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2.
Am J Physiol Regul Integr Comp Physiol ; 318(3): R512-R514, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31940233

RESUMO

Work in adult humans and animals suggest sodium (Na) is stored in tissue reservoirs without commensurate water retention. These stores may protect from water loss, regulate immune function, and participate in blood pressure regulation. A role for such stores early in life, during which total body Na sufficiency is vital for optimal growth, has not been explored. Using data from previously published literature, we calculated total body stores of Na, potassium (K), and chloride (Cl) during fetal development (24-40 wk gestation) using two methods 1) based on the distribution of body water mass within extracellular and intracellular compartments, and 2) reported total mineral content. Based on differences between the models, we argue that Na, and to a lesser extent Cl, but not K, are stored in osmotically inactive pools within the fetus that increase with advancing gestational age. Because human breastmilk is relatively Na deficient, we speculate the fetal osmotically inactive Na pool is vital for providing a sufficient total body Na content that supports optimal postnatal growth.


Assuntos
Feto/fisiologia , Hipertensão/fisiopatologia , Minerais/metabolismo , Sódio/metabolismo , Equilíbrio Hidroeletrolítico/fisiologia , Animais , Pressão Sanguínea/fisiologia , Água Corporal/fisiologia , Humanos , Potássio/metabolismo , Comportamento Sedentário
3.
Pediatr Cardiol ; 41(1): 194-200, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31720782

RESUMO

We hypothesize that there are post-operative, non-surgical risk factors that could be modified to prevent the occurrence of chylothorax, and we seek to determine those factors. Retrospective chart review of 285 consecutive patients < 18 years who underwent cardiac surgery from 2015 to 2017 at a single institution pediatric intensive care unit. Data was collected on patient demographics, cardiac lesion, surgical and post-operative characteristics. Primary outcome was development of chylothorax. Of 285 patients, median age was 189 days, median weight was 6.6 kg, 48% were female, and 10% had trisomy 21. 3.5% of patients developed upper extremity DVTs, and 8% developed chylothorax. At 24 h following surgery, a majority were in the 0-10% fluid overload category or had a negative fluid balance (63% and 34%, respectively), and a positive fluid balance was rare at 72 h (16%). In univariate analysis, age, weight, bypass time, DVT, arrhythmia, and trisomy 21 were significantly associated with chylothorax and adjusted for in logistic regression. Presence of an upper extremity DVT (OR 49.8, p < 0.001) and trisomy 21 (OR 5.8, p < 0.001) remained associated with chylothorax on regression modeling. The presence of an upper extremity DVT and trisomy 21 were associated with the development of chylothorax. Fluid overload was rare in our population. The presence of positive fluid balance, fluid overload, elevated central venous pressure, and early initiation of fat containing feeds were not associated with chylothorax.


Assuntos
Quilotórax/etiologia , Síndrome de Down/complicações , Cardiopatias Congênitas/complicações , Trombose Venosa/complicações , Pré-Escolar , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Risco , Equilíbrio Hidroeletrolítico/fisiologia
4.
Am J Physiol Renal Physiol ; 318(1): F193-F203, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31682170

RESUMO

The kidney is the central organ involved in maintaining water and sodium balance. In human kidneys, nine aquaporins (AQPs), including AQP1-8 and AQP11, have been found and are differentially expressed along the renal tubules and collecting ducts with distinct and critical roles in the regulation of body water homeostasis and urine concentration. Dysfunction and dysregulation of these AQPs result in various water balance disorders. This review summarizes current understanding of physiological and pathophysiological roles of AQPs in the kidney, with a focus on recent progress on AQP2 regulation by the nuclear receptor transcriptional factors. This review also provides an overview of AQPs as clinical biomarkers and therapeutic targets for renal diseases.


Assuntos
Aquaporinas/metabolismo , Nefropatias/metabolismo , Rim/metabolismo , Equilíbrio Hidroeletrolítico/fisiologia , Animais , Homeostase/fisiologia , Humanos
5.
Am J Nurs ; 120(1): 51-56, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31880730

RESUMO

Nurses need to have a firm grasp of normal and pathophysiological mechanisms of sodium and water balance to fully understand assessment findings and establish a rationale for a patient's plan of care. While multiple mechanisms control sodium and water balance, antidiuretic hormone and aldosterone are the most important hormonal influences. This article, the first in a new series designed to improve nurses' understanding of the physiological abnormalities underlying many disorders, reviews the common etiologies and symptoms of hyponatremia and hypernatremia, as well as the role of nursing care in patients with imbalances of sodium and water. Case studies guide the reader through relevant medical history and examination findings to an understanding of both the nursing and medical plans of care.


