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1.
Med Klin Intensivmed Notfmed ; 115(1): 37-42, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-29327197

RESUMO

Acute kidney injury (AKI) occurs in 30-50% of all intensive care patients. Renal replacement therapy (RRT) has to be initiated in 10-15%. The early in-hospital mortality is about 50%. Up to 20% of all survivors develop chronic kidney disease after intensive care discharge and progress to end-stage kidney disease within the next 10 years. For timely initiation of prophylactic or therapeutic interventions, it is crucial to exactly determine the actual kidney function, i. e., glomerular filtration rate (GFR), and to gain insight into the further development of kidney function. Traditionally, renal function has been estimated using serum levels of creatinine or urea. Unfortunately, both are notoriously unreliable and insensitive in intensive care patients. Cystatin C has fewer non-GFR determinants when compared to creatinine and is more sensitive and accurate to detect early decreases of GFR. At present, new functional tests are discussed, namely the furosemide stress test (FST) and renal functional reserve (RFR). The FST consists of an intravenous infusion of 1.0-1.5 mg/kgBW furosemide to critically ill patients with AKI. An increase in urine output to >100 ml/h is indicative of a GFR >20 ml/min and almost certainly excludes progression to AKI stage III and need for RRT. Estimation of RFR can be made by short-term oral or intravenous administration of a high protein load. A subsequent increase in GFR defines the presence and the magnitude of functional reserve which can be activated. Loss of RFR is an indicator of loss of functioning nephron mass and incomplete recovery following AKI. Both FST and RFR can help to improve diagnosis and care of high-risk patients with acute and chronic kidney disease.


Assuntos
Lesão Renal Aguda , Diuréticos , Furosemida , Testes de Função Renal , Lesão Renal Aguda/diagnóstico , Creatinina , Diuréticos/administração & dosagem , Furosemida/administração & dosagem , Humanos , Rim/fisiopatologia , Terapia de Substituição Renal
2.
Crit Care Resusc ; 21(4): 258-64, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31778632

RESUMO

OBJECTIVE: To compare the physiological and biochemical effects of a single intravenous dose of furosemide or acetazolamide in critically ill patients. DESIGN: Single centre, pilot randomised controlled trial. SETTING: Large tertiary adult intensive care unit (ICU). PARTICIPANTS: Twenty-six adult ICU patients deemed to require diuretic therapy. INTERVENTION: Single dose of intravenous 40 mg furosemide or 500 mg acetazolamide. MAIN OUTCOME MEASURES: Data were collected on urine output, cumulative fluid balance, and serum and urine biochemistry for 6 hours before and 6 hours after diuretic administration. RESULTS: Study patients had a median age of 55 years (IQR, 50-66) and median APACHE III score of 44 (IQR, 37-52). Furosemide caused a much greater increase in-urine output and much greater median mass chloride excretion (121.7 mmol [IQR, 81.1-144.6] v 23.3 mmol [IQR, 20.4-57.3]; P < 0.01) than acetazolamide. Furosemide also resulted in a progressively more negative fluid balance while acetazolamide resulted in greater alkalinisation of the urine (change in median urinary pH, +2 [IQR, 1.75-2.12] v 0 [IQR, 0-0.5]; P = 0.02). In keeping with this effect, furosemide alkalinised and acetazolamide acidified plasma (change in median serum pH, +0.03 [IQR, 0.01-0.04] v -0.01 [IQR, -0.04 to 0]; P = 0.01; change in median serum HCO3-, +1.5 mmol/L [IQR, 0.75-2] v -2 mmol/L [IQR, -3 to 0]; P < 0.01). CONCLUSIONS: Furosemide is a more potent diuretic and chloriuretic agent than acetazolamide in critically ill patients, and achieves a threefold greater negative fluid balance. Compared with acetazolamide, furosemide acidifies urine and alkalinises plasma. Our findings imply that combination therapy might be a more physiological approach to diuresis in critically ill patients.


