RESUMO
Acute phosphate nephropathy (APN) is an acute renal failure secondary to the use of oral sodium phosphate (OSP) laxatives, with a high risk of progression to chronicity. We report a 60-year-old woman with mixed connective tissue disease whose serum creatinine increased up to 2.0 mg/dL in her regular control tests, without an evident causative factor. Kidney biopsy showed numerous intratubular calcium phosphate deposits, consistent with APN. She had a history of OSP laxative intake, and a sodium phosphate enema was used before a colonoscopy performed six months earlier. The temporal association between the use of OSP laxatives and acute kidney injury, should lead to the suspicion of APN. The urine sediment is generally normal or with mild to moderate proteinuria. The diagnosis is confirmed with a kidney biopsy. Until now, there is no specific treatment for APN, thus prevention is essential. In high-risk patients for developing APN, the administration of these laxatives should be avoided.
Assuntos
Injúria Renal Aguda , Laxantes , Catárticos/efeitos adversos , Feminino , Humanos , Laxantes/efeitos adversos , Pessoa de Meia-Idade , Fosfatos/efeitos adversosRESUMO
Acute phosphate nephropathy (APN) is an acute renal failure secondary to the use of oral sodium phosphate (OSP) laxatives, with a high risk of progression to chronicity. We report a 60-year-old woman with mixed connective tissue disease whose serum creatinine increased up to 2.0 mg/dL in her regular control tests, without an evident causative factor. Kidney biopsy showed numerous intratubular calcium phosphate deposits, consistent with APN. She had a history of OSP laxative intake, and a sodium phosphate enema was used before a colonoscopy performed six months earlier. The temporal association between the use of OSP laxatives and acute kidney injury, should lead to the suspicion of APN. The urine sediment is generally normal or with mild to moderate proteinuria. The diagnosis is confirmed with a kidney biopsy. Until now, there is no specific treatment for APN, thus prevention is essential. In high-risk patients for developing APN, the administration of these laxatives should be avoided.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Laxantes/efeitos adversos , Injúria Renal Aguda , Fosfatos/efeitos adversos , Catárticos/efeitos adversosRESUMO
Phosphorus (P) is an essential element for the cultivation of sugarcane, which plays an important role in rooting, tillering and forage production. With the objective to evaluate the effects of pre-planting phosphating on soil chemical attributes and sugarcane growth for forage production, an experiment was conducted at the Santa Mercedes plant, Tupi Paulista, SP, using the RB 86 7515 variety. The experimental design consisted of random blocks with 8 treatments and 4 replicates, totaling 32 experimental units, in a 2 x 4 factorial scheme including two P sources (decanted phosphate and monoammonium phosphate) and four P doses (0, 80, 120, and 160 kg/ ha P2O5). The P sources and doses tested increase the availability of P in soil, with the dose of 120 kg/ha P2O5 providing the highest production of green forage mass. Monoammonium phosphate as P source reduces soil pH and increases the availability of micronutrients such as iron, boron and zinc.(AU)
O fósforo (P) é considerado um elemento essencial para o cultivo da cana-de-açúcar, assumindo grande importância no enraizamento, no perfilhamento e na produção de forragem. Com o objetivo de avaliar os efeitos da fosfatagem em pré-plantio nos atributos químicos do solo e no desenvolvimento da cultura da cana-de-açúcar para produção de forragem foi realizado um experimento com a variedade RB 86 7515, junto à unidade produtora da Usina Santa Mercedes, Tupi Paulista, SP. O delineamento experimental foi em blocos ao acaso com 8 tratamentos e 4 repetições, totalizando 32 unidades experimentais, em esquema fatorial 2 x 4, duas fontes de fósforo (fosfato decantado e fosfato de monoamônio) e quatro doses de fósforo (0; 80; 120; 160 kg/ha P2O5). As fontes e doses testadas de fósforo (P) aumenta a disponibilidade de P no solo, sendo a dose de 120 kg/ha P2O5 que apresenta maior produção de massa verde de forragem. A fonte fosfato monoamônico reduz o pH do solo e aumenta a disponibilidade dos micronutrientes como ferro, boro e zinco.(AU)
Assuntos
Fosfatos/efeitos adversos , Fosfatos/análise , Saccharum/química , Análise do SoloRESUMO
Phosphorus (P) is an essential element for the cultivation of sugarcane, which plays an important role in rooting, tillering and forage production. With the objective to evaluate the effects of pre-planting phosphating on soil chemical attributes and sugarcane growth for forage production, an experiment was conducted at the Santa Mercedes plant, Tupi Paulista, SP, using the RB 86 7515 variety. The experimental design consisted of random blocks with 8 treatments and 4 replicates, totaling 32 experimental units, in a 2 x 4 factorial scheme including two P sources (decanted phosphate and monoammonium phosphate) and four P doses (0, 80, 120, and 160 kg/ ha P2O5). The P sources and doses tested increase the availability of P in soil, with the dose of 120 kg/ha P2O5 providing the highest production of green forage mass. Monoammonium phosphate as P source reduces soil pH and increases the availability of micronutrients such as iron, boron and zinc.
