-
1.
Sodium chloride 0.9% versus Lactated Ringer in the management of severely dehydrated patients with choleriform diarrhoea.
Cieza, JA, Hinostroza, J, Huapaya, JA, León, CP
Journal of infection in developing countries. 2013;(7):528-32
Abstract
INTRODUCTION Although experience within Peru suggests clinical and physiological benefits of treating dehydration caused by diarrhoea with Lactated Ringer's solution (LR) over sodium chloride 0.9%, (NaCl) there is little documented scientific evidence supporting this view. It is important to clarify this issue and determine the best solution for use during epidemics. METHODOLOGY Forty patients suffering from dehydration due to choleriform diarrhoea were enrolled in the study. Twenty patients were treated using NaCl (Group A) and the other twenty with LR (Group B). After diuresis recovery was achieved, the patients were continued on a course of oral rehydration salts. Serum electrolytes, arterial pH, HCO3-, and pCO2 were measured at three stages: at admission, after diuresis recovery, and after 12 hours. RESULTS Acidosis was corrected more quickly with LR that NaCl. The hyperosmolality and hypernatremic states were corrected with both solutions. CONCLUSION LR use resulted in a better clinical response than NaCl, illustrated by more rapid physiological correction, showing that mixed metabolic acidosis was corrected more quickly and more appropriately with this treatment.
-
2.
Hemostasis in cardiac arrest patients treated with mild hypothermia initiated by cold fluids.
Spiel, AO, Kliegel, A, Janata, A, Uray, T, Mayr, FB, Laggner, AN, Jilma, B, Sterz, F
Resuscitation. 2009;(7):762-5
Abstract
AIM OF THE STUDY Application of mild hypothermia (32-33 degrees C) has been shown to improve neurological outcome in patients with cardiac arrest. However, hypothermia affects hemostasis, and even mild hypothermia is associated with bleeding and increased transfusion requirements in surgery patients. On the other hand, crystalloid hemodilution has been shown to induce a hypercoagulable state. The study aim was to elucidate in which way the induction of mild therapeutic hypothermia by a bolus infusion of cold crystalloids affects the coagulation system of patients with cardiac arrest. METHODS This was a prospective pilot study in 18 patients with cardiac arrest and return of spontaneous circulation (ROSC). Mild hypothermia was initiated by a bolus infusion of cold 0.9% saline fluid (4 degrees C; 30ml/kg/30min) and maintained for 24h. At 0h (before hypothermia), 1, 6 and 24h we assessed coagulation parameters (PT, APPT), platelet count and performed thrombelastography (ROTEM) after in vitro addition of heparinase. RESULTS A total amount of 2528 (+/-528)ml of 0.9% saline fluid was given. Hematocrit (p<0.01) and platelet count (-27%; p<0.05) declined, whereas APTT increased (2.7-fold; p<0.01) during the observation period. All ROTEM parameters besides clotting time (CT) after 1h (-20%; p<0.05) did not significantly change. CONCLUSION Mild hypothermia only slightly prolonged clotting time as measured by rotation thrombelastography. Therefore, therapeutic hypothermia initiated by cold crystalloid fluids has only minor overall effects on coagulation in patients with cardiac arrest.
-
3.
No-glucose strategy influences posterior cranial fossa tumors' postoperative course: introducing the Glycemic Stress Index.
Pietrini, D, Di Rocco, C, Di Bartolomeo, R, Conti, G, Ranelletti, FO, De Luca, D, Tosi, F, Mensi, S, D'Arrigo, S, Piastra, M
Journal of neuro-oncology. 2009;(3):361-8
Abstract
In a selected patient population, we evaluated the glycemic response to different infusional policies in the management of posterior cranial fossa tumor (PFT) removal. We analyzed the perioperative course, prospectically collected, of 137 children undergoing 150 surgical procedures. Patients were divided in two groups according to different intraoperative fluids (group A, 2.5% glucose; group B, crystalloids). In group B glycemia remained below 125 mg dl(-1), while group A showed persistently supranormal glycemic plasma values, reaching statistical significance at the end of surgery (P < 0.018). As no perioperative mortality occurred and no differences were found between groups regarding PICU respiratory or infectious complications, PICU length of stay (LOS) was assumed as the main outcome indicator. LOS was not influenced by group A or B inclusion, while a new indicator, namely the Glycemic Stress Index (GSI), representing both glycemic intraoperative change and procedure length, showed significantly different results in the study groups (P = 0.004). Our clinical experience suggests that both intraoperative glucose-free solutions are safe, and GSI can be a useful tool to identify prolonged PICU stay patients.
-
4.
Incidence of contrast-induced nephropathy with volume supplementation--insights from a large cohort.
