Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children.

BACKGROUND: Although acute diarrhoea is a self-limiting disease, dehydration may occur in some children. Dehydration is the consequence of an increased loss of water and electrolytes (sodium, chloride, potassium, and bicarbonate) in liquid stools. When these losses are high and not replaced adequately, severe dehydration appears. Severe dehydration is corrected with intravenous solutions. The most frequently used solution for this purpose is 0.9% saline. Balanced solutions (e.g. Ringer's lactate) are alternatives to 0.9% saline and have been associated with fewer days of hospitalization and better biochemical outcomes. Available guidelines provide conflicting recommendations. It is unclear whether 0.9% saline or balanced intravenous fluids are most effective for rehydrating children with severe dehydration due to diarrhoea. OBJECTIVES: To evaluate the benefits and harms of balanced solutions for the rapid rehydration of children with severe dehydration due to acute diarrhoea, in terms of time in hospital and mortality compared to 0.9% saline. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was 4 May 2022. SELECTION CRITERIA: We included randomized controlled trials in children with severe dehydration due to acute diarrhoea comparing balanced solutions, such as Ringer's lactate or Plasma-Lyte with 0.9% saline solution, for rapid rehydration. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. time in hospital and 2. MORTALITY: Our secondary outcomes were 3. need for additional fluids, 4. total amount of fluids received, 5. time to resolution of metabolic acidosis, 6. change in and the final values of biochemical measures (pH, bicarbonate, sodium, chloride, potassium, and creatinine), 7. incidence of acute kidney injury, and 8. ADVERSE EVENTS: We used GRADE to assess the certainty of the evidence. MAIN RESULTS: Characteristics of the included studies We included five studies with 465 children. Data for meta-analysis were available from 441 children. Four studies were conducted in low- and middle-income countries and one study in two high-income countries. Four studies evaluated Ringer's lactate, and one study evaluated Plasma-Lyte. Two studies reported the time in hospital, and only one study reported mortality as an outcome. Four studies reported final pH and five studies reported bicarbonate levels. Adverse events reported were hyponatremia and hypokalaemia in two studies each. Risk of bias All studies had at least one domain at high or unclear risk of bias. The risk of bias assessment informed the GRADE assessments. Primary outcomes Compared to 0.9% saline, the balanced solutions likely result in a slight reduction of the time in hospital (mean difference (MD) -0.35 days, 95% confidence interval (CI) -0.60 to -0.10; 2 studies; moderate-certainty evidence). However, the evidence is very uncertain about the effect of the balanced solutions on mortality during hospitalization in severely dehydrated children (risk ratio (RR) 0.33, 95% CI 0.02 to 7.39; 1 study, 22 children; very low-certainty evidence). Secondary outcomes Balanced solutions probably produce a higher increase in blood pH (MD 0.06, 95% CI 0.03 to 0.09; 4 studies, 366 children; low-certainty evidence) and bicarbonate levels (MD 2.44 mEq/L, 95% CI 0.92 to 3.97; 443 children, four studies; low-certainty evidence). Furthermore, balanced solutions likely reduces the risk of hypokalaemia after the intravenous correction (RR 0.54, 95% CI 0.31 to 0.96; 2 studies, 147 children; moderate-certainty evidence). Nonetheless, the evidence suggests that balanced solutions may result in no difference in the need for additional intravenous fluids after the initial correction; in the amount of fluids administered; or in the mean change of sodium, chloride, potassium, and creatinine levels. AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effect of balanced solutions on mortality during hospitalization in severely dehydrated children. However, balanced solutions likely result in a slight reduction of the time in the hospital compared to 0.9% saline. Also, balanced solutions likely reduce the risk of hypokalaemia after intravenous correction. Furthermore, the evidence suggests that balanced solutions compared to 0.9% saline probably produce no changes in the need for additional intravenous fluids or in other biochemical measures such as sodium, chloride, potassium, and creatinine levels. Last, there may be no difference between balanced solutions and 0.9% saline in the incidence of hyponatraemia.

Enteral hydration in cows: Comparison between continuous flow and bolus administration.

