RESUMEN
INTRODUCTION: The hydration status is a predictor of survival in critically ill patients. However, it is unclear whether this association depends on the patient clinical condition. This study was designed to analyze the impact of hydration status on survival of critically ill patients with acute kidney injury (AKI) with or without sepsis. METHODS: A prospective cohort study following critically ill patients with AKI consecutively admitted over a one-year period to a teaching hospital intensive care unit (ICU). All patients with AKI stage three or higher of the KDIGO score were included. The hydration status was evaluated through the overhydration (OH) parameter of spectroscopy bioimpedance and sepsis was defined according Sepse-3 criteria. The survival analysis used adjusted competing-risks regression. RESULTS: Forty-eight patients were included, 27 (56%) with a sepsis diagnosis. The main negative predictors of survival among sepsis patients, adjusted by SAPS3 score, were higher OH (SHR 1.1, 95% CI 1.0-1.2, p = 0.02), mechanical ventilation (SHR 6.9, 95% CI 1.0-47.8, p = 0.04) and older age (SHR 1.1, 95% CI 1.0-1.1, p = 0.005). The predictors in non-sepsis patients were lower OH (SHR 0.82, 95% CI 0.71-0.95, p = 0.008) and mechanical ventilation (SHR 12, 95% CI 2.4-6.6, p < 0.001). CONCLUSIONS: This finding suggests that extracellular overhydration is an independent predictor of survival in critically ill patients with sepsis, but it seems to have opposite effect in non-sepsis patients.
Asunto(s)
Lesión Renal Aguda , Sepsis , Desequilibrio Hidroelectrolítico , Lesión Renal Aguda/diagnóstico , Enfermedad Crítica , Hospitales de Enseñanza , Humanos , Estudios Prospectivos , Sepsis/diagnóstico , Análisis Espectral , Desequilibrio Hidroelectrolítico/diagnósticoRESUMEN
The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-care ultrasonography (POCUS) is emerging as a valuable, noninvasive, bedside diagnostic tool for objective evaluation of physiologic and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function and quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography, provides additional quantitative information, including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage, adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function and pulmonary and venous congestion using POCUS and review relevant literature.
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Sistemas de Atención de Punto , Desequilibrio Hidroelectrolítico , Humanos , Nefrólogos , Ultrasonografía , Ultrasonografía Doppler , Desequilibrio Hidroelectrolítico/diagnósticoRESUMEN
AIM: To analyze the behavior of B-type natriuretic peptide (BNP) in the presence of defining characteristics (DCs) of the nursing diagnosis Excess fluid volume (00026) in patients hospitalized for acute decompensated heart failure. METHODS: Cohort study of patients admitted with acute decompensated heart failure (September 2015 to September 2016) defined by Boston Criteria. Patients hospitalized for up to 36 h with BNP values ≥ 100 pg/ml were included; BNP values at baseline-final assessment were compared by Wilcoxon test, the number of DCs at baseline-final assessment was compared by paired t-test. RESULTS: Sixty-four patients were included; there was a significant positive correlation between delta of BNP and the number of DCs present at initial clinical assessment. CONCLUSIONS: The behavior of BNP was correlated to the DCs indicating congestion. With clinical compensation, DCs and BNP decreased. The use of this biomarker may provide additional precision to the nursing assessment.
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Insuficiencia Cardíaca/sangre , Péptido Natriurético Encefálico/sangre , Diagnóstico de Enfermería , Desequilibrio Hidroelectrolítico/diagnóstico , Anciano , Biomarcadores/sangre , Estudios de Cohortes , Servicios Médicos de Urgencia , Femenino , Insuficiencia Cardíaca/enfermería , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Tamaño de la Muestra , Volumen Sistólico , Desequilibrio Hidroelectrolítico/sangreRESUMEN
ABSTRACT Aim: To analyze the behavior of B-type natriuretic peptide (BNP) in the presence of defining characteristics (DCs) of the nursing diagnosis Excess fluid volume (00026) in patients hospitalized for acute decompensated heart failure. Methods: Cohort study of patients admitted with acute decompensated heart failure (September 2015 to September 2016) defined by Boston Criteria. Patients hospitalized for up to 36 h with BNP values ≥ 100 pg/ml were included; BNP values at baseline-final assessment were compared by Wilcoxon test, the number of DCs at baseline-final assessment was compared by paired t-test. Results: Sixty-four patients were included; there was a significant positive correlation between delta of BNP and the number of DCs present at initial clinical assessment. Conclusions: The behavior of BNP was correlated to the DCs indicating congestion. With clinical compensation, DCs and BNP decreased. The use of this biomarker may provide additional precision to the nursing assessment.