O fósforo (P) é considerado um elemento essencial para o cultivo da cana-de-açúcar, assumindo grande importância no enraizamento, no perfilhamento e na produção de forragem. Com o objetivo de avaliar os efeitos da fosfatagem em pré-plantio nos atributos químicos do solo e no desenvolvimento da cultura da cana-de-açúcar para produção de forragem foi realizado um experimento com a variedade RB 86 7515, junto à unidade produtora da Usina Santa Mercedes, Tupi Paulista, SP. O delineamento experimental foi em blocos ao acaso com 8 tratamentos e 4 repetições, totalizando 32 unidades experimentais, em esquema fatorial 2 x 4, duas fontes de fósforo (fosfato decantado e fosfato de monoamônio) e quatro doses de fósforo (0; 80; 120; 160 kg/ha P2O5). As fontes e doses testadas de fósforo (P) aumenta a disponibilidade de P no solo, sendo a dose de 120 kg/ha P2O5 que apresenta maior produção de massa verde de forragem. A fonte fosfato monoamônico reduz o pH do solo e aumenta a disponibilidade dos micronutrientes como ferro, boro e zinco.
Assuntos
Análise do Solo , Fosfatos/análise , Fosfatos/efeitos adversos , Saccharum/químicaRESUMO
Phosphate enemas are frequently used in the treatment of constipation. Errors in dosage and administration can lead to severe complications. OBJECTIVE: To report a case of severe toxicity of phosphate enemas in a child with no risk factors. CASE: 2 years old female, with functional constipation, was brought to emergency department because abdominal pain. She was diagnosed with fecal impaction and received half a bottle of Fleet Adult® (Laboratorio Synthon, Chile) two times, with no clinical resolution, deciding to start proctoclisis in pediatric ward. Soon after admission, she presented painful tetany, but alert and oriented. Patient was transferred to PICU where severe hyperphosphatemia and secondary hypocalcemia were confirmed. Her treatment included electrolyte correction; removal of residual phosphate enema and hyperhydration. Tetany resolved over 2 hours after admission and no other complications. Proctoclisis was performed and patient was discharged three days after admission with pharmacological management of constipation. CONCLUSION: Phosphate enemas may cause serious complications in children with no risk factors. Errors in dosage, administration and removal of the enema are causes of toxicity in this group. Pediatricians and health personnel must be aware of risks and signs of toxicity of phosphate enema.
Assuntos
Constipação Intestinal/terapia , Enema/efeitos adversos , Hiperfosfatemia/induzido quimicamente , Fosfatos/efeitos adversos , Tetania/induzido quimicamente , Pré-Escolar , Feminino , Humanos , Hiperfosfatemia/diagnóstico , Fosfatos/uso terapêutico , Tetania/diagnósticoRESUMO
Los enemas fosfatados son utilizados frecuentemente en el tratamiento de la constipación. Errores en la posología pueden producir complicaciones graves. Objetivo: Reportar un caso de toxicidad grave por enema fosfatado en un pre escolar sin factores de riesgo. Caso clínico: Paciente de 2 años con constipación funcional, evaluada en servicio de urgencia por dolor abdominal a quién se le diagnosticó un fecaloma impactado. Recibió 2 dosis de enema de fosfato, medio frasco de Fleet® adulto (Synthon, Chile) por vez, sin resolución de su fecaloma, decidiéndose hospitalización para proctoclisis. Posterior al ingreso presentó un cuadro clínico de tetania. Ingresó a la Unidad de Paciente Crítico donde se confirmó una hiperfosfemia e hipocalcemia secundaria. Se realizó corrección electrolítica progresiva, retiro de enema fosfatado residual del recto e hiperhidratación forzando diuresis. La tetania cedió 2 horas después del ingreso sin otras complicaciones. Se realizó proctoclisis y fue dada de alta a los 3 días. Conclusión: Los enemas fosfatados pueden presentar complicaciones graves en niños sin factores de riesgo. Errores en la posología son la causa más frecuente de toxicidad en este grupo, pero esta puede estar favorecida también por una administración y eliminación inadecuadas. Pediatras y personal de salud que atiende a niños deben conocer factores de riesgo, signos y síntomas de intoxicación por enemas fosfatados.