BACKGROUND: Enteral hydration in cattle is most commonly performed as a bolus (B) via the ororuminal route, although continuous flow (CF) administration via the nasoesophageal route represents a viable alternative. Currently, no study has compared the effectiveness of these two methods. This study aimed to compare the efficiency of enteral hydration using CF and B to correct water, electrolyte and acid-base imbalances in cows. METHODS: Protocols for the induction of dehydration were applied twice to eight healthy cows, with an interval of 1 week. In a crossover design, two types of enteral hydration were performed using the same electrolyte solution and volume equal to 12% of bodyweight (BW): CF (10 mL/kg/h, between 0 and 12 hours) and B (6% BW, twice, at 0 and 6 hours). Clinical and blood variables were determined at -24, 0, 6, 12 and 24 hours and compared using repeated-measures ANOVA. RESULTS: Induced moderate dehydration and hypochloremic metabolic alkalosis were corrected after 12 hours using the two hydration methods, with no differences observed between the methods. LIMITATIONS: The study was conducted with induced rather than natural imbalances, so the findings should be interpreted cautiously. CONCLUSION: Enteral CF hydration is as effective as B hydration in reversing dehydration and correcting electrolyte and acid-base imbalances.

Probióticos y prebióticos: rol en la terapéutica de la enfermedad diarreica aguda infantil / Probiotics and prebiotics: its role in childhood acute diarrheal disease therapy

RESUMEN: La enfermedad diarreica aguda infantil (EDAI), constituye un problema de salud pública, representando la 2ª causa de morbimortalidad infantil en menores de 5 años, en el Ecuador. La hidratación oral y parenteral en los niños hospitalizados bajo normas de administración de conformidad con el grado de deshidratación y pérdida de peso, así como medidas preventivas como la vacunación obligatoria contra el rotavirus, han contribuido a disminuir, pero no a solucionar este problema de salud infantil. Múltiples factores contribuyen para que no se resuelva: socioeconómicos, educacionales, el destete temprano y malas prácticas alimenticias, entre otros. Últimos estudios han propuesto la utilización de probióticos que contribuyan a disminuir el problema sugieriendo el usode Saccharomyces boulardii (SB), asociado a un prebiótico; lo que permitiría acortar el tiempo de tratamiento de una EDAI; por lo que la simbiosis entre SB y un prebiótico denominado fructooligosacárido (FOS), podría ser una alternativa para reducir costos y complicaciones. Una alternativa para medir el curso clínico de una EDAI en infantes es la escala BITTS, de reciente creación y fácil aplicación por clínicos. El objetivo de este manuscrito fue resumir la evidencia existente respecto del rol de losprobióticos y prebióticos en la terapéutica de de la EDAI.

SUMMARY: In Ecuador childhood acute diarrheal disease (CADD) constitutes a serious public health problem, representing the 2nd cause of infant morbidity and mortality in children under 5 years of age. Oral and parenteral hydration in hospitalized children, with standard treatments according to their degree of dehydration and weight loss, as well as preventive measures such as mandatory vaccination against rotavirus, have contributed to a decrease. Nevertheless, this childhood disease has still not been resolved. There are multiple contributing factors involved that prevent complete eradication of the disease Among these are socio-economic problems, education, early weaning and poor feeding practices, all of which continue to affect infants. Recent studies have proposed the use of probiotics that help reduce the problem and it has been suggested that Saccharomyces boulardii (SB), associated with a prebiotic, would reduce the treatment time of an CADD. Therefore, the symbiosis between the SB probiotic and a prebiotic called fructo- oligosaccharide (FOS) could be an alternative to reduce complications and reduce costs. An alternative to measure the clinical course of an CADD in infants is the BITTS scale, which was recently created and can easily be applied by clinicians. The aim of this manuscript was to summarize the existing evidence regarding the role of PROBIOTICS and prebiotics in the treatment of CADD.

Caracterización de recién nacidos a término con deshidratación hipernatrémica / Characterization of full term newborns with hypernatremic dehydration

INTRODUCCIÓN: La deshidratación hipernatrémica neonatal es una condición grave y su incidencia se ha incre mentado en los últimos años, repercutiendo en complicaciones que llevan a la hospitalización del recién nacido. OBJETIVO: Describir las características clínicas y de laboratorio de recién nacidos a término con diagnóstico de deshidratación hipernatremica. PACIENTES Y MÉTODO: Estudio observacional descriptivo de recién nacidos a término que se hospitalizaron por deshidratación hiperna trémica entre los años 2014 y 2016. Se incluyeron recién nacidos a término mayores de 37 semanas con signos clínicos de deshidratación (mucosas secas, fontanela deprimida, llanto sin lágrimas, signos de pliegue cutáneo) y/o pérdida excesiva de peso mayor de 7% y sodio sérico mayor a 145 mEq/L. Se registraron variables sociodemográficas y bioquímicas para su análisis. RESULTADOS: Se incluyeron 43 neonatos. El 60,5% de sus madres fueron primigestantes, el 90% de los neonatos recibieron lactancia materna exclusiva, las madres reportaron problemas en la lactancia materna en el 76,7%. La pérdida de peso al ingreso con respecto al peso de nacimiento fue de 15,3% en promedio. El 83,3% contaba con seguro de salud público. 65,1% presentó signos clínicos de deshidra tación al ingreso y 83,5% signos neurológicos transitorios. El promedio de sodio fue de 155 mEq/L al ingreso. El descenso de sodio en las primeras 24 horas de manejo fue 7,74 mEq/L (0,32mEq/L por hora). La corrección de la hipernatremia fue en el 55,8% por vía oral y la estancia hospitalaria de 4 días en promedio. CONCLUSIONES: Los problemas de alimentación se presentaron en un (76%) madres primigestantes en un (88,4%). El 90,6% de esta población administraban lactancia materna exclusiva, resultados que pueden contribuir para alertar al profesional de la salud a identificar de forma oportuna, signos de alarma y un control precoz posterior al alta del puerperio y a la toma de medidas preventivas.

