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2.
Anesth Analg ; 131(5): 1456-1470, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079869

RESUMO

Assessment of urine concentrations of sodium, chloride, and potassium is a widely available, rapid, and low-cost diagnostic option for the management of critically ill patients. Urine electrolytes have long been suggested in the diagnostic workup of hypovolemia, kidney injury, and acid-base and electrolyte disturbances. However, due to the wide range of normal reference values and challenges in interpretation, their use is controversial. To clarify their potential role in managing critical patients, we reviewed existing evidence on the use of urine electrolytes for diagnostic and therapeutic evaluation and assessment in critical illness. This review will describe the normal physiology of water and electrolyte excretion, summarize the use of urine electrolytes in hypovolemia, acute kidney injury, acid-base, and electrolyte disorders, and suggest some practical flowcharts for the potential use of urine electrolytes in daily critical care practice.


Assuntos
Cuidados Críticos/métodos , Estado Terminal/terapia , Eletrólitos/urina , Unidades de Terapia Intensiva , Humanos , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/fisiopatologia , Desequilíbrio Hidroeletrolítico/terapia
3.
Rev Gaucha Enferm ; 41(spe): e20190095, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32294683

RESUMO

AIM: To analyze the behavior of B-type natriuretic peptide (BNP) in the presence of defining characteristics (DCs) of the nursing diagnosis Excess fluid volume (00026) in patients hospitalized for acute decompensated heart failure. METHODS: Cohort study of patients admitted with acute decompensated heart failure (September 2015 to September 2016) defined by Boston Criteria. Patients hospitalized for up to 36 h with BNP values ≥ 100 pg/ml were included; BNP values at baseline-final assessment were compared by Wilcoxon test, the number of DCs at baseline-final assessment was compared by paired t-test. RESULTS: Sixty-four patients were included; there was a significant positive correlation between delta of BNP and the number of DCs present at initial clinical assessment. CONCLUSIONS: The behavior of BNP was correlated to the DCs indicating congestion. With clinical compensation, DCs and BNP decreased. The use of this biomarker may provide additional precision to the nursing assessment.


Assuntos
Insuficiência Cardíaca/sangue , Peptídeo Natriurético Encefálico/sangue , Diagnóstico de Enfermagem , Desequilíbrio Hidroeletrolítico/diagnóstico , Idoso , Biomarcadores/sangue , Estudos de Coortes , Serviços Médicos de Emergência , Feminino , Insuficiência Cardíaca/enfermagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Tamanho da Amostra , Volume Sistólico , Desequilíbrio Hidroeletrolítico/sangue
4.
BMC Health Serv Res ; 20(1): 154, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111205

RESUMO

BACKGROUND: Electrolyte imbalances (EI) are common among patients. Many patients have repeated hospitalizations with the same EI without being investigated and treated. We established an electrolyte outpatient clinic (EOC) to diagnose and treat patients with EI to improve symptoms and increase their quality of life (QoL). In addition, we also wanted to reduce the number of admissions with the same EI. METHODS: Uncontrolled before-after study reporting experiences from this outpatient clinic as a quality assurance project. From October 2010 to October 2015, doctors at our local hospital and general practitioners could refer adult patients with EI to the EOC. Ninety patients with EI were referred, of whom 60 were included. Medical history, clinical examination and laboratory tests were performed, and results registered. Admissions with the same EI were recorded 1 year before and 1 year after consultation at the EOC. Patients responded to a questionnaire, composed by the authors, about symptoms before the first consultation, as well as symptom and QoL improvement after the last consultation. RESULTS: Hyponatremia was the reason for referral in 45/60 patients. The total number of admissions with the same EI 1 year before the first consultation was 71, compared with 20 admissions 1 year after the last consultation. Improvement of symptoms was reported by 60% of patients, and 62% reported improvement in QoL. CONCLUSIONS: An EOC may be an appropriate way to organize the assessment and treatment of patients with EI.


