RESUMEN
Objective: Hypotonic fluids are commonly used in pediatric oncology despite evidence that these fluids can lead to hospital-acquired hyponatremia. This practice is most likely due to lack of data evaluating risks and benefits of isotonic fluids in pediatric oncology. To address this issue, our study investigates the effects of exchanging hypotonic fluids with isotonic fluids in a large pediatric oncology unit. Study Design: Prevalence of laboratory disorders before and after the change to balanced, isotonic fluids for all patients are compared in this retrospective analysis. Disturbances in electrolyte levels, fluid-, acid-base balance and kidney function were examined. Results: The rate of hyponatremia was reduced using isotonic fluids. There were no hypernatremic events. Volume overload might increase the use of furosemide when using isotonic fluids. Potassium and bivalent cation levels increased. The risk of acidosis is greatly reduced, whereas alkalosis was more frequent due to furosemide use. The rate of acute kidney injury did not increase. Conclusion: Using isotonic fluids for hyper-hydration in pediatric oncology lead to a modest reduction of hospital-acquired hyponatremia without causing hypernatremia, but the effects on fluid balance need further investigation. The additional intake of bivalent cations and buffering anions in balanced fluids has measurable effects.
Asunto(s)
Hipernatremia , Hiponatremia , Niño , Fluidoterapia/efectos adversos , Furosemida , Humanos , Hipernatremia/etiología , Hiponatremia/complicaciones , Soluciones Hipotónicas/efectos adversos , Infusiones Intravenosas , Soluciones Isotónicas , Estudios RetrospectivosRESUMEN
Hypoxia inhibits Na and lung fluid reabsorption, which contributes to the formation of pulmonary edema. We tested whether dexamethasone prevents hypoxia-induced inhibition of reabsorption by stimulation of alveolar Na transport. Fluid reabsorption, transport activity, and expression of Na transporters were measured in hypoxia-exposed rats and in primary alveolar type II (ATII) cells. Rats were treated with dexamethasone (DEX; 2 mg/kg) on 3 consecutive days and exposed to 10% O(2) on the 2nd and 3rd day of treatment to measure hypoxia effects on reabsorption of fluid instilled into lungs. ATII cells were treated with DEX (1 muM) for 3 days before exposure to hypoxia (1.5% O(2)). In normoxic rats, DEX induced a twofold increase in alveolar fluid clearance. Hypoxia decreased reabsorption (-30%) by decreasing its amiloride-sensitive component; pretreatment with DEX prevented the hypoxia-induced inhibition. DEX increased short-circuit currents (ISC) of ATII monolayers in normoxia and blunted hypoxic transport inhibition by increasing the capacity of Na(+)-K(+)-ATPase and epithelial Na(+) channels (ENaC) and amiloride-sensitive ISC. DEX slightly increased the mRNA of alpha- and gamma-ENaC in whole rat lung. In ATII cells from DEX-treated rats, mRNA of alpha(1)-Na(+)-K(+)-ATPase and alpha-ENaC increased in normoxia and hypoxia, and gamma-ENaC was increased in normoxia only. DEX stimulated the mRNA expression of alpha(1)-Na(+)-K(+)-ATPase and alpha-, beta-, and gamma-ENaC of A549 cells in normoxia and hypoxia (1.5% O(2)) when DEX treatment was begun before or during hypoxic exposure. These results indicate that DEX prevents inhibition of alveolar reabsorption by hypoxia and stimulates the expression of Na transporters even when it is applied in hypoxia.
Asunto(s)
Dexametasona/farmacología , Canales Epiteliales de Sodio/metabolismo , Epitelio/metabolismo , Hipoxia/metabolismo , Pulmón/metabolismo , Alveolos Pulmonares/metabolismo , ATPasa Intercambiadora de Sodio-Potasio/metabolismo , Animales , Transporte Biológico , Canales Epiteliales de Sodio/genética , Masculino , ARN Mensajero/genética , ARN Mensajero/metabolismo , Ratas , Ratas Sprague-Dawley , ATPasa Intercambiadora de Sodio-Potasio/genéticaRESUMEN
Topology provides a novel means to describe branching patterns and has not been applied to fungal colonies previously. For any branched structure, various topologies are possible, and these lie between two extremes, a herringbone pattern (main axis with primary laterals) and a dichotomous pattern (highly branched system). We applied topological methods to colonies of Peronospora viciae 48 h after inoculation of Pisum sativum leaves. The methods are based on two simulations, one developed for channel networks such as found in river systems and another for biological systems. Although not a true herringbone form, the Peronospora viciae colonies have a strong herringbone element within their growth pattern. All 25 colonies analysed fell into the random distribution according to the confidence limits calculated from simulations for biological systems. These confidence limits, however, represent the percentile distribution of all simulated networks, and only those structures with a perfect herringbone or dichotomous topology fall outside the range. The tendency of P. viciae colonies towards herringbone growth is reflected by the topological indices for altitude and external pathlength (a(obs)/E(a) and pe(obs)/E(pe), where a = altitude, pe = external pathlength, obs = observed for the P. viciae colonies and E = expected values for random growth), and the slope of the regression analysis for a(obs) and pe(obs). We consider this trend as significant because it was consistent for all but one of the colonies, and implies that growth can be envisaged as an intermediate between random and herringbone topology. It is proposed that initial herringbone growth may reflect a strategy that is aimed at overcoming host resistance, achieving rapid colonisation of infected tissue and maximising the potential for nutrient acquisition. This topology would also increase the likelihood of finding a compatible mating type for reproduction between heterothallic isolates.