Impact of dehydration on laparoscopic performance: a prospective, open-label, randomized cross-over trial.

INTRODUCTION: During laparoscopic surgery, surgeons may experience prolonged periods without fluid intake, which might impact surgical performance, yet there are no objective data investigating this issue. Therefore, the aim of this study was to elucidate the effect of prolonged dehydration on laparoscopic surgical performance and tissue handling. METHODS: A total of 51 laparoscopic novices participated in a single-center, open-label, prospective randomized cross-over trial. All participants were trained to proficiency using a standardized laparoscopic training curriculum. Afterward, all participants performed four different laparoscopic tasks twice, once after 6 h without liquid intake (dehydrated group) and once without any restrictions (control group). Primary endpoints were tissue handling defined by force exertion, task time, and error rate. The real hydration status was assessed by biological parameters, like heart rate, blood pressure, and blood gas analysis. RESULTS: 51 laparoscopic novices finished the curriculum and completed the tasks under both hydrated and dehydrated conditions. There were no significant differences in mean non-zero and peak force between the groups. However, dehydrated participants showed significantly slower task times in the Peg transfer task (hydrated: 139.2 s vs. dehydrated: 147.9 s, p = 0.034) and more errors regarding the precision in the laparoscopic suture and knot task (hydrated: 15.7% accuracy rate vs. dehydrated: 41.2% accuracy rate, p < 0.001). CONCLUSION: Prolonged periods of dehydration do not appear to have a substantial effect on the fundamental tissue handling skills in terms of force exertion among surgical novices. Nevertheless, the observed impact on speed and precision warrants attention.

Use of POCUS for the assessment of dehydration in pediatric patients-a narrative review.

In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions and pleural and pericardial effusions, but less to evaluate fluid depletion. The main aim of this review is to analyze the current literature on the assessment of dehydration in pediatric patients by using POCUS. The size of the inferior vena cava (IVC) and its change in diameter in response to respiration have been investigated as a tool to screen for hypovolemia. A dilated IVC with decreased collapsibility (< 50%) is a sign of increased right atrial pressure. On the contrary, a collapsed IVC may be indicative of hypovolemia. The IVC collapsibility index (cIVC) reflects the decrease in the diameter upon inspiration. Altogether the IVC diameter and collapsibility index can be easily determined, but their role in children has not been fully demonstrated, and an estimation of volume status solely by assessing the IVC should thus be interpreted with caution. The inferior vena cava/abdominal aorta (IVC/AO) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS could be a valuable supplementary tool in the assessment of dehydration in several clinical scenarios, enabling rapid identification of life-threatening primary etiologies and helping physicians avoid inappropriate therapeutic interventions.   Conclusion: POCUS can provide important information in the assessment of intravascular fluid status in emergency scenarios, but measurements may be confounded by a number of other clinical variables. The inclusion of lung and cardiac views may assist in better understanding the patient's physiology and etiology regarding volume status. What is Known: • In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions (like pneumonia and bronchiolitis) and pleural and pericardial effusions, but less to evaluate fluid depletion. • The size of the IVC (inferior vena cava) and its change in diameter in response to respiration have been studied as a possible screening tool to assess the volume status, predict fluid responsiveness, and assess potential intolerance to fluid loading. What is New: • The IVC diameter and collapsibility index can be easily assessed, but their role in predicting dehydration in pediatric age has not been fully demonstrated, and an estimation of volume status only by assessing the IVC should be interpreted carefully. • The IVC /AO(inferior vena cava/abdominal aorta) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS can be a valuable supplementary tool in the assessment of intravascular volume in several clinical scenarios.

Prevalence and factors associated with rotavirus diarrhea among children aged 3-24 months after the introduction of the vaccine at a referral hospital in Uganda: a cross-sectional study.