Assuntos
Instituições de Assistência Ambulatorial , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Pesquisa sobre Serviços de Saúde , Hospitalização/estatística & dados numéricos , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Encaminhamento e Consulta , Inquéritos e Questionários , Resultado do Tratamento
5.
Pediatr. aten. prim ; 22(85): e21-e25, ene.-mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193440

RESUMO

La aparición de clínica neurológica en un cuadro respiratorio agudo, una vez descartadas hipoxia e hipercapnia secundarias a insuficiencia respiratoria grave, nos debe hacer pensar en una hiponatremia subyacente, formando parte de un síndrome de secreción inadecuada de hormona antidiurética (SIADH). Esta alteración hidroelectrolítica se ha considerado un factor de mal pronóstico en la evolución del proceso respiratorio, por lo que es deseable detectarla precozmente y corregirla. Presentamos el caso de un lactante que debutó con hipoactividad y pausas de apnea previas a la clínica respiratoria de una bronquiolitis


The appearance of neurological symptoms in an acute respiratory pattern, once hypoxia and hypercapnia are ruled out secondary to severe respiratory failure, should lead us to think about an underlying hyponatremia, forming part of a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). This hydroelectrolytic alteration has been considered a factor of poor prognosis in the evolution of the respiratory process, so it is desirable to detect it early and correct it. We present the case of an infant who debuted with hypoactivity and apnea pauses prior to the respiratory symptoms of bronchiolitis


Assuntos
Humanos , Masculino , Lactente , Hiponatremia/etiologia , Síndrome Torácica Aguda/complicações , Bronquiolite/complicações , Síndrome de Secreção Inadequada de HAD/complicações , Coinfecção/complicações , Desequilíbrio Hidroeletrolítico/diagnóstico , Apneia/diagnóstico , Fator Natriurético Atrial/fisiologia , Índice de Gravidade de Doença , Fatores de Risco
7.
Nephrology (Carlton) ; 25(1): 82-89, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30887608

RESUMO

AIM: Clinical interpretation of B-type natriuretic peptide (BNP) levels in haemodialysis (HD) patients for fluid management remains elusive. METHODS: We conducted a retrospective observational monocentric study. We built a mathematical model to predict BNP levels, using multiple linear regressions. Fifteen clinical/biological characteristics associated with BNP variation were selected. A first cohort of 150 prevalent HD (from September 2015 to March 2016) was used to build several models. The best model proposed was internally validated in an independent cohort of 75 incidents HD (from March 2016 to December 2017). RESULTS: In cohort 1, mean BNP level was 630 ± 717 ng/mL. Cardiac disease (CD - stable coronary artery disease and/or atrial fibrillation) was present in 45% of patients. The final model includes age, systolic blood pressure, albumin, CD, normo-hydrated weight (NHW) and the fluid overload (FO) assessed by bio-impedancemetry. The correlation between the measured and the predicted log-BNP was 0.567 and 0.543 in cohorts 1 and 2, respectively. Age (ß = 3.175e-2 , P < 0.001), CD (ß = 5.243e-1 , P < 0.001) and FO (ß = 1.227e-1 , P < 0.001) contribute most significantly to the BNP level, respectively, but within a certain range. We observed a logistic relationship between BNP and age between 30 and 60 years, after which this relationship was lost. BNP level was inversely correlated with NHW independently of CD. Finally, our model allows us to predict the BNP level according to the FO. CONCLUSION: We developed a mathematical model capable of predicting the BNP level in HD. Our results show the complex contribution of age, CD and FO on BNP level.


Assuntos
Falência Renal Crônica/terapia , Modelos Biológicos , Peptídeo Natriurético Encefálico/sangue , Diálise Renal/efeitos adversos , Equilíbrio Hidroeletrolítico , Desequilíbrio Hidroeletrolítico/diagnóstico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/fisiopatologia , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estado de Hidratação do Organismo , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/etiologia , Adulto Jovem
8.
Rev. gaúch. enferm ; 41(spe): e20190095, 2020. graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1093864