INTRODUCTION: The hypernatremic neonatal dehydration is a severe condition whose incidence has increased in recent years resulting in complications leading to the hospitalization of the newborn. OBJECTIVE: Describe the clinical and laboratory characteristics of term-newborns with Hypernatremic Dehy dration diagnosis. PATIENTS AND METHOD: Descriptive observational study of hospitalized term- newborns due to hypernatremic dehydration between a period from 2014 to 2016. Term newborns over 37 weeks with clinical signs of dehydration (dry mucous membranes, depressed fontanel, tear less crying, signs of the cutaneous pleat), and/or excessive weight loss greater than 7% and serum sodium greater than 145 mEq/L were included. Sociodemographic and biochemical variables were recorded for analysis. RESULTS: 43 neonates were included. 60.5 percent of their mothers were pri- miparous, 90 percent of neonates received exclusive breastfeeding, mothers reported breastfeeding problems in 76.7 percent. Incoming neonates reported weight loss compared to birth weight at 15.3% on average. 83.3% had public health insurance. 65.1% had dehydration clinical signs at entry and 83.5% transient neurological signs. The average sodium was 155 mEq/L at revenue. The sodium decrease in the first 24 hours of handling was 7.74 mEq/L (0.32mEq/L per hour). The correction of the hypernatremia was 55.8% by oral intake and 4 days hospital stay on average. CONCLUSIONS: The feeding's problems came up in a (76%), primiparous mothers in an (88.4%). 90.6 percent of this population administered exclusive breastfeeding, results that can help to alert the health professional to timely identification, warning signs, and early post-discharge control and preventive measures.

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.

Diretrizes terapêuticas para o restabelecimento do equilíbrio hidroeletrolítico e ácido base em equinos com síndrome cólica nas condições brasileiras de atendimento / Therapeutic guidelines for restoring hydroelectrolytic and acid-base balance in horses with colic syndrome under Brazilían conditions of care / Directrices terapéuticas para el restablecimiento dei equilíbrio hidroeléctrico y ácido base en equinoscon síndrome cólico en las condiciones de atendimiento brasileiras

A síndrome cólica é uma das causas mais importante no desenvolvimento de desequilíbrios hidroeletrolíticos e ácido base em equinos e, por conseguinte, geradora de alteração na homeostase do organismo. É imperativo que medidas terapêuticas sejam adotadas na rotina de atendimento clínico do paciente equino com cólica visando corrigir os desequilíbrios hidroeletrolíticos e ácido base. A primordial opção de tratamento desses desequilíbrios é a terapia hidroeletrolítica, ou hidratação, fundamentada na correção e manutenção do estado hídrico, eletrolítico e ácido base do paciente através da administração de soluções eletrolíticas com o intuito de reestabelecer sua homeostase. As Diretrizes Terapêuticas para o Restabelecimento do Equilíbrio Hidroeletrolítico e Ácido Base em Equinos com Síndrome Cólica nas Condições Brasileiras de Atendimento têm como objetivo congregar vários profissionais com visão ampla, embasamento teórico sólido e vasta experiência prática, de forma a oferecer um guia terapêutico prático e específico, que possa ser utilizado por Médicos Veterinários que trabalham com equídeos em todo o Brasil.

Colic syndrome is one of the most important causes in the development of hydroelectrolytic andacid base imbalances in horses and, therefore, causes alteration in the body's homeostasis. It is imperative the adoptions of therapeutic measures in the clinical care routine of equine colic patients in order to correct the hydroelectrolytic and acid-base imbalances. The primary treatment for these imbalances is hydroelectrolytic therapy, or fluid therapy, based on the correction and maintenance of the patient's water, electrolyte and acid-base status through the administration of electrolyte solutions to reestablish their homeostasis. The therapeutic guidelines for restoring hydroelectrolytic and acid-base balance in horses with colic syndrome under Brazilian conditions of care has the aim of to bring together several professionals with broad vision, solid theoretical background and extensive practical experience, in order to ofter a practical and specific therapeutic guide that can be used by Equine Veterinary Doctors throughout Brazil.