BACKGROUND: Rotavirus has a significant morbidity and mortality in children under two years. The burden of rotavirus diarrhea 4 years post introduction of rotavirus vaccine in Uganda is not well established. This study aimed to determine the prevalence, severity of dehydration and factors associated with rotavirus diarrhea among children aged 3 to 24 months after the introduction of the vaccine at Fort Portal Regional Referral hospital. METHODS: This was a cross-sectional hospital-based study in which children with acute watery diarrhea were included. A rectal tube was used to collect a stool sample for those unable to provide samples. Stool was tested for rotavirus using rapid immunochromatographic assay. Data was analysed using SPSS version 22 with logistic regression done to determine the factors. RESULTS: Out of 268 children with acute watery diarrhea, 133 (49.6%) were females. Rotavirus test was positive in 42 (15.7%), majority of whom had some dehydration 28(66.7%). The factors that were independently associated with rotavirus diarrhea were; age < 12 months (AOR = 8.87, P = 0.014), male gender (AOR = 0.08, P = 0.001), coming from a home with another person with diarrhea (AOR = 17.82, P = 0.001) or a home where the water source was a well (AOR = 50.17, P = 0.002). CONCLUSION: The prevalence of rotavirus diarrhea was three times less in the post rotavirus vaccination period compared to pre-rota vaccination period. Majority of the participants with rotavirus diarrhea had some dehydration. There is need for provision of safe water sources to all homes. Surveillance to determine the cause of the non rota diarrhea should be done.

Challenges in using fractional excretion of sodium in the assessment of salt poisoning.

AIM: Hypernatraemia typically reflects dehydration, yet in rare instances may be caused by salt poisoning. Identifying these rare cases is a difficult challenge. Making the diagnosis of salt poisoning can have severe consequences, such as the removal of the child from its home or even prison sentences for the implicated carer. It is therefore imperative to get the diagnosis right. Guidelines for the assessment of hypernatraemia emphasise the importance of the fractional excretion of sodium to distinguish between dehydration and salt poisoning, but no generally accepted cut-off value exists. Opinions about the diagnosis of salt poisoning in some cases consequently may differ. Here, we aim to highlight the challenges and stimulate discussion on how to improve the tools for the assessment of hypernatraemia. METHODS: Report of a case of unexplained hypernatraemia in which the treating paediatrician raised the suspicion of salt poisoning. RESULTS: Two consulted experts made opposing judgements about the aetiology of the observed hypernatraemia. CONCLUSION: Clear diagnostic criteria for the diagnosis of salt poisoning are lacking and more data are needed for their establishment. Without this, victims may experience further harm and carers are at risk of devastating, yet potentially erroneous accusations.

The incidence and factors associated with dysnatremia in children with acute gastritis/gastroenteritis.

BACKGROUND: The incidence of dysnatremia in children with acute gastritis/gastroenteritis varies, and factors associated with either dysnatremia or hyponatremia at presentation have not been identified clearly. METHODS: This retrospective study included patients aged 1 month to 18 years hospitalized for community-acquired acute gastritis/gastroenteritis from January to October 2016. Factors associated with dysnatremia at presentation were identified using multivariable analysis. RESULTS: Among the 304 children included, the median age was 2.2 (1.0, 4.2) years. The incidence of dysnatremia at presentation was 17.1% (hyponatremia 15.8%; hypernatremia 1.3%). Patients who had moderate (p = 0.03) and severe dehydration (p = 0.04) and presented with vomiting and diarrhea simultaneously (p = 0.03) were associated with dysnatremia at presentation. Patients presented with vomiting and diarrhea simultaneously was associated with hyponatremia at presentation (p = 0.02). CONCLUSIONS: Dysnatremia was common in children with acute gastritis/gastroenteritis. Moderate to severe dehydration and the presence of vomiting and diarrhea simultanously were significantly associated with dysnatremia at presentation. Furthermore, presenting with vomiting and diarrhea silmutaneously was associated with hyponatremia at presentation. Serum electrolytes should be monitored in patients with those conditions.

Diabetes Mellitus and Fluid Imbalance: The Need for Adequate Hydration.

The effect of hydration in modulating metabolic disease risk is a comparatively recent concept. Diabetic patients are at increased risk of dehydration due to osmotic diuresis. Undiagnosed or undertreated hyperglycemia may lead to electrolyte imbalance and elevated renal burden of glucose excretion, which may alter fluid reabsorption in the kidney. Also, the presence of one or more contributory factors, such as inadequate fluid intake, strenuous exercise, high temperatures, alcohol consumption, diarrhea, acute illnesses, fever, nausea, and vomiting, may put diabetic patients at increased risk of dehydration and electrolyte imbalance. Certain antidiabetic agents used by diabetic patients may cause fluid retention/deficits and/or electrolyte abnormalities in a few patients. Thus, drinking ample amounts of water and fluids with appropriate electrolyte composition is important to prevent dehydration. Successful management of dehydration in patients with diabetes is an unmet need and can best be accomplished by maintaining adequate hydration status.

