Neuroleptic malignant syndrome in a postoperative patient: A case report.

Neuroleptic malignant syndrome is a rare medical emergency associated with the use of antipsychotics and other antidopaminergic drugs. There is no specific test, and diagnosis is based on high clinical suspicion and good differential diagnosis. A clinical picture consistent with hyperthermia, muscle rigidity, altered level of consciousness, together with signs of rhabdomyolysis in analytical studies and a history of taking neuroleptic drugs are the key elements in the detection of this entity. Due to its low incidence and potential mortality, it is essential to publish case reports of neuroleptic malignant syndrome in order to raise awareness of this entity and facilitate diagnostic suspicion when encountering a patient with compatible symptoms. The following is the case of a 79 year old patient with chronic alcohol consumption as the only history of interest, who was given a single dose of haloperidol after an episode of delirium in the postoperative period of conventional trauma surgery. She subsequently developed a picture of progressive deterioration of the level of consciousness, diaphoresis, generalized muscle rigidity, hyperthermia, together with severe metabolic acidosis, hyperlacticaemia, rhabdomyolysis, hypertransaminasemia and hypocalcemia. After ruling out other entities compatible with the clinical picture, neuroleptic malignant syndrome was given as the main diagnostic hypothesis. Diagnosis was confirmed after clinical and analytical improvement following treatment with dantrolene. The patient was discharged from hospital with no sequelae a few days after onset of the condition.

Neuroleptic malignant syndrome in a postoperative patient: a case report. / Síndrome neuroléptico maligno en paciente postoperada: a propósito de un caso.

Neuroleptic malignant syndrome is a rare medical emergency associated with the use of antipsychotics and other antidopaminergic drugs. There is no specific test, and diagnosis is based on high clinical suspicion and good differential diagnosis. A clinical picture consistent with hyperthermia, muscle rigidity, altered level of consciousness, together with signs of rhabdomyolysis in analytical studies and a history of taking neuroleptic drugs are the key elements in the detection of this entity. Due to its low incidence and potential mortality, it is essential to publish case reports of neuroleptic malignant syndrome in order to raise awareness of this entity and facilitate diagnostic suspicion when encountering a patient with compatible symptoms. The following is the case of a 79 year old patient with chronic alcohol consumption as the only history of interest, who was given a single dose of haloperidol after an episode of delirium in the postoperative period of conventional trauma surgery. She subsequently developed a picture of progressive deterioration of the level of consciousness, diaphoresis, generalized muscle rigidity, hyperthermia, together with severe metabolic acidosis, hyperlacticaemia, rhabdomyolysis, hypertransaminasemia and hypocalcemia. After ruling out other entities compatible with the clinical picture, neuroleptic malignant syndrome was given as the main diagnostic hypothesis. Diagnosis was confirmed after clinical and analytical improvement following treatment with dantrolene. The patient was discharged from hospital with no sequelae a few days after onset of the condition.

[Preoperative nutritional status and surgical risk. Identification of promissory biochemical markers]. / Estado nutricional preoperatorio y riesgo quirúrgico. Identificación de marcadores bioquímicos promisorios.

BACKGROUND: The fact that deficient or even marginal nutritional levels may contribute to increase morbidity and mortality in the surgical patient is well accepted. The usefulness of vitamin and mineral markers has not been much explored. OBJECTIVE: To evaluate the usefulness of vitamin and mineral indicators as nutritional markers of surgical risk. METHODS: Biomarkers of vitamin A (plasma retinol), carotenes (plasma carotenes), vitamin C (plasma vitamin C), iron (hematocrit, hemoglobin, serum iron, transferrin saturation and erythrocyte protoporphyrin), calcium (calcium/creatinine in basal urine) and zinc (zinc/creatinine in basal urine), were performed 24 ours before surgery. Appearance of complications was evaluated in 100 adult patients from programmed surgical procedures of hernia (n = 41) or gallbladder lithiasis (n = 59), two of the most frequent interventions in general surgery services. RESULTS: Patients were grouped in those that presented postoperative complications (C; n = 26) and those who did not (NC; n=74). Two of the studied markers presented significant differences between both groups: plasma retinol and erythrocyte protoporphyrin. Plasma retinol of C was significantly lower than that obtained in NC: 33.2 +/- 13.5 microg/dl vs. 40.2 +/- 16.3 microg/dl; P = 0.0495 and an association between values below 30 microg/dl and postoperative complications was founded (53.8% in C vs. 30.1% in NC; P = 0.0360). Erythrocyte protoporphyrin of C was significantly higher to that obtained in NC: 52.0 +/- 34.0 microg/dl RBC vs. 36.8 +/- 17.5 microg/dl RBC; P = 0.0453 and the association between values higher than 70 microg/dl RBC and presence of complications were highly significant (25.0% vs. 4.2%; P = 0.0069). CONCLUSIONS: On the basis of the obtained results is concluded that plasma retinol and erythrocyte protoporphyrin would provide useful tools in evaluating surgical risk since they had been allowed to identify patients who were at risk of suffering postoperative complications.

