Primary adipsia and severe hypernatremia in a Pit Bull dog / Adipsia primária e hipernatremia severa em um cão Pit Bull

Primary adipsia is a rare condition in which there is failure in the activation threshold of the hypothalamic osmoreceptors, leading to osmolality imbalance. Here, we reported the case of a Pit Bull dog with an altered level of consciousness (started after weaning) and adipsia. There was an increase in plasma osmolality (444 mOsm/kg), sodium (223.7 mg/dL), and chlorine (173 mg/dL) levels. Based on the suspicion of primary adipsia, water was administered via a nasogastric tube, with clinical improvement. The owner was instructed to supply water with food. Eight months after discharge, the dog returned with parvovirus and died. In the anatomopathological examination, no structural changes were observed in the central nervous system. To our knowledge, this is the first report of hypernatremia due to adipsia in a Pit Bull dog, showing that this is a differential diagnosis that should be considered in this breed.

Adipsia primária é uma rara condição em que há falha no limiar de ativação dos osmoreceptores hipotalâmicos, levando ao desequilíbrio da osmolalidade. Este artigo tem como objetivo relatar o caso de um cão da raça Pit Bull apresentando alteração no nível de consciência (iniciado após o desmame) e adipsia. Foi verificado aumento da osmolalidade plasmática (444 mOsm/kg), sódio (223,7 mg/dL) e cloro (173 mg/dL). Baseado na suspeita de adipsia primária, iniciou-se administração de água via sonda nasogástrica, com melhora clínica. O tutor foi orientado a fornecer água junto a alimentação. Oito meses após alta, o paciente retornou com parvovirose e veio a óbito. No exame anatomopatológico, não foram observadas alterações estruturais no sistema nervoso central. Este é o primeiro relato de hipernatremia por adipsia em um cão Pit Bull, mostrando que este é um diagnóstico diferencial que deve ser considerado nesta raça.

Influence of blocking the short wave visible light on the stability of tear film in healthy people / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of blocking short wave visible light(400-500nm)on tear film stability in healthy people. <p>METHODS: In this prospective intervention experiment, 26 college students were selected, including 12 males and 14 females, aged 22.1±1.4 years, from February to March 2020. At the same time of two adjacent days, the subjects watched the video for 1h under the same environmental conditions. For the first time, there was no short wave visible light blocking, and for the second time, they wore short wave visible light blocking myopia or flat glasses. The subjects were examined the radius of curvature of lacrimal River curved surface, tear osmolality, tear film rupture time, corneal fluorescein sodium staining score, the basic state before watching the video and after watching the video respectively. And the questionnaire of visual perception was completed at the end of the experiment. <p>RESULTS: There were significant differences in the radius of curvature of lacrimal River curved surface, tear osmolality, tear film rupture time, corneal fluorescein sodium staining score between the basic state and the short wave visible unstopped state(<i>t</i>=4.50, 5.72, 4.437, 3.245, <i>P</i><0.05). There was no significant difference between the short wave visible light blocking and the basic state(<i>t</i>=1.972, 1.993, 1.921, 1.641, <i>P</i>>0.05). There was also significant difference between the short wave visible light blocking and the short wave visible light unblocking(<i>t</i>=2.825, 3.771, 2.610, 3.028, <i>P</i>< 0.05). The results of the questionnaire showed that: eighteen subjects(69%)said that wearing the short wave visible light blocking glasses or without wearing short wave visible light blocking glasses had slight eye dryness, pain, foreign body sensation, visual fatigue and other discomfort after watching the video. Sixteen subjects(62%)said that they were more comfortable after blocking the short wave visible light. Twenty-four subjects(92%)said that they were willing to block the short wave visible light. <p>CONCLUSION: The stability of tear film could be reduced by watching the display screen for a short time. Blocking the short wave visible light could protect the stability of tear film of the ocular surface.

Influência da diluição, do tempo e da temperatura pós-preparo na osmolalidade das fórmulas lácteas oferecidas a recém-nascidos / Influence of dilution, time, and temperature after preparation on the osmolality of infant formulas given to newborns

RESUMO Objetivo: Analisar a influência da diluição, o tempo e a temperatura pós-preparo na osmolalidade das fórmulas lácteas oferecidas a recém-nascidos (RN). Métodos: Estudo experimental e descritivo com uma amostra de diferentes fórmulas lácteas neonatais para verificar a osmolalidade do leite segundo a diluição, o tempo e a temperatura pós-preparo. Foram analisadas sete fórmulas lácteas neonatais nos seguintes tempos: imediatamente (até 5 minutos) após o preparo; 20 e 40 minutos após o preparo; de hora em hora, até completar 8 h; e após 12 e 24 h de preparo. As amostras foram avaliadas após o preparo em temperatura ambiente e depois da refrigeração. Foram elaboradas curvas de osmolalidade com a média das triplicatas de cada amostra de leite. O cálculo da osmolalidade foi aferido no Osmômetro digital A+ da Advanced Instruments, modelo 3.320. Resultados: O tempo e a temperatura em que os leites ficaram submetidos após o preparo não ultrapassaram o ponto de corte de segurança da osmolalidade na diluição 1:30 em nenhum dos tipos de leite analisados. Na diluição 1:25 a fórmula láctea que possui prebióticos em sua composição ultrapassou o limite após 4 h de preparo. Conclusões: Os leites testados não ultrapassaram o ponto de corte de 450 mOsm/kg (aproximadamente 400 mOsm/L), indicado como seguro pela Academia Americana de Pediatria (AAP) na diluição preconizada pelos fabricantes. É necessário conhecer os fatores que podem ou não contribuir com o aumento da osmolalidade, afim de se estabelecer condutas seguras e de qualidade para os RN, seguindo protocolos baseados em evidências científicas.