Oral Fluid, Electrolytes, and Energy Management in Various Adult and Geriatric Illnesses beyond Diarrhea: An Indian Expert Panel Delphi Consensus Recommendation.

BACKGROUND: Dehydration is a highly prevalent clinical challenge in adults which can go undetected. Although dehydration is commonly associated with an increased risk of hospitalization and mortality, only a few international guidelines provide recommendations regarding oral fluids, electrolytes, and energy (FEE) management in adults/geriatrics with dehydration due to nondiarrheal causes. Currently, there is a lack of comprehensive recommendations on the role of oral FEE in nondiarrheal dehydration in adult and geriatric Indian patients. MATERIALS AND METHODS: A modified Delphi approach was designed using an online questionnaire-based survey followed by a virtual meeting, and another round of online surveys was used to develop this consensus recommendation. In round one, 130 statements, including 21 open-ended questions, were circulated among ten national experts who were asked to either strongly agree, agree, disagree, or strongly disagree with statements and provide responses to open-ended questions. The consensus was predefined at 75% agreement (pooling "strongly agree" and "agree" responses). Presentation of relevant literature was done during a virtual discussion, and some statements (the ones that did not achieve predefined agreement) were actively discussed and deliberately debated to arrive at conclusive statements. Those statements that did not reach consensus were revised and recirculated during round two. RESULTS: Consensus was achieved for 130/130 statements covering various domains such as assessment of dehydration, dehydration in geriatrics, energy requirement, impact of oral FEE on patient outcome, and fluid recommendations in acute and chronic nondiarrheal illness. However, one statement was not added as a recommendation in the final consensus (129/130) as further literature review did not find any supporting data. Oral FEE should be recommended as part of core treatment from day 1 of acute nondiarrheal illness and started at the earliest feasibility in chronic illnesses for improved patient outcomes. Appropriately formulated fluids with known electrolyte and energy content, quality standards, and improved palatability may further impact patient compliance and could be a good option. CONCLUSION: These consensus recommendations provide guidance for oral FEE recommendations in Indian adult/geriatric patients with various nondiarrheal illnesses.

Association of Physicians of India Expert Recommendations on Oral Fluid, Electrolytes, and Energy Management during Transition Care and Discharge for Hospitalized Patients with Nondiarrheal Illnesses.

Acute nondiarrheal illnesses (NDIs) involve overt or subclinical dehydration, requiring rehydration and electrolyte repletion. Dehydration is frequently under-recognized and under-managed, both in outpatient departments (OPDs) and inpatient departments (IPDs). Postadmission dehydration is associated with longer hospital stays and higher inhospital mortality rates. Recognizing and understanding dehydration in hospitalized patients is necessary due to the adverse outcomes associated with this condition. In this article, we aimed to develop practical consensus recommendations on the role of oral fluid, electrolyte, and energy (FEE) management in hospitalized patients with FEE deficits in NDI. The modified Delphi consensus methodology was utilized to reach a consensus. A scientific committee comprising eight experts from India formed the panel. Relevant clinical questions within three major domains were formulated for presentation and discussion: (1) burden and factors contributing to dehydration in hospitalized patients; (2) assessment of fluid and electrolyte losses and increased energy requirements in hospitalized patients; and (3) management of FEE deficits in hospitalized patients [at admission, during intravenous (IV) therapy, IV to oral de-escalation, and discharge]. The consensus level was classified into agreement (mean score ≥4), no consensus (mean score <4), and exclusion (mean score <4 after the third round of discussion). The questions that lacked agreement were discussed during the virtual meeting. The experts agreed that the most common factors contributing to dehydration in patients with NDI hospitalized in IPDs include decreased oral fluid intake, increased fluid loss due to the illness, insensible fluid loss, and a lack of awareness among doctors about dehydration, which can result in poor fluid intake. Time constraints, discontinuity of care, lack of awareness of the principles of fluid balance, lack of formal procedures for enforcing hydration schemes, and lack of adequate training are most often barriers to the assessment of hydration status in hospital settings. Experts used hydration biomarkers, such as changes in body weight, serum, or plasma osmolality; fluid intake; and fluid balance charts; along with urine output, frequency, quantity, and color, to determine hydration status in hospital settings. Experts agreed that appropriate FEE supplementation in the form of ready-to-drink (RTD) fluids can restore FEE deficits and shorten the length of hospital stays in hospitalized patients at admission, during de-escalation from IV to oral therapy, and at discharge. RTD electrolyte solutions with known concentrations of electrolytes and energy are good choices to avoid taste fatigue and replenish FEE in hospitalized patients during transition care and at discharge.

