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Empiric therapy for kidney stones.
Goldfarb, DS
Urolithiasis. 2019;(1):107-113
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Abstract
Careful phenotyping of patients to classify those with kidney stones has a long and important history in revealing the chemical basis for stone formation. Advances in our genetic understanding of kidney stones will lead to incredible insights regarding the pathophysiology of this common disorder. At this time, both evaluation of urine chemistry and genotyping of patients are extremely useful in the setting of a university and research-based kidney stone clinic. For much of the world, in a more clinically focused setting, these techniques are neither available nor absolutely necessary. Careful implementation of an empiric prescription based on stone composition would have an important effect to reduce stone recurrence in the world's many stone formers. Increased fluid intake, generic dietary manipulations, and prescription of potassium citrate and thiazides are all appropriate empiric therapies for people with calcium and uric acid kidney stones.
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Fluid management and bioimpedance study in peritoneal dialysis.
Ng, JK, Li, PK
Current opinion in nephrology and hypertension. 2019;(1):58-64
Abstract
PURPOSE OF REVIEW Maintaining euvolaemia is an essential yet challenging objective in management of patients on peritoneal dialysis. Optimal method to assess volume status remains to be determined. In this review, we will discuss the risk factors and clinical outcomes of fluid overload in PD patients, and examine the role of bioimpedance study in fluid management. RECENT FINDINGS Applying bioimpedance study to measure body composition has attracted increasing attention because it is noninvasive and provides point-of-care assessment of fluid status. Observational studies suggested that presence of residual renal function did not necessarily protect peritoneal dialysis patients from developing fluid overload. This reinforces the importance of fluid restriction in peritoneal dialysis patients, in whom the thirst sensation could be exacerbated by hyperglycaemia. Notably, fluid overload is present in significant portion of asymptomatic patients. Moreover, bioimpedance-defined fluid overload is associated with increase in all-cause mortality, technique failure and possibly excess peritonitis rate. SUMMARY Although future studies should investigate the clinical benefit of bioimpedance-guided fluid management in high-risk subgroup, raising awareness among clinicians, together with structured clinical assessment and dietary counselling are the cornerstone to maintain stable fluid status.
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Hydration Interventions for older people living in residential and nursing care homes: overview of the literature.
Cook, G, Hodgson, P, Thompson, J, Bainbridge, L, Johnson, A, Storey, P
British medical bulletin. 2019;(1):71-79
Abstract
INTRODUCTION Care home populations experiencing high levels of multi-morbidity and dementia require support from caregivers to meet their hydration requirements. This article provides an overview of literature related to hydration interventions and highlights gaps in knowledge. SOURCES OF DATA This paper draws on UK-focused literature from Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, Medline, Proquest Hospital Premium Collection, Cochrane Library and RCN databases on hydration interventions for older people living with multi-morbidity and dementia in care homes. AREAS OF AGREEMENT Fluid intake is too low in care home residents, and no single hydration intervention is effective in addressing the complex problems that older residents present. AREAS OF CONTROVERSY There is a lack of consensus about how much fluid an older person should consume daily for optimum health. There is also lack of agreement about what interventions are effective in supporting individuals with complex physical and cognitive problems to achieve daily fluid intake targets. GROWING POINTS To improve hydration care for residents, care home teams should be competent in the delivery of hydration care, and work closely with integrated multi-professional healthcare specialists to provide proactive case management. AREAS TIMELY FOR DEVELOPING RESEARCH There is a need for understanding of what hydration practices and processes are effective for care home residents and including these in multi-component interventions.
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In preterm infants, does fluid restriction, as opposed to liberal fluid prescription, reduce the risk of important morbidities and mortality?
Abbas, S, Keir, AK
Journal of paediatrics and child health. 2019;(7):860-866
Abstract
AIM: To answer the clinical question: 'In preterm infants, does fluid restriction, as opposed to liberal fluid prescription, reduce the risk of important morbidities (namely, intraventricular haemorrhage, necrotising enterocolitis, bronchopulmonary dysplasia and patent ductus arteriosus) and mortality?' METHODS Literature searches were conducted of Medline, Embase and Cochrane Library. Results were limited to human clinical trials on infants and those published in English. The reference lists of relevant articles were screened for further articles. Studies that examined measures which inform diagnostic criteria of morbidities of interest (such as echocardiographic changes) but did not go further to confirm or exclude presence of said morbidities in study populations were excluded. RESULTS A total of 110 articles were found and screened by title and abstract. The final analysis included five randomised controlled trials and five case control studies. Among the randomised controlled trials, there is some suggestion (though not unanimous) that liberal fluid regimens are associated with an increased risk of patent ductus arteriosus, necrotising enterocolitis and mortality. Case control studies focused on patent ductus arteriosus and bronchopulmonary dysplasia or chronic lung disease, with all but one study suggesting an increased risk of these complications with liberal fluid regimens. CONCLUSION Further investigation is needed to clarify the optimal fluid regimen for preterm infants to ensure adequate hydration and nutrition without contributing to serious complications.
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Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary Intervention.
Wang, Z, Song, Y, A, G, Li, Y
International heart journal. 2019;(5):1077-1082
Abstract
Patients with ST-segment elevation myocardial infarction (STEMI) who are treated by primary percutaneous coronary intervention (PPCI) have an increased risk of developing contrast-induced nephropathy (CIN) when compared with patients undergoing elective percutaneous coronary intervention (PCI). However, CIN prevention measures are less frequently applied in PPCI than in elective PCI. At present, no preventive strategy has been recommended by the current guidelines for patients with STEMI undergoing PPCI.Published research was scanned by formal searches of electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) from 1966 to July 2018. Internet-based sources of information on the results of clinical trials in cardiology were also searched.A total of three randomized trials involving 924 patients were included in the present meta-analysis, of whom 462 received hydration with isotonic saline (hydration group) and 462 received no hydration (control group). Periprocedural hydration with isotonic saline was associated with a significant decrease in the rate of CIN (16.9% in the hydration group versus 26.4% in the control group; summary risk ratio: 0.64, 95% confidence interval: 0.50-0.82, P = 0.0005). There was no difference in the rate of postprocedural hemodialysis or death between the groups.Intravenous saline hydration during PPCI reduced the risk of CIN without significantly altering the rate of requirement for renal replacement therapy or mortality.