Assuntos
Acetazolamida/farmacologia , Acetazolamida/farmacocinética , Estado Terminal/terapia , Diuréticos/farmacologia , Diuréticos/farmacocinética , Furosemida/farmacologia , Furosemida/farmacocinética , Acetazolamida/administração & dosagem , Adulto , Idoso , Diuréticos/administração & dosagem , Eletrólitos/sangue , Furosemida/administração & dosagem , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento , Urodinâmica/efeitos dos fármacos , Equilíbrio Hidroeletrolítico/efeitos dos fármacos
3.
Int J Clin Pharmacol Ther ; 57(12): 603-606, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31657712

RESUMO

Residual renal function and diuresis preservation are associated with improved volume control and lower mortality in peritoneal dialysis (PD). Loop diuretics are used to maintain diuresis, although their optimal dosage remains unclear. This study aimed to compare the pharmacodynamics of a 250-mg and a 500-mg dose of oral furosemide in PD patients. 12 patients with a diuresis > 100 mL per day were randomized in a crossover pattern to successively receive an oral dose of 250 mg and 500 mg of furosemide. Twelve-hour natriuresis and diuresis were measured before and after each furosemide dose. Fractional excretion of sodium (FENa) and absolute sodium excretion increased after each dose, although these rises were not statistically significantly different (5.8% (250 mg) vs. 6.9% (500 mg), p = 0.57 for FENa and 42.6 mmol/12h (250 mg) vs. 70.8 mmol/12h (500 mg), p = 0.07 for absolute sodium excretion). Urinary volume was significantly increased after the 500-mg dose, whilst the difference did not reach statistical significance after the 250-mg dose. Furthermore, the higher dose was associated with a greater increase in diuresis than the lower dose (226 mL (250 mg) vs. 522 mL (500 mg), p = 0.04). Furosemide could be used at oral single doses reaching 500 mg in PD patients requiring greater volume control.


Assuntos
Diuréticos/administração & dosagem , Diuréticos/farmacocinética , Furosemida/administração & dosagem , Furosemida/farmacocinética , Diálise Peritoneal , Diurese , Humanos , Natriurese
5.
J Vet Intern Med ; 33(5): 2319-2326, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31397944

RESUMO

BACKGROUND: Public pressure exists in the United States to eliminate race-day furosemide administration despite its efficacy in decreasing the severity of equine exercise pulmonary hemorrhage (EIPH). No effective alternative prophylaxis strategies have been identified. OBJECTIVE: To investigate alternative protocols to race-day furosemide that might mitigate EIPH. ANIMALS: Seven fit Thoroughbreds with recent EIPH. METHODS: Double-blinded placebo-controlled Latin square crossover using a treadmill followed by a blinded placebo-controlled crossover study at a racetrack. First, horses exercised supramaximally to fatigue 24 hours after initiating 5 EIPH prophylaxis protocols: 0.5 and 1.0 mg/kg furosemide IV 24 hours pre-exercise with and without controlled access to water, and 24 hour controlled access to water. Effects were compared to those measured after giving a placebo 24 hours pre-exercise, and 0.5 mg/kg furosemide IV 4 hours pre-exercise. Bronchoalveolar lavage (BAL) erythrocyte count was determined 45-60 minutes postexercise after endoscopy to assign an EIPH score. Data were analyzed using linear mixed effects models. The most promising protocol from the treadmill study was further evaluated in 6 horses using endoscopy and BAL after 1100 m simulated races. RESULTS: Intravenous furosemide (0.5 mg/kg) administered 24 hours pre-exercise combined with controlled access to water decreased the severity of EIPH on the treadmill and at the racetrack. CONCLUSION AND CLINICAL IMPORTANCE: Administering 0.5 mg/kg furosemide 24 hours pre-racing combined with controlling water intake may be a strategy to replace race-day furosemide administration for the management of EIPH. A larger study is indicated to further evaluate whether this protocol significantly mitigates EIPH severity.


