Exogenously applied nutrients can improve the chickpea productivity under water stress conditions by modulating the antioxidant enzyme system / Nutrientes aplicados exogenamente melhoram a produtividade do grão-de bico em condições de estresse hídrico, modulando o sistema de enzimas antioxidantes

Water stress is one of the major factor restricting the growth and development of chickpea plants by inducing various morphological and physiological changes. Therefore, the present research activity was designed to improve the chickpea productivity under water stress conditions by modulating antioxidant enzyme system. Experimental treatments comprised of two chickpea genotypes i.e. Bhakhar 2011 (drought tolerant) and DUSHT (drought sensitive), two water stress levels i.e. water stress at flowering stage and water stress at flowering + pod formation + grain filling stage including well watered (control) and three exogenous application of nutrients i.e. KCl 200 ppm, MgCl2, 50 ppm and CaCl2, 10 mM including distilled water (control). Results indicated that water stress at various growth stages adversely affects the growth, yield and quality attributes of both chickpea cultivars. Exogenous application of nutrients improved the growth, yield and antioxidant enzyme activities of both chickpea genotypes even under water stress conditions. However, superior results were obtained with foliar spray of potassium chloride on Bhakhar 2011 under well-watered conditions. Similarly, foliar spray of potassium chloride on chickpea cultivar Bhakhar 2011 cultivated under stress at flowering + pod formation + grain filling stage produced significantly higher contents of superoxide dismutase, peroxidase and catalase. These results suggests that the application of potassium chloride mitigates the adverse effects of water stress and enhanced tolerance in chickpea mainly due to higher antioxidant enzymes activity, demonstrating the protective measures of plant cells in stress conditions.

O estresse hídrico é um dos principais fatores que restringem o crescimento e o desenvolvimento das plantas de grão-de-bico, induzindo várias alterações morfológicas e fisiológicas. Portanto, a presente atividade de pesquisa foi projetada para melhorar a produtividade do grão-de-bico em condições de estresse hídrico, por meio da modulação do sistema de enzimas antioxidantes. Tratamentos experimentais compostos de dois genótipos de grão-de-bico, ou seja, Bhakhar 2011 (tolerante à seca) e DUSHT (sensível à seca), dois níveis de estresse hídrico, ou seja, estresse hídrico na fase de floração e estresse hídrico na floração + formação de vagens + estágio de enchimento de grãos incluindo bem irrigado (controle) e três aplicações exógenas de nutrientes, ou seja, KCl 200 ppm, MgCl2 50 ppm e CaCl2 10 mM, incluindo água destilada (controle). Os resultados indicaram que o estresse hídrico em vários estágios de crescimento afeta negativamente os atributos de crescimento, rendimento e qualidade de ambas as cultivares de grão-de-bico. A aplicação exógena de nutrientes melhorou o crescimento, o rendimento e as atividades das enzimas antioxidantes de ambos os genótipos de grão-de-bico, mesmo em condições de estresse hídrico. No entanto, resultados superiores foram obtidos com pulverização foliar de cloreto de potássio em Bhakhar 2011, em condições bem irrigadas. Da mesma forma, a pulverização foliar de cloreto de potássio na cultivar de grão-de-bico Bhakhar 2011 cultivada sob estresse na fase de floração + formação de vagens + enchimento de grãos produziu teores significativamente maiores de superóxido dismutase, peroxidase e catalase. Esses resultados sugerem que a aplicação de cloreto de potássio atenua os efeitos adversos do estresse hídrico e aumenta a tolerância no grão-de-bico, principalmente em razão de mais atividade de enzimas antioxidantes, demonstrando as medidas protetoras das células vegetais em condições de estresse.

