ABSTRACT
We present the first known complication of forearm compartment syndrome after mannitol infusion during partial nephrectomy. We stress the importance of excellent intravenous catheter access and constant visual monitoring of the intravenous catheter site during and after mannitol infusion as ways to prevent this complication. Prompt recognition of compartment syndrome with appropriate intervention can prevent long-term sequelae.
Subject(s)
Humans , Female , Adult , Compartment Syndromes/etiology , Extravasation of Diagnostic and Therapeutic Materials/complications , Forearm/blood supply , Mannitol/adverse effects , Compartment Syndromes/surgery , Diuretics, Osmotic/adverse effects , Forearm/surgery , Nephrectomy/adverse effectsABSTRACT
METHOD: Eighty patients were prospectively randomized for precolonoscopic cleansing either with 750ml of 10 percent mannitol (Group M) or 180ml of a sodium phosphate preparation (Group NaP). Laboratory examinations before and after preparation on all patients included hemoglobin, hematocrit, sodium, potassium, phosphorous, calcium and serum osmolarity. A questionnaire was used to assess undesirable side effects and patient tolerance to the solution. The quality of preparation was assessed by the endoscopist who was unaware of the solution employed. RESULTS: Statistically significant changes were verified in serum sodium, phosphorous, potassium and calcium between the two groups, but no clinical symptoms were observed. There were no significant differences in the frequency of side effects studied. Six of the eight patients in Group NaP who had taken mannitol for a previous colonoscopy claimed better acceptance of the sodium phosphate solution. The endoscopic-blinded trial reported excellent or good bowel preparation in 85 percent prepared with sodium phosphate versus 82.5 percent for mannitol (p=0.37). CONCLUSIONS: Quality of preparation and frequency of side effects was similar in the two solutions. The smaller volume of sodium phosphate necessary for preparation seems to be related to its favorable acceptance. Nevertheless, the retention of sodium and phosphate ions contraindicates the use of sodium phosphate in patients with renal failure, cirrhosis, ascites, and heart failure.
Subject(s)
Humans , Male , Female , Middle Aged , Cathartics , Colonoscopy/methods , Diuretics, Osmotic , Mannitol , Phosphates , Calcium/blood , Cathartics/adverse effects , Diuretics, Osmotic/adverse effects , Mannitol/adverse effects , Phosphates/adverse effects , Phosphorus/blood , Potassium/blood , Prospective Studies , Sodium/bloodABSTRACT
En este trabajo se realizó una revisión de los principales grupos de diuréticos, sus sitios y mecanismos de acción y sus efectos sobre las pruebas de laboratorio. Se analizó el efecto de los diuréticos sobre: el estado ácido base, los electrolitos séricos y urinarios, el ácido úrico sérico y urinario y sobre la glucemia. También se describió la influencia de los diuréticos sobre los análisis de orina. Finalmente, los efectos hematológicos de los mismos. El objetivo de este trabajo fue estudiar la influencia de los diuréticos en los análisis clínicos, buscando los mecanismos fisiopatológicos o metodológicos de los casos citados