Effectiveness of ORSL® Variants as an Adjuvant along with Standard-of-care Treatment in the Restoration of Oral Fluid, Electrolytes, and Energy in Patients with Fever and/or General Weakness in Indian Patients in an Outpatient Setting.

BACKGROUND: Dehydration due to reduced intake or increased losses including insensible losses in patients with acute nondiarrheal diseases may lead to fluid, electrolytes, and energy (FEE) deficits. The impact of oral FEE supplementation adjuvant to standard of care (SOC) treatment on recovery in patients with acute nondiarrheal diseases is yet to be evaluated. AIM: To determine the effectiveness of ORSL® variants (ORSL® Apple Drink and ORSL® PLUS Orange Drink), fruit juice-based electrolyte drinks as an adjuvant along with SOC in the restoration of oral FEE in patients with acute nondiarrheal disease with fever and/or general weakness who attended an outpatient department (OPD). MATERIALS AND METHODS: This was a prospective, interventional, open-label, multicenter, real-world, study conducted at eight sites across India. Patients with fever and/or general weakness due to an acute nondiarrheal illness were given either ORSL® Apple Drink or ORSL® PLUS Orange Drink as an adjuvant along with SOC treatment per physician's discretion. The primary endpoint of the study was to assess improvement from baseline in energy or hydration levels after ORSL® variants consumption at 6, 24, and 48 hours measured by a new aided recovery scale (ARS). Secondary endpoints were to assess the improvement in energy and hydration levels at 20, 40, and 60 minutes, as well as energy levels and hydration levels at 20, 40, and 60 minutes, 6, 24, and 48 hours after the consumption of ORSL® Apple Drink or ORSL® PLUS Orange Drink. The patient's consumption of ORSL® variants and treatment experience, physician's experience of recommending ORSL® variants, and product safety were evaluated. RESULTS: In total, 612 patients were enrolled with mean age 38.3 years, of whom 62.9% were male. The mean baseline level of energy and hydration was 1.59 (range 1.0-2.0) on ARS. Statistically significant (p < 0.0001) improvements were observed in energy or hydration 6 hours after first consumption of ORSL formulations. Furthermore, improvement was observed from 40 minutes, and in levels of energy, hydration, and both energy and hydration from 60 minutes. Patients and physicians reported a positive experience with ORSL® variants. CONCLUSION: ORSL® Apple Drink and ORSL® PLUS Orange Drink are clinically proven to provide hydration and/or energy to patients with fever and/or general weakness.

Dehydration in Elderly: Revisiting the Assessment and Management Strategies.

Dehydration, like many other aspects of an aging body, is often neglected by patients and physicians alike. Not only does it sometimes become difficult to clinically assess and identify dehydration in the elderly, but it also becomes difficult to attribute gross changes in functioning to something as simple as water depletion. This can be counterproductive to the overall health and even survival of elderly patients if diagnosis is delayed. We propose a comprehensive hydration stewardship program, with public health and clinical interventions, to prevent dehydration and its complications in vulnerable segments of society, such as the elderly. This short review summarizes current evidence available for the diagnosis and identification of dehydration in the elderly and shares preventive strategies to prevent its occurrence and complications.

Neonatal hypernatremic dehydration in breastfed neonates: a prospective study unmasking the influences of breastfeeding practices and early weight monitoring.