Electronic prescription: frequency and severity of medication errors

SUMMARY OBJECTIVE: To assess the frequency and severity of prescriptions errors with potentially dangerous drugs (heparin and potassium chloride for injection concentrate) before and after the introduction of a computerized provider order entry (CPOE) system. METHODS: This is a retrospective study that compared errors in manual/pre-typed prescriptions in 2007 (Stage 1) with CPOE prescriptions in 2014 (Stage 2) (Total = 1,028 prescriptions), in two high-complexity hospitals of Belo Horizonte, Brasil. RESULTS: An increase of 25% in the frequency of errors in Hospital 1 was observed after the intervention (p<0.001). In contrast, a decreased error frequency of 85% was observed in Hospital 2 (p<0.001). Regarding potassium chloride, the error rate remained unchanged in Hospital 1 (p>0.05). In Hospital 2, a significant decrease was recorded in Stage 2 (p<0.001). A reduced error severity with heparin (p<0.001) was noted, while potassium chloride-related prescription severity remain unchanged (p> 0.05). CONCLUSIONS: The frequency and severity of medication errors after the introduction of CPOE was affected differently in the two hospitals, which shows a need for thorough observation when the prescription system is modified. Control of new potential errors introduced and their causes for the adoption of measures to prevent these events must be in place during and after the implementation of this technology.

RESUMO OBJETIVO: Avaliar a frequência e a gravidade de erros em prescrições envolvendo medicamentos potencialmente perigosos (heparina e cloreto de potássio concentrado injetável) antes e após a introdução de um sistema de prescrição eletrônica. MÉTODOS: Trata-se de estudo retrospectivo que comparou erros em prescrições manuais e pré-digitadas de 2007 (Fase 1) com prescrições eletrônicas de 2014 (Fase 2) (total = 1.028 prescrições), em dois hospitais de alta complexidade de Belo Horizonte. RESULTADOS: Foi observado no hospital 1 aumento de 25% dos erros depois da intervenção (p<0,001), e no hospital 2 foi verificada redução de 85% (p<0,001). Para o cloreto de potássio, a frequência de erros permaneceu a mesma no hospital 1 (p>0,05), independentemente da fase e, no hospital 2, ocorreu redução significativa na fase 2 (p<0,001). Foi identificada redução da gravidade dos erros com a heparina (p<0,001), mas não houve alteração na gravidade dos erros com cloreto de potássio (p>0,05). CONCLUSÕES: A frequência e a gravidade dos erros de medicação após a introdução de prescrição eletrônica foram impactadas de forma diferente nos dois hospitais, demonstrando necessidade de observação criteriosa quando o sistema de prescrição é modificado. Durante e após a implantação dessa tecnologia, deve existir controle dos novos erros potenciais introduzidos e suas causas para a adoção de medidas de prevenção desses eventos.

Desenvolvimento de produto cárneo de ovino com reduzido teor de sódio / Development of meat product of sheep with reduced sodium content

O uso de partes pouco comerciais da carne ovina na elaboração de produtos cárneos processados tem se mostrado bastante promissor, bem como práticas que reduzam o teor de sódio presente nos alimentos. O presente trabalho objetivou formular linguiça de ovino com reduzido teor de sódio, substituindo o cloreto de sódio pelo cloreto de potássio e avaliando as características físico-químicas e sensoriais do produto. Os resultados obtidos foram semelhantes quanto à composição centesimal das duas formulações elaboradas. Contudo, o teste sensorial apontou um Índice de Aceitabilidade de 86% para a fórmula contendo sódio, enquanto o mesmo índice foi de 39% para aquela contendo potássio. Aliada à baixa intenção de compra da segunda formulação, constatou-se que o corte do sódio da formulação ainda enfrenta resistência quanto à aceitação dos atributos.

Single-dose lignocaine-based blood cardioplegia in single valve replacement patients

Abstract OBJECTIVE: Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement. METHODS: A total of 110 patients who underwent single (aortic or mitral) valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients), long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients), standard St Thomas IB (short-acting blood-based cardioplegia solution) was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters. RESULTS: We did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43) and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23) in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65) in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB), Troponin-I levels, lactate level and cardiac functions postoperatively. CONCLUSION: This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.