RESUMO

ABSTRACT Aim: To analyze the behavior of B-type natriuretic peptide (BNP) in the presence of defining characteristics (DCs) of the nursing diagnosis Excess fluid volume (00026) in patients hospitalized for acute decompensated heart failure. Methods: Cohort study of patients admitted with acute decompensated heart failure (September 2015 to September 2016) defined by Boston Criteria. Patients hospitalized for up to 36 h with BNP values ≥ 100 pg/ml were included; BNP values at baseline-final assessment were compared by Wilcoxon test, the number of DCs at baseline-final assessment was compared by paired t-test. Results: Sixty-four patients were included; there was a significant positive correlation between delta of BNP and the number of DCs present at initial clinical assessment. Conclusions: The behavior of BNP was correlated to the DCs indicating congestion. With clinical compensation, DCs and BNP decreased. The use of this biomarker may provide additional precision to the nursing assessment.


RESUMEN Objetivo: Analizar el comportamiento del péptido natriurético tipo B (BNP) en presencia de características definitorias (CD) del diagnóstico de enfermería Exceso de volumen de líquidos (00026) en pacientes hospitalizados por insuficiencia cardíaca aguda descompensada (ICAD). Métodos: Estudio de cohorte de pacientes ingresados ​​con ICAD (septiembre/2015 a septiembre/2016).Se incluyeron pacientes hospitalizados hasta 36 h con valores de BNP ≥ 100 pg / ml; Los valores de BNP en la evaluación inicial basal se compararon mediante la prueba de Wilcoxon, el número de CD en la evaluación inicial basal se comparó mediante el Test-T apareado. Resultados: Se incluyeron 64 pacientes; hubo una correlación positiva significativa entre el delta del BNP y las CD presentes en la evaluación clínica inicial. Conclusiones: El comportamiento del BNP se correlacionó con las CD que indican congestión. Con compensación clínica, las CD y el BNP disminuyeron. El uso del BNP puede proporcionar precisión adicional a la evaluación de enfermería.


RESUMO Objetivo: Analisar o comportamento do peptídeo natriurético tipo B (BNP) na presença de características definidoras (CDs) do diagnóstico de enfermagem Excesso de volume de líquidos (00026) em pacientes hospitalizados por insuficiência cardíaca descompensada. Métodos: Estudo de coorte com pacientes internados com insuficiência cardíaca descompensada (setembro-2015 a setembro-2016), definida pelos Critérios de Boston. Pacientes hospitalizados por mais de 36 horas, valor de BNP ≥ 100 pg/ml foram incluídos; valores de BNP basal-final foram comparados pelo teste Wilcoxon; as CDs no basal-final foram comparadas pelo teste t pareado. Resultados: Sessenta e quatro pacientes foram incluídos; houve correlação positiva significativa entre o delta de BNP com o número de CDs presentes na avaliação clínica inicial. Conclusões: O comportamento do BNP foi correlacionado com as CDs, indicando congestão. Com a compensação clínica, as CDs e a concentração de BNP diminuíram. O uso deste biomarcador pode fornecer precisão adicional à avaliação de enfermagem.


Assuntos
Humanos , Masculino , Feminino , Idoso , Desequilíbrio Hidroeletrolítico/diagnóstico , Diagnóstico de Enfermagem , Peptídeo Natriurético Encefálico/sangue , Insuficiência Cardíaca/sangue , Volume Sistólico , Desequilíbrio Hidroeletrolítico/sangue , Biomarcadores/sangue , Estudos de Coortes , Tamanho da Amostra , Serviços Médicos de Emergência , Insuficiência Cardíaca/enfermagem , Insuficiência Cardíaca/fisiopatologia
9.
BMC Nephrol ; 20(1): 454, 2019 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-31815632

