ABSTRACT
O objetivo deste artigo foi abordar as controvérsias científicas acerca dos distúrbios ácido-base nas doenças hepáticas. Nos estágios avançados da doença hepática, os distúrbios ácido-base atuam de forma complexa, comprometendo a qualidade de vida do paciente e desafiando o manejo clínico. A literatura apresenta a alcalose respiratória como uma das principais alterações, porém há uma longa discussão sobre o mecanismo fisiopatológico; em especial, citam-se a hipóxia, a hipocapnia e o nível de progesterona. Nas desordens metabólicas, com destaque para a acidose, os estudos apontam principalmente o lactato, os unmeasured ions ou íons não medidos e as alterações hidroeletrolíticas, mas cada componente desse sobressai-se dependendo da fase da doença estudada, compensada ou descompensada. As controvérsias dos distúrbios ácido-base nas doenças hepáticas devem-se ora à complexidade da fisiopatologia da própria doença, ora à necessidade de mais estudos esclarecedores.
The aim of this study is to address the scientific controversy about acid-base disorders in liver diseases. In the end stage of liver diseases, the acid-base disorder has a complex performance, impairing the patient's quality of life and challenging the clinic management. Although the literature shows respiratory alkalosis as one of the main alterations, there is a long discussion about the pathophysiological mechanism, specially regarding hypoxia, hypocapnia, and progesterone level. In metabolic disorders, especially acidosis, the studies mainly indicate the lactate, unmeasured ions, and hydroelectrolytic alterations, but, depending on the disease phase, either compensated or decompensated, each element has a particular action. The controversy about acid-base disorders in liver diseases is associated with the complexity of this condition, as well as with the necessity of more specialized research.
Subject(s)
Humans , Acid-Base Imbalance/etiology , Liver Diseases/complications , Water-Electrolyte Imbalance/physiopathology , Acidosis, Lactic/physiopathology , Alkalosis, Respiratory/physiopathology , Liver Diseases/physiopathology , Liver Diseases/metabolismABSTRACT
ABSTRACT Background: Renal insufficiency is a disease that affects several organs by provoking hypervolemia and uremia. The disease reaches more than 500 million people worldwide and few studies bring their influence on the gastrointestinal tract. Aim: To evaluate the influence of 5/6 nephrectomy-induced hypervolemia on colonic permeability to water and electrolytes. Method: Sixty male Wistar rats weighing between 280-300 g were divided into three groups: 3, 7 and 14 days after nephrectomy, each one having a false-operated/control and partially nephrectomized. For colonic permeability they were submitted to colonic perfusion with a solution of Tyroad containing phenolphthalein. Differences among the concentrations of Na+, K+ and Cl- were used to calculate the rate of colonic permeability for the electrolytes. Phenolphthalein concentrations were used to evaluate the rate of secretion and water absorption. Results: The colonic secretion of water and electrolytes occurred expressively in the group seven days after nephrectomy. Hemodynamic and biochemical assessments determined the progression of renal failure in all three groups and polyethylene glycol was shown to be effective in reversing the secretory capacity of the colon. Conclusion: Hypervolemia established after 7 days post-nephrectomy 5/6 caused marked colonic secretion for water and electrolytes. The organism presents progressive colonic secretion as the blood volume increases; on the other hand, polyethylene glycol was able to revert this secretory framework of the colon to water and electrolytes by reversing the hypervolemia.