Assuntos
Furosemida/farmacologia , Hemorragia/veterinária , Doenças dos Cavalos/prevenção & controle , Animais , Líquido da Lavagem Broncoalveolar/citologia , Estudos Cross-Over , Diuréticos/administração & dosagem , Diuréticos/farmacologia , Contagem de Eritrócitos , Feminino , Furosemida/administração & dosagem , Hemorragia/prevenção & controle , Cavalos , Pneumopatias/prevenção & controle , Pneumopatias/veterinária , Masculino
7.
AAPS PharmSciTech ; 20(5): 208, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31161450

RESUMO

Individualized medicines for pediatrics are a useful alternative if there is no correct dosage marketed for this segment (easy to swallow, adequate volume and content, correct composition for pediatrics, good organoleptic properties, etc.). Its validation process must ensure quality testing: its content uniformity, physical (homogeneity after shaking), chemical, and microbiological stability. Some of these attributes are checked by the recommendations of European Pharmacopoeia (Ph. Eur.), International Conference of Harmonization (ICH), and National Formularies but others are not. The aim of this study is to develop a general high-demanding strategy to ensure the final quality of liquid dosage forms testing and developing standard operating processes (SOPs) for the elaboration of individualized oral liquid medicines for pediatric use. Furosemide was used as an example of the validation of an individualized liquid solution for pediatric use. Three SOPs were selected according to their composition and the recommendations of liquid dosage forms for pediatric use. Quality attributes according to National Formularies, Ph. Eur., and ICH were tested: pH, organoleptic properties, uniformity of mass of delivered dose from multidose containers, and chemical stability. In this study, a general high-demanding strategy was elaborated to validate oral liquid dosage forms, including validation of the analytical method used to test their quality. A second part focuses on the elaboration of liquid formulations for pediatrics with the highest standards of quality taking into account CQAs that were not contemplated by official compendial such as content uniformity and physical stability.


Assuntos
Excipientes/normas , Furosemida/normas , Pediatria/normas , Medicina de Precisão/normas , Administração Oral , Criança , Diuréticos/administração & dosagem , Diuréticos/normas , Composição de Medicamentos/métodos , Composição de Medicamentos/normas , Excipientes/administração & dosagem , Furosemida/administração & dosagem , Humanos , Pediatria/métodos , Soluções Farmacêuticas/administração & dosagem , Soluções Farmacêuticas/normas , Medicina de Precisão/métodos
8.
Medicine (Baltimore) ; 98(21): e15747, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124957

RESUMO

In chronic kidney disease (CKD), the design of the parenteral nutrition (PN) regimen becomes more challenging where only individualized PN is appropriate, coupled with the increased risk of unintended interactions with diuretic therapy. In an effort to ensure safe therapy in the home, we assessed the physical stability of bespoke PN formulations intended for use in CKD in the simultaneous presence of Y-site compatibility of furosemide and torasemide. The patient's daily needs were determined based on both metabolic demands as well as the demand for fluids.Complete admixtures were subjected to physical stability analysis consisting of visual inspection, a validated light microscope method, pH measurement, zeta potential measurement, and characterization of oily globule size distribution. Y-site compatibility of furosemide and torasemide with the formulated admixtures was also performed.The total parenteral admixture was stable over 7 days at +4°C and 24 h at +25°C and compatible via the Y-line together with furosemide and torasemide over 12 h at +25°C.The stability assessment guarantees the safety and efficiency of home PN with loop diuretics therapy in CKD patients. This means that these patients do not need long hospitalization and they can be safely treated at home. Furthermore, this study proved that torasemide is the same safety diuretic as furosemide, which has a great impact on clinical practice.