RESUMEN Objetivo: Analizar el comportamiento del péptido natriurético tipo B (BNP) en presencia de características definitorias (CD) del diagnóstico de enfermería Exceso de volumen de líquidos (00026) en pacientes hospitalizados por insuficiencia cardíaca aguda descompensada (ICAD). Métodos: Estudio de cohorte de pacientes ingresados con ICAD (septiembre/2015 a septiembre/2016).Se incluyeron pacientes hospitalizados hasta 36 h con valores de BNP ≥ 100 pg / ml; Los valores de BNP en la evaluación inicial basal se compararon mediante la prueba de Wilcoxon, el número de CD en la evaluación inicial basal se comparó mediante el Test-T apareado. Resultados: Se incluyeron 64 pacientes; hubo una correlación positiva significativa entre el delta del BNP y las CD presentes en la evaluación clínica inicial. Conclusiones: El comportamiento del BNP se correlacionó con las CD que indican congestión. Con compensación clínica, las CD y el BNP disminuyeron. El uso del BNP puede proporcionar precisión adicional a la evaluación de enfermería.
RESUMO Objetivo: Analisar o comportamento do peptídeo natriurético tipo B (BNP) na presença de características definidoras (CDs) do diagnóstico de enfermagem Excesso de volume de líquidos (00026) em pacientes hospitalizados por insuficiência cardíaca descompensada. Métodos: Estudo de coorte com pacientes internados com insuficiência cardíaca descompensada (setembro-2015 a setembro-2016), definida pelos Critérios de Boston. Pacientes hospitalizados por mais de 36 horas, valor de BNP ≥ 100 pg/ml foram incluídos; valores de BNP basal-final foram comparados pelo teste Wilcoxon; as CDs no basal-final foram comparadas pelo teste t pareado. Resultados: Sessenta e quatro pacientes foram incluídos; houve correlação positiva significativa entre o delta de BNP com o número de CDs presentes na avaliação clínica inicial. Conclusões: O comportamento do BNP foi correlacionado com as CDs, indicando congestão. Com a compensação clínica, as CDs e a concentração de BNP diminuíram. O uso deste biomarcador pode fornecer precisão adicional à avaliação de enfermagem.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Desequilibrio Hidroelectrolítico/diagnóstico , Diagnóstico de Enfermería , Péptido Natriurético Encefálico/sangre , Insuficiencia Cardíaca/sangre , Volumen Sistólico , Desequilibrio Hidroelectrolítico/sangre , Biomarcadores/sangre , Estudios de Cohortes , Tamaño de la Muestra , Servicios Médicos de Urgencia , Insuficiencia Cardíaca/enfermería , Insuficiencia Cardíaca/fisiopatologíaRESUMEN
INTRODUCTION: Pulmonary hypertension (PH) has been reported in hemodialysis patients, but data regarding its pathogenesis are scarce. This study aimed to evaluate the role of fluid overload in PH and its interrelationships with the usual biomarkers of micro-inflammatory state in hemodialysis patients. MATERIALS AND METHODS: In is a cross-sectional and prospective study, 119 consecutive hemodialysis patients at a Brazilian referral university hospital were evaluated between March 2007 and February 2013. Based on the presence of echocardiographic parameters of PH, patients were allocated to two groups of the PH group and the non-PH group. Clinical parameters, site and type of vascular access, bio-impedance, and laboratory findings were compared between the two groups and a logistic regression model was elaborated. RESULTS: Pulmonary hypertension was found in 23 (19.0%) of 119 patients. The groups significantly differed in extracellular water, ventricular thickness, left atrium diameter, and ventricular filling. Additionally, laboratory data associated with PH were alpha-1-acid glycoprotein (140.0 ± 32.9 versus 116.0 ± 35.5; P < .001); C-reactive protein (median, 1.1 versus 1.6; P = .01) and B-type natriuretic peptide (median, 328 versus 77; P = .03). The adjusted logistic regression model, including alpha-1-acid glycoprotein and B-type natriuretic peptide, showed significant associations for both (odds ratio, 1.023; 95% confidence interval, 1.008 to 1.043; P = .004 and odds ratio, 3.074; 95% confidence interval, 1.49-6.35; P = .002, respectively). CONCLUSIONS: Pulmonary hypertension, cardiac hypertrophy, fluid overload, and inflammation were associated to each other in hemodialysis patients, providing insight into its pathogenesis. Longitudinal studies are warranted.