Introduction: Hypernatremic dehydration in neonates is an uncommon but serious reason for re-hospitalization, especially in exclusively breastfed neonates. The aim was to study the incidence, associated maternal and neonatal characteristics and risk factors, and presenting features of neonatal hypernatremic dehydration (NHD). Methods: A prospective study design was employed to enroll full-term newborns admitted with serum sodium concentrations of ≥145 mEq/L from April 2022 to March 2023 at a tertiary care rural hospital. Maternal and neonatal characteristics and breastfeeding practices of these mother-baby pairs were recorded and observed. Healthy control for every mother-baby pair was taken. Ethical clearance and informed consent were obtained from mothers. Result: 34 newborns out of total 672 NICU admissions were admitted due to NHD, with an incidence of 4.7%. Primiparous mothers were 23 (67.6%) in the cases and 10 (29.4%) in the control group (p = 0.0017). Disparity in maternal breastfeeding practices of cases, such as delayed initiation time 2.3 h vs. 1.27 h (p < 0.0001), less frequency of breastfeeding 6.5 times vs. 9.3 times (p < 0.0001), and duration of breastfeeding sessions 23.3 min vs. 32 min (p = 0.0014) respectively in cases and controls were found to be potential contributing factors. 61.7% of mothers had breast issues in the cases and 17.6% in the control group (p = 0.0002) with average LATCH score of 4.29 in cases as compared to 8.08 in controls (p < 0.0001) at time of baby's admission to NICU. The average neonatal age at presentation was six days and average weight loss was 11.4% in cases vs. 2.8% in controls (p < 0.0001). The main presenting features were excessive weight loss 30 (88.2%), lethargy 20 (58.8%), jaundice 18 (52.9%) and fever 14 (41.1%). Conclusion: Neonatal hypernatremic dehydration (NHD) poses a significant clinical challenge, particularly in full-term, exclusively breastfed healthy neonates. We found an incidence of 4.7%. Delayed initiation of breastfeeding, inadequate breastfeeding techniques, and maternal breast-related issues were significant contributors to NHD. Primiparous mothers were found to be at higher risk, emphasizing the need for targeted breastfeeding education and support for primiparous mothers. The study reaffirmed the critical role of frequent and effective duration of breastfeeding and daily weight monitoring for preventing NHD.

Evaluation of Maternal Risk Factors for Neonatal Hypernatremic Dehydration: A Systematic Review.

BACKGROUND: Neonatal hypernatremic dehydration (NHD) is a severe condition associated with neonatal morbidity and mortality. PURPOSE: The present study evaluated maternal risk factors, including duration of maternal hospitalisation, primiparity, caesarean section, and pregnancy complications, as well as social factors, such as depression, fatigue, and inadequate support for NHD. DATA SOURCES: PubMed, Cochrane Library, International Scientific Indexing, Scopus, and Google Scholar were the databases searched until 2023. STUDY SELECTION: Articles written in English or Persian focusing on the relationship between maternal risk factors and NHD among neonates and providing sufficient information on NHD were included in this study. On the other hand, articles whose abstracts were only available were excluded. DATA EXTRACTION: The extracted data were presented in Excel software with the following titles: authors' names, year, type of study, study location, and maternal risk factors. The methodological quality of the articles was determined using the quality assurance tool for the diagnostic accuracy score (QUADAS). RESULTS: Of the 58 searched articles, 16 were investigated, which included five prospective, seven cross-sectional, and four retrospective articles. Maternal risk factors for NHD included labour and delivery complications, childbirth complications, factors causing insufficient breast milk intake (including breast milk insufficiency, nipple problems, wrong breastfeeding techniques, breast disorders, types of feeding, and breastfeeding training/counselling in pregnancy), as well as delivery and the postpartum period. IMPLICATIONS FOR PRACTICE AND RESEARCH: Maternal problems in pregnancy and delivery, breast disorders, breastfeeding status, maternal knowledge, and lactation skills are the most common maternal risk factors for NHD. Timely (antenatal) identification and proper management of maternal risk factors help reduce the incidence and severity of NHD complications.

Patient adherence to an oral rehydration solution intervention to prevent dehydration following ileostomy creation: A qualitative study.

BACKGROUND: Patients undergoing surgery for ileostomy creation frequently experience postoperative dehydration and subsequent renal injury. The use of oral rehydration solutions (ORS) has been shown to prevent dehydration, but compliance may be variable. METHODS: Semi-structured qualitative interviews were conducted with 17 patients who received a postoperative hydration kit and dehydration education to assess barriers and facilitators to compliance with ORS kit instructions. RESULTS: Qualitative analysis revealed five themes affecting patient adherence to the ORS intervention: (1) patient's perception of the effectiveness of the ORS solution, (2) existing co-morbidities, (3) kit quality and taste of the ORS product, (4) quality of the dehydration education, and (5) social support. CONCLUSIONS: Given that patient adherence can greatly affect the success of an ORS intervention, the design of future ORS interventions should emphasize the educational component, the "patient friendliness" of the ORS kit, and ways that social supports can be leveraged to increase adherence.