RESUMO Racional: A insuficiência renal é doença que afeta diversos órgãos por provocar hipervolemia e quadro urêmico ao organismo. A doença atinge mais de 500 milhões de pessoas em todo o mundo, e poucos estudos trazem sua influência sobre o trato gastrointestinal. Objetivo: Avaliar a influência da hipervolemia induzida pela nefrectomia 5/6 sobre a permeabilidade colônica para água e eletrólitos. Método: Foram utilizados 60 ratos machos Wistar, pesando entre 280-300 g divididos em três grupos: 3, 7 e 14 dias de pós-nefrectomia. Cada grupo foi formado por um controle e outro parcialmente nefrectomizado. Para os estudos de permeabilidade colônica, os animais foram submetidos à perfusão colônica com solução de Tyroad contendo fenolftaleína por 60 min. Diferenças entre as concentrações de Na+, K+, e Cl- foram utilizadas para calcular a taxa de permeabilidade colônica para os eletrólitos e as de fenolftaleína para avaliar a taxa de secreção e absorção de água. Resultados: A secreção colônica de água e eletrólitos ocorreu de forma expressiva no grupo 7 dias pós-nefrectomia. Avaliações hemodinâmicas e bioquímicas determinaram a evolução da insuficiência renal nos três grupos e o polietilenoglicol mostrou-se eficaz na reversão da capacidade secretora do cólon. Conclusão: O quadro de hipervolemia estabelecido a partir dos sete dias pós-nefrectomia 5/6 provocou acentuada secreção colônica para água e eletrólitos. O organismo apresenta secreção colônica progressiva a medida que aumenta a volemia sanguínea; por outro lado, o polietilenoglicol foi capaz de reverter esse quadro secretor do cólon para água e eletrólitos por reverter o quadro hipervolêmico.
Subject(s)
Animals , Male , Rats , Water-Electrolyte Imbalance/physiopathology , Colon/physiopathology , Kidney Failure, Chronic/physiopathology , Permeability , Rats, Wistar , Colon/metabolism , NephrectomyABSTRACT
Os distúrbios hidroeletrolíticos e o equilíbrio ácido-básico são frequentes no dia a dia de especialidades clínicas e cirúrgicas. O entendimento da sua fisiopatologia é essencial para o seu tratamento adequado. Este artigo discursa sobre os distúrbios hidroeletrolíticos e os do equilíbrio ácido-básico mais comuns.
Electrolyte disorders and acid-base balance occur on a daily basis in both clinical and surgical specialties. The pathophysiological understanding of these disorders is essential for their appropriate treatment. This article addresses the most common electrolyte and acid-base disorders.
Subject(s)
Water-Electrolyte Imbalance/classification , Acid-Base Equilibrium/physiology , Alkalosis , Hypernatremia , Hyponatremia , Ketosis , Potassium/metabolism , Water-Electrolyte Imbalance/physiopathologyABSTRACT
Disorders of fluid and electrolyte are common in neonates and a proper understanding of the physiological changes in body water and solute after birth is essential to ensure a smooth transition from the aquatic in-utero environment. The newborn kidney has a limited capacity to excrete excess water and sodium and overload of fluid or sodium in the first week may result in morbidities like necrotizing enterocolitis, patent ductus arteriosus and chronic lung disease. Simple measures like use of transparent plastic barriers, coconut oil application, caps and socks are effective in reducing insensible water loss. Guidelines for the management of fluids according to birth weight, day of life and specific clinical conditions are provided in the protocol.
Subject(s)
Fluid Therapy/methods , Humans , Infant, Newborn , Infant, Premature , Water Loss, Insensible/physiology , Water-Electrolyte Imbalance/physiopathologyABSTRACT
Acute skin failure is a state of total dysfunction of the skin resulting from different dermatological conditions. It constitutes a dermatological emergency and requires a multi-disciplinary, intensive care approach. Its effective management is possible only when the underlying pathomechanism of each event is clear to the treating clinician. The concept of skin failure is new to non-dermatologist clinicians and sketchy among many dermatologists. Here the pathomechanism of skin failure has been analyzed and a guideline for monitoring has been provided. There is a need for intensive care units for patients with acute skin failure.
Subject(s)
Body Temperature Regulation/physiology , Humans , Patient Care Team , Skin/physiopathology , Skin Care , Skin Diseases/mortality , Water Loss, Insensible/physiology , Water-Electrolyte Imbalance/physiopathologyABSTRACT
Diarrhoea, a major cause of morbidity and mortality can be produced by a variety of etiological factors. Management protocol includes assessment of the child, physical examination, lab-evaluation, assessment of severity of dehydration and rehydration therapy using either of the following - WHO - ORS, Home available fluids (HAF), sugar salt solution (SSS), improve WHO-ORS, Amino acid fortified ORS, rice based ORS, low osmolarity ORS. Intravenous fluids are required if patients can't accept orally. Commonly observed electrolyte disturbances are hypernatremia, hyponatremia and hypokalemia. Concussion is a common problem and can result due to electrolyte imbalance, cavernous sinus thrombosis, associated meningitis, shigella encephalopathy and hypoglycemia in undernourished children. Treatment includes i.v. diazepam and i.v. glucose and correction of electrolyte imbalance. Additional treatment interventions include antimicrobial drugs including antibiotics, antimotility drugs, absorbents, nutritional and micro and macro nutrient supplementation.