Assuntos
Composição Corporal/fisiologia , Hipernatremia/fisiopatologia , Hiponatremia/fisiopatologia , Sódio/química , Equilíbrio Hidroeletrolítico/fisiologia , Água/química , Humanos
6.
J. bras. nefrol ; 41(4): 481-491, Out.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056601

RESUMO

Abstract Introduction: It is unclear whether residual renal function (RRF) in dialysis patients can attenuate the metabolic impact of the long 68-hour interdialytic interval, in which water, acid, and electrolyte accumulation occurs. Objective: to evaluate serum electrolyte levels, water balance, and acid-base status in dialytic patients with and without RRF over the long interdialytic interval (LII). Methodology: this was a single-center, cross-sectional, and analytical study that compared patients with and without RRF, defined by diuresis above 200 mL in 24 hours. Patients were weighed and serum samples were collected for biochemical and gasometric analysis at the beginning and at the end of the LII. Results: 27 and 24 patients with and without RRF were evaluated, respectively. Patients without RRF had a higher increase in serum potassium during the LII (2.67 x 1.14 mEq/L, p < 0.001), reaching higher values at the end of the study (6.8 x 5.72 mEq/L, p < 0.001) and lower pH value at the beginning of the interval (7.40 x 7.43, p = 0.018). More patients with serum bicarbonate < 18 mEq/L (50 x 14.8%, p = 0.007) and mixed acid-base disorder (57.7 x 29.2%, p = 0.042), as well as greater interdialytic weight gain (14.67 x 8.87 mL/kg/h, p < 0.001) and lower natremia (137 x 139 mEq/L, p = 0.02) at the end of the interval. Calcemia and phosphatemia were not different between the groups. Conclusion: Patients with RRF had better control of serum potassium, sodium, acid-base status, and volemia throughout the LII.


Resumo Introdução: Não se sabe ao certo se a função renal residual (FRR) de pacientes dialíticos pode atenuar o impacto metabólico do maior intervalo interdialítico (MII) de 68 horas, no qual ocorre acúmulo de volume, ácidos e eletrólitos. Objetivo: Avaliar os níveis séricos de eletrólitos, balanço hídrico e status ácido-básico de pacientes dialíticos com e sem FRR ao longo do MII. Metodologia: Tratou-se de estudo unicêntrico, transversal e analítico, que comparou pacientes com e sem FRR, definida como diurese acima de 200 mL em 24 horas. Para tal, os pacientes foram pesados e submetidos à coleta de amostras séricas para análise bioquímica e gasométrica no início e fim do MII. Resultados: Foram avaliados 27 e 24 pacientes com e sem FRR, respectivamente. Pacientes sem FRR apresentaram maior aumento de potássio sérico durante o MII (2,67 x 1,14 mEq/L, p < 0,001) atingindo valores mais elevados no fim (6,8 x 5,72 mEq/L, p < 0,001); menor valor de pH no início do intervalo (7,40 x 7,43, p = 0,018), maior proporção de pacientes com bicarbonato sérico < 18 mEq/L (50 x 14,8 %, p = 0,007) e distúrbio ácido-básico misto (70,8 x 42,3 %, p = 0,042), além de maior ganho de peso interdialítico (14,67 x 8,87 mL/kg/h, p < 0,001) e menor natremia (137 x 139 mEq/L, p = 0,02) no fim do intervalo. A calcemia e fosfatemia não foram diferentes entre os grupos. Conclusão: Pacientes com FRR apresentaram melhor controle dos níveis séricos de potássio, sódio, status ácido-básico e da volemia ao longo do MII.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Equilíbrio Hidroeletrolítico/fisiologia , Diálise Renal/efeitos adversos , Insuficiência Renal/sangue , Rim/fisiopatologia , Fosfatos/sangue , Potássio/sangue , Sódio/sangue , Desequilíbrio Ácido-Base/fisiopatologia , Bicarbonatos/sangue , Ganho de Peso , Cálcio/sangue , Estudos Transversais , Progressão da Doença , Insuficiência Renal/fisiopatologia , Insuficiência Renal/urina , Insuficiência Renal/terapia , Rim/metabolismo , Rim/química , Testes de Função Renal/métodos
7.
J. bras. nefrol ; 41(4): 550-559, Out.-Dec. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1056604