Acute kidney injury in nonagenarians: clinical characteristics and mortality.

INTRODUCTION: Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. METHODS: Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 150 patients were included, with a median age of 93.0 years (91.2-95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04-0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17-8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03-49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98-16.85, p = 0.001) were associated with mortality. CONCLUSION: AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.

Predictive factors for readmission after bariatric surgery: Experience of an obesity center.

Avoidable readmissions after bariatric surgery are a major burden on the healthcare systems. Rates of readmission after bariatric surgery have ranged from 1% up to 20%, but the factors that predict readmission have not been well studied. The objective of this study was to determine readmission rates following bariatric surgery and identify factors that contribute to early (within 90 days of surgery) and late readmission. A retrospective cohort study of 736 patients undergoing either Laparoscopic Sleeve Gastrectomy or Laparoscopic Roux-en-Y Gastric Bypass in Jordan University Hospital from 2016 to 2019. Demographic characteristics, co-morbidities, and readmissions were extracted from their medical records and analyzed. Multivariable logistic regression analysis was performed to determine which factors predict readmission. A total of 736 patients had bariatric surgery (Laparoscopic Sleeve Gastrectomy 89% vs Laparoscopic Roux-en-Y Gastric Bypass 11%) during the study period. Thirty-day readmission rate was 6.62% and an overall readmission rate of 23.23%. Common reasons for early readmission (within 90 days of surgery) were nausea, vomiting, and dehydration. Late readmissions were mainly caused by gallbladder stones. Three risk factors were identified that independently predicted readmission: the type of procedure being performed (P-value = .003, odds ratio [OR] 2.14, 95% confidence interval [CI] 1.32-3.49), depression (P-value = .028, OR 6.49, 95% CI 1.18-52.9) and preoperative body mass index (P-value = .011, OR 1.03, 95% CI 1.01-1.05). Several factors were identified that cause patients to represent and subsequently admitted into hospitals. Early readmission was usually due to nausea, vomiting, and dehydration, whereas late admissions were mostly due to biliary complications. Preoperative body mass index and depression were independent risk factors for readmission.

Manejo de deshidratación con alteración del sodio en pacientes pediátricos / Management of dehydration with sodium alteration in pediatric patients

Los cuadros de deshidratación son frecuentes en pediatría, muchos de ellos acompañados de alteraciones electrolíticas. La deshidratación asociada a trastornos del sodio puede implicar riesgos para la salud de los pacientes pediátricos tanto en el desarrollo del cuadro como en su tratamiento. Objetivo: crear un algoritmo de manejo de los cuadros de deshidratación asociados a lateraciones del sodio para manejo de pacientes pediátricos. Métodos: se realizó revisión de la literatura disponible sobre deshidratación con hiper e hiponatremia, en inglés y español, incluyendo libros y artículos de revistas. Se presenta en el actual documento los aspectos básicos sobre la fisiopatología de la deshidratación asociada a trastornos del sodio, su clínica, diagnóstico y manejo detallado, para el uso en la práctica clínica diaria.

Dehydration is common in pediatric patients, frequently accompanied with electrolite disturbances. Dehydration associated with sodium disturbances can involve risk for pediatric patient health during the development of the disease and during its treatment. Objective: to create an algorithm of management of dehydration with sodium disturbances in pediatric patients. Methods: review of literature about dehydration with hypernatremia and hyponatremia, in english and spanish, including books and published articles. We present in this document the basic aspects of physiopathology of dehydration with sodium disturbances, clinical presentation, diagnosis and detailed management, so it can be consulted for clinical practice.

Diarrea aguda en el lactante y preescolar / Acute diarrhea in toddlers and infants

Acute diarrhea (AD) is the increase in frequency and volume of bowel movements with decrease in their consistency that lasts less than 14 days. AD is a major public health problem and is still nowadays a cause of significant morbidity and mortality during childhood, especially in children with nutritional deficits. At a younger age, there is a greater susceptibility to diarrhea, which is more intense and more likely cause dehydration. The prevention and management of dehydration is the mainstay of treatment. The use of medications must be used with caution, analyzing individual cases and based on the best available evidence. We will analyze the subject with special emphasis on treatment according to scientific evidence.