ABSTRACT Objective: To analyze the influence of dilution, time, and temperature after preparation on the osmolality of infant formulas given to newborns (NBs). Methods: Experimental and descriptive study with samples of different neonatal formulas to verify the osmolality of the milk according to dilution, time, and temperature after preparation. We analyzed seven neonatal formulas in the following times after preparation: immediately (up to 5 minutes); 20 and 40 minutes; every hour up to 8 hours; and 12 and 24 hours. The samples were evaluated at room temperature and after refrigeration. Osmolality curves were designed with the mean of triplicate samples of each milk sample. The digital Osmometer A+, model 3320, from Advanced Instruments measured the osmolality. Results: The time and temperature at which the milk was subjected after preparation did not cause the osmolality to exceed its safety cut-off point at a 1:30 dilution in any of the types of milk analyzed. At a 1:25 dilution, the formula with prebiotics in its composition went over the limit after 4 hours. Conclusions: The milk tested did not exceed the cut-off point of 450 mOsm/kg (approximately 400 mOsm/L), indicated as safe by the American Academy of Pediatrics (AAP) at a dilution recommended by manufacturers. It is important to know the factors that may or may not contribute to the rise of osmolality, in order to establish safe and quality practices for NBs, following protocols based on scientific evidence.

The measurement of serum osmolality and its application to clinical practice and laboratory: literature review / A medida da osmolalidade sérica e sua aplicação na prática clínica e laboratorial: revisão da literatura

ABSTRACT Introduction: Serum osmolality is an essential laboratory parameter to understand several clinical disorders such as electrolyte disturbances, exogenous intoxication and hydration status. Objective: This study aims to update knowledge about the osmolality examination through research papers published to date. Materials and methods: The survey was conducted on PubMed database. It highlights main concepts, both historical and physiological aspects, and the clinical applications of the serum osmolality test. In addition, an extensive survey of formulas for the serum osmolality calculation was conducted. Discussion: The measurement of serum osmolality is relevant in changes in intracellular and extracellular balance, as a trusted and valuable indicator of solute concentration in the blood. The mathematical equations for serum osmolality calculation acquire relevance in health services where serum is not available, and situations in which calculation of the osmolal gap is necessary, but the variability of the formulas is a significant bias. Conclusion: The measurement of serum osmolality is useful in cases of dehydration, sodium and potassium disorders, glucose alteration, exogenous poisoning, adrenal insufficiency, neurological injury, physical exercise and others.

RESUMO Introdução: A osmolalidade sérica constitui um parâmetro laboratorial importante para compreensão de diversas desordens clínicas, como os distúrbios eletrolíticos, as intoxicações exógenas e o status de hidratação. Objetivo: Este trabalho visa atualizar os conhecimentos acerca do exame de osmolalidade por meio da pesquisa de artigos científicos publicados até a presente data. Materiais e métodos: A pesquisa foi realizada no banco de dados do PubMed. Este artigo de atualização aborda os principais conceitos, aspectos históricos, aspectos fisiológicos e aplicações clínicas do exame de osmolalidade sérica. Foi também realizado um levantamento das diferentes fórmulas propostas para o cálculo da osmolalidade sérica. Discussão: A medida da osmolalidade sérica é pertinente nas alterações do equilíbrio intra e extracelular, sendo um bom indicador para avaliar as concentrações de solutos no sangue. As fórmulas matemáticas para o cálculo da osmolalidade sérica são úteis quando a medida laboratorial não está disponível, bem como nas situações em que o cálculo do gap osmolal se faz necessário, mas a variabilidade das fórmulas é um viés significativo. Conclusão: A medida da osmolalidade sérica é útil na avaliação de diversas condições clínicas, como na desidratação, nos distúrbios dos íons sódio e potássio, nas disglicemias, nas intoxicações exógenas, na insuficiência adrenal, nas lesões neurológicas, nos exercícios físicos, entre outras.

Propriedades físico-químicas e nutricionais de dietas enterais artesanais produzidas a partir de vegetais de baixa carga glicêmica / Physico-chemical and nutritional properties of handmade enteral diets produced from vegetables of low glycemic load