Subject(s)
Child , Diarrhea/physiopathology , Fluid Therapy , Humans , Nutritional Status , Water-Electrolyte Imbalance/physiopathologyABSTRACT
Salt loading on pigeons (C. livia) had stimulatory effects on brain amines (dopamine and 5-hydroxytryptamine), corticosterone, norepinephrine and epinephrine contents of adrenal gland. Conjoint administration of dopamine with hypertonic saline restored the brain amines and corticosterone of adrenal gland, but had no effect on catecholamine (CAM) contents of adrenal medulla. The excessive release of CAM in the plasma indicates sympathetic stimulation after both the treatments.
Subject(s)
Adrenal Glands/metabolism , Animals , Brain Chemistry/drug effects , Columbidae , Corticosterone/metabolism , Dopamine/analysis , Epinephrine/metabolism , Male , Norepinephrine/metabolism , Organ Size , Osmotic Pressure , Pituitary Gland, Anterior/metabolism , Pituitary-Adrenal System/physiopathology , Prolactin/metabolism , Saline Solution, Hypertonic/toxicity , Serotonin/analysis , Water-Electrolyte Imbalance/physiopathologyABSTRACT
The author analyses, through elaborated clinical cases, the interpretation of natremia, a very solicited laboratory exam in daily clinical practice. He also shows its importance in the evaluation of osmolal disturbs and in the indication of a correct treatment.
Subject(s)
Humans , Female , Male , Hypernatremia/diagnosis , Hypernatremia/therapy , Hyponatremia/diagnosis , Hyponatremia/therapy , Osmolar Concentration , Body Fluids , Brain Edema/complications , Acid-Base Equilibrium , Extracellular Space , Hypernatremia/physiopathology , Hyponatremia/physiopathology , Water-Electrolyte Imbalance/physiopathologyABSTRACT
É apresentada uma revisäo sobre os aspectos etiopatogênicos e terapêuticos ligados à diarréia aguda e suas complicaçöes
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Water-Electrolyte Imbalance/etiology , Diarrhea, Infantile/complications , Dehydration/etiology , Escherichia coli Infections/complications , Water-Electrolyte Imbalance/physiopathology , Water-Electrolyte Imbalance/therapy , Diarrhea, Infantile/diagnosis , Diarrhea, Infantile/physiopathology , Dehydration/physiopathology , Dehydration/therapy , Diagnosis, DifferentialABSTRACT
La deshidratación por diarrea es el trastorno más frecuente del metabolismo hidroelectrolítico en los niños. Se analizan los mecanismos de regulación del agua, los electrolitos y el equilibrio ácido base y los trastornos observados en la deshidratación por diarrea: acidosis metabólica con hipokalemia y tendencia a hipernatremia por la pérdida proporcional mayor de agua que de soluto. El medicamento de elección para prevenir y tratar estos trastornos es el suero oral con la fórmula recomendada por la Organización Mundial de la Salud y el Fondo de las Naciones Unidad para la Infancia (UNICEF). En los últimos años se han analizado nuevas fórmulas que además de hidratar, pueden reducir el gasto fecal y la duración de la diarrea, siendo las soluciones a base de arroz las únicas que han mostrado esta propiedad en pacientes con cólera. De acuerdo a la evaluación del estado de hidratación, se clasifica a los pacientes en: a) hidratados, b)deshidratados y c) con choque hipovolémico, y se aplica el plan de tratamiento correspondiente (A, B o C). Se analizan estos nuevos esquemas de tratamiento y sus resultados
Subject(s)
Infant, Newborn , Infant , Child, Preschool , Child , Humans , Water-Electrolyte Imbalance/etiology , Water-Electrolyte Imbalance/physiopathology , Diarrhea, Infantile/physiopathology , Diarrhea, Infantile/therapy , Acid-Base Equilibrium , Water-Electrolyte Balance/physiology , Rehydration Solutions/metabolism , Rehydration Solutions/chemistry , Rehydration Solutions/therapeutic useABSTRACT
The effect of an 8 hour-period of water deprivation on fluid and electrolyte renal excretion was investigated in male Wistar rats infected with the strain Sao Felipe (12SF) of Trypanosoma cruzi, in comparison with age and sex matched non-infected controls. The median percent reductions in the urinary flow (-40 per cent v -63 per cent) and excretion of sodium (-57 per cent v - 79 per cent) were smaller in chagasic than in control rats, respectively. So, chagasic rats excereted more than controls. On the other hand, the median percent decrement in the clearance of creatinine was higher in chagasic (-51 per cent) than in controls (-39 per cent). Thus, chagasic rats showed some disturbed renal hydroelectrolytic responses to water deprivation, expressed by smaller conservation, or higher excretion of water and sodium in association with smallerglotmerular filtration rate. This fact denoted an elevation in the fractional excretion of sodium and water.