RESUMO

Abstract Fluid volume and hemodynamic management in hemodialysis patients is an essential component of dialysis adequacy. Restoring salt and water homeostasis in hemodialysis patients has been a permanent quest by nephrologists summarized by the 'dry weight' probing approach. Although this clinical approach has been associated with benefits on cardiovascular outcome, it is now challenged by recent studies showing that intensity or aggressiveness to remove fluid during intermittent dialysis is associated with cardiovascular stress and potential organ damage. A more precise approach is required to improve cardiovascular outcome in this high-risk population. Fluid status assessment and monitoring rely on four components: clinical assessment, non-invasive instrumental tools (e.g., US, bioimpedance, blood volume monitoring), cardiac biomarkers (e.g. natriuretic peptides), and algorithm and sodium modeling to estimate mass transfer. Optimal management of fluid and sodium imbalance in dialysis patients consist in adjusting salt and fluid removal by dialysis (ultrafiltration, dialysate sodium) and by restricting salt intake and fluid gain between dialysis sessions. Modern technology using biosensors and feedback control tools embarked on dialysis machine, with sophisticated analytics will provide direct handling of sodium and water in a more precise and personalized way. It is envisaged in the near future that these tools will support physician decision making with high potential of improving cardiovascular outcome.


Resumo O volume de fluidos e o controle hemodinâmico em pacientes em hemodiálise é um componente essencial da adequação da diálise. A restauração da homeostase do sal e da água em pacientes em hemodiálise tem sido uma busca constante por parte dos nefrologistas, no que condiz à abordagem do "peso seco. Embora essa abordagem clínica tenha sido associada a benefícios no desfecho cardiovascular, recentemente tem sido questionada por estudos que mostram que a intensidade ou agressividade para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos.para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos. Uma abordagem mais precisa é necessária para melhorar o desfecho cardiovascular nessa população de alto risco. A avaliação e monitorização do estado hídrico baseiam-se em quatro componentes: avaliação clínica, ferramentas instrumentais não invasivas (por exemplo, US, bioimpedância, monitorização do volume sanguíneo), biomarcadores cardíacos (e.g. peptídeos natriuréticos), algoritmos e modelagem de sódio para estimar a transferência de massa. O manejo otimizado do desequilíbrio hídrico e de sódio em pacientes dialíticos consiste em ajustar a remoção de sal e líquido por diálise (ultrafiltração, dialisato de sódio), e restringir a ingestão de sal e o ganho de líquido entre as sessões de diálise. Tecnologia moderna que utiliza biosensores e ferramentas de controle de feedback, hoje parte da máquina de diálise, com análises sofisticadas, proporcionam o manejo direto sobre o sódio e a água de uma maneira mais precisa e personalizada. Prevê-se no futuro próximo que essas ferramentas poderão auxiliar na tomada de decisão do médico, com alto potencial para melhorar o resultado cardiovascular.


Assuntos
Humanos , Sódio/metabolismo , Diálise Renal/efeitos adversos , Hemodinâmica/fisiologia , Homeostase/fisiologia , Falência Renal Crônica/terapia , Equilíbrio Hidroeletrolítico/fisiologia , Pressão Sanguínea/fisiologia , Algoritmos , Biomarcadores/metabolismo , Soluções para Diálise/química , Sistema Cardiovascular/fisiopatologia , Diálise Renal/normas , Resultado do Tratamento , Descondicionamento Cardiovascular , Nefrologistas/estatística & dados numéricos , Falência Renal Crônica/fisiopatologia
8.
J. bras. nefrol ; 41(4): 518-525, Out.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056611

RESUMO

ABSTRACT Introduction: Proximal femur fractures affect the mortality and morbidity of elderly individuals. Recent studies have shown an association between fragility fractures and hyponatremia, a common fluid and electrolyte balance disorder. Objectives: This study aimed to investigate the occurrence of hyponatremia in patients with fragility fractures of the proximal femur. Methods: The authors looked into the data from the medical records of patients admitted to the emergency unit of the Real Hospital Português for fragility fractures of the proximal femur from 2014 to 2017. The study included patients with serum sodium levels recorded in their charts. Results: Fourteen of 69 (20.3%) patients with proximal femur fractures had hyponatremia. The main factors linked to hyponatremia were lung disease, and prescription of amiodarone and/or antidepressants. Conclusion: In elderly individuals, fragility fractures of the proximal femur may correlate with hyponatremia, particularly among patients on amiodarone or antidepressants.