O propósito desse estudo foi elaborar dietas enterais artesanais, para uso por pacientes em Terapia Nutricional Enteral Domiciliar estabilizados e com expectativa de uso prolongado ou permanente da via enteral, a partir de uma formulação contendo fontes vegetais de baixa carga glicêmica e teores significativos de fibra alimentar. O presente trabalho objetivou avaliar as propriedades físico-químicas e nutricionais das dietas enterais artesanais produzidas a partir de vegetais de baixa carga glicêmica, oferecendo alternativas de baixo custo para a nutrição e controle da glicemia e metabolismo glicídico para indivíduos em uso domiciliar de dietas enterais. Foram estabelecidas 18 combinações classificadas em 3 grupos, utilizando diferentes vegetais, acrescidos de maltodextrina, albumina, óleo de soja e amido de milho até que a fórmula obtivesse a proporção de 1 kcal/mL. Verificou-se a fluidez e estabilidade das dietas, além da realização de análise bromatológica de macro e micronutrientes. Todas as dietas formuladas foram caracterizadas como normocalóricas, normoprotéicas e normolipídicas. O teor médio de fibra alimentar dos 3 grupos de dietas foi de 1,83 g/100 mL, sendo 0,87 g (47%) de fibra solúvel, atingindo valores próximos às recomendações diárias. Em relação aos micronutrientes, as dietas prescritas para um dia atingiram 71% das necessidades recomendadas de ferro, 116% das de cobre, 48% das de zinco, 32% das de cálcio, 110% das de fósforo, 46% das de potássio, 50% das de magnésio, 90% das de manganês, 25% das de selênio e 39% das de sódio. A partir dos dados analisados neste trabalho, é possível concluir que as dietas formuladas possuem um perfil de macronutrientes que atendem as necessidades de um indivíduo adulto. No tocante aos minerais, essa adequação é parcial e ajustes são necessários. As características de cor, fluidez e estabilidade fazem dessas dietas uma opção importante para uso domiciliar, podendo contribuir para a diminuição de custos e aumento da aceitação desse tipo de alimentação.

The purpose of this study was to elaborate handmade enteral diets for use by patients in stabilized enteral home therapy and with an expectation of extend or permanent use of the enteral route from a formulation containing vegetal sources of low glycemic load and significant levels of dietary fiber. The aim of this study was to evaluate the physicochemical and nutritional properties of handmade enteral diets produced from vegetables with low glycemic load, offering low-cost alternatives for nutrition and control of glycemic metabolism for people using enteral diets. Eighteen food combinations were established in 3 groups, using different vegetables associated with maltodextrin, albumin, soybean oil and cornstarch until the formula obtained the ratio of 1 kcal / mL. The fluidity and stability of the diets were verified, as well as the macromicronutrient and bromatological markers. All diets formulated were characterized as normocaloric, normoprotein and normolipidic. The average dietary fiber content of the three groups of diets was 1.83 g / 100 mL, being 0.87 g (47%) of soluble fiber, reaching values close to daily recommendations. In the case of micronutrients, caloric values prescribed for one day reached 71% of recommended iron requirements, 116% of copper, 48% of zinc, 32% of calcium, 110% of phosphorus, 46% of potassium, 50% of magnesium, 90% of manganese, 25% of selenium and 39% of sodium. From the data analyzed in this study, it is possible to conclude that the formulated diets have a macronutrient profile that meets the needs of an normal adult. Regarding minerals, this availability is partial and adjustments are required. The characteristics of color, fluidity and stability make these diets an important option for home use, which may contribute to lower costs and increase the acceptance of this type of food therapy.

Água de coco em pó como suplemento hidroeletrolítico e energético para atletas / Powdered coconut water as hydroelectrolytic and energetic supplement for athletes / Agua de coco en polvo como suplemento hidroelectrolítico y energético para atletas

RESUMOIntrodução:O uso de bebidas esportivas vem sendo adotado em diversas modalidades com o intuito de propiciar hidratação adequada durante atividades físicas. A água do coco verde vem sendo usada como repositor de eletrólitos devido à sua composição físico-química rica em sais minerais.Objetivo:Avaliar uma bebida esportiva à base de água de coco em pó (ACP ) a partir de um blend de ACP com polpa de maracujá (Passiflora edulis S.) voltada ao mercado de alimentos funcionais, com o objetivo de melhorar o desempenho de atletas amadores e profissionais em relação a um produto repositor eletrolítico já estabelecido no mercado (Gatorade sabor maracujá).Métodos:O experimento obedeceu a um delineamento inteiramente casualizado em esquema fatorial 2 x 2 x 3 (2 gêneros x 2 tipos de bebidas x 3 dias da semana), comparando o desempe-nho de dois grupos de atletas, sendo cinco atletas do sexo masculino e cinco atletas do sexo feminino, em relação à eficácia de dois suplementos hidroeletrolíticos (ACP com 20% de polpa de maracujá e Gatorade sabor maracujá) em diferentes dias da semana (segunda-feira, quarta-feira e sexta-feira).Resultados:ACP com polpa de maracujá apresentou resultados semelhantes ao Gatorade sabor maracujá em relação à os-molaridade plasmática do sangue dos atletas, os quais não apresentaram nenhuma perda de desempenho e tiveram maior conforto gástrico ao se hidratarem com ACP com polpa de maracujá.Conclusão:As respostas fisiológicas mostram a eficiência de ACP com polpa de maracujá como um repositor de eletrólitos seme-lhante ao do produto Gatorade sabor maracujá, podendo assim ACP com polpa de maracujá também ser utilizada como uma bebida esportiva.

