuretics. CONCLUSION: BIS can aid clinicians to categorize CKD patients on basis of their fluid status and provide individualized pharmacotherapy to manage hypertensive CKD patients.
Assuntos
Pressão Sanguínea/efeitos dos fármacos , Composição Corporal/efeitos dos fármacos , Diurese/efeitos dos fármacos , Diuréticos/uso terapêutico , Hipertensão/tratamento farmacológico , Padrões de Prática Médica , Insuficiência Renal Crônica/tratamento farmacológico , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Desequilíbrio Hidroeletrolítico/tratamento farmacológico , Idoso , Espectroscopia Dielétrica , Diuréticos/efeitos adversos , Prescrições de Medicamentos , Impedância Elétrica , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Rim/efeitos dos fármacos , Rim/fisiopatologia , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Resultado do Tratamento , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/epidemiologia , Desequilíbrio Hidroeletrolítico/fisiopatologiaRESUMO
Universal drinking water and beverages containing moderate to high levels of magnesium (10100 ppm) could potentially prevent 4.5 million heart disease and stroke deaths per year, worldwide. This potential is calculated with 2010 global mortality figures combined with a recent quantification of water-magnesium's inverse association with heart disease and stroke mortality. The modern processed food diet, low in magnesium and spreading globally, makes this well-researched potential of drinking-water magnesium worth serious consideration, especially in areas where insufficient dietary intake of magnesium is prevalent.
Assuntos
Água Potável/química , Cardiopatias/epidemiologia , Cardiopatias/prevenção & controle , Magnésio/análise , Magnésio/farmacologia , Modelos Biológicos , Humanos , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
BACKGROUND: Hydration status is important to the cardiovascular system because of its effects on preload. Decreased preload can alter echocardiographic measurements of systolic and diastolic function, potentially confounding interpretation of results. HYPOTHESIS/OBJECTIVES: Mild fluid deficits are associated with measurable echocardiographic changes that are validated by physical and biochemical markers of decreased intravascular volume. ANIMALS: Twenty-five healthy staff/student-owned dogs with no evidence of cardiac or renal disease. METHODS: Prospective, interventional laboratory study. Dogs were randomly assigned to water deprivation (WD) alone for 8 hours (n = 13) or to furosemide treatment (FTx, 2.5mg/kg IV) followed by WD for 8 hours (n = 12). Echocardiograms, biochemical sampling, and physical parameters were measured at baseline, and after 4 and 8 hours. RESULTS: Both protocols induced fluid deficit as indicated by significant (P < .00001) decreases in weight at 4 hours (WD, 1.1%; FTx, 3.7%) and 8 hours (WD, 2.7%; FTx, 4.5%). Furosemide significantly decreased left ventricular end-diastolic volume (54.3 +/- 19.3-42.1 +/- 17.3 mL, P < .0001), cardiac index (4.2 +/- 1.1-2.9 +/- 0.9 L/min/M2, P < .0001), and mitral valve E wave velocity (0.79 +/- 0.2-0.66 +/- 0.2 m/s, P = .0004). These changes were accompanied by significant increases in blood urea nitrogen concentration (13.8 +/- 2.6-14.8 +/- 2.7 mg/dL, P = .04), vasopressin concentration (1.4 +/- 1.2-3.3 +/- 1.9 pg/mL, P = .045), and PCV (49.8 +/- 4.5-53.2 +/- 6.5%, P = .006). Effects of water deprivation alone were similar, but less pronounced. CONCLUSIONS AND CLINICAL IMPORTANCE: Mild fluid deficits have measurable hemodynamic effects in dogs. Hydration status should be considered when evaluating cardiac function by echocardiogram.
Assuntos
Desidratação/induzido quimicamente , Ecocardiografia Doppler/veterinária , Furosemida/farmacologia , Hemodinâmica/fisiologia , Privação de Água , Animais , Cães , Feminino , Masculino , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
A suite of biomarkers was used to evaluate acute (1-day) to semichronic (3-month) heavy metal-induced toxicity in channel catfish, lctalurus punctatus, caged at an abandoned strip mine and a noncontaminated reference site. Assays performed include indicators of metabolic, hematological, osmoregulatory, and genotoxic stress. Two cage designs were used to evaluate the importance of exposure routes: one excluding contact with the sediments and the other allowing contact with water and sediments. Significant DNA strand breakage was observed in catfish exposed to both exposure regimens, but evidence of DNA repair was observed only in water-exposed catfish. Transient increases in hemoglobin, delta-aminolevulinic acid dehydratase, and hematocrit levels were observed at 1 month's exposure for both exposure regimens, followed by a return to control levels for the duration of the study. Environmental conditions (i.e., weather-related changes in water quality) may have contributed to the variable plasma chloride and glucose levels observed in all catfish exposed to strip-mine wastes. The transient changes in biomarkers followed by a return to reference values represent an initial stress and an acclimation to normal levels.
Assuntos
Minas de Carvão , Ictaluridae/metabolismo , Metais Pesados/efeitos adversos , Poluentes do Solo/efeitos adversos , Poluentes Químicos da Água/efeitos adversos , Animais , Biomarcadores , Dano ao DNA , Estudos de Avaliação como Assunto , Testes Hematológicos , Ictaluridae/genética , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
Studies over the past three decades have documented the protein-anabolic effects of human growth hormone (GH) administration in malnourished or critically ill patients. The availability of recombinant GH has facilitated clinical investigation on the metabolic and clinical effects of this peptide in ICU settings. These studies demonstrate that GH improves nutrient utilization efficiency in critically ill patients. Recent randomized, controlled trials document improved wound healing with GH therapy in both adult and pediatric burn patients and reduced length of hospital stay in pediatric burn injury. However, little data have been published on functional or clinical outcome variables in other groups of catabolic patients treated with GH. Administration of growth factors in combination with specialized nutrition represents a novel strategy that may improve outcomes in critically ill patients. Additional clinical studies are needed to further define the safety, functional benefits, cost-effectiveness, and clinical utility of GH use in catabolic patients.