EI síndrome cólico es una de las causas más importantes en el desarrollo de desequilibrios hidroelectrolíticos y ácido base en equinos y, portanto, causa alteraciones en Ia homeostasis dei organismo. Es imperativo que se adopten medidas terapéuticas en Ia rutina de atendimiento clínico de los pacientes equinos con cólico para corregir los desequilibrios hidroelectrolíticos y de ácido base. La opción primordial de tratamiento para estos desequilibrios es Ia terapia hidroelectrolítica, o hidratación, basada en la corrección y el mantenimiento del estado hídrico, electrolítico y ácido base del paciente a través de la administración de soluciones electrolíticas para restablecer su homeostasis. Las Directrices Terapéuticas para el Restablecimiento del Equilibrio Hidroeléctrico y Ácido Base en Equinos con Síndrome Cólico en las condiciones de Atendimiento Brasileras tienen como objetivo reunir a vários profesionales con visión amplia, antecedentes teóricos sólidos y amplia experiencia práctica para proporcionar una guía terapéutica práctica y específica, que pueda ser utilizada por Médicos Veterinarios que trabajan con equinos en todo Brasil.

[Characterization of full term newborns with hypernatremic dehydration]. / Caracterización de recién nacidos a término con deshidratación hipernatrémica.

INTRODUCTION: The hypernatremic neonatal dehydration is a severe condition whose incidence has increased in recent years resulting in complications leading to the hospitalization of the newborn. OBJECTIVE: Describe the clinical and laboratory characteristics of term-newborns with Hypernatremic Dehy dration diagnosis. PATIENTS AND METHOD: Descriptive observational study of hospitalized term- newborns due to hypernatremic dehydration between a period from 2014 to 2016. Term newborns over 37 weeks with clinical signs of dehydration (dry mucous membranes, depressed fontanel, tear less crying, signs of the cutaneous pleat), and/or excessive weight loss greater than 7% and serum sodium greater than 145 mEq/L were included. Sociodemographic and biochemical variables were recorded for analysis. RESULTS: 43 neonates were included. 60.5 percent of their mothers were pri- miparous, 90 percent of neonates received exclusive breastfeeding, mothers reported breastfeeding problems in 76.7 percent. Incoming neonates reported weight loss compared to birth weight at 15.3% on average. 83.3% had public health insurance. 65.1% had dehydration clinical signs at entry and 83.5% transient neurological signs. The average sodium was 155 mEq/L at revenue. The sodium decrease in the first 24 hours of handling was 7.74 mEq/L (0.32mEq/L per hour). The correction of the hypernatremia was 55.8% by oral intake and 4 days hospital stay on average. CONCLUSIONS: The feeding's problems came up in a (76%), primiparous mothers in an (88.4%). 90.6 percent of this population administered exclusive breastfeeding, results that can help to alert the health professional to timely identification, warning signs, and early post-discharge control and preventive measures.

La administración de ondansetrón no mejora la evolución de los niños con gastroenteritis aguda sin deshidratación / Administration of ondansetron does not improve the course of children with acute gastroenteritis without dehydration

Sobre la base de una viñeta clínica de un niño con gastroenteritis aguda sin deshidratación, el autor de este artículo realiza una búsqueda bibliográfica para revisar la evidencia que avala el uso de ondansetrón para tratar sus vómitos, práctica bastante común en instituciones con acceso a este fármaco en sus centrales de emergencia. Luego de dicha búsqueda, el autor concluye que en niños con gastroenteritis aguda sin deshidratación, la administración de ondansetrón no reduce la necesidad de hidratación intravenosa ni la frecuencia ni la severidad de los vómitos. (AU)

Based on a clinical vignette of a child with acute gastroenteritis without dehydration, the author of this article performs a literature search to review the evidence supporting the use of ondansetron to treat his vomiting, a fairly common practice in institutions with access to this drug in their emergency rooms. After this search, the author concludes that in children with acute gastroenteritis without dehydration, the administration of ondansetron does not reduce the need for intravenous hydration or the frequency or severity of vomiting. (AU)

Sudden unexpected death in Parkinson's disease: why is drinking water important?

Parkinson's disease (PD) is one of the most common age-related neurodegenerative disorders. Several studies over the last few years have shown that PD is accompanied by high rates of premature death compared with healthy controls. Death in PD patients is usually caused by determinant factors such as pneumonia, and cerebrovascular and cardiovascular diseases. During recent years it has emerged that dehydration may also contribute to mortality in PD. Interestingly, it has been documented that a substantial proportion of patients with PD die suddenly (known as sudden and unexpected death in PD). In this article, we focus on the magnitude of the problem of sudden and unexpected death in PD, with special reference to the daily water consumption of PD patients.

