Germination of Dypsis decaryi seeds under salt stress / Germinação de sementes de Dypsis decaryi submetidas ao estresse salino

The triangle palm (Dypsis decaryi), a species native to Madagascar, possesses various ornamental characteristics that make it highly valued in the international market. Seed propagation is the primary method for its cultivation, and this process is influenced by factors such as sowing time and salinity. In this study, we aimed to investigate the germination behavior of D. decaryi seeds under different saline concentrations of sodium chloride (NaCl) and potassium chloride (KCl), in two distinct periods. The experiment followed a completely randomized design, employing a 2 × 2 × 5 factorial arrangement corresponding to two seasons of experimentation (summer and winter), two salt types (NaCl and KCl), and four salt concentrations (25, 50, 75, and 100 mM), in addition to a control group without salt. Each treatment consisted of four replications, with 25 seeds per replication. The evaluated parameters were germination percentage, germination speed index, and mean germination time. No significant effects were observed when analyzing the salt types individually, the interaction between seasons and salts, or the interaction between all three factors. However, during the summer season, the seeds exhibited higher mean germination percentages and germination speed indices and shorter mean germination times, regardless of the salt used. A high germination percentage (73.79%) was observed at the highest salt concentration tested for both NaCl and KCl. Consequently, we conclude that D. decaryi is tolerant to salinity, as simulated by KCl and NaCl, during the seed germination process. Sowing time, salt concentrations, and the interaction between these variables influenced germination.(AU)

A palmeira triângulo (Dypsis decaryi), nativa de Madagascar, apresenta diversas características de interesse ornamental, tornando-a uma espécie importante para o mercado internacional. Seu principal método de propagação é por semente, que é influenciado por vários fatores como época de semeadura e salinidade. Propôs-se avaliar o comportamento germinativo de sementes de D. decaryi em diferentes concentrações salinas de cloreto de sódio (NaCl) e cloreto de potássio (KCl) em duas épocas. O delineamento experimental foi o inteiramente casualizado; o experimento foi realizado em esquema fatorial 2 x 2 x 5, sendo duas épocas de condução do experimento (verão e inverno), dois tipos de sais (NaCl e KCl) e quatro concentrações salinas (25, 50, 75 e 100 mM) e ausência de sais - controle; foram quatro repetições e 25 sementes por parcela. Avaliou-se porcentagem de germinação, índice de velocidade de germinação e tempo médio de germinação. Não houve efeito significativo de forma isolada entre os tipos de sais, para interação de épocas e sais e, entre os três fatores avaliados. Observou-se que no verão as sementes apresentaram maiores médias de porcentagem de germinação, maior índice de velocidade de germinação, e menor tempo médio de germinação para ambos os sais. Foi possível observar alta porcentagem de germinação (73,79%) na maior concentração salina avaliada para ambos os sais. Concluiu-se que a espécie se mostrou tolerante à salinidade simulada por KCl e NaCl, durante o processo de germinação de sementes, o qual foi influenciado pela época de semeadura, concentrações salinas e interação entre épocas e concentrações.(AU)

Effect of sublethal concentrations of insecticides associated with NaCl and KCl on feeding behavior and mortality of Euschistus heros and Diceraeus melacanthus (Hemiptera: Pentatomidae) / Efeito de concentracoes subletais de inseticidas associados com NaCl e KCl sobre comportamento alimentar e mortalidade de Euschistus heros e Diceraeus melatacanthus (Hemiptera: Pentatomidae)