RESUMO

BACKGROUND: Extracellular volume overload is a common problem in peritoneal dialysis (PD) patients and is associated with excessive mortality. We determine the effectiveness of treating PD patients with extracellular volume overload by a structured nurse-led intervention program. METHODS: The hydration status of PD patients was screened by bioimpedance spectroscopy (BIS). Fluid overload was defined as overhydration volume ≥ 2 L. Patients were classified into Symptomatic and Asymptomatic Groups and were managed by a structured nurse-led intervention protocol that focused on education and motivation. Hypertonic cycles were given for short term symptom relief for the Symptomatic group. Patients were followed for 12 weeks for the change in volume status, blood pressure, knowledge and adherence as determined by standard questionnaires. RESULTS: We recruited 103 patients (53 Symptomatic, 50 Asymptomatic Group. There was a significant reduction in overhydration volume 4 weeks after intervention, which was sustained by week 12; the overall reduction in overhydration volume was 0.96 ± 1.43 L at 4 weeks, and 1.06 ± 1.70 L at 12 weeks (p < 0.001 for both). The improvement was significant for both Symptomatic and Asymptomatic Groups. There was a concomitant reduction in systolic blood pressure in the Asymptomatic (146.9 ± 20.7 to 136.9 ± 19.5 mmHg, p = 0.037) but not Symptomatic group. The scores of knowledge, adherence to dietary control and advices on daily habit at week 4 were all significantly increased, and the improvement was sustained at week 12. CONCLUSIONS: The structured nurse-led intervention protocol has a lasting benefit on the volume status of PD patients with extracellular volume overload. BIS screening allows prompt identification of volume overload in asymptomatic patients, and facilitates a focused effort on this high risk group.


Assuntos
Gerenciamento Clínico , Intervenção Médica Precoce/métodos , Papel do Profissional de Enfermagem , Diálise Peritoneal/efeitos adversos , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/terapia , Idoso , Dispneia/diagnóstico , Dispneia/etiologia , Dispneia/terapia , Edema/diagnóstico , Edema/etiologia , Edema/terapia , Líquido Extracelular/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estado de Hidratação do Organismo/fisiologia , Diálise Peritoneal/métodos , Resultado do Tratamento , Desequilíbrio Hidroeletrolítico/diagnóstico
10.
Indian Pediatr ; 56(11): 976-977, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31729333
11.
BMC Nephrol ; 20(1): 211, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31474223

RESUMO

BACKGROUND: Sleep disturbance is common among chronic haemodialysis patients, which leads to poor quality of life, in addition to increased instances of morbidity and mortality. Hypervolemia has been linked to sleep problems observed in chronic haemodialysis patients, which suggests that optimising one's fluid status could improve the sleep quality of this patient group. In our study, we subjectively examined and objectively measured sleep parameters, using actigraphy recordings, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and Epworth Sleepiness Scale (ESS), in order to compare bioelectrical impedance analysis (BIA)-guided and standard clinical-guided dry weight adjustment. METHODS: We randomly selected 19 chronic haemodialysis patients with subclinical hypervolemia, defined as a clinically euvolemic status, despite the ratio of extracellular water to total body water being more than 0.4 in BIA. Furthermore, these patients, who were poor sleepers (PSQI > 5), were assigned to either a BIA-guided dry weight group (BIA group) or a standard clinical-guided one (clinical group). The primary outcome was changes in sleep actigraphy parameters between the groups at 1, 3, and 6 months. Changes observed in the PSQI and ESS score between the two groups over the same period of time were the secondary endpoints. RESULTS: The mean age of the participants was 63.53 ± 11.12 years, and 42% of them were male. All sleep parameters measured by means of actigraphy were not significantly different between the two groups. Interestingly, at 3 and 6 months, the subjective sleep quality significantly improved in the BIA group, as reflected by a greater decline in the PSQI score, in comparison with the clinical group (3 months: mean difference - 1.82 [- 3.13 to - 0.51], P = 0.006; 6 months: mean difference - 3.16 [- 4.49 to - 1.83], P <  0.001). However, sleepiness assessed by the ESS was not significantly different between the groups throughout the study. CONCLUSIONS: Optimisation of the fluid status by employing BIA did not improves sleep actigraphy parameter, however, it significantly ameliorates the subjective sleep quality of chronic haemodialysis patients. This observation should be further explored in larger samples and longer clinical trials. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov ( NCT02825589 ) on July 7, 2016.