Phosphate enemas are frequently used in the treatment of constipation. Errors in dosage and administration can lead to severe complications. Objective: To report a case of severe toxicity of phosphate enemas in a child with no risk factors. Case: 2 years old female, with functional constipation, was brought to emergency department because abdominal pain. She was diagnosed with fecal impaction and received half a bottle of Fleet Adult® (Laboratorio Synthon, Chile) two times, with no clinical resolution, deciding to start proctoclisis in pediatric ward. Soon after admission, she presented painful tetany, but alert and oriented. Patient was transferred to PICU where severe hyperphosphatemia and secondary hypocalcemia were confirmed. Her treatment included electrolyte correction; removal of residual phosphate enema and hyperhydration. Tetany resolved over 2 hours after admission and no other complications. Proctoclisis was performed and patient was discharged three days after admission with pharmacological management of constipation. Conclusion: Phosphate enemas may cause serious complications in children with no risk factors. Errors in dosage, administration and removal of the enema are causes of toxicity in this group. Pediatricians and health personnel must be aware of risks and signs of toxicity of phosphate enema.
Assuntos
Humanos , Feminino , Pré-Escolar , Fosfatos/efeitos adversos , Tetania/induzido quimicamente , Constipação Intestinal/terapia , Enema/efeitos adversos , Hiperfosfatemia/induzido quimicamente , Fosfatos/uso terapêutico , Tetania/diagnóstico , Hiperfosfatemia/diagnósticoRESUMO
BACKGROUND AND AIMS: Hyperphosphatemia is common in patients with chronic kidney disease (CKD) stages IV and V because of decreased phosphorus excretion. Phosphatemia is closely related to dietary intake. Thus, a better understanding of sources of dietary phosphate consumption, absorption and restriction, particularly inorganic phosphate found in food additives, is key to prevent consequences of this complication. Our aims were to investigate the most commonly consumed processed foods by patients with CKD on hemodialysis, to analyze phosphate and protein content of these foods using chemical analysis and to compare these processed foods with fresh foods. METHODS: We performed a cross-sectional descriptive analytical study using food frequency questionnaires to rank the most consumed industrialized foods and beverages. Total phosphate content was determined by metavanadate colorimetry, and nitrogen content was determined by the Kjeldahl method. Protein amounts were estimated from nitrogen content. The phosphate-to-protein ratio (mg/g) was then calculated. Processed meat protein and phosphate content were compared with the nutritional composition of fresh foods using the Brazilian Food Composition Table. Phosphate measurement results were compared with data from the Food Composition Table - Support for Nutritional Decisions. An α level of 5% was considered significant. RESULTS: Food frequency questionnaires were performed on 100 patients (mean age, 59 ± 14 years; 57% male). Phosphate additives were mentioned on 70% of the product labels analyzed. Proteins with phosphate-containing additives provided approximately twice as much phosphate per gram of protein compared with that of fresh foods (p < 0.0001). CONCLUSIONS: Protein and phosphate content of processed foods are higher than those of fresh foods, as well as phosphate-to-protein ratio. A better understanding of phosphate content in foods, particularly processed foods, may contribute to better control of phosphatemia in patients with CKD.