Stink bugs are important pests of highly profitable agricultural crops worldwide, and the use of insecticides remains the main strategy for their control. The objectives of this study were to evaluate the behavioral aspects of Euschistus heros and Diceraeus melacanthus through feeding after exposure to chloride solutions (NaCl and KCl), as well as the control efficacy of insecticides in combination with salt. Two bioassays were performed with stink bugs exposed to treated substrate: i) feeding preference by salivary sheath counting in a free choice test for chloride solutions, using bean pod or corn seedling as counting substrate for newly emerged E. heros and D. melacanthus adults, respectively; and ii) comparative efficiency of five synthetic insecticides associated with NaCl or KCl in the mortality of 4th instar nymphs (N4). Pre-determined sublethal (LC25) and median lethal (LC50) concentrations of commercially available insecticides (Lfn), buprofezin (Bpf), pyriproxyfen (Ppx), chlorantraniliprole (Ctn) and spinosad (Spn) were used. For each species and insecticide, the treatments were pure LC25, LC25 + NaCl 5% m/m, LC25 + KCl 5% m/m, pure LC50, and distilled water (dH2O) as the control. Corn seedlings treated with 5% NaCl saline solution had reduced salivary sheaths from D. melacanthus. Ctn LC25 (0.63 mL L-1) + 5% NaCl and pure Ctn LC50 (1.16 mL L-1) were similar and more efficient in terms of mortality of D. melacanthus N4s than any other treatment. The association of Spn LC25(0.37 mL L-1) + 5% NaCl and Spn LC50 only (0.90 mL L-1) was similar to that of E. heros N4s compared to other treatments. The insecticide concentrations used in this study have potential for stink bug pest control, thus the association of insecticides with commercially available, easy-to-find, and low-cost chloride salts may represent a good strategy for stink bug control.(AU)

Os percevejos são importantes pragas de culturas agrícolas altamente rentáveis em todo o mundo, e o uso de inseticidas continua sendo a principal estratégia para seu controle. Os objetivos deste estudo foram avaliar os aspectos comportamentais de Euschistus heros e Diceraeus melacanthus através da alimentação após exposição a soluções cloradas (NaCl e KCl), bem como a eficiencia de controle de inseticidas em combinação com sal. Dois bioensaios foram realizados com percevejos expostos ao substrato tratado: i) preferência alimentar por contagem de bainhas salivares em teste de livre escolha de soluções contendo cloreto, usando vagem de feijão ou plantulas de milho como substrato de contagem para adultos de E. heros e D. melacanthus recém-emergidos, respectivamente; e ii) eficiência comparativa de cinco inseticidas sintéticos associados a NaCl ou KCl na mortalidade de ninfas de 4º estágio (N4). Foram utilizadas concentrações subletais pré-determinadas (CL25) e letais medias (LC50) de inseticidas comercialmente disponíveis lufenurom (Lfn), buprofezina (Bpf), piriproxifem (Ppx), clorantraniliprole (Ctn) e espinosade (Spn). Para cada espécie e inseticida, os tratamentos foram CL25 pura, CL25 + NaCl 5% m/m, CL25 + KCl 5% m/m, CL50 pura e água destilada (dH2O) como controle. Plantulas de milho tratadas com a solução salina NaCl 5% apresentaram redução das bainhas salivares de D. melacanthus. Ctn CL25 (0,63 mL L-1) + 5% NaCl e Ctn CL50 pura (1,16 mL L-1) foram semelhantes e mais eficientes em termos de mortalidade de N4s de D. melacanthus do que qualquer outro tratamento. A associação de Spn CL25 (0,37 mL L-1) + 5% NaCl e Spn CL50 pura (0,90 mL L-1) foi semelhante à de N4s de E. heros em relação aos outros tratamentos. As concentrações de inseticidas utilizadas neste estudo têm potencial para o controle de pragas de percevejos, portanto, a associação de inseticidas com sais de cloreto comercialmente disponíveis, de fácil acesso e baixo custo pode representar uma boa estratégia para o controle de percevejos.(AU)

Suicidio con cloruro de potasio: Reporte de un caso / Suicide with potassium chloride: Case report

Resumen El suicidio es el uso deliberado de violencia externa con la intención de quitarse la vida, y el uso de medicamentos es una forma en la que esta se puede consumar, el cloruro de potasio es uno de los medicamentos que en concentraciones elevadas tienen efectos letales, por lo que el objetivo de este artículo científico es detallar características farmacológicas del cloruro de potasio, y los elementos a considerar en el estudio postmorten de cadáveres cuando se sospecha de una intoxicación por cloruro de potasio con manera de muerte suicida; con la metodología de estudio de artículos científicos, exposición de un caso clínico y discusión de la importancia del análisis de los elementos aportados y solicitados durante la investigación médico legal, también la especial y delicada importancia de una correcta recolección de muestras biológicas y continentes de medicamentos para el estudio toxicológico y químicoanalítico; de esta manera se concluye que el Cloruro de potasio es un fármaco con efectos colaterales dañinos en la función eléctrica cardiaca, la determinación de la manera de muerte es un trabajo complejo para el médico forense en este tipo de casos, y los resultados de la pericias complementarias a la autopsia tienen mucha importancia para el análisis de este tipo de casos.