Pectina e cloreto de potássio na produção de presunto cozido / Pectin and potassium chloride in the production of cooked ham

No Brasil, as Doenças Cardiovasculares são as principais causas de morte, fenômeno que ocorre mundialmente. Dentre os fatores de risco considerados de maior importância para a aterosclerose estão: hipertensão arterial, dislipidemias,obesidade, diabetes mellitus e alguns hábitos relacionados ao estilo de vida, como dieta pobre em fibras e rica em calorias, gorduras saturadas, colesterol e sal (NaCl). A pectina é uma fibra dietética solúvel, podendo também ser classificada como fibra funcional, ou seja, que possui benefícios adicionais à saúde humana. Na fabricação de produtos cárneos, a pectina vem sendo avaliada em razão da capacidade de associação com moléculas de água, favorecendo a capacidade de retenção de água, aumentando o rendimento dos processos e melhorando a textura dos produtos. O cloreto de potássio (KCl) tem sido amplamente estudado como principal substituto do sal comum (NaCl), a fim de garantir alimentos voltados à população portadora de desordens no aparelho circulatório.

In Brazil, cardiovascular diseases are major causes of death, a phenomenon that occurs worldwide. Among the risk factors considered most important for atherosclerosis are hypertension, dyslipidemia, obesity, diabetes mellitus and certain habits related to lifestyle such as diet low in fiber and rich in calories, saturated fat, cholesterol and salt (NaCl). Pectin is a soluble dietary fiber, may also be classified as functional fiber, ie, which has additional benefits to human health. In the manufacture of meat products, the pectin is being evaluated because of the capacity of association with water molecules, by promoting water retention, increasing the efficiency of processes and improving the texture of products. Potassium chloride (KCl) has been widely studied as a main substitute for common salt (NaCl), to ensure foods aimed at people suffering from disorders of the circulatory system.

Comparison of two maintenance electrolyte solutions in children in the postoperative appendectomy period: a randomized, controlled trial / Comparação de duas soluções para manutenção hidroeletrolítica no pós-operatório de apendicectomia em crianças: um estudo controlado e randomizado

ABSTRACT OBJECTIVE: To compare two electrolyte maintenance solutions in the postoperative period in children undergoing appendectomy, in relation to the occurrence of hyponatremia and water retention. METHODS: A randomized clinical study involving 50 pediatric patients undergoing appendectomy, who were randomized to receive 2,000 mL/m2/day of isotonic (Na 150 mEq/L or 0.9% NaCl) or hypotonic (Na 30 mEq/L NaCl or 0.18%) solution. Electrolytes, glucose, urea, and creatinine were measured at baseline, 24 h, and 48 h after surgery. Volume infused, diuresis, weight, and water balance were analyzed. RESULTS: Twenty-four patients had initial hyponatremia; in this group, 13 received hypotonic solution. Seventeen patients remained hyponatremic 48 h after surgery, of whom ten had received hypotonic solution. In both groups, sodium levels increased at 24 h (137.4 ± 2.2 and 137.0 ± 2.7 mmol/L), with no significant difference between them (p = 0.593). Sodium levels 48 h after surgery were 136.6 ± 2.7 and 136.2 ± 2.3 mmol/L in isotonic and hypotonic groups, respectively, with no significant difference. The infused volume and urine output did not differ between groups during the study. The water balance was higher in the period before surgery in patients who received hypotonic solution (p = 0.021). CONCLUSIONS: In the post-appendectomy period, the use of hypotonic solution (30 mEq/L, 0.18%) did not increase the risk of hyponatremia when compared to isotonic saline. The use of isotonic solution (150 mEq/L, 0.9%) did not favor hypernatremia in these patients. Children who received hypotonic solution showed higher cumulative fluid balance in the preoperative period.