RESUMO Introdução: Fratura de fêmur proximal tem impacto na mortalidade e morbidade de idosos. Estudos recentes vêm demonstrando associação entre fratura por fragilidade e hiponatremia, um distúrbio hidroeletrolítico comum na prática médica. Objetivos: Investigar a ocorrência de hiponatremia em pacientes com fratura proximal de fêmur por fragilidade. Metodologia: Foram coletados dados a partir de prontuários de pacientes admitidos na emergência do Real Hospital Português devido à fratura proximal de fêmur por fragilidade, entre 2014 e 2017, e aqueles com natremia disponível no prontuário eletrônico foram incluídos no estudo. Resultado: Dentre os 69 pacientes com fratura de fêmur proximal, houve uma ocorrência de 14 pacientes com hiponatremia, o que corresponde a 20,3%. Os principais fatores associados à hiponatremia no estudo foram doença pulmonar, uso de amiodarona e antidepressivos. Conclusão: Em idosos, a fratura de fêmur proximal por fragilidade pode estar correlacionada com hiponatremia, principalmente quando estão sob uso de amiodarona ou antidepressivos.


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Fraturas Ósseas/sangue , Fraturas do Fêmur/sangue , Hiponatremia/complicações , Equilíbrio Hidroeletrolítico/fisiologia , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Fraturas Ósseas/epidemiologia , Fraturas do Fêmur/epidemiologia , Amiodarona/efeitos adversos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Pneumopatias/complicações , Antiarrítmicos/efeitos adversos , Antidepressivos/efeitos adversos
9.
Bull Exp Biol Med ; 168(2): 219-223, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31776946

RESUMO

We analyzed the expression of molecular targets of natriuretic action of prolactin in different layers of the kidney in the rat model of cholestasis of pregnancy. Sodium bicarbonate cotransporter NBCe1 was most sensitive to the conditions of cholestasis and cholestasis of pregnancy: the expression NBCe1 mRNA and protein in the renal outer medulla decreased in comparison with the normal. All forms of cholestasis affected the mRNA expression of sodium-potassium chloride co-transporter NCC, α-subunit of the ENaCα epithelial sodium channel, and Nedd4-2 ubiquitin ligase in different layers of the kidney. The obtained data suggest that prolactin provides fine tuning of various sodium transporters in different parts of the nephron under pathological conditions.


Assuntos
Colestase/patologia , Transporte de Íons/fisiologia , Medula Renal/metabolismo , Prolactina/metabolismo , Equilíbrio Hidroeletrolítico/fisiologia , Animais , Modelos Animais de Doenças , Canais Epiteliais de Sódio/biossíntese , Canais Epiteliais de Sódio/genética , Feminino , Ubiquitina-Proteína Ligases Nedd4/biossíntese , Ubiquitina-Proteína Ligases Nedd4/genética , Gravidez , RNA Mensageiro/biossíntese , Ratos , Simportadores de Sódio-Bicarbonato/biossíntese , Simportadores de Sódio-Bicarbonato/genética , Membro 3 da Família 12 de Carreador de Soluto/biossíntese , Membro 3 da Família 12 de Carreador de Soluto/genética
10.
Am J Physiol Renal Physiol ; 317(6): F1405-F1408, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31566434

RESUMO

Insulin is known to be an important regulator of a number of different channels and transporters in the kidney, but its role in the kidney to prevent Na+ and volume loss during the osmotic load after a meal has only recently been validated. With increasing numbers of people suffering from diabetes and hypertension, furthering our understanding of insulin signaling and renal Na+ handling in both normal and diseased states is essential for improving patient treatments and outcomes. The present review is focused on postprandial effects on Na+ reabsorption in the kidney and the role of the epithelial Na+ channels as an important channel contributing to insulin-mediated Na+ reclamation.


Assuntos
Rim/metabolismo , Rim/fisiologia , Período Pós-Prandial/fisiologia , Equilíbrio Hidroeletrolítico/fisiologia , Animais , Homeostase/fisiologia , Humanos
11.
Crit Care ; 23(1): 329, 2019 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665065

