En respuesta a la pregunta: «¿Jugamos todos en el mismo equipo?» / In reply to the question: "Are we really playing together in the same team?"

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Actualización sobre la fluidoterapia en el proceso de reanimación del paciente crítico / Update on fluid therapy in the critical patient resuscitation process

La administración de fluidos para la reanimación del paciente grave en las unidades de cuidados intensivos es una de las intervenciones más frecuentes y hasta en un 40% de las ocasiones es el equipo de enfermería el que toma la decisión de administrar un bolo de fluido a un paciente crítico según protocolos establecidos, por lo que en el presente trabajo se realiza una revisión del estado actual de la fluidoterapia y su empleo en este tipo de pacientes. Asimismo, para optimizar los conocimientos y el tratamiento administrado a este tipo de pacientes, se describen los distintos tipos de fluidos existentes y los posibles efectos adversos que se puedan desarrollar derivados de su administración

The administration of fluids for the resuscitation of the seriously ill patient in intensive care units is one of the most frequent interventions. Up to 40% of the time it is the nursing team that makes the decision to administer a fluid bolus to a critically ill patient according to established protocols. Therefore we perform a review in this paper of the current status of fluid therapy and its use in this type of patient. In order to optimize the knowledge and the treatment administered to this type of patient, we also describe the different types of fluids currently used and possible adverse effects that may develop after their administration

Cetoacidosis diabética euglucémica / Euglycemic diabetic ketoacidosis

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Historia del suero salino / Saline solutions in history

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Update on fluid therapy in the critical patient resuscitation process. / Actualización sobre la fluidoterapia en el proceso de reanimación del paciente crítico.

The administration of fluids for the resuscitation of the seriously ill patient in intensive care units is one of the most frequent interventions. Up to 40% of the time it is the nursing team that makes the decision to administer a fluid bolus to a critically ill patient according to established protocols. Therefore we perform a review in this paper of the current status of fluid therapy and its use in this type of patient. In order to optimize the knowledge and the treatment administered to this type of patient, we also describe the different types of fluids currently used and possible adverse effects that may develop after their administration.

SMART: ¿está el suero salino en la cuerda floja? / SMART: Is saline on the tightrope?

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Síndrome de Wünderlich por rotura de vena iliaca, secundario a trombosis venosa profunda / Wünderlich syndrome due to a ruptured iliac vein secondary to deep venous thrombosis

El síndrome de Wünderlich, o hematoma retroperitoneal espontáneo, secundario a una rotura espontánea de la vena iliaca es una entidad clínica poco común que constituye una urgencia médica. No está claro el desencadenante en muchos casos, proponiéndose diferentes hipótesis etiológicas relacionadas con factores hormonales, inflamatorios y/o mecánicos; y en este punto, puede ser importante valorar la existencia de un factor que desencadene la trombosis venosa profunda y que, secundariamente, se genere la rotura de la vena iliaca y el hematoma retroperitoneal. Presentamos un caso clínico donde la trombosis venosa pudo ser la causa de la rotura de la vena iliaca y realizamos una discusión del tema con base en la literatura médica encontrada

Wünderlich syndrome, or spontaneous retroperitoneal hematoma, secondary to spontaneous rupture of the iliac vein is a rare clinical entity and a medical emergency. Often the aetiology is difficult to identify and different hypotheses have been proposed, such as the presence of hormonal, inflammatory and/or mechanical factors. It may be important to assess the presence of a factor that triggered the deep vein thrombosis and secondary rupture of the iliac vein and retroperitoneal hematoma. We present a case where venous thrombosis could have caused rupture of the iliac vein and we discuss the entity in light of the current literature

[Wünderlich syndrome due to a ruptured iliac vein secondary to deep venous thrombosis]. / Síndrome de Wünderlich por rotura de vena iliaca, secundario a trombosis venosa profunda.

