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1.
Medicine (Baltimore) ; 99(25): e20831, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569232

RESUMO

The objective was to investigate the association of different hydration doses and its effect on renal function in patients with primary osteoporosis treated with zoledronic acid.The subjects with primary osteoporosis treated with zoledronic acid at the First Affiliated Hospital of Chongqing Medical University, China, from January 2015 to December 2018 were included in this study. The subjects were classified according to different hydration doses. Renal function indexes before and after treatment were collected and adverse reactions recorded to analyze the changes in renal function associated with different hydration doses.The choice of the hydration dose treated with zoledronic acid deserves attention. The lower hydration dose is, the greater impact on renal function can be caused.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Rim/fisiopatologia , Osteoporose/tratamento farmacológico , Soluções para Reidratação/uso terapêutico , Ácido Zoledrônico/uso terapêutico , Idoso , Conservadores da Densidade Óssea/efeitos adversos , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Masculino , Osteoporose/fisiopatologia , Soluções para Reidratação/administração & dosagem , Estudos Retrospectivos , Ácido Zoledrônico/efeitos adversos
2.
J Glob Health ; 10(1): 010503, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32257158

RESUMO

Diarrheal disease remains a leading cause of child death globally, especially in low and middle-income countries. Use of oral rehydration solution (ORS) for treatment of diarrhea in children, a very cost-effective intervention, remains below 50% in many countries. Here we use a multi-level longitudinal model to reveal important predictors of ORS use at the national level. The findings suggest that increasing government effectiveness along with increased implementation and affordability of community-based health programs can lead to substantial increases in ORS use. Key informant interviews with national health leaders in countries that significantly improved ORS coverage support these quantitative findings.


Assuntos
Diarreia/terapia , Hidratação , Soluções para Reidratação/uso terapêutico , Criança , Pré-Escolar , Planejamento em Saúde Comunitária , Humanos , Programas Nacionais de Saúde , Soluções para Reidratação/administração & dosagem
3.
Ann Pharmacother ; 54(1): 5-13, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31364382

RESUMO

Background: The optimal resuscitative fluid remains controversial. Objective: To assess the association between crystalloid fluid and outcomes in critically ill adults. Methods: Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, and Cochrane Central Register for Controlled Trials were searched from inception through July 2019. Cohort studies and randomized trials of critically ill adults provided predominantly nonperioperative fluid resuscitation with balanced crystalloids or 0.9% sodium chloride (saline) were included. Results: Thirteen studies (n = 30 950) were included. Balanced crystalloids demonstrated lower hospital or 28-/30-day mortality (risk ratio [RR] = 0.86; 95% CI = 0.75-0.99; I2 = 82%) overall, in observational studies (RR = 0.64; 95% CI = 0.41-0.99; I2 = 63%), and approached significance in randomized trials (RR = 0.94; 95% CI = 0.88-1.02; I2 = 0%). New acute kidney injury occurred less frequently with balanced crystalloids (RR = 0.91; 95% CI = 0.85-0.98; I2 = 0%), though progression to renal replacement therapy was similar (RR = 0.91; 95% CI = 0.79-1.04; I2 = 38%). In the sepsis cohort, odds of hospital or 28-/30-day mortality were similar, but the odds of major adverse kidney events occurring in the first 30 days were less with balanced crystalloids than saline (OR = 0.78; 95% CI = 0.66-0.91; I2 = 42%). Conclusion and Relevance: Resuscitation with balanced crystalloids demonstrated lower hospital or 28-/30-day mortality compared with saline in critically ill adults but not specifically those with sepsis. Balanced crystalloids should be provided preferentially to saline in most critically ill adult patients.


Assuntos
Soluções Cristaloides/administração & dosagem , Hidratação/métodos , Soluções para Reidratação/administração & dosagem , Sepse/terapia , Cloreto de Sódio/administração & dosagem , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/terapia , Adulto , Estado Terminal , Soluções Cristaloides/efeitos adversos , Humanos , Tempo de Internação , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Soluções para Reidratação/efeitos adversos , Terapia de Substituição Renal , Sepse/mortalidade , Cloreto de Sódio/efeitos adversos
4.
J Coll Physicians Surg Pak ; 29(12): 1179-1182, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31839091