Cost-effectiveness analysis of oral rehydration therapy compared to intravenous rehydration for acute gastroenteritis without severe dehydration treatment.

BACKGROUND: Diarrhea causes, annually, approximately 1.7 billion cases and 760,000 deaths worldwide among children under 5 years of age, although these are preventable and treatable. This study aim to assess the cost-effectiveness for the treatment of diarrhea in emergency services in the management of children of acute gastroenteritis with non-severe dehydration. METHODS: A stochastic decision tree model considering the perspective of the Brazilian public health system was used to calculate the cost-effectiveness of the 5 interventions: oral rehydration therapy (ORT) at home, and if it fails supervised ORT; they would receive; ORT at home, and if it fails intravenous rehydration therapy (IVT). ORT at home and if it fails, the half of them will receive supervised ORT, and the other half would receive IVT; Patient receives supervised oral treatment; Patient receives IVT. Quality-adjusted life year (QALY) was used to measure the clinical outcomes. RESULTS: The strategy of initiating oral rehydration in children younger than 5 is the most efficient practice with a cost of $14.28 and effectiveness of 0.89 QALYs. CONCLUSION: ORT is an underutilized resource for the management of children with non-severe dehydration in emergency services. The overprescribed IVT increases cost without a corresponding significant increase in effectiveness.

Hypotonic enteral electrolyte solutions administered by nasoesophageal tube in continuous flow in dogs dehydrated by water restriction: Part 1 / Soluções eletrolíticas enterais hipotônicas administradas por sonda nasoesofágica em fluxo contínuo em cães desidratados por restrição hídrica: Parte 1

The present study assessed and compared the effects of hypotonic enteral electrolyte solutions administered by nasoesophageal tube in continuous flow in dogs submitted to water restriction on packed cell volume; total serum protein and serum osmolarity concentrations; blood volume; plasma glucose and lactate levels; blood gas analysis, anion gap, and strong ion difference. Six adult dogs were used (four males and two females). All animals were submitted to both proposed treatments in a crossover design 6×2. The treatments were as follows: ESmalt consisting of 5g sodium chloride, 1g potassium chloride, 1g calcium acetate, 0.2g magnesium pidolate, and 9.6g maltodextrin that were diluted in 1.000mL water (measured osmotic concentration of 215mOsm L−1) and ESdext consisting of 5g sodium chloride, 1g potassium chloride, 1g calcium acetate, 0.2g magnesium pidolate, and 9.6g dextrose that were diluted in 1.000mL water (measured osmotic concentration of 243mOsm L−1). All solutions were administered at 15ml kg−1 h−1 for 4 hours. Both solutions increased the plasma volume in dehydrated dogs without causing adverse effects. However, ESmalt was more effective in promoting the increase in blood volume.(AU)

O presente estudo avaliou e comparou os efeitos de soluções eletrolíticas enterais hipotônicas, administradas por sonda nasoesofágica em fluxo contínuo em cães submetidos a restrição hídrica, sobre o hematócrito, proteínas totais séricas, osmolaridade sérica, volemia, glicose e lactato plasmáticos, hemogasometria, ânion gap e DIF. Foram utilizados seis cães adultos (quatro machos e duas fêmeas). Todos os animais foram submetidos aos dois tratamentos propostos, em um delineamento crossover 6×2. Os tratamentos foram os seguintes: SEmalt - 5g de cloreto de sódio, 1g de cloreto de potássio, 1g de acetato de cálcio, 0,2g de pidolato de magnésio e 9,6g de maltodextrina, diluídos em 1.000mL de água (osmolaridade mensurada: 215mOsm L -1 ); SEdext - 5g de cloreto de sódio, 1g de cloreto de potássio, 1g de acetato de cálcio, 0,2g de pidolato de magnésio e 9,6g de dextrose, diluídos em 1.000mL de água (osmolaridade mensurada: 243mOsm L -1 ). Todas as soluções foram administradas no volume de 15mL kg -1 hora -1 , durante quatro horas, em fluxo contínuo. Ambas as soluções aumentaram o volume plasmático em cães desidratados, sem gerar o aparecimento de efeitos adversos. Porém, a SEmalt foi mais eficaz em promover a expansão da volemia.