ABSTRACTIntroduction:The use of sports drinks has been adopted in various forms in order to provide adequate hydration during physical activities. Green coconut water has been used as electrolyte replenishing due to its physicochemical composition, which is rich in minerals.Objective: To evaluate a sports drink based on powdered coconut water (ACP ) as from a blend of ACP with passion fruit pulp (Passiflora edulis S.), focused on the functional food market, aiming at improving the performance of amateur and professional athletes compared with an electrolytic replenishing already established in the market (passion fruit flavored Gatorade ).Methods:The experiment followed a completely rando-mized design in a factorial scheme 2 x 2 x 3 (2 genders x 2 drink types x 3 times a week) comparing the performance of two groups of athletes, five male athletes and five female athletes, as to the effectiveness of two hydroelectrolytic supplements (ACP with 20% passion fruit pulp and passion fruit flavored Gatorade ) on different days of the week (Monday, Wednesday and Friday).Results:ACP with passion fruit pulp showed results similar to the passion fruit flavored Gatorade in relation to blood plasma osmolarity of athletes, who experienced no loss of performance and more gastric comfort when hydrated with ACP with passion fruit pulp.Conclusion:The physiological responses show the efficiency of ACP with passion fruit pulp as a replenishing of electrolytes similar to Gatorade passion fruit flavored, the ACP with passion fruit pulp being, therefore, also appropriate to be used as a sports drink.

RESUMENIntroducción:El uso de bebidas deportivas viene siendo adoptado en diversas modalidades con el objetivo de propiciar hidratación adecuada durante actividades físicas. El agua de coco verde viene siendo usada como repositor de electrolitos debido a su composición físico-química rica en sales minerales.Objetivo:Evaluar una bebida deportiva a base de agua de coco en polvo (ACP ) a partir de un blend de ACP con pulpa de maracuyá (Passiflora edulis S.) dirigida al mercado de alimentos funcionales, con el objetivo de mejorar el desempeño de atletas amateurs y profesionales en relación a un producto repositor electrolítico ya establecido en el mercado (Gatorade sabor maracuyá).Métodos:El experimento obedeció a una delineación totalmente casualizada en esquema factorial 2 x 2 x 3 (2 géneros x 2 tipos de bebidas x 3 días de la semana), comparando el desempeño de dos grupos de atletas, siendo cinco atletas del sexo masculino y cinco atletas del sexo femenino, en relación a la eficacia de dos suplementos hidroelectrolíticos (ACP(r) con 20% de pulpa de maracuyá y Gatorade sabor maracuyá) en diferentes días de la semana (lunes, miércoles y viernes).Resultados:ACP(r) con pulpa de maracuyá presentó resultados semejantes al Gatorade sabor maracuyá en relación a la osmolaridad plasmática de la sangre de los atletas, los que no presentaron ninguna pérdida de desempeño y tuvieron mayor comodidad gástrica al hidratarse con ACP con pulpa de maracuyá.Conclusión:Las respuestas fisiológicas muestran la eficiencia de ACP con pulpa de maracuyá como un repositor de electrolitos semejante al del producto Gatorade sabor maracuyá, pudiendo así ACP con pulpa de maracuyá también ser utilizada como una bebida deportiva.

Bebida eletrolítica a base de permeado da ultrafiltração de leite: avaliação física, química e microbiológica durante o armazenamento / Milk ultrafiltration permeate-based electrolyte drink: physical, chemical and microbiological assessment during storage

Este trabalho teve como objetivo a elaboração de uma bebida eletrolítica a base de permeado da ultrafiltração de leite e avaliação de suas características físicas, químicas e microbiológicas, durante o período de armazenamento por 30 dias, nas temperaturas de 7°C e 25°C. A bebida apresentou-se clara, com coloração amarelo-esverdeada, osmolalidade de 311,6mOsmol.L-1 e carboidratos totais de 6,48% m/v. Não foram observadas alterações significativas de pH, acidez titulável e sólidos solúveis durante o tempo e temperatura de armazenamento (P>0,05). A osmolalidade e o teor de açúcares totais foram afetados pelo tempo (P<0,05), enquanto que o aumento de açúcares redutores foi afetado pelo tempo e pela temperatura de armazenamento (P<0,05). Observou-se correlação positiva (P<0,05) entre o teor de açúcares redutores e totais com a osmolalidade,porém a bebida manteve-se dentro da faixa de osmolalidade(entre 290mOsm L-1 e 330mOsm L-1). As coordenadas L*, a*, b* e C* foram afetadas somente pelo tempo de armazenamento (P<0,05). No estudo de vida útil, a bebida mostrou-se estável microbiologicamente. Assim, o permeado pode ser aproveitado como coproduto industrial na elaboração de bebidas eletrolíticas, em vista dos critérios de osmolalidade, além de conter minerais naturais.

This study aimed to prepare a electrolyte drink based on permeate of milk ultrafiltration with evaluation of its physical, chemical, and microbiological properties during 30 days of storage at 7°C and 25°C. The drink became clear, with greenish-yellow color, osmolality of 311,6mOsmol L-1and total carbohydrates of 6.48 % m/v. There were no significant changes in pH, titratable acidity, and soluble solids during storage time and temperature (P>0.05). The osmolality and total sugars were affected by time (P<0.05), whereas the increase in reducing sugars was affected by storage temperature and time (P<0.05). Positive correlation (P<0.05) between total reducing sugars and osmolality was observed, but the drink was within the osmolality range for isotonic drinks (290mOsm L-1 and 330mOsm L-1). L*, a*, b*, and C* coordinates were affected only by the storage time (P<0.05). In the study of shelf life, the drink showed to be microbiologically stable. The permeate can be used as industrial residue in the preparation of electrolyte drinks in view of osmolality criteria, besides containing natural minerals.