RESUMO OBJETIVO: Comparar duas soluções de manutenção hidroeletrolítica no período pós-operatório (PO) de crianças submetidas à apendicectomia quanto à ocorrência de hiponatremia e retenção hídrica. MÉTODOS: Estudo clínico randomizado que envolveu 50 pacientes pediátricos submetidos à apendicectomia, randomizados para receber 2.000 ml/m2/dia de solução isotônica (Na 150 mEq/L ou NaCl 0,9%) ou hipotônica (Na 30mEq/L ou NaCl 0,18%). Eletrólitos, glicose, ureia e creatinina foram mensurados no início do estudo, 24 e 48 horas após a cirurgia. Foram analisados volume infundido, diurese, peso e balanço hídrico. RESULTADOS: Apresentaram hiponatremia inicial 24 pacientes. Desses, 13 receberam solução hipotônica. Dezessete pacientes permaneceram hiponatrêmicas 48 horas após a cirurgia, 10 haviam recebido solução hipotônica. Nos dois grupos os níveis de sódio aumentaram na 24ª hora PO (137,4 ± 2,2 e 137,0 ± 2,7) e não houve diferença entre eles (p = 0,593). Níveis de sódio 48 h após a cirurgia foram 136,6 ± 2,7 e 136,2 ± 2,3 no grupo isotônico e hipotônico respectivamente sem diferença significativa. Os volumes infundidos e a diurese não diferiram entre os grupos durante o estudo. O balanço hídrico foi maior no período anterior à cirurgia no grupo de pacientes que receberam solução hipotônica (p = 0,021). CONCLUSÕES: No período pós-apendicectomia, o uso da solução hipotônica não aumentou o risco de hiponatremia quando comparado com uma solução salina isotônica. O uso da solução isotônica não favoreceu a hipernatremia nesses pacientes. Crianças que receberam solução hipotônica apresentaram maior balanço hídrico cumulativo no período pré-operatório.

Enteral fluid therapy through nasogastric tube in rumen cannulated goats / Fluidoterapia enteral por via nasogástrica em cabras fistuladas no rúmen

This paper reports the effects of fluid therapy in goats through nasogastric route with an electrolyte solution composed by concentrations of sodium, potassium and chloride similar to goat plasma (140mmol/L of Na+, 4.5mmol/L of K+, 110mmol/L of Cl-). Four Alpine Chamoisee goats, two of them with evident leakage of the rumen cannulas, were used in a crossover experimental design of two periods and two groups. In one group the two goats were submitted to a treatment protocol to induce dehydration before the fluid therapy, whereas the other group was not. Fluid therapy consisted supplying 10mL/kg/h of the electrolyte solution during 8 hours. No signs of discomfort or stress were observed. The dehydration model employed caused a mild dehydration indicated by decrease in feces humidity, body weight and abdominal circumference, and increase in plasma total solids concentration. During fluid therapy globular volume and plasma total solids decreased, whereas % body weight and abdominal circumference increased. No signs of hyperhydration were observed and serum electrolytes (Na+, Cl-, K+) presented no significant alterations in both groups. Fluid therapy proposed in this study was efficient to treat dehydration, even for rumen cannulated animals with evident leakage, and can be administrated safely with no electrolyte imbalance.

Este estudo relata os efeitos da fluidoterapia em cabras que receberam, por via nasogástrica, uma solução eletrolítica com concentrações de sódio, potássio e cloreto similares às verificadas no plasma de caprinos (140mmol/L of Na+, 4.5mmol/L of K+, 110mmol/L of Cl-). Foram utilizadas quatro cabras da raça Parda Alpina, sendo duas com cânulas ruminais apresentando vazamento evidente, em um delineamento experimental crossover com dois períodos e dois grupos. Em um grupo, as cabras eram submetidas a um protocolo terapêutico para induzir a desidratação antes da fluidoterapia enquanto o outro grupo não passava por este protocolo. A fluidoterapia consistia em fornecer 10mL/kg/h da solução eletrolítica durante 8 horas. Não foi observado nenhum sinal de desconforto ou estresse. O protocolo para induzir a desidratação ocasionou desidratação moderada indicada pela diminuição da umidade das fezes, peso corporal e circunferência abdominal e aumento da concentração de sólidos totais no plasma. Durante a fluidoterapia o volume globular e a concentração de sólidos totais no plasma diminuiram, enquanto o peso vivo e a circunferência abdominal aumentaram. Não foram observados sinais de hiper-hidratação e dos eletrólitos (Na+, K+, Cl-) em ambos os grupos. A fluidoterapia proposta neste trabalho foi eficiente em tratar a desidratação, inclusive dos animais fistulados apresentando evidente extravasamento de líquido ruminal, e pode ser administrada com segurança, sem a ocorrência de desequilíbrios eletrolíticos.