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Presión Arterial , Hipertensión Pulmonar/etiología , Mediadores de Inflamación/sangre , Inflamación/etiología , Fallo Renal Crónico/terapia , Arteria Pulmonar/fisiopatología , Diálisis Renal/efectos adversos , Equilibrio Hidroelectrolítico , Desequilibrio Hidroelectrolítico/etiología , Adulto , Anciano , Biomarcadores/sangre , Composición Corporal , Brasil , Cardiomegalia/etiología , Distribución de Chi-Cuadrado , Estudios Transversales , Impedancia Eléctrica , Femenino , Hospitales Universitarios , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/fisiopatología , Inflamación/sangre , Inflamación/diagnóstico , Fallo Renal Crónico/diagnóstico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Desequilibrio Hidroelectrolítico/diagnóstico , Desequilibrio Hidroelectrolítico/fisiopatologíaRESUMEN
Objective To analyze the concept of fluid overload in Chronic Kidney Disease patients undergoing dialysis therapy and comparing it to the Nursing Diagnosis of Excess fluid volume present in the NANDA International. Method An integrative literature review carried out in the LILACS, CINAHL and SCOPUS databases. Results The sample was comprised of 22 articles. The defining attributes of the concept were: fluid retention, fluid buildup in the body, and weight gain over a short period; while the attributes composing the definition were: fluid retention in the body (intracellular/extracellular space) expressed by weight gain over short period of time. Twenty-one (21) antecedents and 22 consequents of fluid overload in patients with renal disease in dialysis therapy were identified. Conclusion The definition evidenced by the NANDA International taxonomy for the Excess fluid volume Nursing Diagnosis and the components of this diagnosis need to be complemented in order to better target the care of patients with kidney disease undergoing dialysis therapy.
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Diálisis Renal , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia , Desequilibrio Hidroelectrolítico/etiología , Humanos , Diagnóstico de Enfermería , Terminología Normalizada de Enfermería , Desequilibrio Hidroelectrolítico/diagnósticoRESUMEN
Hypokalemia and hyperkalemia are the most common electrolyte disorders managed in the emergency department. The diagnosis of these potentially life-threatening disorders is challenging due to the often vague symptomatology a patient may express, and treatment options may be based upon very little data due to the time it may take for laboratory values to return. This review examines the most current evidence with regard to the pathophysiology, diagnosis, and management of potassium disorders. In this review, classic paradigms, such as the use of sodium polystyrene and the routine measurement of serum magnesium, are tested, and an algorithm for the treatment of potassium disorders is discussed.
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Manejo de la Enfermedad , Servicio de Urgencia en Hospital , Medicina Basada en la Evidencia , Hiperpotasemia/diagnóstico , Hiperpotasemia/terapia , Hipopotasemia/diagnóstico , Hipopotasemia/terapia , Desequilibrio Ácido-Base/diagnóstico , Desequilibrio Ácido-Base/fisiopatología , Desequilibrio Ácido-Base/terapia , Algoritmos , Diagnóstico Diferencial , Electrocardiografía , Humanos , Hiperpotasemia/fisiopatología , Hipopotasemia/fisiopatología , Desequilibrio Hidroelectrolítico/diagnóstico , Desequilibrio Hidroelectrolítico/fisiopatología , Desequilibrio Hidroelectrolítico/terapiaRESUMEN
Hypokalemia and hyperkalemia are the most common electrolyte disorders managed in the emergency department. The diagnosis of these potentially life-threatening disorders is challenging due to the often vague symptomatology a patient may express, and treatment options may be based upon very little data due to the time it may take for laboratory values to return. This review examines the most current evidence with regard to the pathophysiology, diagnosis, and management of potassium disorders. In this review, classic paradigms, such as the use of sodium polystyrene and the routine measurement of serum magnesium, are tested, and an algorithm for the treatment of potassium disorders is discussed. [Points & Pearls is a digest of Emergency Medicine Practice].