Analysis on Osmolality of Domestic Recombinant Human Interferon α2 b Injection / 中国药师

Objective:To examine the osmolality of domestic recombinant human interferon α2b injection to provide evidence for the improvement of the national quality standard. Methods:Totally 66 batches of recombinant human interferonα2b injection produced by 9 manufacturers were withdrawn, and the osmolality was determined according to the appendix of Chinese Pharmacopoeia Ⅲ(2010 edition). The results were analyzed with statistical methods. Results:The pass rate of osmolality was 98. 5%. The osmolality of more than 90% of the batches was between 85% and 115% of the intermediate value set by the manufacturers. Conclusion:Comprehensive understanding of the quality control of osmolality of domestic recombinant human interferon α2b injection is obtained, which provides data support for the improvement of quality standard of osmolality.

Osmotic Pressure Measurement of Pirenoxinun Sodium Eye Drops / 中国药师

Objective:To investigate the feasibility and accuracy of osmometer in the osmolarity measurement of pirenoxinun sodi-um eye drops. Methods:An osmometer was used to measure the osmolarity of pirenoxinun sodium eye drops, and the stability of the osmolality was studied. Results:The osmolarity of pirenoxinun sodium eye drops with different formula conformed to the requirement of ophthalmic preparations. The osmolality showed no significant change at the ambient temperature, indicating the stability of the prepa-ration. Conclusion:The method is simple, rapid and practical, which can be used as the osmolarity measurement method for pirenoxi-nun sodium eye drops.

Evaluation of a Test Index Obtained by Coupling Protein with Specific Gravity of Screening Urine Test

BACKGROUND: The 24-hr urine protein excretion test is regarded as a standard for quantitative urinary protein analysis; however, collection of urine over 24 hr is troublesome and errors may occur during the process. We obtained a test index reflecting diluted or concentrated urine by coupling the results of a simple and rapid routine urine analysis and evaluated its usefulness as a marker that quantitatively reflects the 24-hr urine protein excretion. METHODS: The estimated urine protein-osmolality ratio (Pro/Osm) was obtained by two linear regression equations between urine dipstick protein and natural logarithm of the protein concentration, and between urine specific gravity (SG) and urine osmolality (Osm). Sensitivity and specificity of 'estimated urine Pro/Osm' and the widely used urine protein-creatinine ratio were evaluated for their efficiency in diagnosing pathological proteinuria and nephrotic proteinuria based on 24-hr urine protein excretion. RESULTS: Moderate correlations were noted between protein concentration determined by the urine dipstick protein assay and natural logarithm of protein concentration (r=0.86) and between urine SG and urine Osm (r=0.74). The receiver operating characteristics analysis showed that an estimated urine Pro/Osm value of 0.045 had a sensitivity of 91.1% and a specificity of 88.6% for diagnosing pathological proteinuria, and a value of 0.204 had a sensitivity of 100% and a specificity of 80.4% for diagnosing nephrotic proteinuria. CONCLUSIONS: Coupling the results of urine dipstick protein and urine SG determined by the routine analysis will provide additional useful information that will make the screening of renal diseases more cost-effective.

Role of urine osmolality as a predictor of the effectiveness of combined imipramine and desmopressin in the treatment of monosymptomatic nocturnal enuresis / 영남의대학술지

BACKGROUND: We examined the usefulness of urine osmolality, as a predictive factor in the treatment of monosymptomatic nocturnal enuresis (NE) with combination therapy of imipramine and desmopressin. METHODS: From May 2014 to April 2015, 59 monosymptomatic NE patients participated in this study. Early morning urine osmolality was measured at 1 week and 1 day before combination therapy of imipramine and desmopressin, and at 1 week and 2 weeks after therapy. The response to combination therapy was evaluated at 3 months after treatment. The mean period of combination therapy was 6.4+/-4.2 weeks. Therapeutic response was classified as complete (0-1 wet night/week), partial (over 50% reduction of night) and non-responders (less than 50% reduction of night). RESULTS: The cumulative rate of the complete and partial responders was 76.3%. Among the 3 groups, the statistically lowest value of pre-treatment urine osmolality was observed in the complete responder group (p<0.001). Urine osmolality increased in all groups after treatment, however, statistically the greatest difference between pre and post-treatment urine osmolality was observed in the complete responder group (p=0.024). No serious side effects were observed. CONCLUSION: Early morning urine osmolality and change of urine osmolality between pre and post-treatment have predictive values in the response to combined imipramine and desmopressin for treatment of monosymptomatic NE.

Terapia de rehidratacion oral en pacientes deshidratados por diarrea aguda infantil / Oral rehydration therapy in children with acute diarrhea and dehydration

La Terapia de Rehidratación Oral (TRO) se ha convertido en las últimas décadas en la piedra angular del tratamiento de las enfermedades diarreicas, constituyendo un gran avance para tratar en forma segura y eficaz la deshidratación producida por diarrea de diversas etiologías en todas las edades, excepto cuando la deshidratación es grave. La composición de las soluciones de rehidratación oral (SRO) ha sido objeto de controversias relacionadas con el contenido de electrolitos, bicarbonato, osmolaridad, transportadores, y micronutrientes. Sin embargo, los resultados de investigaciones promovidas por la Organización Mundial de la Salud (OMS) y el Fondo para la Infancia de las Naciones Unidas (UNICEF) en el año 2001, recomiendan el uso de las SRO de Osmolaridad Reducida (SROOR) ya que estas muestran superioridad significativa, en los resultados clínicos, sobre las SRO estándar (SRO-S). En el texto, a continuación, se describen las bases fisiológicas de la terapia de la rehidratación oral, la composición y características de las SRO, la evaluación clínica de la deshidratación, los planes de hidratación en casos de diarrea, y la terapia de rehidratación oral en el niño desnutrido.