Uso da hidratação enteral em fluxo contínuo (HETfc) em equinos / Use of continuous flowing enteral hydration in horses / Uso de la hidratación enteral en flujo continuo en equinos

A Hidratação, modalidade terapêutica que consiste na administração de soluções eletrolíticas para pacientes acometidos por distúrbios nos equilíbrios hídrico, eletrolítico e ácido base, é considerada uma importante terapia na Medicina Veterinária. Na espécie equina ela pode ser administrada de várias formas, sendo que a terapia hidroeletrolítica pela utilização de soluções comerciais por via intravenosa é considerada a mais eficaz, de forma que, até hoje, é a mais utilizada apesar de demonstrar diversas desvantagens e alto custo. Por outro lado, a hidratação enteral em fluxo contínuo (HETfc), apesar de subestimada, vem se mostrando eficiente em muitas situações clínicas e proporciona significativa redução no custo do tratamento já que o valor das soluções utilizadas para esse fim, produzidas artesanalmente, é de cerca de 1 a 2,5% do valor da terapia com soluções eletrolíticas intravenosas disponíveis comercialmente. Além disso, a HETfc possui outras vantagens, tais como sua eficácia na promoção da volemia e na correção dos desequilíbrios hidroeletrolíticos e ácido base leves e moderados com menor risco de complicações e iatrogenias, promoção do bem-estar e menor estresse do paciente, além de significativo efeito sobre o teor da umidade das fezes. Desse modo, a HETfc deve ser considerada como a primeira escolha de terapia hidroeletrolítica no paciente equino, salvo nas situações onde seu emprego é limitado ou contraindicado. Sendo assim, objetivo desse trabalho é realizar uma revisão de literatura sobre a terapia de HETfc na espécie equina, além de relatar a sua utilização em diversas situações na rotina no Centro de Desenvolvimento da Pecuária (CDP), hospital de animais de grande porte pertencente a Escola de Medicina Veterinária e Zootecnia da Universidade Federal da Bahia (EMEVZ-UFBA).(AU)

Hydration, a therapeutic modality that consists in the administration of electrolytic solutions for patients affected by water, electrolyte and acid base balance disturbances, can be considered an important therapy in Veterinary Medicine. In the equine species it can be administered in several ways, and hydroelectrolytic therapy by the use of intravenous commercial solutions is considered the most effective, so that, to this day, it is the most used despite demonstrating several disadvantages and high cost. On the other hand, although underestimated, continuous enteral hydration (HETfc) has proven to be efficient in many clinical situations and provides a significant reduction in the cost of treatment since the value of the solutions used for this purpose, produced by hand, is about 1 to 2.5% of the value of therapy with commercially available intravenous electrolyte solutions. In addition, HETfc has other advantages, such as its effectiveness in the promotion of blood volume and the correction of mild and moderate hydroelectrolytic and acidic imbalances, with a lower risk of complications and iatrogenies, the promotion of well being and lower stress of the patient, as well as significant effect on the moisture content offeces. Thus, HETfc should be considered as the first choice of hydroelectrolytictherapy in the equine patient, except in situations where their use is limited or contraindicated. Thus, the objective of this work is to carry out a literature review on HETfc therapy in the equine species, in addition to reporting its use in several situations in the routine of the Centro de Desenvolvimento da Pecuária (CDP), a large animal hospital belonging to the School of Veterinary Medicine and Animal Science of the Federal University of Bahia (EMEVZ-UFBA).(AU)

La hidratación, modalidad terapéutica que consiste en la administración de soluciones electrolíticas para pacientes acometidos por disturbios en los equilibrios hídrico, electrolítico y ácido base, es considerada una importante terapia en la Medicina Veterinaria. En la especie equina puede ser administrada de varias formas, siendo que la terapia hidroelectrolítica por la utilización de soluciones comerciales por vía intravenosa es considerada la más eficaz, de forma que, hasta hoy, es la más utilizada a pesar de demostrar diversas desventajas y alto costo. Por otro lado, la hidratación enteral en flujo continuo (HETfc), a pesar de subestimada, viene mostrándo se eficiente en muchas situaciones clínicas y proporciona una significativa reducción en el costo del tratamiento ya que el valor de las soluciones utilizadas para ese fin, producidas artesanalmente, aproximadamente 1 a 2,5% del valor de la terapia con soluciones electrolíticas intravenosas disponibles comercialmente. Además, HETfc pose e otras ventajas, tales como su eficacia en la promoción de la volemia y en la corrección de los desequilibrios hidroelectroliticos y ácido base leves y moderados con menor riesgo de complicaciones e iatrogenias, promoción del bien estar y menor estrés del paciente, además de significativo efecto sobre el contenido de la humedad de las heces. De este modo, la HETfc debe ser considerada como la primera elección de terapia hidroelectrolítica en el paciente equino, salvo en las situaciones donde su empleo es limitado o contraindicado. Por lo tanto, el objetivo de este trabajo es realizar una revisión de literatura sobre la terapia de HETfc en la especie equina, además de relatar su utilización en diversas situaciones en la rutina del en el Cento de Desarrollo de la Ganadería (CDP), hospital de animales de gran porte pertencie entela Escuela de Medicina Veterinaria y Zootecnia de la Universidad Federal de Bahía (EMEVZ-UFBA).(AU)