RESUMO

BACKGROUND: The interactive effect of cumulative input and output on achieving optimal fluid balance has not been well elucidated in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). This study evaluated the interrelation of fluid components with mortality in patients with AKI requiring CRRT. METHODS: This is a retrospective observational study conducted with a total of 258 patients who were treated with CRRT due to AKI between 2016 and 2018 in the intensive care unit of Ewha Womans University Mokdong Hospital. The amounts of fluid input and output were assessed at 24-h and 72-h from the initiation of CRRT. The study endpoints were 7- and 28-day all-cause mortality. RESULTS: The mean patient age was 64.7 ± 15.8 years, and 165 (64.0%) patients were male. During the follow-up, 7- and 28-day mortalities were observed in 120 (46.5%) and 157 (60.9%) cases. The patients were stratified into two groups (28-day survivors vs. non-survivors), and the cumulative fluid balances (CFBs) at 24 h and 72 h were significantly higher in the 28-day non-survivors compared with the survivors. The increase in 24-h and 72-h CFB was significantly associated with an increase in 7- and 28-day mortality risks. To examine the interactive effect of cumulative input or output on the impact of CFB on mortality, we also stratified patients into three groups based on the tertile of 24-h and 72-h cumulative input or output. The increases in 24-h and 72-h CFBs were still significantly related to the increases in 7-day and 28-day mortality, irrespective of the cumulative input. However, we did not find significant associations between increase in 24-h and 72-h CFB and increase in mortality risk in the groups according to cumulative output tertile. CONCLUSIONS: The impact of cumulative fluid balance on mortality might be more dependent on cumulative output. The physicians need to decrease the cumulative fluid balance of CRRT patients as much as possible and consider increasing patient removal.


Assuntos
Lesão Renal Aguda/fisiopatologia , Terapia de Substituição Renal Contínua/métodos , Equilíbrio Hidroeletrolítico/fisiologia , APACHE , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Terapia de Substituição Renal Contínua/tendências , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Prognóstico , Estudos Retrospectivos , Estatísticas não Paramétricas
12.
J Bras Nefrol ; 41(4): 550-559, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31661543

RESUMO

Fluid volume and hemodynamic management in hemodialysis patients is an essential component of dialysis adequacy. Restoring salt and water homeostasis in hemodialysis patients has been a permanent quest by nephrologists summarized by the 'dry weight' probing approach. Although this clinical approach has been associated with benefits on cardiovascular outcome, it is now challenged by recent studies showing that intensity or aggressiveness to remove fluid during intermittent dialysis is associated with cardiovascular stress and potential organ damage. A more precise approach is required to improve cardiovascular outcome in this high-risk population. Fluid status assessment and monitoring rely on four components: clinical assessment, non-invasive instrumental tools (e.g., US, bioimpedance, blood volume monitoring), cardiac biomarkers (e.g. natriuretic peptides), and algorithm and sodium modeling to estimate mass transfer. Optimal management of fluid and sodium imbalance in dialysis patients consist in adjusting salt and fluid removal by dialysis (ultrafiltration, dialysate sodium) and by restricting salt intake and fluid gain between dialysis sessions. Modern technology using biosensors and feedback control tools embarked on dialysis machine, with sophisticated analytics will provide direct handling of sodium and water in a more precise and personalized way. It is envisaged in the near future that these tools will support physician decision making with high potential of improving cardiovascular outcome.


Assuntos
Hemodinâmica/fisiologia , Homeostase/fisiologia , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Sódio/metabolismo , Algoritmos , Biomarcadores/metabolismo , Pressão Sanguínea/fisiologia , Descondicionamento Cardiovascular , Sistema Cardiovascular/fisiopatologia , Soluções para Diálise/química , Humanos , Falência Renal Crônica/fisiopatologia , Nefrologistas/estatística & dados numéricos , Diálise Renal/normas , Resultado do Tratamento , Equilíbrio Hidroeletrolítico/fisiologia
13.
Biomed Res Int ; 2019: 8162975, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31662997

RESUMO

Background: Preserved blood cells undergo progressive structural and functional changes that may affect their function, integrity, and viability after transfusion. The impact of transfusion of stored blood on potassium, sodium, or acid-base balance in the recipient may be complex, but information on it is inconsistent. This study therefore sought to determine the changes in the potassium and sodium levels in whole blood stored at 4°C for 28 days and clinical outcomes when such blood are transfused. Methods: Whole blood were taken into double CPDA-1 bags and 50 ml transferred into the satellite bags for the study. Electrolyte concentration determinations were made on each of the blood sample on days 0, 7, 14, 21, and 28 using the Vitalab Selectra Junior chemistry analyser. The remaining blood in the main bags was transfused after the 28-day period, and biochemical analysis carried out on the patients before and after the transfusion. One-way ANOVA was used for the analysis of variance between the weekly ion concentrations and independent sample Mann-Whitney U test for the data obtained from the patients. Results: The mean potassium level of all the samples started with a normal value of 3.45 mmol/L on the first day followed by a sharp rise to 9.40 mmol/L on day 7, 13.40 mmol/L on day 14, 14.60 mmol/L on day 21, and 15.40 mmol/L on day 28. Sodium on the other hand started with a high value of 148.4 mmol/L on day 0 and then reduced to 146.4 mmol/L on day 7, 140.8 mmol/L on day 14, 135.6 mmol/L on day 21, and a low value of 130.8 mmol/L on day 28. No adverse clinical outcomes were seen in patients after they were transfused with the blood. Conclusion: It can be deduced that potassium concentration in refrigerated blood increases, whilst sodium concentration reduces with time and when such blood is transfused, it may not result in any adverse clinical outcome.