RESUMO

OBJECTIVE: To compare the mean number of stools per day in children treated with combination of probiotic (lactobacillus rhamnosus) with ORS and ORS only in acute diarrhea. STUDY DESIGN: Randomised control trial. PLACE AND DURATION OF STUDY: Department of Pediatric Medicine, PNS Shifa Hospital, from February to July, 2017. METHODOLOGY: A total of 80 children with acute watery diarrhea were randomly divided into two groups. Forty patients in first group were given probiotic with ORS and 40 patients in second group (control) were given ORS only. All children were monitored from 0 day (inclusion day) to next 5 days. Demographic data was collected regarding age, gender, weight and frequency of loose stools. Dehydration status was also assessed at the time of admission by the attending physician. Data was collected through a structured proforma. RESULTS: The average age of the children was 24.3 ±18.65 months. There were 47 (58.8%) males and 33 (41.3%) females. Mean number of stools was significantly low in those patients who were treated with combination of probiotic (lactobacillus rhamnosus) with ORS than those who were treated with ORS only in acute diarrhea (3.25 ±1.13 vs. 4.13 ±0.79; p<0.001). CONCLUSION: Probiotics are found to be significantly more effective in reducing the stool frequency in acute diarrhea.


Assuntos
Desidratação/tratamento farmacológico , Diarreia/tratamento farmacológico , Eletrólitos/administração & dosagem , Probióticos/administração & dosagem , Doença Aguda , Administração Oral , Pré-Escolar , Desidratação/etiologia , Diarreia/complicações , Feminino , Seguimentos , Humanos , Lactente , Masculino , Soluções para Reidratação/administração & dosagem , Estudos Retrospectivos , Resultado do Tratamento
5.
J Spec Oper Med ; 19(3): 76-81, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539437

RESUMO

BACKGROUND: In recent combat operations, 5% to 15% of casualties sustained thermal injuries, which require resource-intensive therapies. During prolonged field care or when caring for patients in a multidomain battlefield, delayed transport will complicate the challenges that already exist in the burn population. A lack of resources and/or vascular access in the future operating environment may benefit from alternative resuscitation strategies. The objectives of the current report are 1) to briefly review actual and potential advantages/caveats of resuscitation with enteral fluids and 2) to present new data on palatability of oral rehydration solutions. METHODS: A review of the literature and published guidelines are reported. In addition, enlisted US military active duty Servicemembers (N = 40) were asked to taste/rank five different oral rehydration solutions on several parameters. RESULTS AND CONCLUSIONS: There are several operational advantages of using enteral fluids including ease of administration, no specialized equipment needed, and the use of lightweight sachets that are easily reconstituted/ administered. Limited clinical data along with slightly more extensive preclinical studies have prompted published guidelines for austere conditions to indicate consideration of enteral resuscitation for burns. Gatorade® and Drip-Drop® were the overall preferred rehydration solutions based on palatability, with the latter potentially more appropriate for resuscitation. Taken together, enteral resuscitation may confer several advantages over intravenous fluids for burn resuscitation under resource-poor scenarios. Future research needs to identify what solutions and volumes are optimal for use in thermally injured casualties.


Assuntos
Queimaduras/terapia , Hidratação/métodos , Medicina Militar , Humanos , Soluções para Reidratação/administração & dosagem , Soluções para Reidratação/provisão & distribução , Paladar , Resultado do Tratamento
6.
J Trop Pediatr ; 65(6): 583-591, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31330028

RESUMO

Oral rehydration solution (ORS) is the mainstay of treatment of acute watery diarrhoea, but it is underutilized in many hospitals, resulting in children with moderate degrees of dehydration being unnecessarily hospitalized and receiving intravenous fluids. We aimed to assess the utility of an ORS tolerance test on initial presentation to an emergency department, and determine the volume of ORS a child with diarrhoea and moderate dehydration needed to tolerate to be successfully managed at home. One hundred and twenty-nine children with acute watery diarrhoea and moderate dehydration were given ORS and observed in a Children's Emergency Department (CED) over a period of 2-4 h. Patients were admitted, kept in the CED for further management or discharged, based on the assessment of oral intake and the clinical judgement of the treating health workers. Seventy-nine (61.2%) patients tolerated ORS well. They drank a median [interquartile range (IQR)] of 24.4 ml (IQR 12.5-28.8) ml/kg, were judged to have passed the ORS test and were discharged to continue oral rehydration treatment at home. At follow-up on days 2 and 5, 63/79 (79.7%) children had improved, were adequately hydrated and the diarrhoea had reduced. Sixteen of the 79 (20.3%) failed oral home treatment, with persisting diarrhoea, vomiting, hypokalaemia and/or weakness. The 63 who succeeded had tolerated a median of 25.8 (IQR 18.4-30.0) ml/kg of ORS in the CED, whilst the 16 who failed oral home treatment had tolerated 11.1 (IQR 9.1-23.0) ml/kg ORS (p < 0.001).