Uso da hidratação enteral em fluxo contínuo (HETfc) em equinos / Use of continuous flowing enteral hydration in horses / Uso de la hidratación enteral en flujo continuo en equinos

A Hidratação, modalidade terapêutica que consiste na administração de soluções eletrolíticas para pacientes acometidos por distúrbios nos equilíbrios hídrico, eletrolítico e ácido base, é considerada uma importante terapia na Medicina Veterinária. Na espécie equina ela pode ser administrada de várias formas, sendo que a terapia hidroeletrolítica pela utilização de soluções comerciais por via intravenosa é considerada a mais eficaz, de forma que, até hoje, é a mais utilizada apesar de demonstrar diversas desvantagens e alto custo. Por outro lado, a hidratação enteral em fluxo contínuo (HETfc), apesar de subestimada, vem se mostrando eficiente em muitas situações clínicas e proporciona significativa redução no custo do tratamento já que o valor das soluções utilizadas para esse fim, produzidas artesanalmente, é de cerca de 1 a 2,5% do valor da terapia com soluções eletrolíticas intravenosas disponíveis comercialmente. Além disso, a HETfc possui outras vantagens, tais como sua eficácia na promoção da volemia e na correção dos desequilíbrios hidroeletrolíticos e ácido base leves e moderados com menor risco de complicações e iatrogenias, promoção do bem-estar e menor estresse do paciente, além de significativo efeito sobre o teor da umidade das fezes. Desse modo, a HETfc deve ser considerada como a primeira escolha de terapia hidroeletrolítica no paciente equino, salvo nas situações onde seu emprego é limitado ou contraindicado. Sendo assim, objetivo desse trabalho é realizar uma revisão de literatura sobre a terapia de HETfc na espécie equina, além de relatar a sua utilização em diversas situações na rotina no Centro de Desenvolvimento da Pecuária (CDP), hospital de animais de grande porte pertencente a Escola de Medicina Veterinária e Zootecnia da Universidade Federal da Bahia (EMEVZ-UFBA).

Hydration, a therapeutic modality that consists in the administration of electrolytic solutions for patients affected by water, electrolyte and acid base balance disturbances, can be considered an important therapy in Veterinary Medicine. In the equine species it can be administered in several ways, and hydroelectrolytic therapy by the use of intravenous commercial solutions is considered the most effective, so that, to this day, it is the most used despite demonstrating several disadvantages and high cost. On the other hand, although underestimated, continuous enteral hydration (HETfc) has proven to be efficient in many clinical situations and provides a significant reduction in the cost of treatment since the value of the solutions used for this purpose, produced by hand, is about 1 to 2.5% of the value of therapy with commercially available intravenous electrolyte solutions. In addition, HETfc has other advantages, such as its effectiveness in the promotion of blood volume and the correction of mild and moderate hydroelectrolytic and acidic imbalances, with a lower risk of complications and iatrogenies, the promotion of well being and lower stress of the patient, as well as significant effect on the moisture content offeces. Thus, HETfc should be considered as the first choice of hydroelectrolytictherapy in the equine patient, except in situations where their use is limited or contraindicated. Thus, the objective of this work is to carry out a literature review on HETfc therapy in the equine species, in addition to reporting its use in several situations in the routine of the Centro de Desenvolvimento da Pecuária (CDP), a large animal hospital belonging to the School of Veterinary Medicine and Animal Science of the Federal University of Bahia (EMEVZ-UFBA).