Assuntos
Fast Foods/efeitos adversos , Análise de Alimentos , Hiperfosfatemia/complicações , Fosfatos/efeitos adversos , Fósforo na Dieta/efeitos adversos , Proteínas/análise , Diálise Renal , Idoso , Brasil , Estudos Transversais , Dieta , Proteínas Alimentares/efeitos adversos , Proteínas Alimentares/análise , Fast Foods/análise , Feminino , Aditivos Alimentares/efeitos adversos , Aditivos Alimentares/análise , Humanos , Hiperfosfatemia/sangue , Masculino , Pessoa de Meia-Idade , Nitrogênio/análise , Avaliação Nutricional , Fosfatos/sangue , Fósforo/análise , Fósforo na Dieta/análise , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Inquéritos e QuestionáriosRESUMO
Oral sodium phosphate (OSP) solutions are widely used for bowel cleansing before colonoscopy, for stercoral retention phenomena and persistent chronic constipation. Its main risk, is acute phosphate nephropathy (APN), which is a clinic-pathological entity characterized by acute kidney disease secondary to deposition of calcium phosphate crystals in the renal tubules. Its recognition has been documented over the last decade in relation to case reports and the warning of the FDA. This report discusses two cases of APN certified by renal biopsy after the administration of OSP. One of them had an acute symptomatic presentation, and the other one, was a late finding. Both developed renal failure.
Las soluciones de fosfato de sodio oral (FSO) son ampliamente utilizadas para la preparación de colon previo a colonoscopia, para fenómenos de retención estercorácea y constipación crónica pertinaz. Su principal riesgo, la nefropatía aguda por fosfatos (NAF), es una entidad clínico-patológica caracterizada por falla renal aguda secundaria a depósito de cristales de fosfato de calcio en los túbulos renales. En la última década se han comunicado reportes de casos clínicos y una advertencia del uso de FSO por parte de la Food and Drug Administration de EE.UU. (FDA). En esta publicación se comunican dos casos de NAF, posterior a la administración de FSO, confirmadas por biopsia. Uno de ellos tuvo una presentación aguda y sintomática y el otro fue un hallazgo tardío. Ambos se acompañaron de falla renal.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Injúria Renal Aguda/induzido quimicamente , Colonoscopia/métodos , Fosfatos/efeitos adversos , Cuidados Pré-Operatórios , Administração Oral , Nefropatias/induzido quimicamente , Fosfatos/administração & dosagemRESUMO
Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here.
Assuntos
Catárticos/administração & dosagem , Colo/patologia , Doenças do Colo/diagnóstico , Colonoscopia , Fosfatos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Irrigação Terapêutica/métodos , Administração Oral , Catárticos/efeitos adversos , Doenças do Colo/patologia , Esquema de Medicação , Jejum , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Adesão à Medicação , Educação de Pacientes como Assunto , Seleção de Pacientes , Fosfatos/efeitos adversos , Polietilenoglicóis/efeitos adversos , Valor Preditivo dos Testes , Fatores de TempoRESUMO
AIM: To compare the efficacy of different doses of sodium phosphate (NaP) and polyethylenglicol (PEG) alone or with bisacodyl for colonic cleansing in constipated and non-constipated patients. METHODS: Three hundred and forty-nine patients, older than 18 years old, with low risk for renal damage and who were scheduled for outpatient colonoscopy were randomized to receive one of the following preparations (prep): 90 mL of NaP (prep 1); 45 mL of NaP + 20 mg of bisacodyl (prep 2); 4 L of PEG (prep 3) or 2 L of PEG + 20 mg of bisacodyl (prep 4). Randomization was stratified by constipation. Patients, endoscopists, endoscopists' assistants and data analysts were blinded. A blinding challenge was performed to endoscopist in order to reassure blinding. The primary outcome was the efficacy of colonic cleansing using a previous reported scale. Secondary outcomes were tolerability, compliance, side effects, endoscopist perception about the necessity to repeat the study due to an inadequate colonic preparation and patient overall perceptions. RESULTS: Information about the primary outcome was obtained from 324 patients (93%). There were no significant differences regarding the preparation quality among different groups in the overall analysis. Compliance was higher in the NaP preparations being even higher in half-dose with bisacodyl: 94% (prep 1), 100% (prep 2), 81% (prep 3) and 87% (prep 4) (2 vs 1, 3 and 4, P < 0.01; 1 vs 3, 4, P < 0.05). The combination of bisacodyl with NaP was associated with insomnia (P = 0.04). In non-constipated patients the preparation quality was also similar between different groups, but endoscopist appraisal about the need to repeat the study was more frequent in the half-dose PEG plus bisacodyl than in whole dose NaP preparation: 11% (prep 4) vs 2% (prep 1) (P < 0.05). Compliance in this group was also higher with the NaP preparations: 95% (prep 1), 100% (prep 2) vs 80% (prep 3) (P < 0.05). Bisacodyl was associated with abdominal pain: 13% (prep 1), 31% (prep 2), 21% (prep 3) and 29% (prep 4), (2, 4 vs 1, 2, P < 0.05). In constipated patients the combination of NaP plus bisacodyl presented higher rates of satisfactory colonic cleansing than whole those PEG: 95% (prep 2) vs 66% (prep 3) (P = 0.03). Preparations containing bisacodyl were not associated with adverse effects in constipated patients. CONCLUSION: In non-constipated patients, compliance is higher with NaP preparations, and bisacodyl is related to adverse effects. In constipated patients NaP plus bisacodyl is the most effective preparation.