Síndrome neuroléptico maligno en paciente postoperada: a propósito de un caso / Neuroleptic malignant syndrome in a postoperative patient: a case report

El síndrome neuroléptico maligno es una emergencia médica poco frecuente asociada al uso de antipsicóticos y otros fármacos antidopaminérgicos. No se dispone de una prueba específica para su diagnóstico, basándose este en una alta sospecha clínica y la realización de un buen diagnóstico diferencial. Un cuadro clínico compatible, destacando la hipertermia, rigidez muscular, alteración del nivel de conciencia y signos de rabdomiolisis en los estudios analíticos, junto con el antecedente de la toma de fármacos neurolépticos, constituyen los elementos clave para la detección de esta entidad. Debido a su escasa incidencia y su potencial mortalidad, es primordial su conocimiento a través de series de casos descritos en la literatura para facilitar su sospecha diagnóstica ante un caso clínico compatible. A continuación, exponemos un caso de una paciente de 79 años con consumo crónico de alcohol como único antecedente de interés, que recibió una dosis única de haloperidol tras un cuadro de delirio en el contexto de un postoperatorio convencional de traumatología. Posteriormente, desarrolló un cuadro de deterioro progresivo del nivel de conciencia, diaforesis, rigidez muscular generalizada, hipertermia, junto a acidosis metabólica severa, hiperlactacidemia, rabdomiolisis, hipertransaminasemia e hipocalcemia. Tras excluir otras entidades compatibles con la clínica, el síndrome neuroléptico maligno se postuló como la principal hipótesis diagnóstica, reforzándose el diagnóstico tras la mejoría clínica y analítica evidente posterior al inicio del tratamiento con dantrolene. La paciente pudo, finalmente, ser dada de alta escasos días después del inicio del cuadro sin presentar secuelas.(AU)

Neuroleptic malignant syndrome is a rare medical emergency associated with the use of antipsychotics and other antidopaminergic drugs. There is no specific test, and diagnosis is based on high clinical suspicion and good differential diagnosis.A clinical picture consistent with hyperthermia, muscle rigidity, altered level of consciousness, together with signs of rhabdomyolysis in analytical studies and a history of taking neuroleptic drugs are the key elements in the detection of this entity.Due to its low incidence and potential mortality, it is essential to publish case reports of neuroleptic malignant syndrome in order to raise awareness of this entity and facilitate diagnostic suspicion when encountering a patient with compatible symptoms.The following is the case of a 79 year old patient with chronic alcohol consumption as the only history of interest, who was given a single dose of haloperidol after an episode of delirium in the postoperative period of conventional trauma surgery. She subsequently developed a picture of progressive deterioration of the level of consciousness, diaphoresis, generalized muscle rigidity, hyperthermia, together with severe metabolic acidosis, hyperlacticaemia, rhabdomyolysis, hypertransaminasemia and hypocalcemia. After ruling out other entities compatible with the clinical picture, neuroleptic malignant syndrome was given as the main diagnostic hypothesis. Diagnosis was confirmed after clinical and analytical improvement following treatment with dantrolene. The patient was discharged from hospital with no sequelae a few days after onset of the condition.(AU)

Influence of growth rate on the ability of hypertransfusion induced plethora to suppress erythropoiesis in the growing rat.