Assuntos
Desidratação/terapia , Diarreia/terapia , Hidratação , Soluções para Reidratação/administração & dosagem , Doença Aguda , Pré-Escolar , Desidratação/diagnóstico , Desidratação/etiologia , Diarreia/complicações , Diarreia Infantil/etiologia , Diarreia Infantil/terapia , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Educação em Saúde , Humanos , Lactente , Masculino , Papua Nova Guiné , Abastecimento de Água
7.
Nutrients ; 11(7)2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31261904

RESUMO

Oral rehydration solutions (ORS) are specifically formulated with an osmolality to optimize fluid absorption. However, it is unclear how many ORS products comply with current World Health Organization (WHO) osmolality guidelines and the osmotic shelf-life stability is not known. Therefore, the purpose of this investigation was to examine the within and between ORS product osmolality variation in both pre-mixed and reconstituted powders. Additionally, the osmotic stability was examined over time. The osmolality of five different pre-mixed solutions and six powdered ORS products were measured. Pre-mixed solutions were stored at room temperatures and elevated temperatures (31 °C) for two months to examine osmotic shelf stability. Results demonstrated that only one pre-mixed ORS product was in compliance with the current guidelines both before and after the prolonged storage. Five of the six powdered ORS products were in compliance with minimal inter-packet variation observed within the given formulations. This investigation demonstrates that many commercially available pre-mixed ORS products do not currently adhere to the WHO recommended osmolality guidelines. Additionally, due to the presence of particular sugars and possibly other ingredients, the shelf-life stability of osmolality for certain ORS products may be questioned. These findings should be carefully considered in the design of future ORS products.


Assuntos
Comércio , Armazenamento de Medicamentos , Soluções para Reidratação/química , Temperatura , Administração Oral , Comércio/normas , Estabilidade de Medicamentos , Armazenamento de Medicamentos/normas , Fidelidade a Diretrizes , Guias como Assunto , Concentração Osmolar , Controle de Qualidade , Soluções para Reidratação/administração & dosagem , Soluções para Reidratação/normas , Fatores de Tempo
8.
JBJS Case Connect ; 9(2): e0318, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167220

RESUMO

CASE: A 31-year-old male sustained acute compartment syndrome to his left leg after a low-energy fall and required a 4-compartment fasciotomy release. His immediate postoperative course was complicated by acute tubular necrosis (ATN) with creatinine elevated to 4.89 mg/dL from rhabdomyolysis. ATN was managed with aggressive hydration, sodium bicarbonate, and alkaline diuresis, and his creatinine levels improved. CONCLUSIONS: ATN from rhabdomyolysis is a rare complication of compartment syndrome that requires high suspicion and timely treatment to prevent further nephrotoxicity and the resultant increases in mortality. It is imperative for orthopedic surgeons to be aware of this potential complication.


Assuntos
Lesão Renal Aguda/etiologia , Síndromes Compartimentais/complicações , Síndromes Compartimentais/cirurgia , Rabdomiólise/complicações , Lesão Renal Aguda/patologia , Lesão Renal Aguda/terapia , Adulto , Assistência ao Convalescente , Síndromes Compartimentais/diagnóstico por imagem , Creatinina/sangue , Diurese/fisiologia , Fasciotomia/métodos , Humanos , Masculino , Complicações Pós-Operatórias/patologia , Soluções para Reidratação/administração & dosagem , Bicarbonato de Sódio/administração & dosagem , Resultado do Tratamento
9.
Med Hypotheses ; 127: 66-70, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31088651