Assuntos
Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colonoscopia , Constipação Intestinal/tratamento farmacológico , Defecação/efeitos dos fármacos , Fosfatos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Irrigação Terapêutica/métodos , Idoso , Assistência Ambulatorial , Argentina , Bisacodil/efeitos adversos , Catárticos/efeitos adversos , Distribuição de Qui-Quadrado , Constipação Intestinal/fisiopatologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Fosfatos/efeitos adversos , Polietilenoglicóis/efeitos adversos , Irrigação Terapêutica/efeitos adversos , Resultado do TratamentoRESUMO
Fleet enemas are hypertonic solutions with an osmotic action and a high concentration of phosphate. When retained in the human body they have a great toxic potential, causing severe hydro-electrolyte disorders in children, especially in newborns. We report the case of a previously healthy 8-day-old newborn who needed neonatal intensive care treatment after the inadvertent administration of an osmotically active hypertonic phosphate enema. Taking into account that phosphate removal by peritoneal dialysis (PD) strongly depends on total dialysate turnover, we chose continuous flow PD (CFPD) as the treatment option, with a successful outcome. Clinical experience with this dialytic modality is limited to a few case reports in pediatric and adult patients. To the best of our knowledge, we report here the first description of CFPD in the setting of acute phosphate nephropathy in the neonatal period. The modality of PD described here has potential as an alternative management option as it is a highly efficient, methodologically simple, and low-cost method without any need for sophisticated equipment. Physicians and parents should be aware of the adverse effects of a hypertonic phosphate enema and should never use these medications in infants and newborns.
Assuntos
Enema/efeitos adversos , Hiperfosfatemia/terapia , Diálise Peritoneal/métodos , Humanos , Hiperfosfatemia/etiologia , Hiperfosfatemia/fisiopatologia , Soluções Hipertônicas/efeitos adversos , Recém-Nascido , Fosfatos/efeitos adversosRESUMO
UNLABELLED: The development of colonoscopy has increased the oral sodium phosphate (OSP) laxative use. OSP complications like hyperphosphatemia with acute and chronic kidney impairment with nephrocalcinosis have been reported. OBJECTIVE: To describe and analyze acute and one year after OSP complications in low risk well hydrated patients. METHODS: We performed a prospective study in 100 consecutive patients undergoing colonic cleansing with OSP for colonoscopy aged 35-74 year, ASA I-II. Exclusion criteria were congestive heart failure, chronic kidney disease, diabetes, liver cirrhosis, intestinal obstruction, decreased bowel motility, increased bowel permeability, hyperparathyroidism. Arterial pressure, hematocrit, serum osmolality, serum phosphate, ionic calcium, electrolytes (Na+, Cl-, K+), creatinine and urea were measured before and after OSP. The day before colonoscopy all the participants entered a 24 hr-period diet consisting in 4 litres of clear fluids and standard OSP dose (30 g at 17:00 and 30 gr at 22:00). Phosphatemia levels post OSP according to patient's weight (> or =, < or = 70 kg) and one year later kidney function were compared. RESULTS: Mean age was 58.9 +/- 8.4 years, 66% of patients were women and mean weight was 71 +/- 13 kg. Kidney function showed no significant difference between pre and post OSP, and after one year values. Hyperphosphatemia appeared in 87%. Hyperphosphatemia was higher in patients with low weight (5.8 mg/dl vs 5.3 mg/dl, P < 0.05). CONCLUSION: OSP complications were reduced through an adequate patient selection in order to avoid risk factors and an effective hydration. Phosphate overload was tolerated without symptoms. Considering high hyperphosphatemia incidence and its relation with weight, to adjust dose related to weight should be evaluated. There was no acute or a year later renal damage.