To induce different rates of growth male rats 23 days of age were places on diets containing no protein or 20% casein for 10 days. They were then divided into three subgroups which were placed on diets containing 5%, 10% or 20% casein until the end of the experimental period (day 17). Adult rats were used as controls. Rats were hypertransfused on days 8 and 9 and RBC-59Fe uptake determined on day 17. Body weight was directly correlated with the casein content of the diet in the growing rats. RBC-radioiron incorporation was also influenced by the protein content of the diet in the young rats in spite of the fact that hematocrits were over 60% in all the animals. On the contrary, 59Fe uptake by erythrocytes was not related to diet composition in the adult rats. When radioiron incorporation values were plotted against growth rate it became evident that a close direct correlation exists between erythropoiesis and growth rate in transfused-polycythemic rats, indicating that the degree of suppression of red cell production provoked by hypertransfusion-induced plethora is dependent on the rate of growth of the animal, keeping with it an inverse relationship.

Effect of maternal dietary amino acid pattern on rat offspring.

The effect of lifetime feeding to gravid rats of diets containing different indispensable amino acid patterns on body and brain composition of the offspring was studied. Two groups of rats were fed, from weaning to delivery, either experimental diet B or diet I. Both diets contained the same amount of total nitrogen (3.14%), available lysine (0.4%) and "complete protein to total protein ratio" (22.5%), but whereas diet I provided an excess of indispensable amino acids over the amount of limiting amino acid, diet B supplied all of the indispensable amino acids in marginal amounts and in a rather well balanced pattern. The nitrogen content of diet B was matched to the nitrogen content of diet I by addition of a mixture of dispensable amino acids. A control group fed stock diet (C) was run simultaneously. Birth body weight, carcass nitrogen to water ratio, and brain weight of pups were significantly lower in B than in I. The figures for I were not significantly different from the controls. Brain DNA content in B was significantly lower than in C, but in I it was lower than for both B and C. Nitrogen to water ratio and brain DNA content of group B were low when compared to the standard curves for our colony; however, DNA content was normal for the degree of body development. On the other hand, in group I brain DNA was preferentially affected, as if body and brain maturity were dissociated.

A whole genome screen for association with multiple sclerosis in Portuguese patients.

Multiple sclerosis (MS) is common in Europe affecting up to 1:500 people. In an effort to identify genes influencing susceptibility to the disease, we have performed a population-based whole genome screen for association. In this study, 6000 microsatellite markers were typed in separately pooled DNA samples from MS patients (n=188) and matched controls (n=188). Interpretable data was obtained from 4661 of these markers. Refining analysis of the most promising markers identified 10 showing potential evidence for association.

Effect of low-quality dietary protein on the thymus of growing rats.

The status of the thymus of growing rats fed for 45 days after weaning on a low-quality dietary protein (7.5% maize) was compared with that in an age-matched control group receiving a diet containing casein at the same concentration. At the end of the feeding period, body weight (bw) was determined and the thymus was removed; its weight and cell number and the mature T-cell population--characterized by the monoclonal antibody W3/13 using the indirect immunofluorescence technique--were determined. Thymus weight expressed as mg/bw0.75 (3.9 +/- 0.75 vs 7.7 +/- 2.0), cell number (4.4 +/- 2.2 vs 26.3 +/- 7.6), and the absolute number of W3/13+ T cells (1.59 +/- 0.75 vs 17.8 +/- 5.4) were significantly lower (p less than 0.0005) in the experimental group than in the control group. The results suggest severe atrophy of the thymus of weaning animals chronically fed a low-quality protein.

A possible explanation of the effects of dietary lactose concentration during recovery of protein depletion in growing rats.