Asunto(s)
Servicio de Urgencia en Hospital , Medicina Basada en la Evidencia , Hiperpotasemia , Hipopotasemia , Desequilibrio Ácido-Base/diagnóstico , Desequilibrio Ácido-Base/fisiopatología , Desequilibrio Ácido-Base/terapia , Resinas de Intercambio de Catión/uso terapéutico , Manejo de la Enfermedad , Pruebas Hematológicas/métodos , Humanos , Hiperpotasemia/diagnóstico , Hiperpotasemia/fisiopatología , Hiperpotasemia/terapia , Hipopotasemia/diagnóstico , Hipopotasemia/fisiopatología , Hipopotasemia/terapia , Magnesio/sangre , Desequilibrio Hidroelectrolítico/diagnóstico , Desequilibrio Hidroelectrolítico/fisiopatología , Desequilibrio Hidroelectrolítico/terapiaRESUMEN
OBJECTIVES: To evaluate whether changes in hydration status (reflecting fluid retention) would be detected by bioelectrical impedance vector analysis (BIVA) and phase angle during hospitalization for acute decompensated heart failure (ADHF) and after clinical stabilization. METHODS: Patients admitted to ADHF were evaluated at admission, discharge and after clinical stabilization (3 mo after discharge) for dyspnea, weight, brain natriuretic peptide, bioelectrical impedance resistance, reactance, and phase angle. Generalized estimating equations and chi-square detected variations among the three time points of evaluation. RESULTS: Were included 57 patients: Mean age was 61 ± 13 y, 65% were male, LVEF was 25 ± 8%. During hospitalization there were improvements in clinical parameters and increase in resistance/height (from 250 ± 72 to 302 ± 59 Ohms/m, P < 0.001), reactance/height (from 24 ± 10 to 31 ± 9 Ohms/m, P < 0.001), and phase angle (from 5.3 ± 1.6 to 6 ± 1.6°, P = 0.007). From discharge to chronic stability, both clinical and BIVA parameters remained stable. At admission, 61% of patients had significant congestion by BIVA, and they lost more weight and had higher improvement in dyspnea during hospitalization (P < 0.05). At discharge, more patients were in the upper half of the graph (characterizing some degree of dehydration) while at chronic stability normal hydration status was more prevalent (P < 0.001). CONCLUSIONS: BIVA and phase angle were able to detect significant changes in hydration status during ADHF, which paralleled the clinical course of recompensation, both acutely and chronically. The classification of congestion by BIVA at admission identified patients with more pronounced changes in weight and dyspnea during compensation.
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Insuficiencia Cardíaca/diagnóstico , Enfermedad Aguda , Anciano , Composición Corporal , Peso Corporal , Estudios de Cohortes , Disnea/diagnóstico , Disnea/patología , Impedancia Eléctrica , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/patología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/metabolismo , Desequilibrio Hidroelectrolítico/diagnóstico , Desequilibrio Hidroelectrolítico/patologíaRESUMEN
Hydroelectrolytic disorders are one of the most common metabolic complications in cancer patients. Although often metabolic alterations affecting various ions are part of the manifestations of the oncological disease, even in the form of paraneoplastic syndrome, we must not forget that very often, these disorders could be caused by various drugs, including some of the antineoplastic agents most frequently used, such as platin derivatives or some biologics. These guidelines review major management of diagnosis, evaluation and treatment of the most common alterations of sodium, calcium, magnesium and potassium in cancer patients. Aside from life-sustaining treatments, we have reviewed the role of specific drug treatments aimed at correcting some of these disorders, such as intravenous bisphosphonates for hypercalcemia or V2 receptor antagonists in the management of syndrome of inappropriate antidiuretic hormone secretion-related hyponatremia.
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Neoplasias/complicaciones , Síndromes Paraneoplásicos/diagnóstico , Desequilibrio Hidroelectrolítico/diagnóstico , Humanos , Síndromes Paraneoplásicos/terapia , Desequilibrio Hidroelectrolítico/etiología , Desequilibrio Hidroelectrolítico/terapiaRESUMEN
OBJECTIVE: To identify the prevalence of nursing diagnosis of fluid volume excess and their defining characteristics in hemodialysis patients and the association between them. METHOD: Cross-sectional study conducted in two steps. We interviewed 100 patients between the months of December 2012 and April 2013 in a teaching hospital and one hemodialysis clinic. The inference was performed by diagnostician nurses between July and September 2013. RESULTS: The diagnostic studied was identified in 82% of patients. The characteristics that were statistically associated: bounding pulses, pulmonary congestion, jugular vein distention, edema, change in electrolytes, weight gain, intake greater than output and abnormal breath sounds. Among these, edema and weight gain had the highest chances for the development of this diagnostic. CONCLUSION: The analyzed diagnostic is prevalent in this population and eight characteristics presented significant association.
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Diagnóstico de Enfermería , Diálisis Renal/efectos adversos , Desequilibrio Hidroelectrolítico/diagnóstico , Desequilibrio Hidroelectrolítico/etiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Insuficiencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Objective: To identify the prevalence of nursing diagnosis of fluid volume excess and their defining characteristics in hemodialysis patients and the association between them. Method: Cross-sectional study conducted in two steps. We interviewed 100 patients between the months of December 2012 and April 2013 in a teaching hospital and one hemodialysis clinic. The inference was performed by diagnostician nurses between July and September 2013. Results: The diagnostic studied was identified in 82% of patients. The characteristics that were statistically associated: bounding pulses, pulmonary congestion, jugular vein distention, edema, change in electrolytes, weight gain, intake greater than output and abnormal breath sounds. Among these, edema and weight gain had the highest chances for the development of this diagnostic. Conclusion: The analyzed diagnostic is prevalent in this population and eight characteristics presented significant association. .