Assuntos
Catárticos/efeitos adversos , Colonoscopia/efeitos adversos , Hiperfosfatemia/induzido quimicamente , Fosfatos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
AIM: To establish the frequency of hyperphosphatemia following the administration of sodium phosphate laxatives in low-risk patients. METHODS: One hundred consecutive ASA I-II individuals aged 35-74 years, who were undergoing colonic cleansing with oral sodium phosphate (OSP) before colonoscopy were recruited for this prospective study. EXCLUSION CRITERIA: congestive heart failure, chronic kidney disease, diabetes, liver cirrhosis, intestinal obstruction, decreased bowel motility, increased bowel permeability, and hyperparathyroidism. The day before colonoscopy, all the participants entered a 24-h period of diet that consisted of 4 L of clear fluids with sugar or honey and 90 mL (60 g) of OSP in two 45-mL doses, 5 h apart. Serum phosphate was measured before and after the administration of the laxative. RESULTS: The main demographic data (mean +/- SD) were: age, 58.9 +/- 8.4 years; height, 163.8 +/- 8.6 cm; weight, 71 +/- 13 kg; body mass index, 26 +/- 4; women, 66%. Serum phosphate increased from 3.74 +/- 0.56 to 5.58 +/- 1.1 mg/dL, which surpassed the normal value (2.5-4.5 mg/dL) in 87% of the patients. The highest serum phosphate was 9.6 mg/dL. Urea and creatinine remained within normal limits. Post-treatment OSP serum phosphate concentration correlated inversely with glomerular filtration rate (P < 0.007, R(2) = 0.0755), total body water (P < 0.001, R(2) = 0.156) and weight (P < 0.013, R(2) = 0.0635). CONCLUSION: In low-risk, well-hydrated patients, the standard dose of OSP-laxative-induced hyperphosphatemia is related to body weight.
Assuntos
Catárticos , Hiperfosfatemia/induzido quimicamente , Laxantes , Fosfatos , Adulto , Idoso , Catárticos/efeitos adversos , Catárticos/química , Feminino , Humanos , Laxantes/efeitos adversos , Laxantes/química , Masculino , Pessoa de Meia-Idade , Fosfatos/efeitos adversos , Fosfatos/química , Estudos Prospectivos , Fatores de RiscoRESUMO
PURPOSE: To study the effects on the water, electrolyte, and acid-base balances in rabbits submitted to antegrade enema with different solutions through appendicostomy. METHODS: Forty male New Zealand rabbits were submitted to appendicostomy, and distributed in 4 groups, according to the antegrade enema solution: PEG group, polyethylene glycol electrolyte solution (n=10); ISS group, isotonic saline solution (n=10); GS group, glycerin solution (n=10); SPS group, sodium phosphate solution (n=10). After being weighed, arterial blood gas analysis, red blood count, creatinine and electrolytes were measured at 4 times: preoperatively (T1); day 6 postop, before enema (T2); 4h after enema (T3); and 24h after T3 (T4). RESULTS: In PEG group occurred Na retention after 4h, causing alkalemia, sustained for 24h with HCO3 retention. In ISS group occurred isotonic water retention and hyperchloremic acidosis after 4h, which was partially compensated in 24h. GS group showed metabolic acidosis after 4h, compensated in 24h. In SPS group occurred hypernatremic dehydration, metabolic acidosis in 4h, and hypokalemia, hypocalcemia, hypomagnesemia, and metabolic alkalosis with partially compensated dehydration in 24h. CONCLUSIONS: All solutions used in this study caused minor alterations on water, electrolyte or acid-base balances. The most intense ones were caused by hypertonic sodium phosphate solution (SPS) and isotonic saline solution (ISS) and the least by polyethyleneglycol electrolyte solution (PEG) and glycerin solution 12% (GS).