Mueller-Lenke, N, Buerkle, G, Klima, T, Breidthardt, T, Buettner, HJ, Mueller, C
Medical principles and practice : international journal of the Kuwait University, Health Science Centre. 2008;(5):409-14
Abstract
OBJECTIVE The present study was performed to determine the effect of combined intravenous and oral volume supplementation on the incidence of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). SUBJECTS AND METHODS Consecutive patients (n = 958) receiving iomeprol 350 during PCI were evaluated prospectively for the development of CIN. All patients received protocol-defined intravenous and oral volume supplementation. CIN was defined as an increase in serum creatinine of at least 44 micromol/l within 48 h. RESULTS Of the 958 patients enrolled in the study, 147 (15%) were diabetic and 107 (11%) had stage III renal disease. The average baseline glomerular filtration rate was 88 +/- 25 ml/min/1.73 m(2). During the intervention an average of 238 +/- 86 ml of contrast medium was administered. CIN developed in 13 of 958 (1.4%; 95% confidence interval 0.6-2.1%) patients. The incidence of CIN was low even in predefined risk subgroups (women: 2.4%, diabetics: 2.7%, patients with stage III kidney disease: 6.5%). CONCLUSIONS The incidence of CIN is low when preprocedural fluid volume supplementation is used.
-
5.
Efficacy of Tonimer gel spray on postoperative nasal care after endonasal surgery.
Ercan, I, Cakir, BO, Ozcelik, M, Turgut, S
ORL; journal for oto-rhino-laryngology and its related specialties. 2007;(4):203-6
Abstract
OBJECTIVE To investigate the effect of the addition of Tonimer gel spray into nasal mucosa care on nasal mucosal findings and patient comfort in the postoperative period of endonasal surgery. MATERIAL AND METHOD 40 patients who underwent endonasal surgery were included in the study. For the postoperative nasal care, isotonic saline was applied to both nasal cavities, and subsequently, Tonimer nasal gel spray was additionally applied to the right nasal cavity. Patients were examined on the 2nd, 7th, and 15th postoperative days. The findings of the examinations were scored with respect to crusting and the patient nasal comfort was assessed using the visual analog scale (VAS). RESULTS The VAS values which measure patient comfort and crusting were significantly lower on the Tonimer side compared to control (p < 0.01). CONCLUSION Tonimer and saline combination was found to be superior to saline per se in decreasing crusting and improving patient nasal comfort in the postoperative period.
-
6.
Water versus carbohydrate-electrolyte fluid replacement during loaded marching under heat stress.
Byrne, C, Lim, CL, Chew, SA, Ming, ET
Military medicine. 2005;(8):715-21
Abstract
This study compared the effectiveness of carbohydrate-electrolyte (CHO-E) fluid replacement versus water (WAT) on hydration status, physiological and subjective responses, and exercise performance during a 3 x 60-minute loaded (14 kg) treadmill walk in 35 degrees C ambient temperature and 55% humidity. CHO-E did not affect urine loss, plasma volume change (WAT = -3.0 +/- 1.6% vs. CHO-E = -1.1 +/- 1.6%), dehydration (WAT = 0.4 +/- 0.3% vs. CHO-E = 0.4 +/- 0.3% of body mass), or core body temperature (Tc) and heart rate (HR) responses. Endurance time was greater but not significantly different with CHO-E (WAT = 134 +/- 9 vs. CHO-E = 146 +/- 9 minutes). CHO-E increased the frequency of task completion (WAT = 21% vs. CHO-E = 50%), elevated blood glucose, and reduced perceived exertion. CHO-E offers potential to enhance exercise capacity by elevating blood glucose and thereby preventing hypoglycemia, maintaining high rates of carbohydrate oxidation, and/or preventing central fatigue; but provided no additional benefits with regard to hydration status and physiological function during loaded walking under heat stress.
-
7.
A randomized, double-blind comparison of lactated Ringer's solution and 0.9% NaCl during renal transplantation.
O'Malley, CMN, Frumento, RJ, Hardy, MA, Benvenisty, AI, Brentjens, TE, Mercer, JS, Bennett-Guerrero, E
Anesthesia and analgesia. 2005;(5):1518-1524
Abstract
Normal saline (NS; 0.9% NaCl) is administered during kidney transplantation to avoid the risk of hyperkalemia associated with potassium-containing fluids. Recent evidence suggests that NS may be associated with adverse effects that are not seen with balanced-salt fluids, e.g., lactated Ringer's solution (LR). We hypothesized that NS is detrimental to renal function in kidney transplant recipients. Adults undergoing kidney transplantation were enrolled in a prospective, randomized, double-blind clinical trial of NS versus LR for intraoperative IV fluid therapy. The primary outcome measure was creatinine concentration on postoperative Day 3. The study was terminated for safety reasons after interim analysis of data from 51 patients. Forty-eight patients underwent living donor kidney transplants, and three patients underwent cadaveric donor transplants. Twenty-six patients received NS, and 25 patients received LR. There was no difference between groups in the primary outcome measure. Five (19%) patients in the NS group versus zero (0%) patients in the LR group had potassium concentrations >6 mEq/L and were treated for hyperkalemia (P = 0.05). Eight (31%) patients in the NS group versus zero (0%) patients in the LR group were treated for metabolic acidosis (P = 0.004). NS did not adversely affect renal function. LR was associated with less hyperkalemia and acidosis compared with NS. LR may be a safe choice for IV fluid therapy in patients undergoing kidney transplantation.