Assuntos
Impedância Elétrica , Falência Renal Crônica , Qualidade de Vida , Diálise Renal , Transtornos do Sono-Vigília , Desequilíbrio Hidroeletrolítico , Actigrafia/métodos , Peso Corporal , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/fisiopatologia , Resultado do Tratamento , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/fisiopatologia , Desequilíbrio Hidroeletrolítico/terapia
12.
Nihon Shokakibyo Gakkai Zasshi ; 116(7): 576-582, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31292319

RESUMO

A 65-year-old man was previously admitted to our university hospital thrice in the last 2 years because of acute kidney failure. This time he was admitted because of frequent diarrhea, anorexia, exacerbation of renal function, and hyponatremia. Rectal wall thickening was detected on computed tomography. Subsequently, a rectal polyp with mucous secretion was found on colonoscopy, which was further diagnosed as a subcutaneous villous adenoma on biopsy. Thus, electrolyte depletion syndrome associated with the rectal polyp was thought to be the cause of his symptoms. Finally, the patient underwent abdominoperineal resection of the rectum. Histopathologically, the rectal lesion was diagnosed as a villous/tubularadenoma without malignancy, and this is such a rare case to be reported.


Assuntos
Adenoma Viloso/diagnóstico , Neoplasias Retais/diagnóstico , Desequilíbrio Hidroeletrolítico/diagnóstico , Adenoma Viloso/complicações , Adenoma Viloso/cirurgia , Idoso , Eletrólitos , Humanos , Masculino , Lesões Pré-Cancerosas , Neoplasias Retais/complicações , Neoplasias Retais/cirurgia
13.
BMC Nephrol ; 20(1): 216, 2019 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185935

RESUMO

BACKGROUND: Diuresis has been observed within a week following renal transplantation, suggesting that the procedure causes acute disturbance of renal water homeostasis. Aquaporin (AQP) 1 and AQP2, important proteins for renal water reabsorption, have been identified in urinary extracellular vesicles (uEV-AQP1 and -AQP2), and experimental studies have shown that the presence of uEV-AQP1 and -AQP2 may be an indicator of their levels of expression in the kidney. However, the release patterns of uEV-AQP1 and -AQP2 during the acute phase following renal transplantation are largely unknown. METHODS: In this study, we examined the release of uEV-AQP1 and -AQP2 in recipients until 6 days (day 6) after renal transplantation. At Miyazaki prefectural Miyazaki Hospital, Japan, uEVs were obtained from 7 recipients, all of whom had received renal allografts from living donors. uEVs were isolated by differential centrifugation. RESULTS: Immunoblotting analysis showed that the release of uEV-AQP2 was significantly decreased on day 1 in comparison with a control sample (from 3 healthy volunteers), accompanied by high urine output and low urine osmolality. Thereafter, the level increased gradually to the control level by day 6. The release pattern of uEV-AQP1 was similar to that of uEV-AQP2, but the levels did not reach statistical significance in comparison with the control level at any of the time points examined. Evaluation of the relationship between urinary osmolality and uEV-AQPs revealed a significant correlation for uEV-AQP2, but not for uEV-AQP1. CONCLUSION: These results indicate that acute diuresis after renal transplantation might be due to a decrease in the renal expression of AQP2, whose level can be estimated from the amount released in uEVs.


Assuntos
Aquaporina 1/metabolismo , Aquaporina 2/metabolismo , Vesículas Extracelulares/metabolismo , Transplante de Rim , Complicações Pós-Operatórias , Reabsorção Renal/fisiologia , Adulto , Feminino , Humanos , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/metabolismo , Urinálise/métodos , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/metabolismo
14.
Int J Chron Obstruct Pulmon Dis ; 14: 1053-1061, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190790