La diarrea aguda (DA) se define como el aumento en la frecuencia y volumen de las deposiciones con disminución de la consistencia y que dura menos de 14 días. La DA es un gran problema de salud pública y es aún hoy en día una causa de importante morbimortalidad durante la infancia en especial en niños con déficits nutricionales. A menor edad hay mayor susceptibilidad de presentar diarrea, siendo ésta de mayor intensidad y con mayores posibilidades de producir deshidratación. La prevención y el manejo de la deshidratación es el pilar fundamental del tratamiento. El uso de medicamentos debe ser criterioso, analizando cada caso individual y basado en la mejor evidencia disponible. Analizaremos el tema con especial énfasis en el tratamiento según evidencia científica.

Weight loss thresholds to detect early hypernatremia in newborns / Limites de perda de peso para detecção de hipernatremia precoce em recém-nascidos

ABSTRACT Objective: The literature indicates a single universal cut-off point for weight loss after birth for the risk of hypernatremia, without considering other factors. The aim of this study was to construct and internally validate cut-off points for the percentage weight loss associated with the risk of hypernatremia, taking into account risk factors. Methods: A prospective study with a three-day follow-up was conducted in 165 neonates with a gestational age ≥35 weeks. The main outcome variable was mild or moderate hypernatremia (serum sodium ≥ 145 mmol/L). Secondary variables (risk factors) were maternal and infant variables. A multivariate logistic regression model was constructed to predict hypernatremia, obtaining its probability and the optimal discriminant cut-off point for hypernatremia (receiver operating characteristic analysis). Based on this point, threshold weight loss values were obtained according to the other variables. These values were internally validated by bootstrapping. Results: There were 51 cases (30.9%) of hypernatremia. The mean percentage weight loss for hypernatremic infants was 8.6% and 6.0% for the rest. Associated variables in the multivariate model included greater weight loss, male gender, higher education level, multiparity, and cesarean delivery. The model had an area under the receiver operating characteristic curve of 0.84 (sensitivity = 77.6%; specificity = 73.2%). Similar values were obtained in the bootstrapping validation. The lowest percentage weight loss was 4.77%, for cesarean delivery in male infants of mothers with a higher education level. Conclusions: The weight loss percentage values depended on the type of delivery, parity, newborn gender, and level of maternal education. External studies are required to validate these values.

RESUMO Objetivo: A literatura indica um único ponto de corte universal na perda de peso após o nascimento para risco de hipernatremia, sem considerar outros fatores. Nosso objetivo foi criar e validar internamente pontos de corte para o percentual de perda de peso associado ao risco de hipernatremia considerando fatores de risco. Métodos: Foi feito um estudo prospectivo que incluiu 165 neonatos com idade gestacional ≥ 35 semanas, acompanhados por três dias. A principal variável de resultado foi hipernatremia leve ou moderada (sódio sérico ≥ 145 mmol/L). As variáveis secundárias (fatores de risco) foram variáveis maternas e dos neonatos. Um modelo multivariado de regressão logística foi criado para diagnosticar hipernatremia, obteve sua probabilidade e o ponto de corte discriminativo ideal para hipernatremia (análise da Característica de Operação do Receptor). Com base nesse ponto, obtivemos então os valores limites de perda de peso de acordo com as outras variáveis. Esses valores foram internamente validados por. Resultados: Há 51 casos (30,9%) de hipernatremia. O percentual de perda de peso para neonatos hipernatrêmicos foi 8,6% e 6,0% para o restante. As variáveis associadas no modelo multivariado incluíram maior perda de peso, sexo masculino, maior nível de escolaridade, multiparidade e cesárea. O modelo apresentou uma área sob a curva da Característica de Operação do Receptor de 0,84 (sensibilidade = 77,6%; especificidade = 73,2%). Valores semelhantes foram obtidos na validação da bootstrapping. O menor percentual de perda de peso foi 4,77% para cesárea em neonatos do sexo masculino de mães com maior nível de escolaridade. Conclusões: Os valores percentuais de perda de peso dependem do tipo de parto, paridade, sexo do recém-nascido e nível de escolaridade materna. São necessários estudos externos para validar esses valores.