NaCl plus chitosan as a dietary salt to prevent the development of hypertension in spontaneously hypertensive rats

The effect of NaCl plus 3% chitosan on the systolic blood pressure of spontaneously hypertensive rats (SHR) were evaluated and compared with NaCl plus KCl (NaCl, 49.36% + KCl 49.36%) and chitosan or NaCl treatment alone. In SHR, administration of NaCl plus chitosan (44 mM Na/day) for two months significantly decreased the systolic blood pressure greater than of NaCl plus KCl and NaCl alone. NaCl plus chitosan resulted, though not statistically significant, in decreased urinary Na+ excretion and decreased blood urea nitrogen levels. Urinary creatinine of NaCl plus chitosan was slightly decreased compared to 3 treated groups. Serum electrolytes levels, however, remained unchanged. The combination of NaCl and chitosan may be superior to the conventional use of NaCl plus KCl or NaCl alone in the prevention of hypertension. Even though these supplementary diets have demonstrated potential anti-hypertensive effects in the experimental animal model, further research is needed before any recommendations can be made.

Oral potassium chloride and oral rehydration solution supplement to prevent hypokalemia in sodium phosphate regimen for bowel preparation prior to gynecological laparoscopic surgery.

OBJECTIVE: To evaluate the efficacy of oral potassium chloride and oral rehydration solution (ORS) supplement for hypokalemia prevention after sodium phosphate (NaP) bowel preparation. MATERIAL AND METHOD: A comparative historical study of patients who underwent gynecological laparoscopic surgery between June 2005 and December 2007 and received NaP for bowel preparation prior to surgery. In the experiment group, a 10% Potassium chloride (KCl) elixir and ORS supplement was introduced to 47 of the patients. The control group of 42 patients received only pure water Age, body mass index, and time of defecation after NaP bowel preparation were recorded. Serum potassium level before NaP (K0), 4 hours (K4), and 10 hours (K10) after last dose of NaP were measured in both groups. RESULTS: It was found that the experiment group could maintain serum potassium level well. The mean +/- SD of serum potassium level before NaP (K0), at 4 hours after NaP (K4) and at 10 hours after NaP (K10) were 3.99 +/- 0.35, 4.09 +/- 0.43, 4.03 +/- 0.63, respectively. In the control group, the K0 was similar to that in the experiment group but the K4 decreased to 3.50 +/- 0.35 and K10 was 3.76 +/- 0.40 which had a significant difference (p = 0.011). Serum hypokalemia (K < 3.5 mmol/L) was found in 22 patients (52.38%) of the control group. CONCLUSION: Oral KCl elixir and ORS supplement for sodium phosphate bowel preparation regimen can prevent hypokalemia prior to surgery.

Padronização de modelo de coração isolado "working heart" com circulação parabiótica / Development of isolated swine "working heart model" with parabiotic circulation

OBJETIVO: Desenvolver modelo de coração isolado de suíno "working heart" sob suporte por circulação parabiótica e verificar se o mesmo é estável e se possibilitou de forma efetiva a mensuração dos dados propostos. MÉTODOS: O modelo foi padronizado durante preparação para estudo de associação de agente à solução cardioplégica. Foram realizados 18 experimentos com um animal suporte e um animal doador em cada. O coração do animal doador foi perfundido como coração isolado pelo animal suporte em modo de execução de trabalho ("coração ejetante"). O coração isolado foi submetido à isquemia regional por pinçamento da artéria interventricular anterior seguido de isquemia global. Durante reperfusão, com o coração ejetante (em modo "working heart"), aos 30, 60 e 90 minutos foram medidos parâmetros hemodinâmicos de contratilidade e metabólicos, obtendo-se assim a elastância máxima (Emáx), o trabalho sistólico pré-recrutável (PRSW), rigidez do ventrículo (EDPRV), fluxo coronariano, consumo de oxigênio e dosagens de lactato e glicose. RESULTADOS: Os animais suporte ficaram estáveis durante todo o experimento. O pH, a pressão parcial de oxigênio e o hematócrito foram mantidos estáveis e dentro da faixa fisiológica. O coração isolado foi perfundido de forma adequada durante todo o experimento. Os dados hemodinâmicos e metabólicos propostos puderam ser mensurados adequadamente e sempre com o coração ejetante, em modo de execução de trabalho ("working heart"). CONCLUSÃO: O modelo de coração isolado desenvolvido tipo "working heart" se manteve estável durante todo o experimento, sem a administração de drogas cardiotônicas e possibilitou a mensuração de todos os dados propostos de forma efetiva com o coração executando trabalho.