Assuntos
Nutrição Parenteral Total no Domicílio/métodos , Insuficiência Renal Crônica/terapia , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Inibidores de Simportadores de Cloreto de Sódio e Potássio/química , Administração Intravenosa , Incompatibilidade de Medicamentos , Furosemida/administração & dosagem , Furosemida/química , Humanos , Concentração de Íons de Hidrogênio , Tamanho da Partícula , Torasemida/administração & dosagem , Torasemida/química
10.
J Vet Emerg Crit Care (San Antonio) ; 29(3): 279-287, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30983126

RESUMO

OBJECTIVE: To describe the frequency of renal tubular vacuolization (RTV) as a surrogate of osmotic nephrosis and assess hyperosmolar agents as predictors of RTV severity. DESIGN: Retrospective study (February 2004-October 2014). SETTING: Veterinary teaching hospital. ANIMALS: Fifty-three client-owned, critically ill dogs that had a postmortem examination. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The frequency, severity, and location of RTV were determined in small group of critically ill dogs postmortem. Logistic regression was performed to assess cumulative 6% HES (670/0.75) and mannitol dose as predictors for RTV severity with presenting serum creatinine concentration, cumulative furosemide dose, and duration of hospitalization as covariates. RTV was noted in 45 (85%) of 53 critically ill dogs and was most commonly located to the medullary rays (68%). Cumulative 6% HES (670/0.75) dose (P = 0.009) and presenting serum creatinine concentration (P = 0.027) were significant predictors of RTV severity. For every 1 mL/kg increase in 6% HES (670/0.75) dose that a dog received, there was 1.6% increased chance of having more severe RTV (OR 1.016; 95% CI 1.004-1.029). In addition, for every 88.4 µmol/L (1 mg/dL) increase in presenting serum creatinine, there was a 22.7% increased chance of having more severe RTV (OR 1.227; 95% CI 1.023-1.472). Cumulative mannitol (P = 0.548) and furosemide (P = 0.136) doses were not significant predictors of RTV severity. CONCLUSION: In a small group of critically ill dogs, there was a high frequency of RTV identified on postmortem examination. Administration of 6% HES (670/0.75) and presenting serum creatinine concentration were significant predictors of RTV severity. Larger prospective studies are needed to determine the etiology and significance of RTV in dogs.


Assuntos
Lesão Renal Aguda/veterinária , Doenças do Cão/patologia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/patologia , Animais , Autopsia/veterinária , Creatinina/sangue , Cuidados Críticos , Estado Terminal , Diuréticos/administração & dosagem , Doenças do Cão/sangue , Cães , Feminino , Furosemida/administração & dosagem , Hospitais Veterinários , Derivados de Hidroxietil Amido/administração & dosagem , Masculino , Substitutos do Plasma/administração & dosagem , Estudos Prospectivos , Estudos Retrospectivos
11.
Obstet Gynecol ; 133(4): 669-674, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870291

RESUMO

OBJECTIVE: To investigate the effect of intravenous administration of furosemide on the time to confirmation for ureteral patency during intraoperative cystoscopy. METHODS: In a double-blind randomized controlled trial, intravenous administration of furosemide 10 mg was compared with placebo (normal saline) to investigate the effect of furosemide on the time to confirmation for ureteral patency during intraoperative cystoscopy. The primary outcome was time to confirmation of ureteral patency. Secondary outcomes included adverse reaction to study medication and delayed diagnosis of ureteric injury. A sample size of 72 per group (N=144) was powered to detect a 3-minute difference in time to confirmation of ureteral patency between groups. RESULTS: From May 2017 to March 2018, 215 patients were eligible for inclusion and 150 were randomized, with 145 available for final evaluation. The two groups were similar in regard to baseline characteristics. The administration of intravenous furosemide 10 mg in a routine cystoscopy resulted in a shorter time to confirmation compared with the administration of the placebo (86.5 seconds, interquartile range 55.0-137.0 vs 165.0 seconds, interquartile range 77.0-280.0; P<.05). Furthermore, at any given time period, patients receiving intravenous administration of furosemide 10 mg were 2.3 times more likely to have ureteral patency confirmed compared with patients receiving normal saline (95% CI 1.59-3.23). There were no adverse events related to administration of intravenous furosemide and no delayed diagnoses of ureteric injury. CONCLUSION: Compared with placebo, intravenous administration of 10 mg furosemide at time of intraoperative cystoscopy resulted in a statistically significantly shorter time to confirmation of ureteral patency, though the clinical significance of this finding is small. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02960412.