Oral rehydration therapy (ORT) has been in the last decades the corner stone of the therapy for diarrheic diseases, this type of treatment produced a great improvement in safety and efficiency in the therapy of diarrheas of diverse etiologies, in all ages, with the only exception of serious dehydration. The therapy of diarrheas with oral rehydration solutions (ORS) has triggered numerous controversies related to the composition of the solutions on the basis of electrolytes content, sodium bicarbonate, osmolality, transporters, and micronutrients. However, the results of the research conducted, in 2001, by the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF), recommend the use of the ORS of reduced osmolality (ORS-R), because this kind of therapy shows a meaningful superiority in the clinical outcome of the patients, when compared with the ORS of standard osmolality (ORS-S). In the text, we describe the physiological basis for oral therapy rehydration, the composition and characteristics of ORS, the clinical evaluation of dehydration, different therapy treatments for hydration in diarrheic disease, and the use of therapy of oral rehydration in malnourished infant.

Efeito da associação de furosemida e fenilbutazona sobre variáveis hidroeletrolíticas de cavalos antes e após a corrida / The effect of furosemide and phenylbutazone association on the fluid and electrolyte characteristics of horses before and after a race

Verificaram-se os efeitos da associação de furosemida e fenilbutazona sobre variáveis hidroeletrolíticas de cavalos antes e após a corrida. Dezenove equinos foram distribuídos em três grupos, de acordo com os protocolos de tratamento. O primeiro grupo, de cinco animais, não recebeu medicação (grupo-controle); o segundo grupo, de sete animais, foi tratado com furosemida, na dose de 1mg/kg, por via intramuscular, até quatro horas antes do páreo; o terceiro, de sete animais, recebeu furosemida, por via intramuscular, e fenilbutazona, por via intravenosa, nas doses de 1,0 e 4,4mg/kg, respectivamente, até quatro horas antes da corrida. Amostras de sangue foram colhidas antes, imediatamente após e duas horas após o páreo, para avaliação da osmolalidade plasmática e das concentrações plasmáticas de sódio, potássio e cloreto. A utilização de furosemida e da associação furosemida e fenilbutazona até 4h antes dos páreos nas dosagens descritas alterou (P<0,05) a osmolalidade plasmática dos equinos, mas não alterou (P>0,05) as concentrações de sódio, potássio e cloreto. Os páreos alteraram de forma fisiológica a osmolalidade plasmática e a concentração sanguínea de K+ devido ao exercício de alta intensidade.

The objective of this study was to verify the effects of furosemide and phenylbutazone association on fluid and electrolyte balance characteristics of horses before and after a race. Nineteen horses were divided into three groups according to treatment protocols. The first group (five animals - control) was not medicated. A second group (seven animals) was treated with furosemide (1mg/kg, intramuscular up to four hours before the race). A third group (seven animals) received furosemide (1mg/kg) and phenylbutazone (4.4mg/kg), both intramuscular, up to four hours before race. Blood samples were collected before, immediately after and two hours after a race to evaluate the plasma osmolality and sodium, potassium and chloride concentrations. The use of furosemide and furosemide plus phenylbutazone up to four hours before the race altered (P<0.05) the plasma osmolality but did not change (P>0.05) the sodium, potassium and chloride concentrations. It was not possible to determine an antagonist effect of phenylbutazone on furosemide, based on fluid and electrolyte balance. Due to the high intensity exercise, the increase in plasma osmolality and potassium concentration was attributed to the race effect.

Conocimientos sobre el uso de soluciones parenterales en profesionales de la salud del municipio Boyeros / Knowledge about the use of parenteral solutions among health professionals of Boyeros municipality

El conocimiento del uso de soluciones parenterales, sus fundamentos fisiológicos y aplicación es importante; por ello, diseñamos un instrumento evaluativo para explorarlo. El examen fue distribuido entre médicos y enfermeros trabajadores de Boyeros divididos en dos grupos: núm.1: Master o maestrantes en Urgencias Médicas y núm. 2 los que no lo eran. Se recogieron, 14 exámenes del grupo 1 y 14 del grupo 2. Para las 5 preguntas y nota final, no hubo diferencias significativas entre grupos. Dos examinados del grupo 2 suspendieron. La pregunta de más dificultad fue la que explora conocimientos básicos; y la de mejores resultados la referida a conocimientos sobre el manejo práctico de esas soluciones. Resulta estimulante encontrar que no existen grandes dificultades en el manejo práctico de las soluciones, evidenciando buena capacidad de desempeño de nuestros profesionales en situaciones concretas, como expresión de su formación fundamentada en la educación en el trabajo.

The knowledge about parenteral solutions and the principles of their use for medical staff has great importance. Because of that we designed a test for its exploration and applied it to physicians and nurses with master degree in medical emergencies or studying for it (group 1), and those who were not (group 2) working at Boyeros Municipality. 14 tests were obtained from group 1 and 14 from group 2. No significant differences appeared for both groups with the 5 questions and final mark. 2 professionals of group #2 failed. The most difficult question was #1 dealing with basic knowledge and the one with best performance was #5 about practical issues. Although there are problems, it is stimulating to find that there are not great difficulties regarding the use of solutions, showing good practical education of the explored professionals.