OBJECTIVE: To develop an isolated working heart model with parabiotic circulaton in swines and verify its stability and possibility to allow effective measurements of hemodinamic and metabolic data. METHODS: This model was developed during study of association of agents to cardiolegia. There were performed 18 experiments, each with a support animal and a donor animal. Donor animal heart was perfused as isolated working heart with parabiotic circulation from support animal. Isolated heart underwent regional ischemia by interventricular artery clamping, followed by global ischemia. During reperfusion in working heart state mode at 30, 60 and 90 minutes, contractility indices such as elastance, preload recruitable stroke work index and metabolic data were acquired. RESULTS: Support animals were kept stable throughout the procedures without use of blood transfusions or vasoactive drugs. pH, oxygen partial pressure and hematocrit were kept stable and within physiologic ranges. Isolated heart was perfused adequately throughout the experiment. All hemodinamic and metabolic data proposed were adequately measured in working heart state mode. CONCLUSION: This swine isolated "working heart" model was kept stable throughout the experiments with no administration of vasoactive drugs and it allowed adequate measurements of metabolic and hemodinamic data.

Corpus of biochemical changes after death by potassium intoxication in rabbits / 法医学杂志

OBJECTIVE@#To explore the objective evidence of the corpus biochemical changes in rabbits for postmortem diagnosis of potassium intoxication.@*METHODS@#Rabbits were sacrificed by Infusion of 0.3% KCl at full speed push or 1% KCl at 100 drip/min, respectively, with normal rabbits used as control. Cardiac blood and urine samples were collected before and after potassium infusion to examine the concentrations of various electrolytes (K+, Na+, Ca2+, Mg2+, Cl-, and HCO3-) and to observe the antemortem and postmortem biochemical changes.@*RESULTS@#The mean lethal infusion time in the 0.3%KCl group was longer than that in the 1% KCl group (P = 0.006). The serum concentration of K+ increased while the serum concentrations of Na+, Ca2+, Cl-, and HCO3- decreased after the infusion. There were no statistically significant differences in the whole blood concentration of K+ as well as the serum concentration of Mg2+ between the two groups (P = 0.062). There were statistically significant differences in the concentrations of whole blood K+, as well as serum Na+, Mg2+, and Cl-, but not in the serum K+, Ca2+, and HCO3-. There were no statistically significant differences seen in the urine volumes and the concentrations of all the urine electrolytes between the groups.@*CONCLUSION@#Examination of the concentrations of K+ both in the whole blood and serum, as well as Mg2+ in the serum may be helpful for postmortem diagnosis of potassium intoxication.

Morphological changes in rabbits died of potassium intoxication / 法医学杂志

OBJECTIVE@#Morphologic features of the corpse of rabbits died of potassium intoxication were studied in order to elucidate an objective evidence for forensic determination of death caused by potassium intoxication.@*METHODS@#Macroscopic, microscopic, and ultrastructural (by transmission electron microscopy) changes were observed in the heart, brain, and kidney of rabbits killed by intravenous push or continuous infusion at 100 drips per minute with 0.3% and 1% KCl, respectively. Normal rabbits without any treatment killed by bleeding were used as controls.@*RESULTS@#Macroscopically, cardiac dilatation and congestion/stasis as well as ischemic and hypoxic changes in various organs were observed in rabbits died of potassium injection. Microscopically and ultrastructurally, there were destruction of the cardiac fibers with thickening, concentrating, or disappearing of the Z-line, constriction of the glomerular capillaries, enlargement of the Bowman capsule, thinning and fusion of foot processes, as well as apoptosis with phagocytosis in brain observed, particularly in the group infused with 1% KCl.@*CONCLUSION@#The morphologic changes observed in the heart and kidney appear to be characteristic, supporting death caused by potassium intoxication.