La hidratación, modalidad terapéutica que consiste en la administración de soluciones electrolíticas para pacientes acometidos por disturbios en los equilibrios hídrico, electrolítico y ácido base, es considerada una importante terapia en la Medicina Veterinaria. En la especie equina puede ser administrada de varias formas, siendo que la terapia hidroelectrolítica por la utilización de soluciones comerciales por vía intravenosa es considerada la más eficaz, de forma que, hasta hoy, es la más utilizada a pesar de demostrar diversas desventajas y alto costo. Por otro lado, la hidratación enteral en flujo continuo (HETfc), a pesar de subestimada, viene mostrándo se eficiente en muchas situaciones clínicas y proporciona una significativa reducción en el costo del tratamiento ya que el valor de las soluciones utilizadas para ese fin, producidas artesanalmente, aproximadamente 1 a 2,5% del valor de la terapia con soluciones electrolíticas intravenosas disponibles comercialmente. Además, HETfc pose e otras ventajas, tales como su eficacia en la promoción de la volemia y en la corrección de los desequilibrios hidroelectroliticos y ácido base leves y moderados con menor riesgo de complicaciones e iatrogenias, promoción del bien estar y menor estrés del paciente, además de significativo efecto sobre el contenido de la humedad de las heces. De este modo, la HETfc debe ser considerada como la primera elección de terapia hidroelectrolítica en el paciente equino, salvo en las situaciones donde su empleo es limitado o contraindicado. Por lo tanto, el objetivo de este trabajo es realizar una revisión de literatura sobre la terapia de HETfc en la especie equina, además de relatar su utilización en diversas situaciones en la rutina del en el Cento de Desarrollo de la Ganadería (CDP), hospital de animales de gran porte pertencie entela Escuela de Medicina Veterinaria y Zootecnia de la Universidad Federal de Bahía (EMEVZ-UFBA).

Hypotonic enteral electrolyte solutions administered by nasoesophageal tube in continuous flow in dogs dehydrated by water restriction: Part 1 / Soluções eletrolíticas enterais hipotônicas administradas por sonda nasoesofágica em fluxo contínuo em cães desidratados por restrição hídrica: Parte 1

The present study assessed and compared the effects of hypotonic enteral electrolyte solutions administered by nasoesophageal tube in continuous flow in dogs submitted to water restriction on packed cell volume; total serum protein and serum osmolarity concentrations; blood volume; plasma glucose and lactate levels; blood gas analysis, anion gap, and strong ion difference. Six adult dogs were used (four males and two females). All animals were submitted to both proposed treatments in a crossover design 6×2. The treatments were as follows: ESmalt consisting of 5g sodium chloride, 1g potassium chloride, 1g calcium acetate, 0.2g magnesium pidolate, and 9.6g maltodextrin that were diluted in 1.000mL water (measured osmotic concentration of 215mOsm L−1) and ESdext consisting of 5g sodium chloride, 1g potassium chloride, 1g calcium acetate, 0.2g magnesium pidolate, and 9.6g dextrose that were diluted in 1.000mL water (measured osmotic concentration of 243mOsm L−1). All solutions were administered at 15ml kg−1 h−1 for 4 hours. Both solutions increased the plasma volume in dehydrated dogs without causing adverse effects. However, ESmalt was more effective in promoting the increase in blood volume.(AU)

O presente estudo avaliou e comparou os efeitos de soluções eletrolíticas enterais hipotônicas, administradas por sonda nasoesofágica em fluxo contínuo em cães submetidos a restrição hídrica, sobre o hematócrito, proteínas totais séricas, osmolaridade sérica, volemia, glicose e lactato plasmáticos, hemogasometria, ânion gap e DIF. Foram utilizados seis cães adultos (quatro machos e duas fêmeas). Todos os animais foram submetidos aos dois tratamentos propostos, em um delineamento crossover 6×2. Os tratamentos foram os seguintes: SEmalt - 5g de cloreto de sódio, 1g de cloreto de potássio, 1g de acetato de cálcio, 0,2g de pidolato de magnésio e 9,6g de maltodextrina, diluídos em 1.000mL de água (osmolaridade mensurada: 215mOsm L -1 ); SEdext - 5g de cloreto de sódio, 1g de cloreto de potássio, 1g de acetato de cálcio, 0,2g de pidolato de magnésio e 9,6g de dextrose, diluídos em 1.000mL de água (osmolaridade mensurada: 243mOsm L -1 ). Todas as soluções foram administradas no volume de 15mL kg -1 hora -1 , durante quatro horas, em fluxo contínuo. Ambas as soluções aumentaram o volume plasmático em cães desidratados, sem gerar o aparecimento de efeitos adversos. Porém, a SEmalt foi mais eficaz em promover a expansão da volemia.

Hypoxic hepatitis and furosemide.

Hypoxic hepatitis is a rather common complication of heart, circulatory or respiratory failure. We present the case of a patient with hypoxic hepatitis in the setting of heart failure and dehydration from furosemide as a reminder of an important clinical lesson. The pathogenesis of hypoxia (especially in the case of heart failure) is explained by a two-hit mechanism in which the liver at risk of hypoxic injury by passive hepatic congestion (right heart failure) is subsequently exposed to systemic hypoperfusion, which leads to a marked and transient elevation of aminotransferases. In the case presented, the use of furosemide (at least partially) promoted the second hit because it helped to generate hypotension and splanchnic hypovolaemia and favoured hepatic hypoxia.