RESUMO

Immune checkpoint inhibitor (ICPi) therapy has transformed the way we treat cancer. However, its immune related adverse events (irAEs) can be debilitating and life threatening. Immune therapy-induced diarrhea (ITID) is one of the most commonly encountered irAEs and can lead to expensive and prolonged hospitalizations. The current standard of care for grade 3 or 4 ITID involves ICPi discontinuation, the initiation of steroids, and infliximab for refractory disease. This treatment regimen reverses the desired anti-tumor effect of ICPis, can lead to side effects, and is cost-ineffective. We report the first case of the successful treatment of grade 3 ITID with steroids and an amino acid-based oral rehydration solution (AA-ORS), enterade. Research suggests that AA-ORS may be used to reduce diarrhea and adequately hydrate patients, in contrast to glucose-based oral rehydration solutions, which have been implicated as a contributing factor to diarrhea in cancer patients. We hypothesize that an AA-ORS may mitigate ITID via safer and more economically viable means than the current standard of care, but more controlled trials are needed to test this hypothesis.


Assuntos
Antineoplásicos/efeitos adversos , Diarreia/induzido quimicamente , Neoplasias/tratamento farmacológico , Soluções para Reidratação/administração & dosagem , Administração Oral , Aminoácidos , Antineoplásicos/uso terapêutico , Bicarbonatos/administração & dosagem , Ensaios Clínicos como Assunto , Colite/imunologia , Colite/prevenção & controle , Feminino , Glucose/administração & dosagem , Humanos , Imunoterapia , Pessoa de Meia-Idade , Cloreto de Potássio/administração & dosagem , Guias de Prática Clínica como Assunto , Cloreto de Sódio/administração & dosagem , Esteroides/uso terapêutico
10.
Rev. esp. anestesiol. reanim ; 66(5): 259-266, mayo 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187470

RESUMO

Introducción: Los protocolos ERAS de cirugía colorrectal son programas multimodales cuyo objetivo es minimizar la respuesta al estrés quirúrgico y acelerar así la recuperación del paciente. Un aspecto fundamental es el manejo intraoperatorio de fluidos, ya que tanto la hipovolemia como la hipervolemia se han relacionado con complicaciones. Los protocolos de fluidoterapia guiada por objetivos se basan en la monitorización de parámetros hemodinámicos para guiar la administración de fluidos y optimizar la perfusión tisular. Objetivo: Comparar la aplicación de 2regímenes de fluidoterapia (balance cero vs. optimización hemodinámica) en pacientes intervenidos mediante cirugía colorrectal laparoscópica ERAS, en cuanto a la aparición de infección del sitio quirúrgico, dehiscencia anastomótica, íleo, náuseas y vómitos postoperatorios y cambios en la función renal. Materiales y métodos: Estudio observacional retrospectivo, para comparar la aplicación de 2regímenes de fluidoterapia en pacientes intervenidos mediante cirugía colorrectal laparoscópica ERAS y estudiar la tasa de complicaciones postoperatorias?. Resultados: Recogimos datos de 128 pacientes, en 43 (33,6%) se empleó la fluidoterapia intraoperatoria habitual o balance cero, y en 85 (66,4%) la fluidoterapia guiada por objetivos. El total de fluidos administrados fue menor en el grupo de optimización. La tasa de complicaciones sépticas postoperatorias (infección del sitio quirúrgico o dehiscencia anastomótica) e íleo fue mayor en el grupo balance cero, y la aparición de náuseas y vómitos postoperatorios fue menor en el grupo de optimización; todos estos resultados fueron estadísticamente significativos. No observamos diferencias en la estancia hospitalaria, diuresis intraoperatoria ni en el filtrado glomerular estimado. Conclusión: La aplicación de un algoritmo de fluidoterapia guiada por objetivos puede conseguir una reducción en la cantidad de fluidos administrada, con una menor incidencia en las complicaciones analizadas, sin afectar a la función renal