Wünderlich syndrome, or spontaneous retroperitoneal hematoma, secondary to spontaneous rupture of the iliac vein is a rare clinical entity and a medical emergency. Often the aetiology is difficult to identify and different hypotheses have been proposed, such as the presence of hormonal, inflammatory and/or mechanical factors. It may be important to assess the presence of a factor that triggered the deep vein thrombosis and secondary rupture of the iliac vein and retroperitoneal hematoma. We present a case where venous thrombosis could have caused rupture of the iliac vein and we discuss the entity in light of the current literature.

Síndrome de takotsubo secundario a traumatismo raquimedular / Takotsubo syndrome secondary to spinal cord injury

Resumen Antecedentes: El síndrome de takotsubo secundario a traumatismo raquimedular cervical es infrecuente y no se describen series de casos en la literatura. Pacientes y método: Se describe el caso clínico de una mujer de 82 años que ingresó en la Unidad de Cuidados Intensivos tras traumatismo raquimedular cervical y como consecuencia desarrolló miocardiopatía de takotsubo. Resultado: Desarrollo de una miocardiopatía de takotsubo tras un traumatismo raquimedular cervical. Conclusiones: En la actualidad el diagnóstico de miocardiopatía de takotsubo en Cuidados Intensivos está en aumento, en parte por el uso de la ecocardiografía trastorácica por parte de los Intensivistas; con ello se descartan otras causas posibles de la misma y no sólo la cardiológica o la descarga catecolaminérgica secundaria a una situación de estrés.

Abstract Background: Takotsubo syndrome secondary to spinal cord injury is rare, and there are no case series described in the literature. Patients and method: A clinical case is presented of an 82 year-old woman admitted to the Intensive Care Unit after a spinal cord injury, and as a results developed Takotsubo cardiomyopathy. Results: A Takotsubo cardiomyopathy developed after a spinal cord injury. Conclusions: The diagnosis of Takotsubo cardiomyopathy is currently increasing in Intensive Care Units. This is partly due to use of transthoracic echocardiography by intensive care specialists. Using this technique they can rule out other possible causes of this condition, and not just the cardiological ones, or the catecholamine release following a stressful event.

Elección de fluidos en el periodo perioperatorio del trasplante renal / Choice of fluids in the perioperative period of kidney transplantation

El suero salino normal (SSN) ha sido clásicamente el fluido de resucitación elegido en el periodo perioperatorio del trasplante renal frente a aquellas soluciones balanceadas con potasio. Sin embargo, los problemas derivados de la hipercloremia desencadenada por la infusión de SSN han llevado a la realización de estudios que comparaban esta solución con los fluidos equilibrados. Mediante la presente revisión narrativa se deduce que el uso de cristaloides balanceados con contenido de potasio en su formulación, en el perioperatorio de trasplante renal, puede considerarse seguro. Estas soluciones no provocan una alteración del potasio sérico mayor que la provocada por el SSN y mantienen mejor el equilibrio ácido-base en estos enfermos (AU)

Normal saline has traditionally been the resuscitation fluid of choice in the perioperative period of kidney transplantation over balanced potassium solutions. However, the problems arising from hyperchloraemia triggered by the infusion of normal saline have led to studies being conducted that compare this solution with balanced solutions. From this narrative review it can be concluded that the use of balanced crystalloids containing potassium in the perioperative period of kidney transplantation can be considered safe. These solutions do not affect serum potassium levels any more than normal saline, whilst maintaining a better acid-base balance in these patients (AU)

Choice of fluids in the perioperative period of kidney transplantation. / Elección de fluidos en el periodo perioperatorio del trasplante renal.

Normal saline has traditionally been the resuscitation fluid of choice in the perioperative period of kidney transplantation over balanced potassium solutions. However, the problems arising from hyperchloraemia triggered by the infusion of normal saline have led to studies being conducted that compare this solution with balanced solutions. From this narrative review it can be concluded that the use of balanced crystalloids containing potassium in the perioperative period of kidney transplantation can be considered safe. These solutions do not affect serum potassium levels any more than normal saline, whilst maintaining a better acid-base balance in these patients.

Acidosis láctica asociada (o inducida por) metformina / Lactic acidosis associated (or induced by) metformin

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Reanimación con fluidos: perspectiva actual / Fluid resuscitation: Current perspective

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