Assuntos
Nutrição Enteral/métodos , Hormônio do Crescimento/uso terapêutico , Distúrbios Nutricionais/terapia , Nutrição Parenteral Total/métodos , Adulto , Criança , Análise Custo-Benefício , Estado Terminal/terapia , Nutrição Enteral/efeitos adversos , Nutrição Enteral/economia , Hormônio do Crescimento/farmacologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Distúrbios Nutricionais/metabolismo , Nutrição Parenteral Total/efeitos adversos , Nutrição Parenteral Total/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Cicatrização/efeitos dos fármacosAssuntos
Benzotiadiazinas , Diuréticos/efeitos adversos , Indapamida/efeitos adversos , Inibidores de Simportadores de Cloreto de Sódio/efeitos adversos , Análise Custo-Benefício , Humanos , Indapamida/farmacocinética , Metabolismo/efeitos dos fármacos , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
To examine the oxygen requirement of carbonic anhydrase-dependent sodium reabsorption in the proximal tubule, 18 anaesthetized dogs were studied under conditions of saturated distal NaCl reabsorption; the latter was accomplished by volume expansion (all groups) combined with infusion of loop diuretics (groups 1 and 3). Acetazolamide reduced HCO3- reabsorption by 602 +/- 32 mumol min-1 (55%, group 1) and by 777 +/- 103 mumol min-1 (66%, group 2). This was accompanied with a reduction in sodium reabsorption and oxygen consumption in a molar delta Na/delta O2 ratio of about 45 in both groups of dogs. The delta HCO3/delta O2 ratio averaged 16 +/- 1, which was not significantly different from the theoretical value of 18 expected for transcellular sodium transport by Na+, K+-ATPase. Mannitol (group 3) reduced NaCl reabsorption by 37 +/- 2% without affecting NaHCO3 reabsorption or oxygen consumption significantly. We conclude that carbonic anhydrase-dependent NaCl reabsorption in the proximal tubules is passive, and that NaHCO3 reabsorption is the only important active sodium transport which is sensitive to inhibition of carbonic anhydrase.
Assuntos
Anidrases Carbônicas/metabolismo , Túbulos Renais Proximais/metabolismo , Consumo de Oxigênio , Cloreto de Sódio/metabolismo , Acetazolamida/farmacologia , Animais , Bicarbonatos/metabolismo , Diuréticos Osmóticos/farmacologia , Cães , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Masculino , Manitol/farmacologia , Consumo de Oxigênio/efeitos dos fármacos , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
In 31 infants and children (body weights ranging from 3.8 to 25 kg), indirect calorimetry was used for the calculation of energy needs (E, kcal/h), fluid volume (FV, ml/h) and electrolyte requirements (sodium, Na+, and potassium, K+, mmol/liter per hour) during halothane anesthesia. The children were spontaneously breathing and undergoing minor lower abdominal or orthopedic surgery. A nonrebreathing anesthesia circuit was used, and gas concentrations were measured by a mass spectrometer. For the evaluation of ventilation during periods of measurements, pneumotachography and in-line capnography were used. Energy expenditure was related to weight and followed the regression equation E = 1.5 X kg + 5.2; r = 0.96. The energy needs were converted to fluid volumes according to the water requirements for heat production, which resulted in the following relationship between FV and weight: FV = 2.4 X kg + 8.6; r = 0.96. The energy expenditure was up to 50% lower than in previous reports. Extrapolations of energy needs from awake values are inappropriate to use during halothane anesthesia. Because of the low energy expenditure during anesthesia, requirements of sodium and potassium were up to 50% lower than those based on previous standards.
Assuntos
Anestesia , Metabolismo Energético/efeitos dos fármacos , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Peso Corporal , Calorimetria Indireta , Criança , Pré-Escolar , Halotano , Humanos , Lactente , Recém-Nascido , Espectrometria de Massas , Óxido Nitroso , Consumo de Oxigênio/efeitos dos fármacos , Troca Gasosa Pulmonar/efeitos dos fármacos , Respiração/efeitos dos fármacosRESUMO
We studied ten obese patients on prolonged caloric restriction by metabolic balance techniques two weeks before and two weeks after the start of treatment with triiodothyronine (T3) (0.36-1.01 micrograms/kg/d). The rate of weight, nitrogen and fat loss calculated from metabolic balance increased during T3 therapy and these effects were maximal in the second week of treatment. In seven patients studied continuously for four weeks on T3 therapy, the rates of weight and fat loss during the fourth week of treatment were not significantly different from pretreatment values while nitrogen loss was still significantly greater. The increase in nitrogen loss, studied after the period of adaptation to caloric restriction, implies that prolonged treatment with T3 can result in significant losses of lean tissue in addition to that resulting from caloric restriction alone. Mean weight loss increased by 92 g/d during T3 therapy. T3 significantly increased the metabolic rate as measured by two other independent measures: the resting energy expenditure (REE), measured by indirect calorimetry (fourteen patients), and the sleeping heart rate (six patients).