Objetivo: Identificar la prevalencia del diagnóstico de enfermería Exceso de volumen de líquidos y sus características definitorias en pacientes sometidos a hemodiálisis y verificar la asociación entre ambos. Método: Estudio transversal, realizado en dos etapas. Se entrevistaron 100 pacientes, entre los meses de diciembre de 2012 y abril de 2013, de un hospital universitario y de una clínica de hemodiálisis. La inferencia diagnóstica fue realizada por enfermeros diagnosticadores, entre julio y septiembre de 2013. Resultados: El diagnóstico estudiado fue identificado en 82% de los pacientes. Las características que presentaron asociación estadística fueron: agitación, congestión pulmonar, distensión de la yugular, edema, electrolitos alterados, aumento de peso, ingesta mayor a las pérdidas y sonidos adventicios. Entre estos, el edema y el aumento de peso presentan mayor relación para la formulación del diagnóstico. Conclusión: Se concluye que el diagnóstico analizado es prevalente en esta población y que presentó asociación significativa con ocho características. .
Objetivo: Identificar a prevalência do diagnóstico de enfermagem Volume de líquidos excessivo e de suas características definidoras em pacientes submetidos à hemodiálise e verificar a associação entre ambos. Método: Pesquisa transversal realizada em duas etapas. Foram entrevistados 100 pacientes, entre os meses de dezembro de 2012 e abril de 2013, em um hospital universitário e em uma clínica de hemodiálise. A inferência foi realizada por enfermeiros diagnosticadores, entre julho e setembro de 2013. Resultados: O diagnóstico estudado foi identificado em 82% dos pacientes. As características que apresentaram associação estatística foram: agitação, congestão pulmonar, distensão de jugular, edema, eletrólitos alterados, ganho de peso, ingestão maior que o débito e ruídos adventícios. Dentre estas, edema e ganho de peso apresentaram as maiores chances para o desenvolvimento desse diagnóstico. Conclusão: O diagnóstico analisado é prevalente nesta clientela e oito características apresentaram associação significante. .
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Diagnóstico de Enfermería , Diálisis Renal/efectos adversos , Desequilibrio Hidroelectrolítico/diagnóstico , Desequilibrio Hidroelectrolítico/etiología , Estudios Transversales , Insuficiencia CardíacaRESUMEN
Dysnatremia is among the most common electrolyte disorders in clinical medicine and its improper management can have serious consequences associated with increased morbidity and mortality of patients. The aim of this study is to update the pathophysiology of dysnatremia and review some simple clinical and laboratory tools, easy to interpret, that allow us to make a quick and simple approach. Dysnatremia involves water balance disorders. Water balance is directly related to osmoregulation. There are mechanisms to maintain plasma osmolality control; which are triggered by 1-2% changes. Hypothalamic osmoreceptors detect changes in plasma osmolality, regulating the secretion of Antidiuretic Hormone (ADH), which travels to the kidneys resulting in more water being reabsorbed into the blood; therefore, the kidney is the main regulator of water balance. When a patient is suffering dysnatremia, it is important to assess how his ADH-renal axis is working. There are causes of this condition easy to identify, however, to differentiate a syndrome of inappropriate ADH secretion from cerebral salt-wasting syndrome is often more difficult. In the case of hypernatremia, to suspect insipidus diabetes and to differentiate its either central or nephrogenic origin is essential for its management. In conclusion, dysnatremia management requires pathophysiologic knowledge of its development in order to make an accurate diagnosis and appropriate treatment, avoiding errors that may endanger the health of our patients.
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Hipernatremia/fisiopatología , Hiponatremia/fisiopatología , Desequilibrio Hidroelectrolítico/fisiopatología , Niño , Humanos , Hipernatremia/diagnóstico , Hipernatremia/terapia , Hiponatremia/diagnóstico , Hiponatremia/terapia , Síndrome de Secreción Inadecuada de ADH/diagnóstico , Síndrome de Secreción Inadecuada de ADH/fisiopatología , Síndrome de Secreción Inadecuada de ADH/terapia , Vasopresinas/metabolismo , Desequilibrio Hidroelectrolítico/diagnóstico , Desequilibrio Hidroelectrolítico/terapiaRESUMEN
Osmotic demyelination syndrome (ODS) is the damage over the central nervous system caused by several electrolytes, metabolic and toxic disorders. We aimed to describe cases of unusual forms of ODS. In a 9-year period, 25 consecutive patients with ODS (15 men; mean age 42 years) were registered in our referral institution, among them, four (16 %) with atypical neuroimaging findings were abstracted for this communication. None of them presented cardiorespiratory arrest, head trauma, seizures, neuromyelitis optica spectrum or contact with toxic chemicals. Case 1 was a 33-year-old alcoholic man without hypertension or electrolyte imbalance, who presented a classic central pontine myelinolysis (CPM) and a hemorrhage within the pons. Case 2 was a 34-year-old alcoholic man with hypoglycemia and hyponatremia who presented CPM and diffuse bihemispheric extrapontine myelinolysis (EPM) after correction of serum sodium. Case 3 was a 52-year-old woman with mild hypokalemia and hyponatremia (inadequately corrected), who presented a peduncular and cerebellar EPM. Case 4 was a 67-year-old woman who had a suicidal attempt with antidepressants and carbamazepine without impaired consciousness, who complicated with mild hyponatremia associated with a classical CPM and a spinal cord EPM. Case 2 died and the rest remained with variable neurological impairments at last follow-up visit. With modern neuroimaging, the so-called atypical forms of ODS may not be as rare as previously thought; however, they could have a more adverse outcome than the classical ODS.