Introduction: Enhanced recovery after surgery protocols (ERAS) are used in peri-operative care to reduce the stress response to surgical aggression. As fluid overload has been associated with increased morbidity and delayed hospital discharge, a major aspect of this is fluid management. Intra-operative goal-directed fluid protocols have been shown to reduce post-operative complications, particularly in high risk patients.?. Objective: To compare 2fluid therapy models (zero-balance versus goal-directed fluid therapy) in patients who were scheduled for laparoscopic colorectal surgery within an ERAS program, recording the rate of complications such as surgical site infection, ileus, post-operative náusea and vomiting, and variability of the estimated glomerular filtration rate (eGFR). Materials and methods: An observational, retrospective study was conducted including adults who were scheduled for elective laparoscopic colorectal surgery within an ERAS program, and to investigate the postoperative complication rate. Results: A total of 128 patients were included in this study; 43 (33.6%) in the zero-balance group and 85 (66.4%) in the goal-directed fluid therapy group. The total fluids administered was lower in the goal-directed fluid therapy group, as well as the incidence of post-operative complications (surgical site infection, anastomotic leak, ileus, and postoperative náusea and vomiting). No significant differences were found for length of stay, intra-operative urine output, and variability of the eGFR?. Conclusion: The results of this study show that by using a goal-directed fluid therapy algorithm, the total amount of fluids administered can be reduced, as well as obtaining a lower incidence of post-operative complications


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hidratação/métodos , Soluções para Reidratação/administração & dosagem , Neoplasias Colorretais/cirurgia , Laparoscopia/métodos , Terapia Combinada/métodos , Complicações Pós-Operatórias/epidemiologia , Hipovolemia/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
13.
J Vet Med Sci ; 81(2): 256-262, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30606893

RESUMO

Several manufacturers recommend to feed mixture comprising equal amounts of oral rehydration salt (ORS) solution and milk for diarrheic calves after milk withdrawal. Such a feeding method is expected to supply more nutrients and energy compared to feeding only the ORS solution. However, little is known about the effects of feeding milk diluted with ORS solution on calves' digestive process. This study examined the abomasal contents, volumes, and emptying rates in calves fed whole milk, milk diluted by 50% with ORS solution (50% ORS-milk), and ORS solution. Ultrasonography identified curds in the milk-fed calves, but not in the 50% ORS-milk-fed or the ORS-fed calves. The abomasal fluid of the 50% ORS-milk-fed calves contained not only ß-lactoglobulin but also α-casein (CN), ß-CN, and κ-CN, which were used for curd formation and undetectable in the milk-fed calves. Abomasal pH was relatively higher in the 50% ORS-milk-fed than that in the milk-fed calves. Abomasal emptying rates were significantly faster in the ORS-fed than in the 50% ORS-milk-fed and the milk-fed calves. These data indicate that the formation of abomasal curd is inhibited in the 50% ORS-milk-fed calves due to the resultant high abomasal pH and low κ-CN concentration. The 50% ORS-milk may not provide rehydration as quickly as the ORS solution. In conclusion, we do not recommend feeding 50% ORS-milk to calves.


Assuntos
Abomaso/efeitos dos fármacos , Doenças dos Bovinos/terapia , Diarreia/veterinária , Soluções para Reidratação/farmacologia , Abomaso/fisiologia , Ração Animal , Animais , Animais Recém-Nascidos/fisiologia , Bovinos , Diarreia/terapia , Esvaziamento Gástrico/efeitos dos fármacos , Esvaziamento Gástrico/fisiologia , Leite , Soluções para Reidratação/administração & dosagem , Fatores de Tempo
14.
Eur J Pediatr Surg ; 29(6): 539-544, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30650449

RESUMO

BACKGROUND: Infants are likely to develop anuria during laparoscopy which is uncommon in older patients. The reason for this susceptibility remains unknown. We compared the impact of CO2 pneumoperitoneum on renal perfusion and urine production in piglets compared with adolescent pigs. We furthermore investigated the effects of different resuscitation strategies. MATERIALS AND METHODS: Male piglets (n = 21) were divided into four groups: (a) infant controls (n = 5), (b) infants with crystalloid restitution (n = 6), (c) infants with colloidal restitution (n = 5), and (d) adolescents with crystalloid restitution (n = 5). Animals were ventilated, the central vessels and ureters were cannulated, and the animals were subjected to a 3-hour, 10 mm Hg CO2 pneumoperitoneum followed by 2-hour resuscitation. Renal perfusion was assessed by fluorescent microspheres and the rate of urine flow was measured. RESULTS: Urine production significantly decreased after insufflation only in the infant crystalloid and adolescent group, but not in controls or infants treated with colloids. In the infant crystalloid group, urine production remained at levels below 20% of baseline throughout the experiment. In this group, the renal perfusion dropped significantly after the beginning of the capnoperitoneum and remained significantly reduced throughout the experiment. CONCLUSION: Our data indicates that capnoperitoneum impairs renal perfusion and urine production in infants. In moderate-pressure capnoperitoneum, this effect cannot be compensated by application of crystalloids but with colloids.