The research about the connection between the urine osmolafity and the syndrome type of kidney Yin deficiency or kidney Yang deficiency in chronic kidney disease / 国际中医中药杂志

Objective To explore the regularity between the change of urine osmotic pressure to the syndrome of kidney Yin deficiency and kidney Yang deficiency in patients with chronic kidney disease,to provide an objective evident for the syndrome differentiation of TCM and the judgment of renal function.Methods Urine osmolality and renal function of one hundred and twenty-one patients with chronic kidney disease,belonging to the syndrome of kidney Yin deficiency of kidney Yang deficiency,were detected.The connection between urine osmolality,renal function and TCM syndromes of kidney Yin deficiency and kidney Yang deficiency and the relation of TCM symptom score between them were analyzed.Results The research suggested an obvious link between urine osmolality,renal function and the TCM Syndromes of kidney Yin deficiency and kidney Yang deficiency in Chronic kidney disease.It also suggested an obvious correlation between the urine osmolality and TCM symptom scores.Conclusion The determination of urine osmolality can provide an objective evident for differentiating syndromes of kidney Yin deficiency or kidney Yang deficiency in chronic renal disease.

Hyponatremia in visceral leishmaniasis / Hiponatremia no calazar

There are few reports linking hyponatremia and visceral leishmaniasis (kala-azar). This is a study of 55 consecutive kala-azar patients and 20 normal individuals as a control group. Hyponatremia and serum hypo-osmolality were detected in 100 percent of kala-azar patients. High first morning urine osmolality (750.0 ± 52.0 vs. 894.5 ± 30.0mOsm/kg H2O, p < 0.05), and high 24-hour urine osmolality (426.0 ± 167.0 vs. 514.6 ± 132.0 mOsm/kg H2O, p < 0.05) demonstrated persistent antidiuretic hormone secretion. Urinary sodium was high (82.3 ± 44.2 vs.110.3 ± 34.7 mEq/L, p < 0.05). Low seric uric acid occurred in 61.8 percent of patients and increased fractional urinary uric acid excretion was detected in 74.5 percent of them. Increased glomerular filtration rate was present in 25.4 percent of patients. There was no evidence of extracellular volume depletion. Normal plasma ADH levels were observed in kala-azar patients. No endocrine or renal dysfunction was detected. It is possible that most hyponatremic kala-azar patients present the syndrome of inappropriate antidiuretic hormone secretion.

Existem poucos relatos relacionando hiponatremia com a leshmaniose visceral (calazar). Este é um estudo de 55 pacientes portadores de calazar e um grupo controle de 20 indivíduos normais. Hiponatremia e hipo-osmolalidade sérica foram detectados em 100 por cento dos pacientes portadores de calazar. A presença de alta osmolalidade da primeira urina da manhã (750,0 ± 52,0 vs. 894,5 ± 30 mOsm/Kg H2O, p < 0,05) e da urina de 24h (426,0 ± 167,0 vs. 514,6 ± 132,0 mOsm/Kg H2O, p < 0,05), demonstraram a presença de persistente secreção de hormônio antidiurético. A concentração de sódio urinário foi elevada (82,3 ± 44,2 vs. 110,3 ± 34,7 mEq/L, p < 0,05). Hipouricemia ocorreu em 61,8 por cento dos pacientes e aumento da fração de excreção urinária de ácido úrico foi detectada em 74,5 por cento dos casos. Aumento da velocidade de filtração glomerular estava presente em 25,4 por cento dos pacientes. Não havia evidência clínica de depleção de volume extracelular. Valores normais de ADH plasmático foram observados nos pacientes com calazar. Não foi detectada disfunção renal ou endócrina. É provável, que a maioria dos pacientes com calazar apresente uma síndrome de secreção inapropriada de hormônio antidiurético.

The Relationship between the Popular Beverages in Korea and Reported Postprandial Heartburn / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to investigate the frequency of heartburn produced by beverages available in Korea and to clarify the mechanism causing heartburn. METHODS: We measured pH, titratable acidity, and osmolality of 35 beverages in vitro and correlated them with the severity of heartburn reported by questionnaire in 382 patients from November 2004 to June 2005. RESULTS: Coffee (1.15) and soju (1.12) showed the highest heartburn score, while oolong tea (0.17) and carrot juice (0.18) showed the lowest heartburn score among all beverages. Titratable acidity of citrus juices correlated with heartburn (r=0.78; p=0.023). Soft drinks had the lowest pH, which was unrelated with heartburn scores (r=-0.54; p=0.460). Increasing pH among alcoholic beverages was correlated with heartburn scores (r=0.84; p=0.037), and osmolality was inversely associated with heartburn scores (r=-0.86; p=0.028). The heartburn score of decaffeinated coffee was significantly lower than that of regular coffee (p<0.001). Regular milk caused more heartburn than low-fat milk (p=0.008). CONCLUSIONS: Our findings provide dietary information that helps to select appropriate beverages to the patients with heartburn.