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Enfermedades Desmielinizantes/diagnóstico , Mielinólisis Pontino Central/diagnóstico , Desequilibrio Hidroelectrolítico/diagnóstico , Adulto , Enfermedades Desmielinizantes/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mielinólisis Pontino Central/etiología , Desequilibrio Hidroelectrolítico/complicacionesRESUMEN
JUSTIFICATIVA E OBJETIVOS: Desequilíbrios hidroeletrolíticos são frequentemente observados em pacientes críticos, sendo comuns em pacientes de emergência. A apresentação clinica pode ser assintomática ou com graves sintomas como alteração do estado neurológico ou arritmias cardíacas. Fazer o diagnóstico através de exames laboratoriais parece ser fácil, porém é necessário conhecer os mecanismos patofisiológicos envolvidos, uma vez que uma correção inadequada pode causar sequelas importantes ou mesmo a morte do paciente. CONTEÚDO: Foram selecionados artigos da base de dados Pubmed, dando prioridade aqueles publicados entre 2007 e 2012. Foram usadas como palavras-chave: hiponatremia, hipernatremia, hipocalemia, hipercalemia, hipocalcemia, hipercalcemia,distúrbios eletrolíticos, magnésio e fósforo. CONCLUSÃO: Os principais desequilíbrios hidroeletrolíticos encontrados na sala de emergência e a associação clínica com as principais doenças associadas, bem como a importância de uma correção adequada devem pertencer ao conhecimento do médico emergencista.
BACKGROUND AND OBJECTIVES: Water-electrolyte imbalances are frequently observed in critical ill patients and are common in the emergency care. Clinical presentation can be asymptomatic or severe with neurological alterations or cardiac arrhythmias. Make the diagnosis using laboratory tests may be easy, but the pathophysiological understanding of these disorders is more important: an innapropriated correction may cause severe damage or can be fatal to the patient. CONTENTS: We selected articles in Pubmed baseline and we gave priority to those published from 2007 to 2012. The keywords were: hyponatremia, hypernatremia, hypocalemia, hypercalemia, hypocalcemia, hypercalcemia, electrolyte disturbance, magnesium, chloro and phosphorus. CONCLUSION: The main electrolyte imbalances found in the emergency room, showing the clinical association with major diseases, and the importance of a proper correction must belong tothe knowledge of the emergency physician.
Asunto(s)
Humanos , Desequilibrio Hidroelectrolítico/diagnóstico , Medicina de EmergenciaRESUMEN
BACKGROUND: Unstimulated whole salivary parameters have been identified as potential markers of hydration status. Reduced salivary flow rate and increased salivary osmolality have been shown to be useful to identify dehydration, even when minimal loss of body water occurs. This study aimed to evaluate whether unstimulated salivary flow rate and salivary osmolality from individuals with cerebral palsy correlate with plasma and urine osmolality. METHODS: Thirty-five male and female children, aged 9-13 years old, diagnosed with cerebral palsy were compared to 27 nondisabled children (10-12 years old). Unstimulated whole saliva was collected under slight suction and salivary flow rate (ml/min) was calculated. Plasma without venostasis and urine were also collected. Salivary, plasma and urine osmolality were measured using a freezing point depression osmometer. RESULTS: Cerebral palsy children presented a reduction in salivary flow rate (50%) compared to the control group (P < 0.01). Moreover, an increase in salivary (50%), plasma (3%), and urine osmolality (20%) was also observed in the cerebral palsy children compared to the control group (P < 0.01). Salivary flow rate was negatively correlated with the salivary, plasma and urine osmolality (P < 0.01). Salivary osmolality correlated positively with plasma and urine osmolality (P < 0.01). CONCLUSION: Cerebral palsy children seem to present impaired adequate hydration status. Since the possible hypohydration condition may be reflected in saliva fluid, which could compromise the protective function exerted by saliva, the earlier this condition is identified the greater the chances of administering preventive measures. Moreover, salivary osmolality is a reliable parameter that reflects changes in plasma and urine.