Assuntos
Coloides/administração & dosagem , Soluções Cristaloides/administração & dosagem , Hidratação/métodos , Soluções para Reidratação/administração & dosagem , Animais , Modelos Animais de Doenças , Feminino , Humanos , Rim/fisiologia , Masculino , Perfusão/métodos , Pneumoperitônio Artificial/métodos , Suínos , Micção/efeitos dos fármacos
15.
J Appl Physiol (1985) ; 126(2): 422-430, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30496706

RESUMO

The aim of this study was to investigate the acute effect of hydration status on glycemic regulation in healthy adults and explore underlying mechanisms. In this randomized crossover trial, 16 healthy adults (8 men, 8 women) underwent an oral glucose tolerance test (OGTT) when hypohydrated and rehydrated after 4 days of pretrial standardization. One day before OGTT, participants were dehydrated for 1 h in a heat tent with subsequent fluid restriction (HYPO) or replacement (RE). The following day, an OGTT was performed with metabolic rate measurements and pre- and post-OGTT muscle biopsies. Peripheral quantitative computer tomography thigh scans were taken before and after intervention to infer changes in cell volume. HYPO (but not RE) induced 1.9% (SD 1.2) body mass loss, 2.9% (SD 2.7) cell volume reduction, and increased urinary hydration markers, serum osmolality, and plasma copeptin concentration (all P ≤ 0.007). Fasted serum glucose [HYPO 5.10 mmol/l (SD 0.42), RE 5.02 mmol/l (SD 0.40); P = 0.327] and insulin [HYPO 27.1 pmol/l (SD 9.7), RE 27.6 pmol/l (SD 9.2); P = 0.809] concentrations were similar between HYPO and RE. Hydration status did not alter the serum glucose ( P = 0.627) or insulin ( P = 0.200) responses during the OGTT. Muscle water content was lower before OGTT after HYPO compared with RE [761 g/kg wet wt (SD 13) vs. 772 g/kg wet wt (SD 18) RE] but similar after OGTT [HYPO 779 g/kg wet wt (SD 15) vs. RE 780 g/kg wet wt (SD 20); time P = 0.011; trial × time P = 0.055]. Resting energy expenditure was similar between hydration states (stable between -1.21 and 5.94 kJ·kg-1·day-1; trial P = 0.904). Overall, despite acute mild hypohydration increasing plasma copeptin concentrations and decreasing fasted cell volume and muscle water, we found no effect on glycemic regulation. NEW & NOTEWORTHY We demonstrated for the first time that an acute bout of hypohydration does not impact blood sugar control in healthy adults. Physiological responses to mild hypohydration (<2% body mass loss) caused an elevation in copeptin concentrations similar to that seen in those with diabetes as well as reducing cell volume by ~3%; both of these changes had been hypothesized to cause a higher blood sugar response.


Assuntos
Glicemia/metabolismo , Desidratação/sangue , Músculo Esquelético/metabolismo , Estado de Hidratação do Organismo , Adulto , Biomarcadores/sangue , Composição Corporal , Estudos Cross-Over , Desidratação/fisiopatologia , Desidratação/terapia , Metabolismo Energético , Feminino , Hidratação , Teste de Tolerância a Glucose , Voluntários Saudáveis , Humanos , Insulina/sangue , Masculino , Músculo Esquelético/diagnóstico por imagem , Projetos Piloto , Soluções para Reidratação/administração & dosagem , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Pediatr Emerg Care ; 35(10): 692-695, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28678057