Clorhidrorrea congénita / Congenital chloride diarrhea

Congenital chloride diarrhea (CCD) is a rare hereditary disease, with a prenatal onset, secondary to a deficit in the intestinal chloride transport. In the present study, we describe the clinical characteristics of three patients with congenital watery diarrhea, two of them females, aged between 9 and 14 months at the first visit. All patients presented perinatal antecedents of polyhydramnios and prematurity, watery stools since birth and growth failure. Metabolic alkalosis, hypokalemia and hypochloremia were found. Stool ionogram with elevated doses of chloride, exceeding both sodium and potassium, confirmed the diagnosis of CCD. Substitute treatment with sodium and potassium chloride was started with good results. CCD should be considered as a differential diagnosis to congenital watery diarrhea, since early diagnosis and appropriate treatment are mandatory for the normal development of the child, avoiding severe complications such as neurological sequelae and even death.

La clorhidrorrea congénita (CHC) es una enfermedad hereditaria rara, de comienzo prenatal secundaria aun defecto en el transporte intestinal de cloro. En este trabajo describimos las características clínicas de tres pacientes con diarrea acuosa congénita, dos desexo femenino, con edades comprendidas entre 9 y 14meses al momento de la consulta. Todos presentaban antecedentes perinatales de polihidramnios y prematurez,deposiciones líquidas desde el nacimiento y mal progreso ponderal. Se comprobó alcalosis metabólica,hipokalemia e hipocloremia. El ionograma en materia fecal, con dosajes de cloro elevado que superaban la sumade sodio y potasio, permitió confirmar el diagnóstico de CHC. Se instituyó tratamiento sustitutivo con cloruro de sodio y de potasio, con evolución favorable. Es de suma importancia tener en cuenta la CHC dentro de los diagnósticos diferenciales de diarrea acuosa congénita, ya que el diagnóstico precoz y el tratamiento adecuado permiten un desarrollo normal, evitandocomplicaciones graves, como secuelas neurológicas e incluso la muerte.

Tratamiento de la hipokalemia grave en el paciente pediátrico críticamente enfermo utilizando infusiones de KCI a 0.5 y 1.5 mEq/kg/hora / Treatment of severe hypokalemia in critically ill pediatric patients using KCl infusions at 0.5 and 1.5 mEq/kg/h

Introducción. Objetivo. determinar la utilidad de dos esquemas de tratamiento de hipokalemia grave con infusión de KCl a dosis de 0.5 y 1.5 mEq/kg/hora intravenosa (IV) en niños críticamente enfermos. Material y métodos. Se realizó un ensayo clínico controlado en la Unidad de Terapia Intensiva Pediátrica (UTIP) del Hospital de Pediatría del Centro Médico Nacional de enero de 1993 a enero de 1994. Se incluyeron niños de 1 mes a 16 años de edad que ameritaron ingreso a la UTIP y que durante algún momento de su evolución desarrollaron hipokalemia grave (potasio sérico igual o menor de 2.5 mEq/L). Fueron asignados en forma aleatoria a dos grupos, el grupo 1 al cual se le administró KCl a 0.5 mEq/kg/hora IV hasta la obtención de potasio de potasio sérico igual o mayor a 3 mEq/L con un máximo de 2 infusiones. En el grupo 2 se administró KCl a 1.5 mEq/kg/hora hasta la obtención de potasio sérico igual o mayor de 3 mEq/L. Se determinaron previo a cada infusión: gasometría arterial, glucosa semicuatitativa en sangre, registro del estado de gravedad de acuerdo a la esacala de falla orgánica múltiple (FOM), diagnóstico, edad, sexo, potasio sérico basal y del mismo modo, al término de cada infusión se registró glucosa semicuantitativa en sangre y gasometría arterial. El análisis consistió en medidas de tendencias central (promedio y mediana), para la descripción de variables; se realizó la comparación de las características basales entre los grupos con "U" de Mann-Whitney y prueba exacta de Fisher. Para determinar la influencia de las características basales en la respuesta al tratamiento se realizó correlación de Pearson y Spearman. Resultados. Se estudiaron 37 pacientes, 17 del grupo 1 y 20 del grupo 2. El promedio de edad para ambos grupos fue de 6.37 años con una desviación estándar de 5.51 con distribución normal (sesgo 0.5, curtosis 2). En ambos grupos predominó el sexo masculino. El estado de gravedad de acuerdo a la escala de FOM fue una mediana de 12 puntos....