Asunto(s)
Parálisis Cerebral/fisiopatología , Saliva/química , Equilibrio Hidroelectrolítico/fisiología , Adolescente , Parálisis Cerebral/sangre , Parálisis Cerebral/orina , Niño , Femenino , Humanos , Masculino , Concentración Osmolar , Saliva/fisiología , Tasa de Secreción/fisiología , Desequilibrio Hidroelectrolítico/diagnósticoRESUMEN
This study assessed sweat electrolyte concentration and losses in asthmatic children during exercise in the heat. Eleven asthmatics (AG; 11 +/- 2 years old) and 11 nonasthmatics (CG; 10 +/- 1 year old) underwent a maximal progressive cycleergometer test. During a second session, participants cycled in the heat (35 degrees C, 60% RH) of a climatic chamber for 30 min at 50-60% of maximal workload. Sweat was collected using sweat patches attached to the dorsal region. No differences were observed in sweat [Na+] (AG = 35 +/- 12.9 and CG = 43.4 +/- 18 mmol/L) and [Cl-] (AG = 27.3 +/- 10.4 and CG = 38.5 +/- 19.1 mmol/L). There was no difference in sweat Na+ losses (AG = 0.47 +/- 0.36 and CG = 0.66 +/- 0.68 mmol/kg/h) and Cl- losses (AG = 0.37 +/- 0.29 and CG = 0.59 +/- 0.62 mmol/kg/h) between groups. Asthmatic children did not differ from nonasthmatics in their sweat electrolyte concentrations and electrolyte losses.
Asunto(s)
Asma/fisiopatología , Ciclismo , Electrólitos , Ejercicio Físico , Calor/efectos adversos , Sudor/química , Desequilibrio Hidroelectrolítico/diagnóstico , Factores de Edad , Estudios de Casos y Controles , Niño , Protección a la Infancia , Ergometría , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Encuestas y Cuestionarios , Equilibrio Hidroelectrolítico , Desequilibrio Hidroelectrolítico/etiologíaRESUMEN
O Triatlon Ironman caracteriza-se por ser uma atividade de resistência constituída por 3,8km de natação, 180km de ciclismo e 42,2km de corrida, no qual o atleta exercita-se, em média, por cerca de 13 horas. Neste contexto, o atleta exposto a tal carga de esforço e adversidades ambientais, experimenta alterações orgânicas agudas em seus sistemas biológicos, incluindo os distúrbios hidroeletrolíticos. O objetivo deste estudo é descrever as alterações hídricas e eletrolíticas encontradas em atletas de triatlon Ironman. De 2002 a 2005 foram avaliados 109 atletas voluntários antes e imediatamente após as provas realizadas em Florianópolis-SC Brasil, com análise sanguínea dos eletrólitos sódio, e potássio, e medida de massa corporal. Os dados do sódio sérico de 89 atletas foram correlacionados com o grau de desidratação e modificações percentuais de peso corporal. Dados de 77 atletas, quanto ao potássio sérico, foram avaliados isoladamente de forma descritiva. Seis atletas (6,7 por cento) apresentaram-se euhidratados ou superhidratados ao final da prova, 50 atletas desidrataram de 0 a 3 por cento (56,2 por cento), 29 de 3 a 6 por cento (32,6 por cento) e 4 atletas (4,5 por cento) desidrataram mais que 6 por cento. Houve uma tendência a ocorrer hiponatremia entre aqueles que desidrataram menos ou ganharam peso. O potássio teve um comportamento dentro dos limites da normalidade em toda amostra. Conclui-se que os distúrbios hidroeletrolíticos (hiponatremia e desidratação) são incidentes nesta modalidade esportiva, sendo a superhidratação a etiologia provável da hiponatremia denotada pelo ganho ou perdas discretas de peso.
The Ironman Triathlon is characterized for being an endurance activity consisting of 3.8 km of swimming, 180 km of cycling and 42.2 km of running, in which the athlete exercises an average of about 13 hours. In this context, the athlete exposed to such load of effort and environmental adversities, experiences acute organic alterations in his biological systems, including hydroelectrolytic disturbs. The objective of this study is to describe the hydric and electrolytic alterations found in Ironman triathlon athletes. From years 2002 to 2005, 109 volunteer athletes have been evaluated before and immediately after the events which took place in Florianópolis-SC Brazil, with blood analysis of sodium and potassium electrolytes, and body mass measurement. Sodium serum data from 89 athletes have been correlated with the degree of dehydration and percentage alterations of body weight. Data of 77 athletes concerning the serum potassium were separately evaluated in a descriptive way. Six athletes (6.7 percent) were euhydrated or superhydrated at the end of the test; 50 athletes were dehydrated from 0 to 3 percent (56.2 percent); 29 from 3 to 6 percent (32.6 percent) and 4 athletes (4.5 percent) were dehydrated more than 6 percent. There was a tendency to hyponatremia among those who had dehydrated less or gained weight. Potassium behaved within the limits of normality in the entire sample. It was concluded that hydroelectrolytic disturbs (hyponatremia and dehydration) are recurrent in this sportive modality, being superhydration the probable etiology of hyponatremia denoted from profit or small weight loss.