It is generally accepted that lactose intolerance is a cause of delayed recovery from malnutrition. To discriminate the true importance of this factor, the effect of dietary lactose concentration on "catch up" growth was studied on rats fed a protein free diet from weaning to 34 days of age and then refed "ad libitum" with diets providing different levels of Protein Calories (P%: 5, 11, 17 and 25%) and Lactose (L%: 0, 1, 15, 27 and 37%) for 4 days. Weight changes, daily dietary intakes and gastrointestinal disorders (GID) were recorded. The growth rate (GR) -g/100g rat/day- showed a direct correlation with P% whereas a decrease in (GR) as well as in Protein Utilization (PU) was associated with increasing L%, the higher the P%, the greater the effect of L%. The observed effect of lactose on (PU) does not correlate with (GID). Analysis of intake data -expressed as calories/day/W0.73- showed that animals ate less diet when lactose was present resulting in energy restriction (ER) from 12 to 62%. A primary effect of food intake might be proposed as a limiting factor for (GR) and (PU) in rats recovering from depletion. The influence of P% on improved lactose tolerance must also be stressed.

Theory about interrelationships between macromineral nutrients and growth rate during recovery from undernutrition.

Previous papers of our group have reported that, in the first stages of nutritional recovery, the needs of undernourished infants, in terms of Protein Calories percentage (P%) were higher than normal, and similar to those of other mammals which double their birth weight faster than man. During this period, a high dietary P% produces an accelerated catch-up growth. Therefore, Calcium and Phosphorus balances increase proportionally to weight gain rate (WGR), and Calcium retention per gram of new tissue is dependent on dietary Calcium/Protein ratio. On the other hand, Bernhart demonstrated that there was a direct correlation between the growth rate of the sucklings of several species, including humans, and the percentage of protein and ash in the fluid milk. As a consequence of these facts, we assume that during catch-up growth, in order to attain a normal body composition, dietary level of essential minerals must be related to factors affecting weight gain. These relationships suggest the hypothesis that, during the recovery from undernutrition, in order to meet the needs of the catch-up growth allowed by the Protein/Calories ratio, Calcium and Phosphorus milk concentrations would be in relation to the Protein/Calorie concentration. In this way, Calcium and Phosphorus concentrations might be the limiting factors for attaining a normal body composition. This hypothesis might also be generalized to other minerals in order to prevent them from becoming the limiting factors for attaining a normal body composition.

Hypothesis on the time course of antigen dependent changes in lymphoid organs proved by experimental data of depleted growing rats' mesenteric lymph nodes.

The results described in this paper partially agree with the hypothesis that mesenteric lymph nodes (MLN) of depleted growing rats recover their antigen specific determinants after the oral administration of 20% casein for 5-9 days following the time course of antigen dependent changes observed in virgin lymph nodes. With respect to the 39 days old control group, depleted MLN showed a highly diminished number of mature T cells (W3/13+) as well as surface and intracellular alpha heavy chain (alpha s and alpha cit). The oral administration of a 20% casein diet during 5 days tends to restore the appearance of these determinants; however, normal values were not attained even if refeeding was continued for 9 days. The discrepancy between the proposed hypothesis and the observed results might be ascribed to: a) defective migration of T cells from thymus; b) the diminished number of TH cells involved in terminal differentiation; c) inability of B cells to respond to T cell-derived factors.

Kinetic constants of lactase of the small intestine of growing rats fully recovered from protein depletion, in relation to dietary protein and lactose concentration.

The effect of dietary composition on the kinetic constants of intestinal lactase was studied using rats depleted of protein by feeding protein-free diet from the weanling stage to 34 days of age and subsequently allowed to recover on diets containing 11.5 or 17% of protein calories (P%) and different levels of lactose (L%; 1, 15, 27 and 37%). After four days of refeeding, rats were decapitated and lactase activity was determined at different substrate concentrations by the method of Dahlqvist using homogenate of intestinal mucosa. Maximum velocity (Vmax) and Michaelis constant (Km) were calculated according to Eisenthal and Cornish-Bowden. At both levels of P%, Vmax tended to increase with the dietary lactose concentration. With diets containing 37% lactose, at P% 11 Vmax was about 60% of that at P% 17.0 Km tended to increase with L% in groups given the 17.0% protein calorie diets, but no difference was observed between groups fed at the lower level of protein. These results can be explained on the basis of interactions between dietary protein at different concentrations and inducer substrate which results in changes in isoenzyme patterns.