Abstract Suicide is the deliberate use of external violence with the intention of taking one's life, and the use of medications is one way in which this can be consumed, potassium chloride is one of the medications that in high concentrations have lethal effects, Therefore, the objective of this scientific article is to detail the pharmacological characteristics of potassium chloride, and the elements to be considered in the postmortem study of corpses when potassium chloride poisoning is suspected as a suicidal death; with the methodology of study of scientific articles, presentation of a clinical case and discussion of the importance of the analysis of the elements provided and requested during the medical-legal research, also the special and delicate importance of a correct collection of biological samples and drug containers for toxicological and chemical analysis; In this way, it is concluded that potassium chloride is a drug with harmful collateral effects on cardiac electrical function, determining the manner of death is a complex job for the forensic doctor in this type of case, and the results of the expertise complementary to the autopsy are very important for the analysis of this type of case.

Accidental epidural catheter infusion of potassium chloride for postoperative analgesia: A case report.

An infusion of 100 cc of 0,2% potassium chloride was accidental performed through a thoracic epidural catheter, inserted to perioperative analgesia, to a 66 years old man who was scheduled for right hemicolectomy, 48 h after surgery. Paresis of upper limbs, flaccid paralysis of lower limbs and a sensitive level at T8 was observed. An epidural lavage with an initial dose of 20 cc of saline was slowly injected, followed for a saline infusion of 20 cc per hour. Neurologic signs were totally reverted some hours later and 24 h after the incident the physical exam was normal. We reviewed the clinical presentation of the complication and its mechanisms, the more frequent clinical evolution, as well as treatment measures and strategies to prevent the incident.

Electronic prescription: frequency and severity of medication errors.

OBJECTIVE: To assess the frequency and severity of prescriptions errors with potentially dangerous drugs (heparin and potassium chloride for injection concentrate) before and after the introduction of a computerized provider order entry (CPOE) system. METHODS: This is a retrospective study that compared errors in manual/pre-typed prescriptions in 2007 (Stage 1) with CPOE prescriptions in 2014 (Stage 2) (Total = 1,028 prescriptions), in two high-complexity hospitals of Belo Horizonte, Brasil. RESULTS: An increase of 25% in the frequency of errors in Hospital 1 was observed after the intervention (p<0.001). In contrast, a decreased error frequency of 85% was observed in Hospital 2 (p<0.001). Regarding potassium chloride, the error rate remained unchanged in Hospital 1 (p>0.05). In Hospital 2, a significant decrease was recorded in Stage 2 (p<0.001). A reduced error severity with heparin (p<0.001) was noted, while potassium chloride-related prescription severity remain unchanged (p> 0.05). CONCLUSIONS: The frequency and severity of medication errors after the introduction of CPOE was affected differently in the two hospitals, which shows a need for thorough observation when the prescription system is modified. Control of new potential errors introduced and their causes for the adoption of measures to prevent these events must be in place during and after the implementation of this technology.

Electronic prescription: frequency and severity of medication errors

SUMMARY OBJECTIVE: To assess the frequency and severity of prescriptions errors with potentially dangerous drugs (heparin and potassium chloride for injection concentrate) before and after the introduction of a computerized provider order entry (CPOE) system. METHODS: This is a retrospective study that compared errors in manual/pre-typed prescriptions in 2007 (Stage 1) with CPOE prescriptions in 2014 (Stage 2) (Total = 1,028 prescriptions), in two high-complexity hospitals of Belo Horizonte, Brasil. RESULTS: An increase of 25% in the frequency of errors in Hospital 1 was observed after the intervention (p<0.001). In contrast, a decreased error frequency of 85% was observed in Hospital 2 (p<0.001). Regarding potassium chloride, the error rate remained unchanged in Hospital 1 (p>0.05). In Hospital 2, a significant decrease was recorded in Stage 2 (p<0.001). A reduced error severity with heparin (p<0.001) was noted, while potassium chloride-related prescription severity remain unchanged (p> 0.05). CONCLUSIONS: The frequency and severity of medication errors after the introduction of CPOE was affected differently in the two hospitals, which shows a need for thorough observation when the prescription system is modified. Control of new potential errors introduced and their causes for the adoption of measures to prevent these events must be in place during and after the implementation of this technology.