Influencia de la ingesta de bebidas con diferente osmolaridad, sobre el tipo de deshidratación y las concentraciones de electrolitos, plasmáticos y urinarios, durante una actividad física de alta intensidad y larga duración / Effect of beverage osmolarity on dehydration type and plasmatic and urinary electrolytic concentrations during a high-intensity, long-lasting physical activity

Objetivo: establecer los efectos sobre la osmolalidad y las concentraciones electrolíticas, plasmáticas y urinarias, del consumo de tres bebidas con diferente osmolaridad después de una actividad física de alta intensidad y larga duración. Métodos: nueve corredores de fondo realizaron 88 minutos de carrera en banda rodante, seguidos de 90 minutos de recuperación; inicialmente, sin reposición hídrica –procedimiento deshidratado– (DH); luego, tres procedimientos secuenciales y aleatorios ingiriendo un volumen similar de una de tres bebidas, isoosmolar, hipoosmolar o hiperosmolar –procedimientos con hidratación (RH)–. Los electrolitos, plasmáticos y urinarios, la osmolalidad plasmática y la osmolaridad urinaria se midieron antes y después de la carrera y al final de la recuperación. Resultados: en DH, al final del ejercicio, se observó una deshidratación hipernatrémica e hiperclorémica (p < 0,05); durante todo el procedimiento hubo hipercaliemia (p < 0,011); al final de la recuperación hubo reducción del volumen urinario (p < 0,05) e hipercaliuria (p < 0,001). La reposición parcial de las pérdidas hídricas atenuó la deshidratación y los cambios plasmáticos del sodio y el cloro pero no los del potasio al final del ejercicio. Todas las variables estudiadas se asociaron con la duración de la actividad física (p < 0,03). Hubo correlaciones, con todos los tratamientos, durante todo el procedimiento, entre el sodio y el cloro plasmáticos (r: 0,85-0,96) y entre la osmolaridad y el sodio urinarios (r: 0,50-0,83). Conclusiones: al final de la actividad física se observó en el grupo DH una deshidratación hipernatrémica, hiperclorémica e hipercaliémica; la reposición parcial de las pérdidas hídricas, en el límite inferior de lo recomendado, atenuó la deshidratación y los cambios de los electrolitos plasmáticos excepto los del potasio. Son pocas las investigaciones que emplean un modelo de mediciones secuenciales, doble ciego, como el utilizado en el presente trabajo.

Objetive: To establish the effects on plasma osmolality and serum and urine electrolyte composition of the intake of three beverages with different osmolarities after a high intensity, long duration run in endurance athletes. Methodology: Nine long-distance runners performed 88 minutes of running on a treadmill (1% of inclination at a speed equivalent to 80% of the reserve heart rate), followed by 90 minutes of recovery; at the beginning there was no fluid replacement –dehydrated treatment–(DH); later on three sequential and randomizedprocedures were used, drinking equal volumes of one ofthree beverages, namely: hyperosmolar (Hyper),hyposmolar (Hypo) and isosmolar (Iso). Plasmaticosmolality and urinary osmolarity were measured bymeans of standard laboratory techniques, before andafter the running period.Results: In DH, at the end of the exercise period, ahypernatremic and hyperchloremic dehydration wasobserved (p < 0.05); throughout the procedure there washyperkaliemia (p < 0.011); at the end of the recoveryperiod there were an urinary volume reduction (p <0.05) and hyperkaliuria (p < 0.001). Partial replacement of the water loss, with beverages of different osmolarity,attenuated dehydration and the plasmatic changes ofsodium and chloride, but not those of potassium at theend of the exercise period, or those of urinary potassium at the end of the recovery period. All studied variables, except for the urinary concentration of chlorine, were associated with the duration of the physical activity (p < 0.03); only the weight loss showed time-treatment association (p < 0.001). There were correlations with all treatments and during all procedures between plasmatic sodium and chloride (r: 0.85-0.96) and between urinary osmolarity and sodium (r: 0.50-0.83). Conclusions: At the end of the physical activity there was, in the DH group, a hypernatremic, hyperchloremic and hyperkaliemic type of dehydration; partial replacement of the water loss, although in the lower level of the recommended volume, attenuated dehydration and the plasmatic electrolytic changes, except for those of the potassium; hyperkaliuria did not change either at the end of the procedure. Few investigations have used the double-blinded model of sequential measurements that was used in the present work.

Correlation Between the Osmolar Gap and Serum Ethanol Level and the Accuracy of Estimated Ethanol Level in Trauma Patients and Non-Trauma Patients

PURPOSE: The osmolar gap increases in proportion to the ethanol level. Some previous studies have shown that the correlation between the osmolar gap and the ethanol level is weak in trauma patient by using an indirect comparison with other patients. We conducted a direct comparison of the correlation of the osmolar gap to the ethanol level between trauma patients and non-trauma patients. We also analyzed the accuracy of the estimated ethanol level between the two groups. METHODS: The research candidates were adult patients who had visited the emergency department of our hospital from December 2003 to November 2008. By using a retrospective chart review, we classified them into three subgroups: non-trauma without shock, trauma without shock, and trauma with shock. In each group, we compared the correlation between the osmolar gap and the measured ethanol level, and we analyzed the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient. RESULTS: Four hundred forty-seven patients were enrolled in this study. For correlation of the osmolar gap and the measured ethanol level, Pearson's correlation coefficient was 0.916 in all patients, 0.939 in non-trauma without shock patients, 0.917 in trauma without shock patients, and 0.844 in trauma with shock patients. In the analysis of the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient, the accuracy in trauma with shock patients was lower than that in non-trauma without shock patients. CONCLUSION: We found that the correlation between the osmolar gap and the measured ethanol level in the patient group with trauma was lower than it was in the patient group without trauma. Moreover trauma patients with shock had a lower accuracy of the estimated ethanol level than non-trauma patients.