[Incorporation of squid oil fatty acids to plasma lipoproteins in rats]. / Incorporación de ácidos grasos de aceite de calamar a lipoproteínas plasmáticas en ratas.

There is clinical and epidemiologic evidence that long chain polyunsaturated fatty acids of the n-3 series, (AGPI n-3): eicosapentaenoic acid (EPA 20:5 n-3) and docosahexaenoic acid (22:6 n-3) decrease the incidence of heart attack, coronary restenosis and also platelet aggregation, leukotriene synthesis and arterial pressure. They also decrease significantly the severity of atherosclerosis in hyperlipidemic models. Some of these results are obtained after daily intake of 3g or more of AGPI n-3. Marine oils are very rich in AGPI n-3 but rarely the amount is larger than 20%. Due to this fact there is great interest in the possibility of obtaining concentrates of AGPI n-3 with a high coefficient of intestinal absorption. EPA and DHA ethyl esters are able to be concentrated over 90% but their absorption is incomplete. For the moment AGPI n-3 can be concentrated as free fatty acids (AGL). Squid oil (Illex argentinus) is one of the natural oils with the highest concentration of AGPI n-3 (31 to 34%). In this paper, we have studied the incorporation of AGPI n-3 to plasmatic lipoproteins of rats fed during 28 days with diets supplemented with squid oil (Ac) or AGL obtained from the same oil. Both groups were compared with a control group (C, n = 5) fed on a standard diet. The composition of oil fatty acids and of AGL is almost identical: EPA 13.6% and DHA 17.7% (Table 1). Daily intake of AGPI n-3 was very similar: in the Ac group (n = 7) 80 mg/day and in the AGL group (n = 7) 90 mg/day.(ABSTRACT TRUNCATED AT 250 WORDS)

[Interrelationship between vitamin D intake and absorption and retention of calcium during nutritional recovery]. / Interrelaciones entre ingesta de vitamina D y absorción y retención de calcio durante la recuperación nutricional.

We have previously reported that, in the first stages of nutritional recovery, the needs of undernourished infants, in terms of protein-calories percentage (P%) are higher than normal, producing an accelerated catch-up. Consequently, calcium (Ca) and phosphorus (P) balances increase proportionally to weight gain rate (WGR) in order to attain a normal body composition. As for the control of Ca metabolism by vitamin D, the question is whether vitamin D intake must also be increased during this accelerated catch-up growth period. In this report we have analysed retrospectively previous results in order to clarify the interrelationship between Ca absorption, Ca retention and vitamin D intake. A total of 29 undernourished infants, from 2 to 18 months of age, were fed Ad libitum with one of two proprietary milk formulas containing, per 100 g.: Ca, 0.50 and 1.17 g.; P, 0.37 and 0.50 g.; vitamin D, 350 and 400 UI (8.7 and 10 micrograms); proteins, 11.34 and 17.00 kcal/100 kcal of total diet, respectively. Recommended Dietary Allowances (RDA) of Ca and vitamin D, according to FAO/OMS and NRC, were calculated with reference to normal infants body weight and to 1000 kcal of recommended dietary energy intake. Ca intake was higher than the RDA and ranged between 60 and 413 mg/kg/day; intake of vitamin D increased proportionally to food intake; calcium absorption ranged between 40.0 and 92.0% (mean = 69.8 +/- 14.6) and CaB correlated with Ca intake (r = 0.97), being higher than normal.(ABSTRACT TRUNCATED AT 250 WORDS)

[Free erythrocyte protoporphyrin as a function of age in growing rats]. / Protoporfirina libre eritrocitaria en función de la edad en ratas en crecimiento.