Subject(s)
Animals , Male , Rats , Chagas Disease/physiopathology , Water Deprivation/physiology , Water-Electrolyte Imbalance/physiopathology , Chronic Disease , Rats, WistarABSTRACT
Nesta revisäo säo apresentadas as bases fisiopatológicas e as condutas terapêuticas dos distúrbios do equilíbrio hidroeletrolítico e da insuficiência renal aguda. Säo discutidos os desequilíbrios dos íons sódio, potássio e cálcio, a necrose tubular aguda e a azotemia pré-renal
Subject(s)
Humans , Acute Kidney Injury/therapy , Kidney Tubular Necrosis, Acute , Uremia , Water-Electrolyte Imbalance/therapy , Hypercalcemia/etiology , Hypercalcemia/therapy , Hypernatremia/diagnosis , Hypernatremia/etiology , Hypernatremia/therapy , Hypocalcemia/etiology , Hypocalcemia/therapy , Hypokalemia/diagnosis , Hypokalemia/etiology , Hypokalemia/therapy , Hyponatremia/classification , Hyponatremia/diagnosis , Hyponatremia/therapy , Symptoms in Homeopathy , Water-Electrolyte Imbalance/physiopathologyABSTRACT
Se comunica la primera experiencia del servicio en el uso de ultrafiltración durante circulación extracorpórea (CEC) en siete pacientes, tres hombres y cuatro mujeres de edades entre 23 y 69 años, que fueron sometidos a cirugía de urgencia por patología valvular. A su ingreso a pabellón seis presentaban insuficiencia cardíaca refractaria y el restante, anemia hemolítica. Cinco tenían evidencia preoperatoria de disfunción renal. En todos pudo realizarse ultrafiltración, extrayéndose en promedio 2.121 ml de volumen (900-3.850). El balance hídrico final promedio fue de 1.340 ml (-650 a 3.470). Los valores promedio de hematocrito pre-CEC, intra-CEC fueron 30 por ciento, 16,8 por ciento y 24,3 por ciento respectivamente. En la evolución postoperatoria, 6 pacientes presentaron insuficiencia renal aguda oligúrica, requiriendo diálisis cuatro de ellos. Cinco fueron dados de alta en buenas condiciones en un promedio de 32 días (18 a 70). Dos fallecieron alrededor del 11º día, uno por necrosis mesentérica y el otro por shock séptico secundario a endocarditis bacteriana subaguda. La ultrafiltración es una técnica fácil de implementar durante CEC
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Extracorporeal Circulation/methods , Heart Valve Diseases/surgery , Hemofiltration/methods , Acute Kidney Injury/complications , Creatinine/blood , Water-Electrolyte Imbalance/physiopathology , Diuresis/physiology , Emergencies , Heart Valve Diseases/complications , HematocritABSTRACT
Faz-se uma revisäo fisiopatológica dos distúrbios do metabolismo da água e eletrolíticos e do equilíbrio àcido-base na insuficiência cardíaca e apresentam as alteraçöes observadas em 30 pacientes. Apesar do pequeno número de casos de uma síndrome muito comum é possível assinalar a elevada freqüência de determinadas anormalidades e salientar a sua importância clínica