Balanço hídrico e excreção renal de metabólitos em ovinos alimentados com palma forrageira (Nopalea cochenillifera Salm Dyck) / Water balance and renal excretion of metabolites in sheep fed forage cactus (Nopalea cochenillifera Salm Dyck)

Objetivou-se avaliar balanço hídrico e excreção renal de metabólitos em borregos sem raça definida, alimentados com diferentes quantidades de palma forrageira (Nopalea cochenillifera Salm Dyck), na forma in natura e em farelo. Foram utilizados 20 borregos, com peso vivo médio inicial de 20 Kg e foram distribuídos no delineamento inteiramente casualizado, sendo cinco tratamentos e quatro repetições. As dietas experimentais consistiram em uma dieta controle à base de feno de tífton, farelo de soja, suplemento mineral e calcário, os demais tratamentos visaram testar níveis diferentes de palma forrageira corrigida com ureia em duas formas: in natura e farelada e em dois níveis de substituição (50 e 100%) da matéria seca do feno de tífton. Amostras de sangue e urina foram coletadas para determinação de diferentes metabólitos e minerais e utilização de equações para obtenção dos índices de excreção urinária destes metabólitos, taxa de depuração endógena de creatinina e reabsorção de água livre de eletrólitos, além do registro de ingestão de água e volume de urina. A ingestão voluntária de água sofreu influência das dietas, sendo que os animais submetidos às dietas contendo farelo de palma e feno e farelo de palma foram superiores aos demais tratamentos. A ingestão de água via alimentos também sofreu influência da dieta, sendo maior nos animais que receberam palma in natura e farelo mais palma in natura. Com relação à ingestão total de água foi maior para os animais alimentados com dietas contendo palma in natura em relação aos demais tratamentos. As dietas experimentais influenciaram na excreção renal de metabólitos derivados purínicos e minerais, sem alterar a função renal. A presença da palma forrageira tanto na condição de farelo como in natura proporciona aumento do volume urinário sem alterar a função renal, além de que deve ser considerado como uma excelente estratégia alimentar no semiárido.

This study aimed to assess fluid balance and renal excretion of metabolites in lambs without defined breed standard, fed different forage cactus (Nopalea cochenillifera Salm Dyck), in natura and bran. 20 lambs were used, with initial body weight of 20 kg and were distributed in a completely randomized design, with five treatments and four repetitions. The experimental diets consisted of a control diet based on Bermuda grass hay, soybean meal, limestone and mineral supplement, other treatments aimed at testing different levels of cactus pear plus urea in two forms: fresh and mash and two levels of substitution (50 and 100%) of dry matter of hay. Blood and urine samples were collected for determination of different metabolites and minerals and use of equations to determine the rates of urinary excretion of these metabolites, rate of endogenous creatinine clearance and electrolyte reabsorption of free water, in addition to recording of water intake and urine volume. The voluntary water intake was influenced by the diets, and the animals subjected to diets containing soybean meal and hay palm and cactus meal were higher than other treatments. Water intake via food was also influenced by diet, being higher in animals fed palm fresh and bran over palm in nature. With respect to total water intake was greater for cows fed diets containing palm in nature compared to the other treatments. The experimental diets influenced the renal excretion of purine metabolites and minerals derived, without changing renal function. The presence of cactus pear both as bran as in nature provides increased urine volume without changing renal function, and to be considered as an excellent food strategy in semiarid.

Efficacy of an extravascular lung water-driven negative fluid balance protocol

OBJECTIVE: To analyze the efficacy of negative fluid balance in hypoxemic patients with an elevated extravascular lung water index (EVLWI). DESIGN: A retrospective observational study was made. SETTING: Intensive Care Unit of Virgen de las Nieves Hospital (Spain). PARTICIPANTS: Forty-four patients participated in the study. INTERVENTIONS: We analyzed our database of hypoxemic patients covering a period of 11 consecutive months. We included all hemodynamically stable and hypoxemic patients with EVLWI > 9 ml/kg. The protocol dictates a negative fluid balance between 500 and 1500 ml/day. We analyzed the impact of this negative fluid balance strategy upon pulmonary, hemodynamic, and renal function. MAIN VARIABLES OF INTEREST: Demographic data, severity scores, clinical, hemodynamic, pulmonary, metabolic and renal function data. RESULTS: Thirty-three patients achieved negative fluid balance (NFB group) and 11 had a positive fluid balance (PFB group). In the former group, PaO2/FiO2 improved from 145 (IQR 106, 200) to 210 mmHg (IQR 164, 248) (p < 0.001), and EVLWI decreased from 14 (11, 18) to 10 ml/kg (8, 14) (p < 0.001). In the PFB group, EVLWI also decreased from 11 (10, 14) to 10 ml/kg (8, 14) at the end of the protocol (p = 0.004). For these patients there were no changes in oxygenation, with a PaO2/FiO2 of 216 mmHg (IQR 137, 260) at the beginning versus 205 mmHg (IQR 99,257) at the end of the study (p = 0.08). CONCLUSION: Three out of four hypoxic patients with elevated EVLWI tolerated the NFB protocol. In these subjects, the improvement of various analyzed physiological parameters was greater and faster than in those unable to complete the protocol. Patients who did not tolerate the protocol were usually in more severe condition, though a larger sample would be needed to detect specific characteristics of this group

OBJETIVO: Analizar la eficacia del balance hídrico negativo en pacientes hipoxémicos y con Agua Pulmonar Extravascular Indexada (EVLWI) elevada. Diseño: Estudio retrospectivo y observacional. ÁMBITO: Unidad de Cuidados Intensivos del Hospital Virgen de las Nieves. Participantes: 44 pacientes. Intervenciones: Se analizó la base de datos de pacientes hipoxémicos durante 11 meses consecutivos. Se incluyeron los pacientes hipoxémicos, hemodinámicamente estables y con EVLWI > 9 ml/kg. El protocolo dicta un balance hídrico negativo entre 500 y 1500 ml/día. Se analizó el impacto de esta estrategia de balance negativo en la función respiratoria, hemodinámica y renal. Variables de interés principales: Datos demográficos, escalas de gravedad y datos clínicos hemodinámicos, respiratorios, metabólicos y de función renal. RESULTADOS: 33 pacientes lograron balance hídrico negativo (Grupo BHN) y 11 tuvieron balance hídrico positivo (Grupo BHP). En el grupo BHN la PaO2/FiO2 pasó de 145 (IQR 106,200) a 210 (IQR 164, 248) mmHg (p < 0.001), el EVLWI descendió de 14 (11, 18) a 10 (8, 14) ml/kg (p < 0.001). En el grupo BHP, el EVLWI también descendió de 11(10, 14) a 10 (8, 14) ml/kg al final del protocolo (p = 0.004); en este último grupo no hubo cambios estadísticamente significativos en la oxigenación y la PaO2/FiO2 pasó de 216 (IQR 137, 260) a 205 (IQR 99, 257) mmHg (p = 0.08). CONCLUSIÓN: Tres de cada cuatro pacientes hipoxémicos y con EVLWI elevados toleraron el protocolo; en ellos, la mejora de diversos parámetros analizados fue mayor y más rápida que en los pacientes que no hicieron balance negativo. Los pacientes que no toleraron el protocolo fueron los más graves aunque se necesitaría una muestra mayor para determinar las características específicas en estos