RESUMO OBJETIVO: Avaliar a frequência e a gravidade de erros em prescrições envolvendo medicamentos potencialmente perigosos (heparina e cloreto de potássio concentrado injetável) antes e após a introdução de um sistema de prescrição eletrônica. MÉTODOS: Trata-se de estudo retrospectivo que comparou erros em prescrições manuais e pré-digitadas de 2007 (Fase 1) com prescrições eletrônicas de 2014 (Fase 2) (total = 1.028 prescrições), em dois hospitais de alta complexidade de Belo Horizonte. RESULTADOS: Foi observado no hospital 1 aumento de 25% dos erros depois da intervenção (p<0,001), e no hospital 2 foi verificada redução de 85% (p<0,001). Para o cloreto de potássio, a frequência de erros permaneceu a mesma no hospital 1 (p>0,05), independentemente da fase e, no hospital 2, ocorreu redução significativa na fase 2 (p<0,001). Foi identificada redução da gravidade dos erros com a heparina (p<0,001), mas não houve alteração na gravidade dos erros com cloreto de potássio (p>0,05). CONCLUSÕES: A frequência e a gravidade dos erros de medicação após a introdução de prescrição eletrônica foram impactadas de forma diferente nos dois hospitais, demonstrando necessidade de observação criteriosa quando o sistema de prescrição é modificado. Durante e após a implantação dessa tecnologia, deve existir controle dos novos erros potenciais introduzidos e suas causas para a adoção de medidas de prevenção desses eventos.

Characterization of potential drug-drug interactions in patients hospitalized in the intensive care unit of a tertiary hospital in Bogotá

Introduction: Drug-drug interactions occur more frequently in intensive care units than in other services. However, in Colombia, there are few studies on this problem in critically ill patients. Objectives: To characterize potential drug-drug interactions generated from prescriptions during hospitalization in an intensive care unit and to determine factors associated with their onset. Materials and methods: A retrospective cohort was assembled with patients hospitalized in an intensive care unit for a seven-month period. The daily prescription was assessed for potential drugdrug interactions using the Lexicomp® program. We calculated the incidence of interactions, classified them by type, severity, and level of documentation, and evaluated the factors associated with their onset using logistic regression. Results: The proportion of patients with at least one interaction was 84% while 87% had more than one interaction; the median was six interactions per patient. The most frequent was fentanyl and midazolam (23%). Moderate interactions were the most frequent by severity (77.6%) and by documentation (52.6%). The most common index and precipitating drugs were midazolam (12%) and fentanyl (10.6%), respectively. Age (OR=3.1) and the number of drugs (OR=11.8) were associated with the occurrence of interactions. Conclusions: Given their high frequency and potential negative impact, the systematic monitoring of prescriptions in intensive care units to detect interactions is important. Such monitoring contributes to the rational use of medicines and to improve the quality of care.

Caracterización de las potenciales interacciones farmacológicas en pacientes de una unidad de cuidados intensivos en un hospital de tercer nivel de Bogotá / Characterization of potential drug-drug interactions in patients hospitalized in the intensive care unit of a tertiary hospital in Bogotá