RESUMO

BACKGROUND: Dehydration, mainly due to diarrheal illnesses, is a leading cause of childhood mortality worldwide. Intravenous (IV) therapy is the standard of care for patients who were unable to tolerate oral rehydration; however, placing IVs in fragile, dehydrated veins can be challenging. Studies in resource-rich settings comparing hyaluronidase-assisted subcutaneous rehydration with standard IV rehydration in children have demonstrated several benefits of subcutaneous rehydration, including time and success of line placement, ease of use, satisfaction, and cost-effectiveness. METHODS: A single-arm trial assessing the feasibility of hyaluronidase-assisted subcutaneous resuscitation for the treatment of moderately to severely dehydrated individuals in western Kenya was conducted. Children aged 2 months or older who presented with moderately to severely dehydration clinically warranting parenteral rehydration and had at least 2 failed IV attempts were eligible. Study staff received training on standard dehydration management and hyaluronidase infusion processes. Children received all other standards of care. They were monitored from presentation and through discharge, with a 1-week phone follow-up. Predischarge surveys were completed by caregivers, and semistructured interviews with providers were performed. RESULTS: A total of 51 children were enrolled (median age, 13.0 months; interquartile range of 18 months). Fifty-one patients (100%) had severe dehydration. The median length of subcutaneous infusion was 3.0 hours (interquartile range [IQR], 2.95). The median total subcutaneous infusion was 700.0 mL (IQR, 420 mL). Median time to resolution of moderate to severe dehydration symptoms was 3.0 hours (IQR, 2.95 hours). There were no significant complications. CONCLUSIONS: Hyaluronidase-assisted subcutaneous resuscitation is a feasible alternative to IV hydration in moderately to severely dehydrated children with difficult to obtain IV access in resource-limited areas.


Assuntos
Desidratação/etiologia , Desidratação/terapia , Hialuronoglucosaminidase/administração & dosagem , Ressuscitação/métodos , Cuidadores/estatística & dados numéricos , Análise Custo-Benefício , Desidratação/mortalidade , Diarreia/complicações , Estudos de Viabilidade , Feminino , Humanos , Lactente , Infusões Intravenosas/estatística & dados numéricos , Infusões Subcutâneas/métodos , Quênia/epidemiologia , Masculino , Estudos Prospectivos , Soluções para Reidratação/administração & dosagem , Soluções para Reidratação/uso terapêutico , Ressuscitação/tendências , Fatores de Tempo
17.
J Clin Endocrinol Metab ; 104(3): 721-729, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30247615

RESUMO

Context: Primary hyperparathyroidism (PHPT) in pregnancy has historically been associated with substantial maternofetal morbidity and mortality rates. The optimal treatment and timing of surgical intervention in pregnancy remain contested. Objective: To compare maternofetal outcomes of medically and surgically treated patients with PHPT in pregnancy. Design: Retrospective chart review. Setting: Quaternary referral hospital. Patients: Women with PHPT in pregnancy treated between 1 January 2000 and 31 December 2015. Interventions: Medical therapy or parathyroid surgery. Main Outcomes Measured: Timing of diagnosis; maternal corrected serum calcium concentrations; gestation, indication and mode of delivery; complications attributable to PHPT; birth weight; and admission to the neonatal intensive care unit (NICU). Results: Twenty-two pregnancies were managed medically, and six patients underwent parathyroidectomy in pregnancy (five in trimester 2, and one at 32 weeks gestation). Most patients treated medically either had a corrected serum calcium concentration <2.85 mmol/L in early pregnancy or had PHPT diagnosed in trimester 3. Of viable medically managed pregnancies, 30% were complicated by preeclampsia, and preterm delivery occurred in 66% of this group. All preterm neonates required admission to the NICU for complications related to prematurity. All surgically treated patients delivered their babies at term, and there were no complications of parathyroid surgery. Conclusion: Maternofetal outcomes have improved relative to that reported in early medical literature in patients treated medically and surgically, but the rates of preeclampsia and preterm delivery were higher in medically treated patients. The study was limited by its retrospective design and small sample sizes.


Assuntos
Hiperparatireoidismo Primário/terapia , Doenças do Prematuro/epidemiologia , Pré-Eclâmpsia/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Anti-Hipertensivos/uso terapêutico , Cálcio/sangue , Feminino , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/complicações , Recém-Nascido , Doenças do Prematuro/etiologia , Doenças do Prematuro/terapia , Infusões Intravenosas , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Pamidronato/uso terapêutico , Paratireoidectomia/estatística & dados numéricos , Pré-Eclâmpsia/etiologia , Gravidez , Nascimento Prematuro/etiologia , Encaminhamento e Consulta/estatística & dados numéricos , Soluções para Reidratação/administração & dosagem , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
19.
PLoS One ; 13(11): e0207147, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30439979

