RESUMEN
The purpose of this clinical study was to evaluate prospectively electrolyte disturbances in elderly patients with severe diarrhea due to cholera. A total of 20 adult (Group I; < 60 yr) and 22 elderly (Group II; > or = 60 yr) patients were studied. In all patients, extracellular fluid (ECF) volume reexpansion was achieved with normal saline at 50 mL/kg per hour. Once a diuresis of 40 mL/h was achieved, intravenous therapy was discontinued and patients' ECF volumes were reexpanded orally with a polyelectrolyte solution. Blood and urine samples were obtained on admission, at the time when adequate diuresis ensued, and after 12 h of oral ECF volume reexpansion. On admission, both groups had severe ECF volume contraction but only mild increases in osmolality (308 +/- 12 and 310 +/- 13 mosmol/kg for Groups I and II respectively; P = NS). Acidemia (pH) was equally severe in both (Group I: 7.13 +/- 0.11; Group II: 7.11 +/- 0.09; P = NS), and the anion gap was comparably increased in both groups (30 +/- 8 and 26 +/- 7 mmol/L for Groups I and II, respectively; P = NS). None of the patients was hypokalemic at the time of admission (Group I: 4.3 +/- 0.5 mmol/L; Group II: 4.5 +/- 0.5 mmol/L; P = NS). Adequate diuresis was achieved at 2.0 +/- 0.7 h in both groups. At the end of the rapid ECF volume reexpansion phase, the anion gap normalized in both groups (Group I: 15.6 +/- 3.7 mmol/L; Group II: 14.4 +/- 2.8 mmol/L; P = NS), and serum potassium concentrations remained normal (Group I: 4.4 +/- 0.4 mmol/L; Group II: 4.1 +/- 0.4 mmol/L; P = NS). We conclude that use of aggressive intravenous hydration with normal saline followed by oral ECF volume reexpansion allows prompt correction of electrolyte abnormalities in adult and elderly patients with severe diarrhea as a result of cholera.
Asunto(s)
Cólera/complicaciones , Diarrea/complicaciones , Oliguria/etiología , Desequilibrio Hidroelectrolítico/etiología , Adolescente , Adulto , Anciano , Cloruros/metabolismo , Femenino , Fluidoterapia , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , Concentración Osmolar , Estudios Prospectivos , Sodio/metabolismo , Desequilibrio Hidroelectrolítico/metabolismo , Desequilibrio Hidroelectrolítico/terapiaRESUMEN
It is not known why the cholera epidemic, which affected all other continents, has not affected Latin America in the past 30 years. In addition, it is unclear why cholera appeared in Peru in 1991. Improvements in scientific knowledge and technology have occurred in Peru during the last 30 months. While it is impossible to summarize in only one article all these concepts, this article presents a few of the most important issues and recent developments in the treatment and prevention of cholera.
Asunto(s)
Cólera/epidemiología , Cólera/etiología , Cólera/terapia , Humanos , Perú/epidemiología , Factores de RiesgoRESUMEN
763 patients from the "Honorio Delgado" Regional Hospital of Arequipa city (2300 mts ht) are studied, all suffering of gastroduodenal peptic ulcer disease. A comparison between the principal clinical feactures of patients coming from the Coast and the Hights, is done. It is concluded that in patients from the Hights ulcer disease has an earlier beginning (third decade), clinical features are atypical; the incidence of complications are higher (59%) mainly hemorrhagic ones (53%); the occurrence of gastric ulcer is also higher (DU/GU = 2.5/1 against 5/1 seen in patients from the Coast) and mortality rate is greater (2.0%).