[Disorders in plasmatic levels of potassium, magnesium, and calcium in elderly adults associated with colistin: time series]. / Trastornos en niveles plasmáticos de potasio, magnesio y calcio en adultos mayores asociados a colistina: serie de tiempo.

INTRODUCTION: Water and electrolyte disturbances associated with colistin are understudied adverse effects in the medical literature. We aim to evaluate their incidence in hospitalized older adult patients. MATERIALS AND METHODS: A longitudinal retrospective study of the interrupted time series type was conducted on patients admitted to Dr. César Milstein Hospital. We included adults aged 65 and older who received colistin with normal serum potassium, magnesium, and calcium at the outset. Electrolyte values were collected before, during and after suspending the antibiotic. Values were compared using non-parametric tests, and a multivariate linear regression model with robust intervals was performed to assess sociodemographic and clinical characteristics associated with serum concentrations. RESULTS: A total of 89 patients were included. The rate of hypokalemia was 77.5% (n=69), and factors associated with potassium decline included older age, increased creatinine levels, and longer colistin treatment duration. Serum magnesium disturbances were reported in 66 (79.5%) of the 83 patients evaluated. The decrease in both electrolytes was statistically significant in the measured times and both values normalized after 72 hours of stopping antibiotic therapy. The incidence of acute kidney injury during colistin treatment in patients with normal baseline creatinine was 63.6% (n = 42/66), and in those with abnormal baseline creatinine, it was 47.8% (n = 11/23). CONCLUSION: We report high rates of electrolyte disturbances in patients treated with colistin, with hypokalemia being the most frequent, showing resolution following discontinuation of antibiotic therapy. Continuous monitoring of electrolyte levels and renal function during colistin treatment is crucial.

Introducción: Los trastornos hidroelectrolíticos asociados a la colistina son efectos adversos poco estudiados en la literatura médica. Nos propusimos evaluar su incidencia en pacientes adultos mayores hospitalizados. Materiales y métodos: Se realizó un estudio longitudinal retrospectivo, del tipo serie de tiempo interrumpida, en pacientes internados mayores de 65 años que recibieron colistina, con potasio, magnesio y calcio séricos normales al inicio. Se recabaron valores de dichos electrolitos previo, durante y luego de suspender el antibiótico. Se compararon los valores mediante test no paramétricos y se realizó un modelo multivariado de regresión lineal con intervalos robustos para evaluar las características sociodemográficas y clínicas asociadas a las concentraciones séricas. Resultados: Se incluyeron 89 pacientes. La tasa de hipocalemia fue del 77.5% (n = 69) y las variables asociadas al descenso del potasio fueron mayor edad, aumento de creatininemia, y duración de tratamiento con colistina. Se informaron trastornos del magnesio en 66 (79.5%) de los 83 pacientes evaluados. El descenso de ambos electrolitos fue estadísticamente significativo en los tiempos medidos, y ambos normalizaron valores tras 72 horas de suspendida la antibioticoterapia. La incidencia de insuficiencia renal aguda en pacientes con creatinina basal normal fue del 63.6%, (42/66) y con creatinina basal anormal de 47.8% (11/23). Conclusión: En pacientes tratados con colistina, el trastorno más frecuente fue la hipocalemia, mostrando resolución tras la suspensión del antibiótico. Es importante la monitorización constante de los niveles de electrolitos y la función renal durante el tratamiento con colistina.

Fluid overload is associated with use of a higher number of antihypertensive drugs in hemodialysis patients.

INTRODUCTION: Hypertension is multifactorial, highly prevalent in the hemodialysis (HD) population and its adequate control requires, in addition to adequate volume management, often the use of multiple antihypertensive drugs. We aimed to describe the use of antihypertensive agents in a group of HD patients and to evaluate the factors associated with the use of multiple classes (≥3) of antihypertensives. METHODS: We analyzed the baseline data from the HDFit study. Clinically stable patients with HD vintage between 3 and 24 months without any severe mobility limitation were recruited from sites throughout southern Brazil. Fluid status was measured pre-dialysis with the Body Composition Monitor (BCM; Fresenius, Germany). Fluid overload (FO) was considered when the overhydration index (OH) was greater than 7% of extracellular water (OH/ECW > 7%) and overweight was defined as a body mass index (BMI) greater than 25 kg/m2 . Prescriptions of antihypertensive drugs were obtained from participants' reports and medical records. Logistic regression was employed to determine factors associated with excessive use of antihypertensive medication (≥3 classes). FINDINGS: Of 195 studied patients, 171 with complete data were included (70% male, 53 ± 15 years old, 57% of them with FO). Pre-dialysis systolic blood pressure (SBP) was 150 ± 24 mmHg and patients used a median of 2 (1-3) antihypertensive drugs. Vasodilators (20%) were of lowest prevalence, use of other classes varied from 40% to 53%. Sixty-two (36%) subjects used ≥3 classes and presented a higher prevalence of diabetes and FO, lower prevalence of overweight, and higher SBP. In a logistic regression model age, BMI <25 kg/m2 , and OH/ECW > 7% were associated with excessive drug use. DISCUSSION: More than one-third of participants used ≥3 classes of antihypertensive drugs, and it was associated with older age, BMI <25 kg/m2 and FO. Strategies that better manage FO may aid better blood pressure control and avoid the use of multiple antihypertensive medications.

