Electrolyte disturbances in elderly patients with severe diarrhea due to cholera.

The purpose of this clinical study was to evaluate prospectively electrolyte disturbances in elderly patients with severe diarrhea due to cholera. A total of 20 adult (Group I; < 60 yr) and 22 elderly (Group II; > or = 60 yr) patients were studied. In all patients, extracellular fluid (ECF) volume reexpansion was achieved with normal saline at 50 mL/kg per hour. Once a diuresis of 40 mL/h was achieved, intravenous therapy was discontinued and patients' ECF volumes were reexpanded orally with a polyelectrolyte solution. Blood and urine samples were obtained on admission, at the time when adequate diuresis ensued, and after 12 h of oral ECF volume reexpansion. On admission, both groups had severe ECF volume contraction but only mild increases in osmolality (308 +/- 12 and 310 +/- 13 mosmol/kg for Groups I and II respectively; P = NS). Acidemia (pH) was equally severe in both (Group I: 7.13 +/- 0.11; Group II: 7.11 +/- 0.09; P = NS), and the anion gap was comparably increased in both groups (30 +/- 8 and 26 +/- 7 mmol/L for Groups I and II, respectively; P = NS). None of the patients was hypokalemic at the time of admission (Group I: 4.3 +/- 0.5 mmol/L; Group II: 4.5 +/- 0.5 mmol/L; P = NS). Adequate diuresis was achieved at 2.0 +/- 0.7 h in both groups. At the end of the rapid ECF volume reexpansion phase, the anion gap normalized in both groups (Group I: 15.6 +/- 3.7 mmol/L; Group II: 14.4 +/- 2.8 mmol/L; P = NS), and serum potassium concentrations remained normal (Group I: 4.4 +/- 0.4 mmol/L; Group II: 4.1 +/- 0.4 mmol/L; P = NS). We conclude that use of aggressive intravenous hydration with normal saline followed by oral ECF volume reexpansion allows prompt correction of electrolyte abnormalities in adult and elderly patients with severe diarrhea as a result of cholera.

Cholera. Lessons from the epidemic in Peru.

It is not known why the cholera epidemic, which affected all other continents, has not affected Latin America in the past 30 years. In addition, it is unclear why cholera appeared in Peru in 1991. Improvements in scientific knowledge and technology have occurred in Peru during the last 30 months. While it is impossible to summarize in only one article all these concepts, this article presents a few of the most important issues and recent developments in the treatment and prevention of cholera.

Factores asociados al pronóstico del paciente con insuficiencia renal crónica terminal (IRCT) en la ciudad de Lima / Associated factors at prognosis of patient with kidney failure chronic terminal (IRCT) in the Lima city

Se presentan los resultados de 619 pacientes con Insuficiencia Renal Crónica Terminal (IRCT) evaluados mediante dos cortes de tipo transversal realizados en enero de 1990 y enero de 1991 en todos los Sistemas de atención hospitalaria de Salud de Lima (Ministerio de Salud, Instituto Peruano de Seguridad Social-IPSS, Centro Privados de Hemodiálisis, Hospitales Militares y Clínicas Privadas). Se seleccionaron 619 de 782 pacientes evaluados en enero 1990 que completaron la siguiente información: Centro de atención en enero 1990 (CA), cobertura económica de atención en enero 1990 (CE), edad, causa de la IRCT (DX), ciudad de procedencia y estado final en enero 1991 (FIN). Los datos se evaluaron con análisis univariado, regresión múltiple, y ANOVA, usando el paquete estadístico EPI INFO V5. El 82 por ciento de los atendidos en Centros Privados de hemodiálisis, el 55.5 por ciento de le IPSS, el 48 por ciento en los Hospitales Militares y/o Clínicas Privadas, y 4 por ciento en los Hospitales del Ministerio de Salud estuvieron vivos en enero de 1991 (p<0.0001). El 65 por ciento de los que contaban con Seguro Social y el 33 por ciento de pacientes con sustento económico propio estuvieron vivos en enero del 91; mientras que ninguno de los que contaban con Seguro Particular o Institucional estuvieron vivos a la misma fecha. El 83 por ciento del grupo de edad de <20 años, el 64 por ciento entre 21-40 años, el 62 por ciento entre 41-60 y el 52 por ciento >60 años, estuvieron vivos en enero del 91. El 72 por ciento de los casos en Enfermedad Glomerular Primaria, el 63 por ciento de Nefropatía Intersticial sin enfermedad sistémica, el 58 por ciento con diagnóstico desconocido y el 46 por ciento con Nefropatía asociada a enfermedad sistémica, estuvieron vivos en enero del 91. Los resultados mostraron que el centro de atención, la cobertura económica de atención, la edad y la causa de insuficiencia renal crónica influyeron significativamente sobre el estado final (p<0.01).

Effect of salt supplementation on amphotericin B nephrotoxicity.

It has been suggested that salt loading protects against amphotericin B-induced nephrotoxicity. The influence of saline loading on the nephrotoxic response to amphotericin B (50 mg/dose given i.v. over 4 hr 3 X/week for 10 weeks) was assessed in two groups of ten patients each who were diagnosed with mucocutaneous leishmaniasis. Patients were randomized to receive either 1 liter of 0.9% saline or 1 liter of 5% dextrose in water, administered i.v. over one hour in a double-blinded manner, directly prior to amphotericin B administration. Renal function was monitored on a weekly basis two days after the last dose of amphotericin B. Baseline characteristics were similar in both groups except for a slightly higher serum creatinine concentration (Cr) in the saline group (0.8 +/- 0.05 vs. 0.6 +/- 0.04 mg/dl). Baseline sodium (Na) excretion was relatively high (262 +/- 23 mmol/day in the dextrose group and 224 +/- 17 mmol/day in the saline group). None of the patients sustained an increase in Cr to values greater than 1.7 mg/dl. Although mean Cr remained within normal, there was a significant difference between the two groups over the ten week period, with the dextrose group sustaining a significant increase in Cr and the saline group remaining unchanged. Serum potassium (K) levels fell in both groups necessitating oral K supplementation. The saline group required significantly greater amounts of K supplementation to maintain a normal serum K. Amphotericin B caused a rapid reduction in the acidification ability of the kidney in response to an ammonium chloride load. Under these conditions, the saline group had a poorer ability to acidify the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Reacción hemolítica transfusional por anticuerpo anti-JKa demostrado sólo por el método manual de baja concentración iónica y agregado de polibrene (LIM-P) / Hemolytic transfusion reaction by anti-JKa antibody only demonstrated by the manual method of low ionic concentration and adding of polybrene

Se comunica el caso de una mujer multigesta que presentó grave reacción hemolítica transfusional por anticuerpo anti-JKa no identificado por las pruebas convencionales de compatibilidad y sólo detectado en el período inmediato post-reaccional por el método manual de baja concentración iónica y agregado de polibrene

Reacción hemolítica transfusional por anticuerpo anti-JKa demostrado sólo por el método manual de baja concentración iónica y agregado de polibrene (LIM-P) / Hemolytic transfusion reaction by anti-JKa antibody only demonstrated by the manual method of low ionic concentration and adding of polybrene

Se comunica el caso de una mujer multigesta que presentó grave reacción hemolítica transfusional por anticuerpo anti-JKa no identificado por las pruebas convencionales de compatibilidad y sólo detectado en el período inmediato post-reaccional por el método manual de baja concentración iónica y agregado de polibrene (AU)