Assuntos
Cistoscopia/métodos , Diuréticos/administração & dosagem , Furosemida/administração & dosagem , Ureter/lesões , Doenças Ureterais/diagnóstico , Idoso , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Placebos , Fatores de Tempo , Doenças Ureterais/etiologia , Procedimentos Cirúrgicos Urogenitais/efeitos adversos
12.
Pharmacol Rep ; 71(2): 351-356, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30831441

RESUMO

BACKGROUND: Drug-induced ototoxicity is still a main clinical problem in otolaryngology. It is widely known that aminoglycoside antibiotics combined with loop diuretics significantly contribute to permanent ototoxicity. The aim of this study was to find out whether ascorbic acid (vitamin C) is able to reverse or alleviate ototoxicity evoked by systemic (ip) administration of combination of amikacin and furosemide in experimental male albino Swiss mice. METHODS: Ototoxic combination of amikacin and furosemide was isobolographically evaluated based on the hearing threshold decreasing doses by 20% and 50% (TDD20 and TDD50), respectively. Linear regression analysis was used to determine the TDD20 and TDD50 values for amikacin, furosemide, vitamin C administered alone and in combination (at the fixed-ratio of 1:1). RESULTS: Vitamin C (in a dose of 500 mg/kg, ip) alleviated the impairment in hearing threshold evoked by combined ip administration of amikacin and furosemide (at the fixed-ratio of 1:1) in mice by reducing TDD50 values from 49.82 to 21.56 (p < 0.01). In contrast, vitamin C (500 mg/kg, ip) had no significant effect on TDD20 values for the combination of amikacin and furosemide at the fixed-ratio of 1:1. CONCLUSIONS: Vitamin C administered together with ototoxic drug combination of amikacin and furosemide reduced ototoxicity evoked by this two-drug combination in the experimental mice.


Assuntos
Amicacina/toxicidade , Ácido Ascórbico/farmacologia , Furosemida/toxicidade , Perda Auditiva/prevenção & controle , Amicacina/administração & dosagem , Animais , Antibacterianos/administração & dosagem , Antibacterianos/toxicidade , Ácido Ascórbico/administração & dosagem , Diuréticos/administração & dosagem , Diuréticos/toxicidade , Furosemida/administração & dosagem , Perda Auditiva/induzido quimicamente , Modelos Lineares , Masculino , Camundongos
13.
Medicine (Baltimore) ; 98(8): e14657, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813209