Assuntos
Eletrólitos/metabolismo , Íons/sangue , Potássio/sangue , Sódio/sangue , Equilíbrio Hidroeletrolítico/fisiologia , Adenina/metabolismo , Doadores de Sangue , Preservação de Sangue/métodos , Transfusão de Sangue/métodos , Citratos/metabolismo , Glucose/metabolismo , Humanos , Fosfatos/metabolismo
14.
PLoS One ; 14(9): e0221970, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31479489

RESUMO

BACKGROUND: Chronic fluid overload is common in patients with chronic kidney disease (CKD) and can with time lead to poor prognosis regarding to the cardiovascular events. Serum NT-proBNP and OH/ECW might reflect fluid status of the patients, and the maximal tricuspid regurgitation velocity (TRVmax) could reflect systolic pulmonary artery pressure (SPAP). We investigated the relationship between markers of volume status and marker of pulmonary hypertension (PH) in non-dialysis CKD5 (CKD5-ND) patients. METHODS: Bioimpedance spectroscopy (BIS), echocardiography, and measurement of serum NT-proBNP were performed in 137 consecutive patients on the same day. TRVmax greater than or equal to 2.9 m/s, corresponding to SPAP of approximately 36 mmHg, was used as a definition of the possibility of PH in the absence of left heart disease and chronic respiratory disease (PH group). RESULTS: Patients with possibility of PH (TRVmax ≥ 2.9 m/s) was found in 27 (19.70%) patients. Among the values obtained from BIS, those reflecting the fluid balance (OH, OH/ECW, and E/I ratio) were significantly higher in the PH group. The OH/ECW in patients with PH were significantly higher than those patients without (26.76 ± 15.07 vs. 13.09 ± 15.05, P < 0.001). NT-proBNP was also significantly higher in PH group compared to the non-PH group (median = 10,112 pg/ml, IQR = 30,847 pg/ml vs. median = 1,973 pg/ml, IQR = 7,093 pg/ml, P < 0.001). OH/ECW was positively associated with TRVmax (r = 0.235, P = 0.006). Multivariate logistic regression revealed that increased OH/ECW and serum NT-proBNP were significantly associated with an increased risk of PH. CONCLUSIONS: A significant number of patients showed increased TRVmax, which was closely related to volume status in CKD5-ND patients. Echocardiography and BIS could be important players in a high possibility of PH detection and treatment in asymptomatic CKD patients. Therefore, these measures could be helpful to improve the cardiac outcomes after initiating renal replacement therapy. Further research may be needed to validate the consistency of this association across other stages of CKD.


Assuntos
Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Adulto , Idoso , Biomarcadores/sangue , Espectroscopia Dielétrica , Ecocardiografia , Feminino , Humanos , Hipertensão Pulmonar/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Diálise Renal , Insuficiência Renal Crônica/terapia , Fatores de Risco , Equilíbrio Hidroeletrolítico/fisiologia
15.
Nutrients ; 11(8)2019 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-31405195

RESUMO

Hypohydration, defined as a state of low body water, increases thirst sensations, arginine vasopressin release, and elicits renin-angiotensin-aldosterone system activation to replenish intra- and extra-cellular fluid stores. Hypohydration impairs mental and physical performance, but new evidence suggests hypohydration may also have deleterious effects on cardiovascular health. This is alarming because cardiovascular disease is the leading cause of death in the United States. Observational studies have linked habitual low water intake with increased future risk for adverse cardiovascular events. While it is currently unclear how chronic reductions in water intake may predispose individuals to greater future risk for adverse cardiovascular events, there is evidence that acute hypohydration impairs vascular function and blood pressure (BP) regulation. Specifically, acute hypohydration may reduce endothelial function, increase sympathetic nervous system activity, and worsen orthostatic tolerance. Therefore, the purpose of this review is to present the currently available evidence linking acute hypohydration with altered vascular function and BP regulation.