Resumen Introducción. Las interacciones farmacológicas ocurren con mayor frecuencia en las unidades de cuidados intensivos que en otros servicios. Sin embargo, en Colombia son pocos los estudios en que se han evaluado en pacientes críticamente enfermos. Objetivos. Caracterizar las potenciales interacciones farmacológicas en las prescripciones de pacientes hospitalizados en una unidad de cuidados intensivos y determinar los factores asociados con su aparición. Materiales y métodos. Se analizó una cohorte retrospectiva de pacientes hospitalizados en una unidad de cuidados intensivos, durante un periodo de siete meses. Las prescripciones diarias se evaluaron en busca de potenciales interacciones farmacológicas mediante el programa Lexicomp™. Se calculó la incidencia de interacciones, se clasificaron según su tipo, gravedad y grado de documentación, y se evaluaron los factores asociados con su aparición mediante regresión logística. Resultados. La proporción de pacientes con por lo menos una interacción fue de 84 %, en tanto que el 87 % presentó más de una interacción; la mediana fue de seis interacciones por paciente. La más frecuente fue entre el fentanilo y el midazolam (23 %). Las interacciones de gravedad y grado de documentación moderados fueron las más frecuentes (77,6 y 52,6 %, respectivamente). El fármaco índice más frecuente fue el midazolam (12 %) y el precipitante más frecuente, el fentanilo (10,6 %). La edad (odds ratio, OR=3,1) y el número de medicamentos (OR=11,8), se asociaron con la aparición de interacciones. Conclusiones. Dada su elevada frecuencia y potencial impacto negativo es importante vigilar sistemáticamente las prescripciones en cuidados intensivos para detectar las interacciones, con el fin de contribuir al uso racional de los medicamentos y a mejorar la calidad de la atención.

Abstract Introduction: Drug-drug interactions occur more frequently in intensive care units than in other services. However, in Colombia, there are few studies on this problem in critically ill patients. Objectives: To characterize potential drug-drug interactions generated from prescriptions during hospitalization in an intensive care unit and to determine factors associated with their onset. Materials and methods: A retrospective cohort was assembled with patients hospitalized in an intensive care unit for a seven-month period. The daily prescription was assessed for potential drugdrug interactions using the Lexicomp® program. We calculated the incidence of interactions, classified them by type, severity, and level of documentation, and evaluated the factors associated with their onset using logistic regression. Results: The proportion of patients with at least one interaction was 84% while 87% had more than one interaction; the median was six interactions per patient. The most frequent was fentanyl and midazolam (23%). Moderate interactions were the most frequent by severity (77.6%) and by documentation (52.6%). The most common index and precipitating drugs were midazolam (12%) and fentanyl (10.6%), respectively. Age (OR=3.1) and the number of drugs (OR=11.8) were associated with the occurrence of interactions. Conclusions: Given their high frequency and potential negative impact, the systematic monitoring of prescriptions in intensive care units to detect interactions is important. Such monitoring contributes to the rational use of medicines and to improve the quality of care.

Neuromuscular activity of Bothrops alcatraz snake venom in chick biventer cervicis preparations.

Venom (10-100 µg/ml) from Bothrops alcatraz, a pitviper from the Alcatrazes Archipelago off the coast of southeastern Brazil, caused progressive, irreversible neuromuscular blockade in chick isolated biventer cervicis preparations. The venom also inhibited contractures to exogenous ACh (110 µM) and KCl (20 mM), caused myofiber damage and increased creatine kinase release. Commercial bothropic antivenom raised against mainland Bothrops species neutralized the neuromuscular activity, depending on the venom concentration.

Investigation of mechanisms involved in (-)-borneol-induced vasorelaxant response on rat thoracic aorta.

The monoterpene (-)-borneol is present in essential oils of several medicinal plants. The aim of this study was to evaluate (-)-borneol effects on rat thoracic aorta artery rings. The cumulative addition of (-)-borneol (10(-9) -3 × 10(-4) M) on a phenylephrine-induced pre-contraction (10(-6) M) promoted a vasorelaxant effect in a concentration-dependent manner and independent of vascular endothelium. A similar effect was obtained on KCl-induced pre-contractions (80 mM). (-)-Borneol (10(-5) -3 × 10(-4 ) M) inhibited contractions induced by cumulative addition of CaCl2 (10(-6) -3 × 10(-2) M) in depolarizing medium without Ca(2+) in a concentration-dependent manner. On S-(-) Bay K 8644-induced pre-contractions (10(-7) M), (-)-borneol did not induce significant changes compared with KCl-induced pre-contractions. In a Ca(2+) -free medium, (-)-borneol (10(-5) , 10(-4) or 10(-3) M) interfered in calcium mobilization from phenylephrine (10(-6) M)- or caffeine (20 mM)-sensitive intracellular stores. The involvement of K(+) channels was evaluated by tetraethylammonium (3 mM), 4-aminopyridine (1 mM) and glibenclamide (10(-5) M) pre-treatment, and (-)-borneol-induced vasorelaxation was markedly attenuated. Thus, this vasorelaxant effect can probably be attributed to calcium influx blockade through voltage-operated calcium channels (CaV L), calcium mobilization from intracellular stores and potassium channels activation.