RESUMO

Recent studies reported that high doses of short-acting loop diuretics are associated with poor outcomes in patients with heart failure (HF). Short-acting loop diuretics have been shown to activate the renin-angiotensin system (RAS) and have no favorable effects on cardiac sympathetic nervous system (SNS) activity. The goal of this study is to investigate the relationship between daily doses of furosemide and the outcomes of patients with left ventricular dysfunction (LVD) from the viewpoint of cardiac SNS abnormalities using iodine-123-labeled metaiodobenzylguanidine (l-MIBG) myocardial scintigraphy.We enrolled 137 hospitalized patients (62.5 ±â€Š14.2 years old, 103 men) with LVEF < 45% who underwent l-MIBG myocardial scintigraphy. A delayed heart-to-mediastinum ratio (delayed HMR) was assessed using l-MIBG scintigraphy. Cardiac events were defined as cardiac death or re-hospitalization due to the deterioration of HF. Cox proportional hazard analysis was used to identify predictors of cardiac events.Cardiac events occurred in 57 patients in a follow-up period of 33.1 ±â€Š30 months. In a multivariate Cox proportional hazard analysis, delayed HMR and furosemide doses were identified as independent predictors of cardiac events (P = .0042, P = .033, respectively). Inverse probability of treatment weighting Cox modeling showed that the use of furosemide (≥40 mg /day) was associated with cardiac events with a hazard ratio of 1.96 (P = .003). In the Kaplan-Mayer analysis, the cardiac event-free survival rate was significantly lower in patients treated with high doses of furosemide (≥60 mg/day vs 40-60 mg/day vs <40 mg/day, the Log-rank test P < .0001). In a receiver-operating characteristic (ROC) analysis, the cut-off value for cardiac events was 40 mg/day of furosemide. The cardiac event-free rate was significantly lower in patients with delayed HMR <1.8 (median value) and receiving furosemide ≥40 mg/day than in other patients (the Log-rank test P < .0001). Significant differences in cardiac event rates according to furosemide doses among patients with delayed HMR <1.8 were observed among patients without ß-blocker therapy (P = .001), but not among those with ß-blocker therapy (P = .127).The present results indicate that a relationship exists between higher doses of furosemide and poor outcomes. The prognosis of HF patients with severe cardiac SNS abnormalities receiving high-dose short-acting loop diuretics is poor.


Assuntos
Furosemida , Insuficiência Cardíaca , Coração , Sistema Nervoso Simpático/efeitos dos fármacos , Disfunção Ventricular Esquerda , 3-Iodobenzilguanidina/farmacologia , Idoso , Disponibilidade Biológica , Relação Dose-Resposta a Droga , Feminino , Furosemida/administração & dosagem , Furosemida/efeitos adversos , Furosemida/farmacocinética , Coração/diagnóstico por imagem , Coração/inervação , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Compostos Radiofarmacêuticos/farmacologia , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Inibidores de Simportadores de Cloreto de Sódio e Potássio/efeitos adversos , Inibidores de Simportadores de Cloreto de Sódio e Potássio/farmacocinética , Volume Sistólico/efeitos dos fármacos , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/tratamento farmacológico
14.
Eur J Heart Fail ; 21(3): 337-341, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30741494

RESUMO

AIMS: To assess differences in diuretic dose requirements in patients treated with sacubitril/valsartan compared with enalapril in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF) trial. METHODS AND RESULTS: Overall, 8399 patients with New York Heart Association class II-IV heart failure and reduced LVEF were randomized to sacubitril/valsartan 200 mg bid or enalapril 10 mg twice daily. Loop diuretic doses were assessed at baseline, 6, 12, and 24 months, and furosemide dose equivalents were calculated via multiplication factors (2x for torsemide and 40x for bumetanide). Percentages of participants with reductions or increases in loop diuretic dose were determined. At baseline, 80.8% of participants were taking any diuretics (n = 6290 for loop diuretics, n = 496 for other diuretics); of those, recorded dosage data for loop diuretics were available on 5487 participants. Mean baseline furosemide equivalent doses were 48.2 mg for sacubitril/valsartan and 49.6 mg for enalapril (P = 0.25). Patients treated with sacubitril/valsartan were more likely to reduce diuretic dose and less likely to increase diuretic dose relative to those randomized to enalapril at 6, 12, 24 months post-randomization, with an overall decreased diuretic use of 2.0% (P = 0.02), 4.1% (P < 0.001), and 6.1% (P < 0.001) at 6, 12, and 24 months, respectively, with similar findings in an on-treatment analysis. CONCLUSION: Treatment with sacubitril/valsartan was associated with more loop diuretic dose reductions and fewer dose increases compared with enalapril, suggesting that treatment with sacubitril/valsartan may reduce the requirement for loop diuretics relative to enalapril in patients with heart failure with reduced ejection fraction.