Assuntos
Água Corporal/fisiologia , Doenças Cardiovasculares/etiologia , Fenômenos Fisiológicos Cardiovasculares , Desidratação/complicações , Equilíbrio Hidroeletrolítico/fisiologia , Humanos
16.
J Bras Nefrol ; 41(4): 518-525, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31429466

RESUMO

INTRODUCTION: Proximal femur fractures affect the mortality and morbidity of elderly individuals. Recent studies have shown an association between fragility fractures and hyponatremia, a common fluid and electrolyte balance disorder. OBJECTIVES: This study aimed to investigate the occurrence of hyponatremia in patients with fragility fractures of the proximal femur. METHODS: The authors looked into the data from the medical records of patients admitted to the emergency unit of the Real Hospital Português for fragility fractures of the proximal femur from 2014 to 2017. The study included patients with serum sodium levels recorded in their charts. RESULTS: Fourteen of 69 (20.3%) patients with proximal femur fractures had hyponatremia. The main factors linked to hyponatremia were lung disease, and prescription of amiodarone and/or antidepressants. CONCLUSION: In elderly individuals, fragility fractures of the proximal femur may correlate with hyponatremia, particularly among patients on amiodarone or antidepressants.


Assuntos
Fraturas do Fêmur/sangue , Fraturas Ósseas/sangue , Hiponatremia/complicações , Idoso , Idoso de 80 Anos ou mais , Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Antidepressivos/efeitos adversos , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas Ósseas/epidemiologia , Humanos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Pneumopatias/complicações , Masculino , Equilíbrio Hidroeletrolítico/fisiologia
17.
Eur J Appl Physiol ; 119(9): 2105-2118, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31377851

RESUMO

PURPOSE: To determine the impact of altering dietary sodium intake for 3 days preceding exercise on sweat sodium concentration [Na+], and cardiovascular and thermoregulatory variables. METHODS: Fifteen male endurance athletes (runners n = 8, cyclists n = 7) consumed a low (LNa, 15 mg kg-1 day-1) or high (HNa, 100 mg kg-1 day-1) sodium diet, or their usual free-living diet [UDiet, 46 (37-56) mg kg-1 day-1] for 3 days in a double-blind, randomized cross-over design, collecting excreted urine (UNa) and refraining from exercise. On day 4, they completed 2 h running at 55% [Formula: see text]O2max or cycling at 55% maximum aerobic power in Tamb 35 °C. Pre- and post-exercise blood samples were collected, and sweat from five sites using absorbent patches along the exercise protocol. RESULTS: UNa on days 2-3 pre-exercise [mean (95% CI) LNa 16 (12-19) mg kg-1 day-1, UDiet 46 (37-56) mg kg-1 day-1, HNa 79 (72-85) mg kg-1 day-1; p < 0.001] and pre-exercise aldosterone [LNa 240 (193-286) mg kg-1 day-1, UDiet 170 (116-224) mg kg-1 day-1, HNa 141 (111-171) mg kg-1 day-1; p = 0.001] reflected sodium intake as expected. Pre-exercise total body water was greater following HNa compared to LNa (p < 0.05), but not UDiet. Estimated whole-body sweat [Na+] following UDiet was 10-11% higher than LNa and 10-12% lower than HNa (p < 0.001), and correlated with pre-exercise aldosterone (1st h r = - 0.568, 2nd h r = - 0.675; p < 0.01). Rectal temperature rose more quickly in LNa vs HNa (40-70 min; p < 0.05), but was similar at the conclusion of exercise, and no significant differences in heart rate or perceived exertion were observed. CONCLUSIONS: Three day altered sodium intake influenced urinary sodium excretion and sweat [Na+], and the rise in rectal temperature, but had no effect on perceived exertion during moderate-intensity exercise in hot ambient conditions.


Assuntos
Transtornos de Estresse por Calor/metabolismo , Transtornos de Estresse por Calor/fisiopatologia , Resposta ao Choque Térmico/fisiologia , Sódio na Dieta/administração & dosagem , Sódio/metabolismo , Sudorese/fisiologia , Adulto , Estudos Cross-Over , Método Duplo-Cego , Ingestão de Líquidos/fisiologia , Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Temperatura Alta , Humanos , Masculino , Resistência Física/fisiologia , Corrida/fisiologia , Suor/metabolismo , Equilíbrio Hidroeletrolítico/fisiologia
18.
Medicina (Kaunas) ; 55(9)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31455034