The assessment of the iron (Fe) status is very important because its deficiency is one of the most common in both developing and industrialized countries, being particularly prevalent among infants and young children. Diagnosis is difficult in the presence of other conditions which interfere with the interpretation of laboratory tests, such as hemoglobin (Hb), hematocrit (Hct), serum iron, transferrin saturation percentage and serum ferritin. Free erythrocyte protoporphyrin (FEP) is a precursor of Heme and normally occurs in very low concentration in red blood cells (RBC); elevated values indicate early impaired iron nutritional status, providing information about gradual changes in the iron supply to the marrow. This laboratory test is a practical and convenient method because it needs a small blood sample easily preserved. Although the Second National Health and Nutritional Examination Survey (NHANES II) of USA has provided a good opportunity to define more precisely the cut-off points, it is doubtful whether the age-related differences in children represent normal development or the effects of iron deficiency. In order to provide information about these aspects the present experimental model was performed: weanling Wistar rats were fed until 95 days of age (t 95) with an isocaloric diet containing 20 or 30 g/100 g. of protein (casein) (N 20 and N 30, respectively), allowing the highest growth and erythropoiesis rates and covering the requirements of all the nutrients (Table 1). Body weight and food intake were recorded three times/week.(ABSTRACT TRUNCATED AT 250 WORDS)

[Serum creatine phosphokinase activity: analysis of information provided by different ways of expressing the results]. / Actividad de creatin-fosfoquinasa en suero: análisis de la información suministrada por differentes formas de expresión de los resultados

An experimental model with undernourished rats fed experimental diets containing either imbalanced proteins or low amount of well balanced proteins was used to evaluate the utility of serum CPK activity determination in human malnutrition. Special attention was given on the information provided by four ways of expression of the enzymatic activity. CPK activity was expressed as: 1) Specific activity, 2) Activity per ml serum, 3) Total activity per rat and 4) Total activity per 100 g body weight. Statystical analysis showed: a) Activity expressed per mg serum protein or per ml serum did not agree with the known physiological phenomena induced on muscle by the experimental diets: CPK activity values expressed in these ways are not useful in malnutrition studies. b) Serum total activity of CPK per rat provides a similar information to the creatinin/height index, which is easier to perform. c) Total CPK activity per 100 g body weight demonstrated to be adequate to provide information about muscle mass in rats under controlled experimental conditions. However, it is not possible to use this form of expressing CPK activity in human malnutrition, because it would be also necessary to know: plasma volumen, age, actual body weight, clinical and the nutritional background, etc., of the patient for an accurate interpretation of results.

[Fat and oil consumption in a university student population in Buenos Aires]. / Ingesta de grasas y aceites en una población estudiantil universitaria de Buenos Aires.

The purpose of this study was to evaluate the fat and oil intake and their distribution according to the dietary origin in students of the University of Buenos Aires. A 7 day dietary record of students (49 males and 127 females) attendant to the 1989 Course of Nutrition, School of Pharmacy and Biochemistry, to obtain in Pharmacy and Biochemistry was collected. This information was processed in a PC Computer (VAN Program, Lujan University, Argentina) to obtain the energy and fat daily intake, according to the Dietary Composition Tables compiled by INCAP; missing data were completed t with the German, Italian or Argentine Tables. The results obtained were (average daily intake +/- SD) for females and males, respectively: Energy (Kcal): 1805 +/- 5431 and 2551 +/- 712; total fat (g): 65.6 +/- 21.8 and 87.8 +/- 28.7; percentage of energy provided by fat: 33.0 and 31.1. The distribution of fat intake according to its dietary source was (g/100 g): meat: 33.3; oils: 15.5; diary products: 19.3; cakes and pasta: 11.6; cereals (bread, crackers, etc.): 8.3; separate animal fat: 5.1; legumes and oil seeds: 1.4; eggs: 2.9; poultry: 1.5; margarines: 0.6; fish: 0.3; viscera: 0.3. These data show that the fat intake is not excessive, about 30% of the energy intake; but the high percentage of animal fat might be one of the risk factors responsible for the high incidence of cardiovascular diseases in the population of Buenos Aires.

[Erythrocyte protoporphyrin during recovery from malnutrition in rats]. / Protoporfirina eritrocitaria durante la recuperación nutricional en ratas.