RESUMO

Objectives: COPD is the fourth-leading cause of mortality worldwide. Prolonged QTc has been found to be a long-term negative prognostic factor in ambulatory COPD patients. The aim of this study was to evaluate the extent of prolonged-QTc syndrome in COPD patients upon admission to an internal medicine department, its relationship to hypomagnesemia, hypokalemia, and hypocalcemia, and the effect of COPD treatment on mortality during hospital stay. Methods: This prospective cohort study evaluated COPD patients hospitalized in an internal medicine department. The study evaluated QTc, electrolyte levels, and known risk factors during hospitalization of COPD patients. Results: A total of 67 patients were recruited. The median QTc interval was 0.441 seconds and 0.434 seconds on days 0 and 3, respectively. Prolonged QTc was noted in 35.8% of patients on admission and 37.3% on day 3 of hospitalization. The median QTc in the prolonged-QTc group on admission was 0.471 seconds and in the normal-QTc group 0.430 seconds. There was no significant difference in age, sex, electrolyte levels, renal function tests, or blood gases on admission between the two groups. Mortality during the hospital stay was significantly higher in the prolonged-QTc group (3 deaths, 12%) than in the normal QTc group (no deaths) (P=0.04). A subanalysis was performed, removing known causes for prolonged QTc. We found no differences in age, electrolytes, or renal functions. There was a small but significant difference in bicarbonate levels. Conclusion: Our findings demonstrated that there was no correlation between QTc prolongation in hospitalized COPD patients and electrolyte levels, comorbidities, or relevant medications. A higher rate of mortality was noted in patients with prolonged QTc in comparison to normal QTc. As such, it is suggested that prolonged QTc could serve as a negative prognostic factor for mortality during hospitalization in COPD patients.


Assuntos
Hospitalização , Síndrome do QT Longo/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Desequilíbrio Hidroeletrolítico/mortalidade , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Cálcio/sangue , Causas de Morte , Progressão da Doença , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Mortalidade Hospitalar , Humanos , Hipocalcemia/sangue , Hipocalcemia/mortalidade , Hipopotassemia/sangue , Hipopotassemia/mortalidade , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/diagnóstico
15.
Ren Fail ; 41(1): 440-445, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31162990

RESUMO

Objectives: Diffuse enlargements of arteriovenous dialysis fistulas customarily attributed to either excessive arterial inflow or central outflow stenosis. The relationship between volume status and clinically enlarged (arteriovenous) fistula (CEF) formation in end-stage renal disease (ESRD) patients is not well understood. Methods: We assessed the pre-dialysis bioimpedance spectroscopy-measured percentage of overhydration (OH%) in 13 prevalent dialysis patients with CEF development and negative angiography and compared the results with those of 52 control dialysis patients (CONTR). All patients were prevalent ESRD patients receiving thrice-weekly maintenance hemodiafiltration at an academic outpatient dialysis unit. Results: 10/13 CEF patients had OH% ≥15% as compared to 20/52 control patients (Chi square p: .02). The degree of OH% was 20.2 ± 7.4% among the CEF vs. 14.4 ± 7.1% in the control group (Student's t-test p: .01), representing 4.2 ± 3.2 vs. 2.8 ± 1.6 L of excess fluid pre-dialysis (p: .03). Patients with CEF development took an average of 1.7 ± 1.4 vs. 0.8 ± 0.8 (p: .002) antihypertensive medications compared to the CONTR patients, yet their blood pressure was higher: 156/91 vs. 141/78 mmHg (systolic/diastolic p: .03<.0001). We found no difference in fistula vintage, body mass index, age, diabetes status, or diuretic use. The odds ratio of having a CEF in patients with ≥15% OH status was 5.3 (95% CI: 1.3-21.7; p: .01), the Number Needed to Harm with overhydration was 4. Conclusions: There is an association between bioimpedance spectroscopy-measured overhydrated clinical state and the presence of CEF; either as an increased volume capacitance or as a potential cause.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Desequilíbrio Hidroeletrolítico/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , Impedância Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Desequilíbrio Hidroeletrolítico/complicações
16.
Nutrients ; 11(4)2019 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-30974817