Asunto(s)
Humanos , Masculino , Atletas , Deshidratación , Desequilibrio Hidroelectrolítico/diagnóstico , Desequilibrio Hidroelectrolítico/prevención & control , Desequilibrio Hidroelectrolítico/terapia , Fluidoterapia , Hiponatremia , Deficiencia de Potasio , Desequilibrio HidroelectrolíticoRESUMEN
O propósito deste trabalho foi avaliar o hematócrito,a concentração das proteínas plasmáticas totais e as possíveis alterações nas concentrações séricas de sódio e potássio em filhotes de cães com diarréia causada por parvovírus canino (CPV) associado ou não ao coronavirus. Para tal, coletaram-se amostras de sangue e fezes de cães com diarréia atendidos na rotina do Hospital Veterinária e de cães sem diarréia (aparentemente sadios). As amostras foram coletadas no período de fevereiro a abril de 2005. As fezes foram encaminhadas ao Laboratório de microbiologia dessa mesma instituição, que realizou a reação de Hemaglutinação Viral, como prova diagnóstica para detecção dos agentes virais. Detectou-se que a maioria dos animais positivos para o CPV apresentou infecção concomitente com o coronavírus canino. A hiponatremia e a anemia foram identificadas nos animais infectados. Sabe-se que, o sódio participa de muitos eventos fisiológicos. Assim, o seu desequilíbrio pode proporcionar efeitos deletéricos no organismo. Além disso, a anemia contribui de forma negativa a condição clínica do paciente. O clínico precisa estar atento a essa condição e considerá-la durante a instituição terapêutica
The purpose of this research is to evaluate blood hematocrit and the blood serum concetration of sodium, potassium and protein of the dogs with diarrhea caused by canine parvovirus associated or not with coronavirus. For such, samples of blood and excrement of the dogs with diarrhea of the UNOPAR Veterinary Hospital. The excrements were carried through to the microbiological laboratory in this institution, and were tested for viral hemoagglutination as a diagnostic proof to defect viral agents. It was detect that the majority of the positive animals in this reaction also presented positive reaction to the research of coronaviral. The hyponatremia and anemia were identified in the infected animals. It is known that sodium participates in many physiological events. The vet needs to be therapeutic institution
Asunto(s)
Perros , Coronavirus Canino/patogenicidad , Perros/virología , Desequilibrio Hidroelectrolítico/diagnóstico , Diarrea/veterinaria , Enteritis , Parvovirus Canino/patogenicidad , Intestinos/virologíaRESUMEN
O propósito deste trabalho foi avaliar o hematócrito,a concentração das proteínas plasmáticas totais e as possíveis alterações nas concentrações séricas de sódio e potássio em filhotes de cães com diarréia causada por parvovírus canino (CPV) associado ou não ao coronavirus. Para tal, coletaram-se amostras de sangue e fezes de cães com diarréia atendidos na rotina do Hospital Veterinária e de cães sem diarréia (aparentemente sadios). As amostras foram coletadas no período de fevereiro a abril de 2005. As fezes foram encaminhadas ao Laboratório de microbiologia dessa mesma instituição, que realizou a reação de Hemaglutinação Viral, como prova diagnóstica para detecção dos agentes virais. Detectou-se que a maioria dos animais positivos para o CPV apresentou infecção concomitente com o coronavírus canino. A hiponatremia e a anemia foram identificadas nos animais infectados. Sabe-se que, o sódio participa de muitos eventos fisiológicos. Assim, o seu desequilíbrio pode proporcionar efeitos deletéricos no organismo. Além disso, a anemia contribui de forma negativa a condição clínica do paciente. O clínico precisa estar atento a essa condição e considerá-la durante a instituição terapêutica(AU)
The purpose of this research is to evaluate blood hematocrit and the blood serum concetration of sodium, potassium and protein of the dogs with diarrhea caused by canine parvovirus associated or not with coronavirus. For such, samples of blood and excrement of the dogs with diarrhea of the UNOPAR Veterinary Hospital. The excrements were carried through to the microbiological laboratory in this institution, and were tested for viral hemoagglutination as a diagnostic proof to defect viral agents. It was detect that the majority of the positive animals in this reaction also presented positive reaction to the research of coronaviral. The hyponatremia and anemia were identified in the infected animals. It is known that sodium participates in many physiological events. The vet needs to be therapeutic institution(AU)