Parálisis hipokalémica tirotóxica / Thyrotoxic hypokalemic paralysis

Se presenta uno de 3 casos de parálisis hipocalémica tirotóxica reunidos en poco más de un año en el Hospital de Iquique. El paciente recibió cloruro de potasio al 10 porciento como tratamiento de su cuadro neurológico y I131 para su hipertiroidismo de base. Desde hace 6 meses se encuentra eutiroídeo y libre de crisis. Los otros dos casos corresponden a hobres jóvenes en tratamiento con propiltiouracilo en espera de recibir I131

Efectos de los compuestos digitálicos sobre la relajación inducida por K+ en anillos de aorta / Effects of digtalis compounds on potassium induced relaxation of aortic rings

Cambios en la estructura de los digitálicos afectan su potencia y modifican sus propiedades farmacológicas sobre el músculo cardiaco. La relajación del músculo liso vascular inducida por KCl ha sido utilizada como índice de la actividad de la ATPasa de Na+K+ arterial, ya que la inhibición experimental de la actividad de esta enzima (incubación con ouabían, eliminación de Na+ y K+ extracelular), reduce la relajación inducida por KCl en anillo arteriales. En el presente estudio, examinamos si los cambios en la estructura química de la ouabaína, modifican su capacidad para inhibir la ATPasa de Na+K+ arterial. Comparamos los efectos de la ouabaína, con los de la ouabagenina, en los cambios del tono vascular de anillo de aorta de rata. Los cambios en el tono basal vascular, fueron potenciados por la ouabaína y no fueron afectados por la ouabagenina. La contracción máxima producida por fenilefrina fue inhibida por la ouabaína y no por la ouabagenina. La relajación producida por KCl fue bloqueada por ouabaína, mientras que la contracción inducida por KCl fue únicamente inhibida por ouabaína. Los presentes resultados nos permiten sugerir que la eliminación de la molécula de 1-Ramnosa en la estructura de la ouabaína disminuye su capacidad de inhibir la ATPasa de Na+ K+ arterial.

Hypokalaemic periodic paralysis in central Sri Lanka.

We describe 14 Sinhalese male patients with hypokalaemic periodic paralysis (HPP). The age at onset was between 10 and 32 years. Each paralytic episode lasted from 6 to 48 hours (except in one patient who had an attack lasting 5 days). The frequency of attacks varied from 8 to 10 per month in one patient to only 2 attacks over a period of 16 years in another. Four patients (28.6%) had a family history of the disease. Hypokalaemia (serum potassium 1.5 to 3 mmol/l) was documented during an attack in 11 patients. No cause for hypokalaemia was evident in any of them. Investigations including EMG, thyroid hormone level and skeletal muscle histology were within normal limits between episodes. All the patients responded well to treatment with potassium supplementation, alone or with acetazolamide.

Safety and efficacy of a concentrated potassium chloride solution infusion for rapid correction of hypokalemia.

Twenty children with hypokalemia (plasma potassium concentration < or = 3.5 mmol/L) with electrocardiographic (ECG) changes were given an infusion of concentrated solution of potassium chloride (200 mmol/L) at a rate of 0.25 mmol per kg per hour till ECG changes reverted to normal, under close monitoring of vital signs and ECG. The regimen effectively corrected the ECG changes in 1 to 6 hours with a mean increase in serum potassium by 0.75 +/- 0.49 mmol/L. No complications occurred. Controlled infusion of a concentrated solution of potassium chloride at a rate of 0.25 mmol/kg/hour is a safe and effective way to achieve rapid correction of hypokalemia with ECG changes, using minimal fluid volumes.