-
8.
Rapid water and slow sodium excretion of acetated Ringer's solution dehydrates cells.
Hahn, RG, Drobin, D
Anesthesia and analgesia. 2003;(6):1590-1594
Abstract
UNLABELLED Acetated Ringer's solution is a slightly hypotonic infusion fluid (osmolality 270 mosmol/kg) that has inspired the belief that the fluid causes a shift of water volume to the intracellular space. We assessed the role of the kidney in modifying this volume shift by infusing 25 mL/kg of Ringer's acetate solution (mean, 1565 mL) over a time period of 15, 30, 45, and 80 min on different occasions in 5 healthy female volunteers. Regardless of the rate of administration, the excreted urine contained only half as much sodium (mean, 67 mmol/L) as the infused fluid. As there was only a slight increase of 0.9 mmol/L in the serum sodium level, mass balance calculations indicated that 274 mL of water had shifted from the intracellular to the extracellular space 30 min after the infusions ended (P < 0.001). This fluid shift was also maintained over the subsequent 90 min. In conclusion, infusion of Ringer's acetate solution does not promote cellular swelling as a result of the excretion of urine that is low in sodium. A slight dehydration of fluid from the intracellular space still persisted when our measurements ended 2 h after completing the infusion. IMPLICATIONS The kidney promotes slight cellular dehydration after infusion of Ringer's acetate solution by rapid excretion of water, whereas natriuresis occurs more slowly. In volunteers, this translocation amounted to 18% of the infused fluid volume and persisted for at least 2 h.
-
9.
Effects of recovery beverages on glycogen restoration and endurance exercise performance.
Williams, M, Raven, PB, Fogt, DL, Ivy, JL
Journal of strength and conditioning research. 2003;(1):12-9
Abstract
The restorative capacities of a high carbohydrate-protein (CHO-PRO) beverage containing electrolytes and a traditional 6% carbohydrate-electrolyte sports beverage (SB) were assessed after glycogen-depleting exercise. Postexercise ingestion of the CHO-PRO beverage, in comparison with the SB, resulted in a 55% greater time to exhaustion during a subsequent exercise bout at 85% maximum oxygen consumption (VO(2)max). The greater recovery after the intake of the CHO-PRO beverage could be because of a greater rate of muscle glycogen storage. Therefore, a second study was designed to investigate the effects of after exercise CHO-PRO and SB supplements on muscle glycogen restoration. Eight endurance-trained cyclists (VO(2)max = 62.1 +/- 2.2 ml.kg(-1) body wt.min(-1)) performed 2 trials consisting of a 2-hour glycogen-depletion ride at 65-75% VO(2)max. Carbohydrate-protein (355 ml; approximately 0.8 g carbohydrate (CHO).kg(-1) body wt and approximately 0.2 g protein.kg(-1) body wt) or SB (355 ml; approximately 0.3 g CHO.kg(-1) body wt) was provided immediately and 2 hours after exercise. Trials were randomized and separated by 7-15 days. Ingestion of the CHO-PRO beverage resulted in a 17% greater plasma glucose response, a 92% greater insulin response, and a 128% greater storage of muscle glycogen (159 +/- 18 and 69 +/- 32 micromol.g(-1) dry weight for CHO-PRO and SB, respectively) compared with the SB (p < 0.05). These findings indicate that the rate of recovery is coupled with the rate of muscle glycogen replenishment and suggest that recovery supplements should be consumed to optimize muscle glycogen synthesis as well as fluid replacement.
-
10.
An evaluation of isotonic "sport drinks" during labor.
Kubli, M, Scrutton, MJ, Seed, PT, O'Sullivan, G
Anesthesia and analgesia. 2002;(2):404-8, table of contents
Abstract
UNLABELLED We compared the metabolic effects of allowing women isotonic "sport drinks" rather than water to drink during labor. The effect of these drinks on gastric residual volume was also evaluated. Sixty women in early labor (cervical dilation <5 cm) were randomized to receive either isotonic sport drinks or water only. Plasma beta-hydroxybutyrate, nonesterified fatty acids, and glucose were measured in early labor and at the end of the first stage of labor. Residual gastric volume was assessed within 45 min of delivery by use of an ultrasound scanner. The incidence and volume of vomiting was recorded. At the end of the first stage of labor, plasma beta-hydroxybutyrate (P = 0.000) and nonesterified fatty acids (P = 0.000) had increased and plasma glucose (P = 0.007) had decreased significantly in the Water-Only group. Gastric antral cross-sectional area after delivery was similar in the two groups. The incidence of vomiting and the volume vomited during labor and within the hour of delivery were also similar. There was no difference between the groups in any maternal or neonatal outcome of labor. In conclusion, isotonic drinks reduce maternal ketosis in labor without increasing gastric volume. IMPLICATIONS Solid foods may endanger a woman's life if consumed during labor. Isotonic sport fluids were evaluated as a nutritional alternative. Results demonstrate that mothers who have not received parenteral opioids can safely drink isotonic drinks in active labor.