RESUMO

BACKGROUND: Low volume resuscitation (LVR) in shock prevents deleterious effects of crystalloid loading in pre-hospital settings. Polyethylene glycol 20,000 (PEG-20k) based LVR solutions are 20-fold more effective at maintaining perfusion and survival in shock compared to conventional crystalloids. The aim of this study was to determine coagulation and platelet function of whole blood treated with 10% PEG-20k. METHODS: Citrated blood from volunteers (n = 25) or early admission severely injured trauma patients (n = 9) were diluted 10% with various LVR solutions in a matched design with a paired volume control (saline), and studied using thromboelastography (TEG). FINDINGS: In healthy volunteers and patients, 10% PEG-20k significantly increased clot amplification time (k), decreased propagation (angle), maximal clot size and strength (MA), and the overall coagulation index (CI), but not clot initiation (R) or fibrinolysis (Ly30), relative to paired saline dilutional controls. Clinically, K, angle, and MA were just outside of the normal limits in volunteers but not in patients. No statistical differences existed between PEG-20k and Hextend (HES) in either patient population. In a dose response series using volunteer blood, all effects of 10% PEG-20k on TEG were reversed and normalized by lower concentrations (7.5% and 5%). Furthermore, 7.5% PEG-20k produced similar resuscitation effects as 10% PEG in rodent hemorrhagic shock models (n = 5). CONCLUSIONS: In conclusion, PEG-20k based LVR solutions produced a dose-dependent minor hypocoagulative state, possibly associated with changes in clot propagation and platelet function, which can be reversed by dose reduction in concentration while providing superior LVR, microvascular rescue, and lactate clearance compared to saline or starch.


Assuntos
Polietilenoglicóis/administração & dosagem , Soluções para Reidratação/administração & dosagem , Choque/terapia , Adolescente , Adulto , Animais , Coagulação Sanguínea/efeitos dos fármacos , Plaquetas/efeitos dos fármacos , Volume Sanguíneo , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Feminino , Fibrinólise/efeitos dos fármacos , Hidratação , Humanos , Masculino , Pessoa de Meia-Idade , Ratos Sprague-Dawley , Choque Hemorrágico/tratamento farmacológico , Soluções , Tromboelastografia , Adulto Jovem
20.
Nutrients ; 10(9)2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30200394

RESUMO

The efficacy of oral rehydration solution (ORS) enriched with Lactobacillus reuteri DSM 17938 and zinc in infants with acute gastroenteritis, is poorly defined. The aim of this double-blind, randomized, placebo-controlled study, was to assess the efficacy of an ORS enriched with Lactobacillus reuteri DSM 17938 and zinc (ORS⁺Lr&Z) in well-nourished, non-hospitalized infants with acute diarrhoea. Fifty one infants with acute diarrhoea were randomly assigned to receive either ORS⁺Lr&Z (28 infants, mean ± SD age 1.7 ± 0.7 years, 21 males), or standard ORS (ORS-Lr&Z; 23 infants, mean ± SD age 1.8 ± 0.7 years, 16 males). Stools volume and consistency were recorded pre- and posttreatment using the Amsterdam Infant Stool Scale and were compared between the two groups, as well as lost work/day care days, drug administration and need for hospitalization. Both groups showed reduction in the severity of diarrhoea on day two (p < 0.001) while, all outcomes showed a trend to be better in the ORS⁺Lr&Z group, without reaching statistical significance, probably due to the relatively small number of patients. No adverse effects were recorded. In conclusion, both ORS were effective in managing acute diarrhoea in well-nourished, non-hospitalized infants. ORS enriched with L. reuteri DSM 17938 and zinc was well tolerated with no adverse effects.


Assuntos
Diarreia/terapia , Hidratação/métodos , Fenômenos Fisiológicos da Nutrição do Lactente , Lactobacillus reuteri/fisiologia , Probióticos/administração & dosagem , Soluções para Reidratação/administração & dosagem , Zinco/administração & dosagem , Doença Aguda , Administração Oral , Pré-Escolar , Diarreia/diagnóstico , Diarreia/microbiologia , Diarreia/fisiopatologia , Método Duplo-Cego , Feminino , Grécia , Humanos , Lactente , Masculino , Estado Nutricional , Probióticos/efeitos adversos , Soluções para Reidratação/efeitos adversos , Índice de Gravidade de Doença , Resultado do Tratamento , Equilíbrio Hidroeletrolítico , Zinco/efeitos adversos
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