Assuntos
Aminobutiratos , Enalapril , Furosemida , Insuficiência Cardíaca , Volume Sistólico , Tetrazóis , Idoso , Aminobutiratos/administração & dosagem , Aminobutiratos/farmacocinética , Antagonistas de Receptores de Angiotensina/administração & dosagem , Antagonistas de Receptores de Angiotensina/farmacocinética , Disponibilidade Biológica , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/estatística & dados numéricos , Enalapril/administração & dosagem , Enalapril/farmacocinética , Feminino , Furosemida/administração & dosagem , Furosemida/farmacocinética , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Pessoa de Meia-Idade , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Inibidores de Simportadores de Cloreto de Sódio e Potássio/farmacocinética , Tetrazóis/administração & dosagem , Tetrazóis/farmacocinética
15.
BMJ Case Rep ; 12(2)2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30787024

RESUMO

We present a case that illustrates the fluctuations in calcium levels to be expected while managing an infant with maternal gestational diabetes mellitus who also develops subcutaneous fat necrosis (SCFN). There is initial hypocalcaemia due to functional hypoparathyroidism, requiring judicious calcium replacement. But with increased extrarenal production of 1,25-dihydroxyvitamin D due to granulomatous inflammation of subcutaneous adipose tissue, hypercalcaemia ensues. With a self-limiting course, SCFN of the newborn has an excellent prognosis and resolves spontaneously. However, aberrations in serum calcium levels can manifest in life-threatening complications and must hence be closely monitored.


Assuntos
Gluconato de Cálcio/uso terapêutico , Necrose Gordurosa/patologia , Hipocalcemia/diagnóstico , Gordura Subcutânea/patologia , Administração Intravenosa , Administração Oral , Gluconato de Cálcio/administração & dosagem , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/complicações , Furosemida/administração & dosagem , Furosemida/uso terapêutico , Humanos , Hipercalcemia/induzido quimicamente , Hipercalcemia/tratamento farmacológico , Hipocalcemia/etiologia , Recém-Nascido , Masculino , Gravidez , Resultado do Tratamento
16.
BMJ Open ; 9(1): e022776, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30782685

RESUMO

OBJECTIVES: Cardiorenal syndrome (CRS) is the combination of acute heart failure syndrome (AHF) and renal dysfunction (creatinine clearance (CrCl) ≤60 mL/min). Real-life data were used to compare the management and outcome of AHF with and without renal dysfunction. DESIGN: Prospective, multicentre. SETTING: Twenty-six academic, community and regional hospitals in France. PARTICIPANTS: 507 patients with AHF were assessed in two groups according to renal function: group 1 (patients with CRS (CrCl ≤60 mL/min): n=335) and group 2 (patients with AHF with normal renal function (CrCl >60 mL/min): n=172). RESULTS: Differences were observed (group 1 vs group 2) at admission for the incidence of chronic heart failure (56.42% vs 47.67%), use of furosemide (60.9% vs 52.91%), insulin (15.52% vs 9.3%) and amiodarone (14.33% vs 4.65%); additionally, more patients in group 1 carried a defibrillator (4.78% vs 0%), had ≥2 hospitalisations in the last year (15.52% vs 5.81%) and were under the care of a cardiologist (72.24% vs 61.63%). Clinical signs were broadly similar in each group. Brain-type natriuretic peptide (BNP) and BNP prohormone were higher in group 1 than group 2 (1157.5 vs 534 ng/L and 5120 vs 2513 ng/mL), and more patients in group 1 were positive for troponin (58.2% vs 44.19%), had cardiomegaly (51.04% vs 37.21%) and interstitial opacities (60.3% vs 47.67%). The only difference in emergency treatment was the use of nitrates, (higher in group 1 (21.9% vs 12.21%)). In-hospital mortality and the percentage of patients still hospitalised after 30 days were similar between groups, but the median stay was longer in group 1 (8 days vs 6 days). CONCLUSIONS: Renal impairment in AHF should not limit the use of loop diuretics and/or vasodilators, but early assessment of pulmonary congestion and close monitoring of the efficacy of conventional therapies is encouraged to allow rapid and appropriate implementation of alternative therapies if necessary.