Ethylene glycol poisoning following ingestion of brake fluid.

A 32-year old male, with a history of depression and previous suicide attempts, was brought to hospital comatose after ingestion of brake fluid. He developed severe metabolic acidosis with an increased anion gap, hypotension, seizures and mild renal impairment. He required intensive care treatment for ventilatory and inotropic support. The clinical features, diagnosis and treatment of this unusual poison are discussed.

Indomethacin responsiveness of patent ductus arteriosus and renal abnormalities in preterm infants treated with indomethacin.

OBJECTIVES: We evaluated the factors related to indomethacin responsiveness of the patent ductus arteriosus (PDA) and subsequent renal and electrolyte abnormalities in a large number of low birth weight infants. METHODS: The ductus was evaluated by Doppler echocardiogram or clinical signs after the last administration of indomethacin for 2538 low birth weight infants, through the use of postmarketing surveillance data. RESULTS: Multivariate logistic regression analyses demonstrated that clinical closure of PDA was significantly associated with pregnancy-induced hypertension and respiratory distress syndrome. In contrast, a 1-point increase of cardiovascular dysfunction score or a 1-day increase in postnatal age at the first indomethacin treatment decreased the responsiveness of the ductus to indomethacin. Clinical ductal reopening was significantly less likely to occur for each week of increased gestational age. Ductal reopening was more likely for each day of postnatal life at the first administration of indomethacin. Infants with preexisting renal and electrolyte abnormalities and infants whose mothers had received indomethacin tocolysis or who had chorioamnionitis were at increased risk of development of renal impairment. CONCLUSIONS: Both antenatal and postnatal factors predict good or poor response to indomethacin therapy for PDA.

Substancias reactivas al ácido tiobarbitúrico, vitamina E, fibronectina y PAI-1 como predictores preclínicos de hipertensión inducida por embarazo / Reactive substances to thiobarbituric acid, vitamin E, fibronectin and PAI-1 like preclinic predictors of hypertension induced by pregnancy

Introducción: niveles circulantes bajos de vitamina E y altos de malondialdehído (como TBARs) como expresión de alteraciones en el equilibrio rédox, niveles circulantes altos de fibronectina como expresión de disfunción endotelial y niveles elevados de PAI-1 como expresión de inhibición de fibrinolisis han sido asociados con pre-eclampsia y eclampsia y con diabetes gestacional (DG) ya instaladas pero no hay información sobre su evolución a lo largo de embarazos no patológicos, ni sobre la cronología de eventuales modificacioes antes de que se expresen clinicamente los trastornos ni sobre el posible poder predictivo de estos marcadores. Objetivo: determinar niveles séricos de substancias reactivas al ácido tiobarbitúrico (TBARs), vitamina E, fibronectina e inhibidor tipo I del activador del plasminógeno (PAI-1) en mujeres eumenorreicas, en menopaúsicas y en primigrávidas. Material y método: se incorporaron 25 mujeres eumenorreicas sanas, 26 postmenopáusicas sanas y 101 primigrávidas sanas al momento de la incorporación. Niveles séricos de TBARs (µM), vitamina E(µM), fibronectina (mg/dl) y PAI-I (ng/ml) se determinaron a las 8 horas en los días 7º-9º y 23º-25º del ciclo en las eumenorreicas, en las menopáusicas al momento de la consulta y a las semanas 8ª-10ª, 21ª-22ª y 31ª-32ª en las embarazadas... (TRUNCADO)(AU)

Substancias reactivas al ácido tiobarbitúrico, vitamina E, fibronectina y PAI-1 como predictores preclínicos de hipertensión inducida por embarazo / Reactive substances to thiobarbituric acid, vitamin E, fibronectin and PAI-1 like preclinic predictors of hypertension induced by pregnancy