Assuntos
Equilíbrio Ácido-Base/efeitos dos fármacos , Enema/métodos , Glicerol/efeitos adversos , Fosfatos/efeitos adversos , Polietilenoglicóis/efeitos adversos , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/etiologia , Animais , Apêndice/cirurgia , Catárticos/administração & dosagem , Catárticos/efeitos adversos , Enema/efeitos adversos , Glicerol/administração & dosagem , Soluções Isotônicas/administração & dosagem , Soluções Isotônicas/efeitos adversos , Deficiência de Magnésio/sangue , Deficiência de Magnésio/etiologia , Masculino , Modelos Animais , Fosfatos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Coelhos , Fatores de Tempo , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/etiologiaRESUMO
PURPOSE: To study the effects on the water, electrolyte, and acid-base balances in rabbits submitted to antegrade enema with different solutions through appendicostomy. METHODS: Forty male New Zealand rabbits were submitted to appendicostomy, and distributed in 4 groups, according to the antegrade enema solution: PEG group, polyethylene glycol electrolyte solution (n=10); ISS group, isotonic saline solution (n=10); GS group, glycerin solution (n=10); SPS group, sodium phosphate solution (n=10). After being weighed, arterial blood gas analysis, red blood count, creatinine and electrolytes were measured at 4 times: preoperatively (T1); day 6 postop, before enema (T2); 4h after enema (T3); and 24h after T3 (T4). RESULTS: In PEG group occurred Na retention after 4h, causing alkalemia, sustained for 24h with HCO3 retention. In ISS group occurred isotonic water retention and hyperchloremic acidosis after 4h, which was partially compensated in 24h. GS group showed metabolic acidosis after 4h, compensated in 24h. In SPS group occurred hypernatremic dehydration, metabolic acidosis in 4h, and hypokalemia, hypocalcemia, hypomagnesemia, and metabolic alkalosis with partially compensated dehydration in 24h. CONCLUSIONS: All solutions used in this study caused minor alterations on water, electrolyte or acid-base balances. The most intense ones were caused by hypertonic sodium phosphate solution (SPS) and isotonic saline solution (ISS) and the least by polyethyleneglycol electrolyte solution (PEG) and glycerin solution 12 percent (GS).
OBJETIVO: Estudar os efeitos no equilíbrio hídrico, eletrolítico e ácido-base, do enema anterógrado com diferentes soluções em coelhos através de apendicostomia. MÉTODOS: 40 coelhos Nova Zelândia, machos, submetidos a apendicostomia, distribuídos em quatro grupos segundo a solução de enema: grupo PEG (n = 10) solução de polietilenoglicol com eletrólitos; grupo SF (n = 10) solução fisiológica; grupo SG (n = 10) solução glicerinada; grupo FS (n = 10) solução de fosfato de sódio. Realizou-se pesagem, gasometria arterial, série vermelha, creatinina e ionograma, em quatro tempos: TI (pré-operatório); T2 (6o PO antes do enema); T3 (4h após enema); T4 (24h após T3). RESULTADOS: No PEG ocorreu retenção de Na em 4h, com alcalemia por retenção de HCO3, mantida por 24h. No SF ocorreu retenção hídrica isotônica e acidose hiperclorêmica em 4h, resolvidos parcialmente com 24h. No SG ocorreu acidose metabólica hiperclorêmica em 4h, compensada com 24h. No FS ocorreu desidratação hipenatrêmica, acidose metabólica com ânion gap elevado em 4h, hipopotassemia, hipocalcemia, hipomagnesemia e alcalose metabólica com recuperação parcial da desidratação em 24h. CONCLUSÕES: Todas as soluções empregadas neste estudo causam alterações de pouca intensidade no equilíbrio hídrico, eletrolítico ou ácido-base. As mais intensas foram causadas pela solução de fosfato de sódio e solução fisiológica, e as menos intensas pela solução de polietilenoglicol com eletrólitos e solução glicerinada.
Assuntos
Animais , Masculino , Coelhos , Equilíbrio Ácido-Base/efeitos dos fármacos , Enema/métodos , Glicerol/efeitos adversos , Fosfatos/efeitos adversos , Polietilenoglicóis/efeitos adversos , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/etiologia , Apêndice/cirurgia , Catárticos/administração & dosagem , Catárticos/efeitos adversos , Enema/efeitos adversos , Glicerol/administração & dosagem , Soluções Isotônicas/administração & dosagem , Soluções Isotônicas/efeitos adversos , Modelos Animais , Deficiência de Magnésio/sangue , Deficiência de Magnésio/etiologia , Fosfatos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Fatores de Tempo , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/etiologiaRESUMO
Adult-onset hypophosphatemic osteomalacia is a rare disease characterized by hypophosphatemia, increased levels of alkaline phosphatase and decreased bone mass. Oral supplementation with phosphate and vitamin D is the main treatment and, in cases of oncogenic osteomalacia, tumor resection is mandatory. We report the case of a patient with hypophosphatemic osteomalacia of an unknown cause. Despite extensive search, no tumor was found. The patient was treated with phosphate for a long period and developed tertiary hyperparathyroidism. Serum PTH levels did not return to normal after surgical excision of three parathyroids and the patient refused to continue clinical investigation and treatment. After ten years absent from the hospital, during which medications were used irregularly, she was admitted with multiple fractures and respiratory insufficiency caused by severe thoracic deformities, and died. The authors discuss the relationship between osteomalacia and hyperparathyroidism and the aggressive course of the disease.