Assuntos
Síndrome Cardiorrenal/terapia , Diuréticos/administração & dosagem , Furosemida/administração & dosagem , Insuficiência Cardíaca/terapia , Rim/efeitos dos fármacos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Síndrome Cardiorrenal/mortalidade , Síndrome Cardiorrenal/fisiopatologia , Comorbidade , Desfibriladores , Gerenciamento Clínico , Diuréticos/efeitos adversos , Feminino , França/epidemiologia , Furosemida/efeitos adversos , Taxa de Filtração Glomerular , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar , Hospitalização , Humanos , Rim/fisiopatologia , Masculino , Estudos Prospectivos
17.
Mayo Clin Proc ; 94(2): 347-355, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30711130

RESUMO

Abdominal wall pain (AWP) is a common and underrecognized cause of chronic abdominal pain. The etiology of AWP varies. History and physical examination are critical to an accurate diagnosis of AWP. Trigger point injection using either a corticosteroid, a local anesthetic, or a combination of both often gives relief of pain and is of diagnostic and therapeutic value. Increased awareness of AWP as a cause of chronic, nonvisceral abdominal pain can prevent fruitless searches for intra-abdominal pathology and reduce medical costs.


Assuntos
Dor Abdominal/etiologia , Hiperpotassemia/complicações , Insuficiência Renal Crônica/complicações , Dor Abdominal/sangue , Dor Abdominal/diagnóstico , Parede Abdominal , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Gluconato de Cálcio/administração & dosagem , Diagnóstico Diferencial , Diuréticos/administração & dosagem , Furosemida/administração & dosagem , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/terapia , Infusões Intravenosas , Lisinopril/uso terapêutico , Masculino , Potássio/sangue , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/terapia
20.
Nephron ; 141(4): 236-248, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30636249

RESUMO

BACKGROUND: Delayed graft function (DGF) could worsen early and long-term outcomes of kidney transplantation (KT). DGF is caused by several pre-transplantation and perioperative factors in both donors and recipients. At present, there are no biomarkers or tests during the immediate post-KT period that can accurately predict the development of DGF. MATERIALS AND METHODS: This prospective study was conducted in deceased donor KT (DDKT) at King Chulalongkorn Memorial Hospital, Thailand. All recipients underwent furosemide stress test (FST) by receiving a single dose of intravenous furosemide, 1.5 mg/kg at 3 h after allograft reperfusion. We determined the correlations between DGF (requiring dialysis within the first week after transplantation) and the values of urine volume recorded hourly after FST until 6 h, the parameters of postoperative dynamic tests, including resistive index (RI) of renal arteries and effective renal plasma flow (ERPF), and urine neutrophil gelatinase-associated lipocalin (NGAL). RESULTS: Of the 59 total DDKT recipients enrolled, 24 developed DGF. The FST is a more accurate biomarker than urine NGAL, RI of renal arteries, and ERPF in the prediction of DGF. The 4-h urine volume less than 350 mL (FST non-responsive) was the best cut-off value in predicting DGF with 87.5% sensitivity, 82.9% specificity, and 82.5% accuracy. Multiple logistic regression analyses showed an odds ratio of 0.993 (0.986-0.999, p = 0.035) for the 4-h urine volume to predict DGF. CONCLUSIONS: The FST is a simple and accurate biomarker for predicting DGF in early post-KT period. Close monitoring and well prepared dialysis are suggested in patients with urine volume < 350 mL after 4 h of FST. The FST non-responsive patients could be the target for further DGF preventive intervention. ClinicalTrials.gov identifier: NCT03071536.


Assuntos
Função Retardada do Enxerto , Diuréticos/administração & dosagem , Furosemida/administração & dosagem , Transplante de Rim , Adulto , Biomarcadores/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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