[Evaluation of body fluid compartments and their relationship with water-electrolyte changes in obstructive jaundice]. / Evaluación de los compartimientos corporales y su relación con las alteraciones hidroelectrolíticas en la ictericia obstructiva.

BACKGROUND: The alteration of the mechanisms of water and sodium preservation may be an important factor in the development of acute postoperative renal failure in obstructive jaundice (OJ). Experimental OJ has been associated with a depletion of the extracellular volume and alteration of the mechanisms of regulation of hydrosaline metabolism. The aim of this study was to evaluate the distribution of the body volumes and the regulating hormones of hydrosaline metabolism in human OJ. PATIENTS AND METHOD: A prospective, clinical study evaluating 18 patients with OJ (9 females and 9 males) with a mean age of 69 +/- 8.9 years was performed. The plasma levels of antinatriuretic peptide (ANP), aldosterone and renin were determined. The body volumes were evaluated by tetrapolar bioimpedanciometry. The results of the patients with OJ were compared with a control group (CG) of 12 healthy subjects, matched for age and sex (6 females and 6 males with a mean age of 64.5 +/- 14 years). RESULTS: High ANP values were observed in 87.5% of the patients. The results of the hormonal studies compared with the CG were: ANP (117.33 +/- 37.7 vs 41.31 +/- 16.8 pg/ml; p < 0.001), aldosterone (185.68 +/- 82.1 vs 44.3 +/- 21.6 pg/ml; p < 0.001) and renine (57.18 +/- 69.9 vs 16.08 +/- 9.7 microU/ml; p < 0.05). Depletion of extracellular volume was found in 75% of the patients. CONCLUSIONS: Human obstructive jaundice is associated with an important alteration in the hormonal mechanisms of water and sodium regulation. This alteration is accompanied by a marked depletion of extracellular volume.

[The utilization of parenteral nutrition at Hospital de Jerez (Cádiz): a description and comparison with other hospital centers]. / Utilización de la nutrición parenteral en el Hospital de Jerez (Cádiz): descripción y comparación con otros centros hospitalarios.

This retrospective study aims to analyze, and compare with other Spanish hospitals, the use of parenteral nutrition, its characteristics and complications, in a general hospital with 610 beds, during 1992. To conduct this study, we have used clinical histories and follow up sheets made up by the Department of Pharmacy for each patient, as well as the results of the sample processing in the microbiology laboratory. Between 1992 and 1993 we have seen an increase in the use of parenteral nutrition, with the number of bags increasing from 2134 to 2575. The departments which have used parenteral nutrition most, were Surgery (57.3%), and ICU (24.8%), with the mean duration being 10.4 days 8SD = +/- 9.3 days). The most frequently used access route in the hospital was the drum, but there are significant differences between the departments. Gastroenterological pathology was, with 71.4% the most frequent indication for its use, and within this, the neoplasias stand out with 26.3% of the total of parenteral nutrition. The complications which affected most patients are: increases of the liver enzymes, hypokalemias, hyponatremias, and hyperglycemias.