Introducción: niveles circulantes bajos de vitamina E y altos de malondialdehído (como TBARs) como expresión de alteraciones en el equilibrio rédox, niveles circulantes altos de fibronectina como expresión de disfunción endotelial y niveles elevados de PAI-1 como expresión de inhibición de fibrinolisis han sido asociados con pre-eclampsia y eclampsia y con diabetes gestacional (DG) ya instaladas pero no hay información sobre su evolución a lo largo de embarazos no patológicos, ni sobre la cronología de eventuales modificacioes antes de que se expresen clinicamente los trastornos ni sobre el posible poder predictivo de estos marcadores. Objetivo: determinar niveles séricos de substancias reactivas al ácido tiobarbitúrico (TBARs), vitamina E, fibronectina e inhibidor tipo I del activador del plasminógeno (PAI-1) en mujeres eumenorreicas, en menopaúsicas y en primigrávidas. Material y método: se incorporaron 25 mujeres eumenorreicas sanas, 26 postmenopáusicas sanas y 101 primigrávidas sanas al momento de la incorporación. Niveles séricos de TBARs (µM), vitamina E(µM), fibronectina (mg/dl) y PAI-I (ng/ml) se determinaron a las 8 horas en los días 7º-9º y 23º-25º del ciclo en las eumenorreicas, en las menopáusicas al momento de la consulta y a las semanas 8ª-10ª, 21ª-22ª y 31ª-32ª en las embarazadas... (TRUNCADO)

[Pharmacologic bases of cardiovascular therapy with diuretics]. / Bases farmacológicas de la terapéutica cardiovascular con diuréticos.

Diuretics may have high, medium or low diuretic potency and their main site of diuretic action at the ascending limb of Henle's loop or at different biochemical sites of the distal tubulus. Loop diuretics have high diuretic potency, act abruptly, are not antihypertensives when prescribed as a monotherapy and are potentially ototoxic. The diuretics acting at the distal tubulus have a gentle time-course of diuretic activity and variable potencies and other properties. The mose frequent side-effect of diuretics is hypokalemia, whose development may be partially prevented by the prescription of a sodium restricted diet. Arrhythmias provoked by diuretics-induced hypokalaemia should be treated with magnesium and potassium. The most frequent drug interaction of diuretics is with unspecific inhibitors of prostaglandin's synthesis (aspirin and indomethacin) which decrease diuretic effects. Diuretics are indicated in the treatment of acute heart failure because of their direct and indirect vasoactive properties, in the treatment of chronic cardiac insufficiency because of their diuretic and vasodilatatory properties and, those diuretics which show as antihypertensives, are first choice drugs in hypertension.

Minoxidil therapy in children with severe hypertension.

Six children, from 1.3 to 18 years of age, with severe hypertension associated with the hemolytic uremic syndrome, periarteritis, and renal transplant rejection received minoxidil, an antihypertensive agent, for three to 36 weeks. All had severe hypertension resistant to oral antihypertensive medications; five required frequent intravenous diazoxide therapy prior to minoxidil therapy. The mean pretreatment systolic and diastolic blood pressures were 176 and 117 mm Hg, respectively. Following treatment, the mean systolic and diastolic blood pressures were 133 and 82 mm Hg, respectively. Concomitant antihypertensive medications were decreased in all six patients once optimal blood pressure control was obtained. The initial dosage of minoxidil was 0.1 to 0.2 mg/kg/day; maximal dosage for blood pressure was 0.3 to 1.4 mg/kh/day. Major complications of therapy were fluid retention and hirsutism. Transient asymptomatic pericardial effusions occurred in two patients. Three patients on prolonged minoxidil therapy had persistent increases in right ventricular end diastolic diameters. Minoxidil is an effective oral antihypertensive agent for treatment of severe hypertension in pediatric patients. Avoidance of fluid retention is mandatory to prevent congestive heart failure.

[Use of mannitol and dexamethasone in the management of acute cerebral edema of infectious origin]. / Uso de manitol y dexametasona en el manejo del edema cerebral agudo de origen infeccioso

The study included 22 patients with meningoencephalitis and hypertensive cranial syndrome from cerebral edema. Mannitol was given to 13 cases and dexamethasone to 9. There were three therapeutic failures in the group given mannitol and none in that of dexamethasone (p greater than 0.05). Both drugs showed similar effect in the duration of the hypertensive cranial syndrome (39-44 hrs). Patients treated with mannitol showed hyponatremia after 48 hours. No untoward effects appeared in patients given dexamethasone.