RESUMO

Although the need to assess hydration is well recognized, laboratory tests and clinical impressions are impractical and lack sensitivity, respectively, to be clinically meaningful. Different approaches use bioelectrical impedance measurements to overcome some of these limitations and aid in the classification of hydration status. One indirect approach utilizes single or multiple frequency bioimpedance in regression equations and theoretical models, respectively, with anthropometric measurements to predict fluid volumes (bioelectrical impedance spectroscopy-BIS) and estimate fluid overload based on the deviation of calculated to reference extracellular fluid volume. Alternatively, bioimpedance vector analysis (BIVA) uses direct phase-sensitive measurements of resistance and reactance, measured at 50 kHz, normalized for standing height, then plotted on a bivariate graph, resulting in a vector with length related to fluid content, and direction with phase angle that indexes hydration status. Comparison with healthy population norms enables BIVA to classify (normal, under-, and over-) and rank (change relative to pre-treatment) hydration independent of body weight. Each approach has wide-ranging uses in evaluation and management of clinical groups with over-hydration with an evolving emphasis on prognosis. This review discusses the advantages and limitations of BIS and BIVA for hydration assessment with comments on future applications.


Assuntos
Espectroscopia Dielétrica/métodos , Impedância Elétrica/classificação , Modelos Teóricos , Estado de Hidratação do Organismo , Desequilíbrio Hidroeletrolítico/diagnóstico , Antropometria/métodos , Água Corporal , Feminino , Humanos , Masculino , Análise de Regressão
17.
PLoS One ; 14(4): e0215673, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022222

RESUMO

BACKGROUND: Although electrolyte imbalances (EIs) are common in the emergency department (ED), few studies have examined the occurrence of such conditions in an unselected population. OBJECTIVES: To investigate the frequency of EI among adult patients who present to the ED, with regards to type and severity, and the association with age and sex of the patient, hospital length of stay (LOS), readmission, and mortality. METHODS: A retrospective cohort study. All patients ≥18 years referred for any reason to the ED between January 1, 2010, and December 31, 2015, who had measured blood electrolytes were included. In total, 62 991 visits involving 31 966 patients were registered. RESULTS: EIs were mostly mild, and the most common EI was hyponatremia (glucose-corrected) (24.6%). Patients with increasing severity of EI had longer LOS compared with patients with normal electrolyte measurements. Among all admitted patients, there were 12928 (20.5%) readmissions within 30 days from discharge during the study period. Hyponatremia (glucose-corrected) was associated with readmission, with an adjusted odds ratio (OR) of 1.25 (95% CI, 1.18-1.32). Hypomagnesemia and hypocalcemia (albumin-corrected) were also associated with readmission, with ORs of 1.25 (95% CI, 1.07-1.45) and 1.22 (95% CI, 1.02-1.46), respectively. Dysnatremia, dyskalemia, hypercalcemia, hypermagnesemia, and hyperphosphatemia were associated with increased in-hospital mortality, whereas all EIs except hypophosphatemia were associated with increased 30-day and 1-year mortality. CONCLUSIONS: EIs were common and increasing severity of EIs was associated with longer LOS and increased in-hospital, 30-days and 1-year mortality. EI monitoring is crucial for newly admitted patients, and up-to-date training in EI diagnosis and treatment is essential for ED physicians.


Assuntos
Eletrólitos/sangue , Serviço Hospitalar de Emergência/estatística & dados numéricos , Desequilíbrio Hidroeletrolítico/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/terapia
18.
BMJ Case Rep ; 12(1)2019 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-30700462

RESUMO

We report a case of a 10-day-old male infant who presented to the emergency department with severe electrolyte imbalance and life-threatening arrhythmia. The parents reported a 3-day history of poor feeding and lethargy. On examination, he was bradycardic (heart rate of 65 beats/min) with signs of dehydration. His ECG showed broad complex bradycardia. Blood gas showed metabolic acidosis with hyponatraemia and hyperkalaemia. A probable diagnosis of congenital adrenal hyperplasia (CAH) with salt-wasting crisis was made and treatment was commenced. He was given saline bolus, nebulised salbutamol, calcium gluconate and hydrocortisone. Following the above interventions, his heart rate rose to 150 beats/min with a regular sinus rhythm within a period of 40 min. The diagnosis of CAH secondary to 21-hydroxylase deficiency with mutation in CYP21A2 was confirmed by genetic studies. He was discharged home with hydrocortisone, fludrocortisone and sodium chloride.