Impact of Plasma-Lyte pH 7.4 on acid-base status and hemodynamics in a model of controlled hemorrhagic shock.

OBJECTIVE: Intravenous infusion of crystalloid solutions is a cornerstone of the treatment of hemorrhagic shock. However, crystalloid solutions can have variable metabolic acid-base effects, perpetuating or even aggravating shock-induced metabolic acidosis. The aim of this study was to compare, in a controlled volume-driven porcine model of hemorrhagic shock, the effects of three different crystalloid solutions on the hemodynamics and acid-base balance. METHODS: Controlled hemorrhagic shock (40% of the total blood volume was removed) was induced in 18 animals, which were then treated with normal saline (0.9% NaCl), Lactated Ringer's Solution or Plasma-Lyte pH 7.4, in a blinded fashion (n = 6 for each group). Using a predefined protocol, the animals received three times the volume of blood removed. RESULTS: The three different crystalloid infusions were equally capable of reversing the hemorrhage-induced low cardiac output and anuria. The Lactated Ringer's Solution and Plasma-Lyte pH 7.4 infusions resulted in an increased standard base excess and a decreased serum chloride level, whereas treatment with normal saline resulted in a decreased standard base excess and an increased serum chloride level. The Plasma-Lyte pH 7.4 infusions did not change the level of the unmeasured anions. CONCLUSION: Although the three tested crystalloid solutions were equally able to attenuate the hemodynamic and tissue perfusion disturbances, only the normal saline induced hyperchloremia and metabolic acidosis.

Impact of Plasma-Lyte pH 7.4 on acid-base status and hemodynamics in a model of controlled hemorrhagic shock

OBJECTIVE: Intravenous infusion of crystalloid solutions is a cornerstone of the treatment of hemorrhagic shock. However, crystalloid solutions can have variable metabolic acid-base effects, perpetuating or even aggravating shock-induced metabolic acidosis. The aim of this study was to compare, in a controlled volume-driven porcine model of hemorrhagic shock, the effects of three different crystalloid solutions on the hemodynamics and acid-base balance. METHODS: Controlled hemorrhagic shock (40 percent of the total blood volume was removed) was induced in 18 animals, which were then treated with normal saline (0.9 percent NaCl), Lactated Ringer's Solution or Plasma-Lyte pH 7.4, in a blinded fashion (n = 6 for each group). Using a predefined protocol, the animals received three times the volume of blood removed. RESULTS: The three different crystalloid infusions were equally capable of reversing the hemorrhage-induced low cardiac output and anuria. The Lactated Ringer's Solution and Plasma-Lyte pH 7.4 infusions resulted in an increased standard base excess and a decreased serum chloride level, whereas treatment with normal saline resulted in a decreased standard base excess and an increased serum chloride level. The Plasma-Lyte pH 7.4 infusions did not change the level of the unmeasured anions. CONCLUSION: Although the three tested crystalloid solutions were equally able to attenuate the hemodynamic and tissue perfusion disturbances, only the normal saline induced hyperchloremia and metabolic acidosis.

Clinical impact of histidine-ketoglutarate-tryptophan (HTK) cardioplegic solution on the perioperative period in open heart surgery patients.

BACKGROUND: Ischemia-reperfusion injury during open heart surgery related to unsuccessful myocardial protection may increase morbidity or mortality. We analyze the clinical outcome after cardiac surgery with a cardioplegic solution based on intracellular components added with histidine-ketoglutarate-tryptophan. METHODS: Thirty patients programmed for elective open heart surgery were randomized into two groups. In group I (n = 15), myocardial protection was carried out with Bretschenider solution (HTK), and in group II (n = 15) with conventional crystalloid cardioplegia. The incidence of arrhythmias, inotropic support requirement, and length-of-stay in the intensive care unit were evaluated. RESULTS: During reperfusion, there was no difference in incidence of arrhythmias; however, in the postoperative period group I had a lower incidence of arrhythmias (p = 0.001). Inotropic support (p = 0.003) and length-of-stay in the intensive care unit (p = 0.037) were lower in group I. There were no deaths in either group. CONCLUSIONS: It was concluded that myocardial protection with Bretschneider solution effectively decreases incidence of arrhythmias, inotropic support, and length-of-stay in the intensive care unit.