RESUMO

Exercise-associated hyponatremia (EAH) is defined as a plasma sodium concentration of <135 mmol/L during or after endurance and ultra-endurance performance and was first described by Timothy Noakes when observed in ultra-marathoners competing in the Comrades Marathon in South Africa in the mid-1980s. It is well-established that a decrease in plasma sodium concentration <135 mmol/L occurs with excessive fluid intake. Clinically, a mild hyponatremia will lead to no or very unspecific symptoms. A pronounced hyponatremia (<120 mmol/L) will lead to central nervous symptoms due to cerebral edema, and respiratory failure can lead to death when plasma sodium concentration reaches values of <110-115 mmol/L. The objective of this narrative review is to present new findings about the aspects of sex, race location, sports discipline, and length of performance. The prevalence of EAH depends on the duration of an endurance performance (i.e., low in marathon running, high to very high in ultra-marathon running), the sports discipline (i.e., rather rare in cycling, more frequent in running and triathlon, and very frequent in swimming), sex (i.e., increased in women with several reported deaths), the ambient temperature (i.e., very high in hot temperatures) and the country where competition takes place (i.e., very common in the USA, very little in Europe, practically never in Africa, Asia, and Oceania). A possible explanation for the increased prevalence of EAH in women could be the so-called Varon-Ayus syndrome with severe hyponatremia, lung and cerebral edema, which was first observed in marathon runners. Regarding the race location, races in Europe seemed to be held under rather moderate conditions whereas races held in the USA were often performed under thermally stressing conditions (i.e., greater heat or greater cold).


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Exercício Físico/fisiologia , Hiponatremia/etiologia , Resistência Física/fisiologia , Fatores Sexuais , Humanos , Hiponatremia/fisiopatologia , Prevalência , Fatores de Risco , Sódio/análise , Sódio/sangue , Esportes/fisiologia , Esportes/estatística & dados numéricos , Temperatura , Equilíbrio Hidroeletrolítico/fisiologia
19.
Semin Nephrol ; 39(4): 368-379, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31300092

RESUMO

Measurements made in the blood, part of the extracellular compartment, are used in the clinical assessment of acid-base disorders; however, intracellular events determine much of the metabolic importance of these disorders. Intracellular and interstitial compartment acid-base balance is complex and varies in different tissues. This review considers the determination of extracellular pH in the context of ion transport processes at the interface of cells and the interstitial fluid, and between epithelial cells lining the transcellular contents of the gastrointestinal and urinary tracts that open to the external environment. A further consideration is the role of these membrane transporters in the generation of acid-base disorders and the associated disruption of electrolyte balance. This review suggests a process of internal and external balance for pH regulation similar to that of potassium, and considers the role of secretory gastrointestinal epithelia and renal epithelia with respect to normal pH homeostasis and clinical disorders. Electroneutrality of electrolytes in the extracellular fluid is a fundamental feature of reciprocal changes in Cl- or non-Cl- anions and HCO3-. Normal mechanisms for protecting cell pH and producing normal gastrointestinal and renal secretions in healthy states also may result in disease when abnormal. In a similar manner, organic anions such as ketoacid anions and lactate, normally transported as fuels between organs, result in acid-base disturbances in disease. Understanding the genomic basis of these transporters may contribute to specific treatments.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Compartimentos de Líquidos Corporais/metabolismo , Membrana Celular/metabolismo , Eletrólitos/metabolismo , Transporte de Íons/fisiologia , Animais , Humanos , Equilíbrio Hidroeletrolítico/fisiologia
20.
Rev Assoc Med Bras (1992) ; 65(6): 839-844, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340314

RESUMO

OBJECTIVE: To verify the association between prone position, increased diuresis, and decreased cumulative fluid balance in critically ill pediatric patients who underwent mechanical ventilation (MV) for pulmonary causes and describe adverse events related to the use of the position. METHODS: This is a retrospective observational study. Patients aged between 1 month and 12 years who underwent MV for pulmonary causes, between January 2013 and December 2015, were selected and divided between those who were put on prone position (PG) and those who were not (CG) during the hospitalization at the Pediatric Intensive Care Unit (PICU). Data were analyzed longitudinally from D1 to D4. RESULTS: A total of 77 patients (PG = 37 and CG = 40) were analyzed. The general characteristics of both groups were similar. In the comparison between the groups, there was no increase in diuresis or decrease in cumulative fluid balance in the prone group. In the longitudinal analysis of D1 to D4, we saw that the PG presented higher diuresis (p = 0.034) and a lower cumulative fluid balance (p = 0.001) in D2. Regarding the use of diuretics, there was greater use of furosemide (P <0.001) and spironolactone (P = 0.04) in the PG. There was no increase in adverse events during the use of the prone position. CONCLUSION: The prone position was not associated with increased diuresis or decreased cumulative fluid balance in critically ill pediatric patients who underwent to MV for pulmonary causes.


Assuntos
Diurese/fisiologia , Decúbito Ventral/fisiologia , Respiração Artificial/efeitos adversos , Equilíbrio Hidroeletrolítico/fisiologia , Criança , Pré-Escolar , Estado Terminal , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Respiração Artificial/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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