Assuntos
Hiperplasia Suprarrenal Congênita/complicações , Arritmias Cardíacas/complicações , Desequilíbrio Hidroeletrolítico/complicações , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperplasia Suprarrenal Congênita/terapia , Anti-Inflamatórios/uso terapêutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Diagnóstico Diferencial , Fludrocortisona/uso terapêutico , Humanos , Hidrocortisona/uso terapêutico , Recém-Nascido , Masculino , Cloreto de Sódio/uso terapêutico , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/terapia
19.
J Pak Med Assoc ; 69(1): 108-112, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30623923

RESUMO

Patients who have secondary pseudohypoaldosteronism (PHA) in addition to hyponatraemia, hyperpotassaemia and high serum aldosterone levels for the age were included in this retrospective study.Among eight patients, seven patients were diagnosed with PHA secondary to obstructive uropathy (OUP), whereas one patient had PHA secondary to ileostomy. Six patients with OUP had simultaneous urinary tract infection (UTI) and in all except one patient, secondary PHA recovered with only UTI treatment before applying surgical correction. All the patients were younger than 3 months age. In three patients with PUV diagnosis, salt wasting recurred in an UTI episode under 3 months of age.


Assuntos
Aldosterona/sangue , Hiperpotassemia , Hiponatremia , Pseudo-Hipoaldosteronismo , Infecções Urinárias , Anormalidades Urogenitais , Desequilíbrio Hidroeletrolítico , Diagnóstico Diferencial , Feminino , Humanos , Hiperpotassemia/diagnóstico , Hiperpotassemia/etiologia , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Lactente , Masculino , Natriurese , Pseudo-Hipoaldosteronismo/diagnóstico , Pseudo-Hipoaldosteronismo/etiologia , Pseudo-Hipoaldosteronismo/metabolismo , Pseudo-Hipoaldosteronismo/terapia , Estudos Retrospectivos , Turquia , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/metabolismo , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/metabolismo , Anormalidades Urogenitais/cirurgia , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/terapia
20.
Rev Cardiovasc Med ; 20(4): 263-266, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31912717

RESUMO

Renal congestion is becoming recognized as a potential contributor to cardiorenal syndromes. Adequate control of congestion with simultaneous preservation of renal function has been proposed as a central goal of the management of heart failure. We report our care of a 48-year-old woman suffering from right heart failure and massive fluid overload due to severe pulmonary hypertension secondary to a combination of left-heart disease and status after recurrent pulmonary embolisms. Alterations in Doppler-derived intrarenal venous flow patterns and a novel renal venous stasis index were used to evaluate improvement in renal venous congestion during recompensation. Due to refractory congestion despite optimal medical treatment and continuous veno-venous hemodialysis, a peritoneal dialysis catheter was placed to relieve the massive ascites. The paracentesis of ascites led to a significant loss of weight, normalization of hydration status with subsequent termination of continuous veno-venous hemodialysis, and a significant improvement in clinical and echocardiographic parameters. Renal Doppler ultrasonography showed continuous improvement in intrarenal venous flow patterns and the renal venous stasis index indicative of effective decongestion up to a normal intrarenal venous flow pattern and renal venous stasis index. Furthermore, residual renal function increased during follow-up. This case demonstrates the feasibility of renal Doppler ultrasonography as a simple, non-invasive, and integrative measure of renal congestion. The renal venous stasis index and intrarenal venous flow patterns may be useful to evaluate the treatment response and to guide therapy in patients with right heart failure.


Assuntos
Síndrome Cardiorrenal/terapia , Insuficiência Cardíaca/terapia , Hipertensão Pulmonar/terapia , Veias Renais/diagnóstico por imagem , Ultrassonografia Doppler , Disfunção Ventricular Direita/terapia , Função Ventricular Direita , Equilíbrio Hidroeletrolítico , Desequilíbrio Hidroeletrolítico/terapia , Velocidade do Fluxo Sanguíneo , Síndrome Cardiorrenal/diagnóstico por imagem , Síndrome Cardiorrenal/etiologia , Síndrome Cardiorrenal/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Pessoa de Meia-Idade , Circulação Renal , Veias Renais/fisiopatologia , Resultado do Tratamento , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/fisiopatologia
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