Sympathetic hyperactivity, respiratory failure, pruritus, and anesthesia after unintentional epidural injection of potassium chloride: case report.

BACKGROUND AND OBJECTIVES: A combination of epidural and general anesthesia has been widely used to attenuate the surgical stress response and to provide postoperative analgesia. This case report illustrates the use of this anesthetic technique. Analgesia was induced with local anesthetic in the immediate postoperative period using unintentional 19.1% potassium chloride (KCl) as diluent. METHODS: An ASA I male patient was scheduled for surgical correction of idiopathic megaesophagus under continuous epidural anesthesia combined with general anesthesia. In the postoperative period, while preparing 10 mL 0.125% bupivacaine to be administered through the epidural catheter for pain control, 5 mL 19.1% KCl was unintentionally used as diluent, resulting in a 9.55% potassium solution concentration. RESULTS: The patient developed warmness of the lower limbs, tachycardia, hypertension, intense pruritus on the chest, agitation, exacerbation of sensory and motor blocks, and respiratory failure secondary to pulmonary edema, requiring ventilatory support. Total recovery was observed after 24 hours. CONCLUSIONS: Epidurally injected potassium leads to severe clinical manifestations caused by autonomic dysfunction, spinal cord irritation, and possible release of histamine. Despite continuous recommendations, ampule misidentification still happens in hospitals, frequently leading to serious accidents.

Lesiones esofágicas medicamentosas / Drug-induced esophageal lesions

Las lesiones agudas erosivas o ulceraciones del esófago provocadas por medicamentos, son poco frecuentes pero no excepcionales. Sus principales causantes son algunos antibióticos y el cloruro de potasio. En su fisiopatología intervienen la naturaleza del medicamento y la lentificación del tránsito esofágico (ingestión con poco líquido, en posición de decúbito; disminución o pérdida del peristaltismo y en especial de las ondas de barrido, administración de antiespasmódicos y anticolinérgicos que reducen la producción de saliva, disminuyen el peristaltismo del cuerpo esofágico y alteranla continencia del esfínter esofágico inferior, permitiendo el reflujo gastroesofágico

[Familial periodic paralysis: study of 8 cases]. / Paralisia periódica familiar: estudo de oito casos.

The authors studied 8 patients with Familial Periodic Paralysis on the clinical, hydroelectrolytic, electrophysiologic, histologic and therapeutic points of view. There was significant predominance in males. The onset of the symptoms in our group began under fifteen years of age. The clinical manifestations were similar to those referred in the literature. The hypokalemic form was found in all patients except in one case that had hyperkalemic form. Natremias on the superior border of the normality, were seen in 21.4% of the cases, and in 21.4% the natremias were higher; this fact suggested aldosterone liberation of the muscle. The histologic examination performed in 5 patients, was normal in 20% of them and, in those cases with repetitive and frequent crises, atrophic muscle fibers were seen. Prophylactic treatments were made. The patients with hypokalemic form received supplementary doses of potassium.

[Stenosis and intestinal ulcer due to chronic ingestion of a combination of a thiazidic diuretic with potassium]. / Estenósis y ulceración intestinal asociada a ingestion crónica de una combinación de diurético tiazídico con potasio.

Reports from recent years shown evidence of the existence of a type of primary ulceration of the small bowel associated with stenosis, relatively frequent and possibly iatrogenic. The primary characteristics of the studied cases were that it was present in patients over 50 years old, a good number of them had cardiorenal diseases or were hypertensives, and ingestion of a thiazide diuretic supplemented with potassium. Clinical and experimental investigations suggest that potassium, with or without a diuretic, could cause ulceration and stenosis of the small bowel. Presented in this report the case of a 62-year-old patient with cardiovascular disease and chronic ingestion of a thiazide diuretic with potassium chloride (Diclotride-K (R) who developed an intestinal obstruction that merited surgical intervention which showed a circumscribed stenosis of jejunum accompanied by ulceration.