Assuntos
Fraturas Espontâneas/etiologia , Hiperparatireoidismo/induzido quimicamente , Hipofosfatemia/diagnóstico , Osteomalacia/diagnóstico , Fosfatos/efeitos adversos , Vitamina D/uso terapêutico , Evolução Fatal , Feminino , Humanos , Hiperparatireoidismo/cirurgia , Hipofosfatemia/complicações , Hipofosfatemia/tratamento farmacológico , Pessoa de Meia-Idade , Osteomalacia/complicações , Osteomalacia/tratamento farmacológico , Paratireoidectomia , Fosfatos/uso terapêutico , Índice de Gravidade de DoençaRESUMO
A osteomalacia hipofosfatêmica é uma doença rara caracterizada por hipofosfatemia, níveis elevados de fosfatase alcalina e diminuição da densidade óssea. O tratamento é realizado com suplementação oral com fosfato e vitamina D e, nos casos de osteomalacia oncogênica, com a ressecção do tumor. Relatamos o caso de uma paciente que apresentou quadro de osteomalácia hipofosfatêmica de causa indeterminada. Apesar de extensivamente procurado, nenhum tumor produtor de substância hipofosfatêmica foi localizado. A paciente foi tratada como suplementação de fosfato e vitamina D por longo período, evoluindo com quadro de hiperparatireoidismo terciário. A retirada de três paratireóides não normalizou os níveis de PTH e a paciente recusou-se a continuar a investigação e o tratamento. Após dez anos de tratamento irregular, foi internada por insuficiência respiratória causada por colabamento do arcabouço costal e múltiplas fraturas, evoluindo para o óbito. Os autores discutem a relação entre osteomalácia e hiperparatireoidismo e o curso agressivo da doença.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fraturas Espontâneas/etiologia , Hiperparatireoidismo/induzido quimicamente , Hipofosfatemia/diagnóstico , Osteomalacia/diagnóstico , Fosfatos/efeitos adversos , Vitamina D/uso terapêutico , Evolução Fatal , Hiperparatireoidismo/cirurgia , Hipofosfatemia/complicações , Hipofosfatemia/tratamento farmacológico , Osteomalacia/complicações , Osteomalacia/tratamento farmacológico , Paratireoidectomia , Fosfatos/uso terapêutico , Índice de Gravidade de DoençaRESUMO
Há uma relação entre o uso de fluoretos, a redução na cárie e o aumento da fluorose dentária. O objetivo deste estudo foi analisar a cinética do flúor na saliva após o uso da goma de mascar Happydent®, que contém 3,38 mg de flúor como monofluorfosfato. A saliva foi coletada de 15 voluntários entre 7 e 9 anos de idade, durante 3 minutos nos intervalos de 0, 3, 6, 9, 15, 30 e 45 minutos. Inicialmente, a coleta foi realizada com o Trident® (controle) e, após 24 h, a coleta foi repetida com a goma de mascar Happydent®. O flúor foi analisado com um eletrodo íon-específico (Orion 96-09) após a realização da hidrólise ácida. Os dados foram analisados através da análise de variância a dois critérios e pelo teste de Tukey (p < 0,05). A quantidade média ± dp (mg) de flúor liberado na saliva foi 0,276 ± 0,126 e 0,024 ± 0,014 para o Happydent® e o Trident®, respectivamente. A quantidade de flúor nas amostras de saliva após o uso do Happydent® foi significativamente maior do que após o uso do Trident® em todos os tempos experimentais, com exceção dos períodos de 30 e 45 minutos. A alta quantidade de flúor na saliva após o uso do Happydent® poderia ser eficiente na prevenção da cárie dentária, o que deveria ser avaliado clinicamente. Por outro lado, essa goma de mascar deveria ser evitada por crianças na idade de risco para a fluorose dentária.