Interrelationships between Erythrocyte Protoporphyrin (EP), dietary Iron/Protein ratio (Fe/Prot) and Fe liver content (Feh) were studied during nutritional recovery in an experimental model: weanling female Wistar rats (To) were depleted with a protein-free diet (LP), losing 20% of their initial body weight. Then they were recovered until 45 days of age (T45) with diets containing: casein: 20 g/100 g; Fe (ammonium Fe citrate) (ppm.): 0, 75 or 100 (groups A1, A2 and A3, respectively). Hematocrit, Hemoglobin (Hb) (g/dL). Erythrocyte Protoporphyrin (EP) (microgram/dL Red Blood Cells) and Feh (microgram) were determined at To, LP and T45. Results were compared with control rats (C) fed with 20% of casein and Fe, 50 ppm. EP: a) decreased in C from To to T45 (99 +/- 24; 36 +/- 9; p < 0.01); b) increased in A1 and A2 at T45 (123 +/- 21; 93 +/- 29, respectively, p < 0.01) while A3 did not show significant difference (45 +/- 7) regarding to C: c) correlated inversely with Feh. According to the inverse correlation between EP and Fe/Prot (r = -0.99), we found that 92 ppm was an adequate Fe amount to prevent EP increase. These results confirm that during recovery from undernutrition EP depends on iron liver content, being an adequate indicator of iron nutritional status; therefore, EP would be useful as a predictor of the optimum Fe/Prot ratio for nutritional recovery.

[Calcium-creatinine in basal urine in relation to calcium intake and nutritional status in children under 3]. / Calcio/creatinina en orina basal en relación a la ingesta de calcio y al estado nutricional, en menores de tres años.

The calcium/creatinine ratio (Ca/Creat.) as an indicator of calcium nutritional status was evaluated in "basal urine" from 24 children comprised within the ages of three to 36 months during a 60-day period. The children were divided in normal or undernourished, according to Waterlow's classification. Children under 12 months of age were fed ad libitum with one of two commercial milk formulas, assigned according exclusively to the pediatric criterium. Children older than 12 months received milk besides the habitual hospital diet. In all cases the food intake was controlled and the calcium intake calculated. At the end of the study, basal urine was collected and calcium and creatinine determined. The results revealed that: a) In the normal children the Ca/Creat. ratio gradually decreased with age tending to a low value of 0.2 at the age of 36 months. The relationship between the Ca/Creat. ratio and the calcium intake showed a change in the slope when the requirements were met according to RNC (60 mg/kg/day); b) In undernourished children, the Ca/Creat. ratio was nearly constant whatever their age or calcium intake. The trend to approach the value of 0.2 for calcium intake (about 250 mg/kg/day), however, and the absence of the inflexion point, would suggest that the requirements of these children are far higher than the NRC recommendation, and that the change of the slope would be found for intakes over those obtained in our study. According to these findings, we conclude that the Ca/Creat. ratio in basal urine does not reflect calcium intake, but would depend on the bone calcium turnover. Consequently, it would be a simple and useful indicator of calcium nutritional status.

[Nutritional status of surgical patients without apparent nutritional compromise]. / Estado nutricional de pacientes quirúrgicos sin aparente compromiso nutricional.

Nutritional status of 80 preoperative patients from programmed surgeries of hernias and lithiasis was studied by anthropometric and biochemical parameters. Nutritional deficiencies related to pathology were not expected in these patients. Results were as follows: 77% of the population showed overweight, being 15% obese. Prevalent protein intake, evaluated by the urea nitrogen/creatinine ratio, was adequate in 87.5% of the patients; however, patients presented 72% of albumin, 52% of prealbumin and 50% of RBP below reference values. Transferrin, ceruloplasmin, alpha 2-macroglobulin and haptoglobin were not decreased. Assessment of vitamin A, carotenes and vitamin C showed plasmatic levels below reference values in 16% of the patients for vitamin A, 5% for carotenes and 27% for vitamin C. Respect to calcium status, data of calcium/creatinine ratio show deficiency in 45% of the population. Respect to iron, the nutritional status was in general adequate, patients at risk being 5% by Htc, 11% by Hb, 5% by TS% and 12.5% by FEP, women showed over twice abnormal values than men. Although some isolated relations were observed, in this population sex, age and pathology were variable that did not affect in a relevant way the nutritional status. In spite of the individual analysis of each nutrient did not show important deficiencies, the analysis by patient showed that only a few of them (7%) presented an optimal biochemical profile with all the studied parameters within the reference values.