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Principles and Practice of Oral Rehydration.
Ofei, SY, Fuchs, GJ
Current gastroenterology reports. 2019;(12):67
Abstract
PURPOSE OF REVIEW An understanding of fluid and electrolyte losses from diarrhea and mechanisms of solute cotransport led to development of oral rehydration solution (ORS), representing a watershed in efforts to reduce diarrheal disease morbidity and mortality. This report reviews the scientific rationale and modifications of ORS and barriers to universal application. RECENT FINDINGS Solutions with osmolality and electrolyte composition different from original ORS for routine and unique pathophysiology such as in malnutrition have met with varying success. Following the conceptual rationale of sodium-glucose cotransportation to facilitate water absorption, other cotransporters and formulations have been explored with the aim to improve ORS efficacy and acceptance. ORS remains the anchor of acute watery diarrhea and dehydration management worldwide. Despite development of different formulations, the current standard solution is the mainstay of treatment for nearly all situations. Efforts to improve oral hydration solution and to increase acceptance and usage are ongoing.
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Fluid Management in Acute Brain Injury.
Rossi, S, Picetti, E, Zoerle, T, Carbonara, M, Zanier, ER, Stocchetti, N
Current neurology and neuroscience reports. 2018;(11):74
Abstract
PURPOSE OF THE REVIEW The aims of fluid management in acute brain injury are to preserve or restore physiology and guarantee appropriate tissue perfusion, avoiding potential iatrogenic effects. We reviewed the literature, focusing on the clinical implications of the selected papers. Our purposes were to summarize the principles regulating the distribution of water between the intracellular, interstitial, and plasma compartments in the normal and the injured brain, and to clarify how these principles could guide fluid administration, with special reference to intracranial pressure control. RECENT FINDINGS Although a considerable amount of research has been published on this topic and in general on fluid management in acute illness, the quality of the evidence tends to vary. Intravascular volume management should aim for euvolemia. There is evidence of harm with aggressive administration of fluid aimed at achieving hypervolemia in cases of subarachnoid hemorrhage. Isotonic crystalloids should be the preferred agents for volume replacement, while colloids, glucose-containing hypotonic solutions, and other hypotonic solutions or albumin should be avoided. Osmotherapy seems to be effective in intracranial hypertension management; however, there is no clear evidence regarding the superiority of hypertonic saline over mannitol. Fluid therapy plays an important role in the management of acute brain injury patients. However, fluids are a double-edged weapon because of the potential risk of hyper-hydration, hypo- or hyper-osmolar conditions, which may unfavorably affect the clinical course and the outcome.
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Normal saline for intravenous fluid therapy in critically ill patients.
Zhou, FH, Liu, C, Mao, Z, Ma, PL
Chinese journal of traumatology = Zhonghua chuang shang za zhi. 2018;(1):11-15
Abstract
The efficacy and safety of normal saline (NS) for fluid therapy in critically ill patients remain controversy. In this review, we summarized the evidence of randomized controlled trials (RCTs) which compared NS with other solutions in critically ill patients. The results showed that when compared with 6% hydroxyethyl starch (HES), NS may reduce the onset of acute kidney injury (AKI). However, there is no significant different in mortality and incidence of AKI when compared with 10% HES, albumin and buffered crystalloid solution. Therefore, it is important to prescribe intravenous fluid for patients according to their individual condition.
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Is parenteral hydration beneficial in terminally ill cancer patients?
Canihuante, J, PĂ©rez, P
Medwave. 2018;(1):e7150
Abstract
INTRODUCTION It is common for terminally ill patients to have a reduced fluid intake, which often results in a need for more medical support. However, it is not clear if this measure has a real clinical impact. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data from primary studies and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified four systematic reviews including 51 studies overall, from which three were randomized trials. We concluded the administration of parenteral hydration might make little or no difference in terms of survival and quality of life in terminally ill cancer patients, and that it is not clear whether it has any other benefit because the certainty of the evidence is very low.
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Acute Decompensated Heart Failure.
Hammond, DA, Smith, MN, Lee, KC, Honein, D, Quidley, AM
Journal of intensive care medicine. 2018;(8):456-466
Abstract
Heart failure (HF) is a societal burden due to its high prevalence, frequent admissions for acute decompensated heart failure (ADHF), and the economic impact of direct and indirect costs associated with HF and ADHF. Common etiologies of ADHF include medication and diet noncompliance, arrhythmias, deterioration in renal function, poorly controlled hypertension, myocardial infarction, and infections. Appropriate medical management of ADHF in patients is guided by the identification of signs and symptoms of fluid overload or low cardiac output and utilization of evidence-based practices. In patients with fluid overload, various strategies for diuresis or ultrafiltration may be considered. Depending on hemodynamics and patient characteristics, vasodilator, inotropic, or vasopressor therapies may be of benefit. Upon ADHF resolution, patients should be medically optimized, have lifestyle modifications discussed and implemented, and medication concierge service considered. After discharge, a multidisciplinary HF team should follow up with the patient to ensure a safe transition of care. This review article evaluates the management options and considerations when treating a patient with ADHF.