Diet and fluid restriction experiences of patients on hemodialysis: a meta-synthesis study / Experiencias de pacientes en hemodiálisis con restricción de dieta y de líquidos: metasíntesis

ABSTRACT Introduction:Non-compliance with diet and fluid restriction is an important and common health behavior problem in the hemodialysis population and is associated with increased morbidity and mortality. Therefore, investigating the perceptions and experiences of patients undergoing hemodialysis regarding diet and fluid restriction is very important in terms of achieving the management of diet and fluid restriction. Methods: This is a meta-synthesis study. CINAHL, MEDLINE, PubMed, Web of Science, OVID, and Scopus electronic databases were utilized for the literature review. Studies were critically evaluated using the Joanna Briggs critical appraisal tool. Qualitative data were extracted, meta-summarized, and then meta-synthesized. The thematic analysis method was used in the analysis of the data. Results: This review consisted of 23 qualitative studies. The experiences of patients undergoing hemodialysis about diet and fluid restriction were classified into three main themes, namely, "the meaning of diet and fluid restriction for the patient", "perceived barriers", and "patient's own management strategies for diet and fluid restriction". Conclusion: The results of the synthesis in our study indicated that patients undergoing hemodialysis perceived diet and fluid restriction as a complex and challenging process involving a constant struggle. Some personal, social, and systemic barriers perceived by the patients made compliance with diet and fluid restriction even more difficult. More importantly, it was determined that most of the patients were not supported enough in the management of diet and fluid restriction and that they had developed strategies in their own right. In line with these results, we recommend that individual counseling services for diet-fluid restriction of patients undergoing hemodialysis should be increased, the obstacles perceived by the patient should be considered while planning patients' diet-fluid restriction, and that the planning should be realistic and feasible.

RESUMEN Introducción: El incumplimiento de la dieta y la restricción de líquidos es un problema de comportamiento común e importante en la población en hemodiálisis, con impacto en el estado de salud, y que se asocia con aumento de la morbimortalidad. Por lo tanto, investigar las percepciones y experiencias de los pacientes en hemodiálisis con respecto a la dieta y a la restricción de líquidos es muy importante para alcanzar el manejo de los mismos. Métodos: Este es un estudio de metasíntesis. Para la revisión de la literatura se utilizaron las bases de datos electrónicas CINAHL, MEDLINE, PubMed, Web ofScience, OVID y Scopus. Los estudios se evaluaron críticamente utilizando la herramienta de evaluación crítica de Joanna Briggs. Fueron extraídos los datos cualitativos, meta-resumidos y luego meta-sintetizados. En el análisis de los datos se utilizó el método de análisis temático. Resultados: Esta revisión consistió en 23 estudios cualitativos. Las experiencias de los pacientes sometidos a hemodiálisis en relación con la dieta y la restricción de líquidos se clasificaron en tres temas principales, a saber, "el significado de la dieta y la restricción de líquidos para el paciente", "barreras percibidas" y "estrategias de manejo propias del paciente para la dieta y la restricción de líquidos". Conclusión: Los resultados de la síntesis en nuestro estudio indicaron que los pacientes en hemodiálisis percibían la dieta y la restricción de líquidos como un proceso complejo y desafiante que implicaba una lucha constante. Algunas barreras personales, sociales y sistémicas percibidas por los pacientes dificultaron aún más el cumplimiento de las indicaciones. Más importante aún, se determinó que la mayoría de los pacientes no recibieron suficiente apoyo en el manejo de la dieta y la restricción de líquidos y que habían desarrollado estrategias por sí mismos. De acuerdo con estos resultados, recomendamos aumentar los servicios de asesoramiento individual para la restricción dietética-líquida de los pacientes en hemodiálisis, considerar los obstáculos percibidos por ellos al planificar la restricción dietética-líquida y realizar una planificación que sea realista y factible.

One case of multiple system atrophy with the syndrome of Inappropriate Antidiuresis / 中华内分泌代谢杂志

To evaluate the diagnosis and treatment of syndrome of inappropriate antidiuresis ( SIAD ) in multiple system atrophy ( MSA ) . Clinical features and treatment of a case of MSA with SIAD was retrospectively analyzed. An MSA-cerebellar predominant ( MSA-C) type patient was admitted for being fever. Pulmonary and urinary infections were identified. The patient was characterized by euvolaemic hyponatremia with reduced plasma osmolality and increased urine sodium. Hypothyroidism and hypoadrenalism were excluded via functional tests of different hormones. The diagnosis of SIAD was made. The fever and SIAD persisted after pulmonary and urinary infections were cured. The patient was sweatless and the body temperature varied with room temperature due to dysfunction of central thermoregulation. With fluid restriction, the serum sodium return to the lower limit of normal range. Though the SIAD in MSA is rare, water and sodium balance should be carefully maintained, especially for those with pulmonary infection.

Effects of intravenous fluid restriction on complications after biliary surgery / 中华消化外科杂志

Objective To investigate the effects of intravenous fluid restriction on complications after biliary surgery.Methods The clinical data of 168 patients who received biliary surgery at the Nanjing General Hospital of Nanjing Military Command from October 2006 to March 2008 were prospectively analyzed.All patients were randomly divided into test group(85 patients received fluid restriction treatment)and control group(83 patients received conventional treatment)by the sealed envelope method.The difference in the fluid volume between the 2groups was observed.Differences in systemic complication rate,local complication rate,general complication rate,time to bowl movement,length of hospital stay and mortality between the 2 groups were compared.All data were analyzed using the chi-square test,t test,Fisher exact test,Results The median total volumes of fluid in test group and control group were 1450 ml and 2420 ml,respectively,with significant difference between the 2 groups (t=-5.067,P0.05).Conclusion Fluid restriction reduces the complication rate,shortens the length of hospital stay and accelerates recovery after biliary operation.

Hyponatremia:Management Errors

Rapid correction of hyponatremia is frequently associated with increased morbidity and mortality. Therefore, it is important to estimate the proper volume and type of infusate required to increase the serum sodium concentration predictably. The major common management errors during the treatment of hyponatremia are inadequate investigation, treatment with fluid restriction for diuretic-induced hyponatremia and treatment with fluid restriction plus intravenous isotonic saline simultaneously. We present two cases of management errors. One is about the problem of rapid correction of hyponatremia in a patient with sepsis and acute renal failure during continuous renal replacement therapy in the intensive care unit. The other is the case of hypothyroidism in which hyponatremia was aggravated by intravenous infusion of dextrose water and isotonic saline infusion was erroneously used to increase serum sodium concentration.

Fluid Therapy and Transfusion on Mechanical Ventilation

In newborn infants with mechanical ventilation in the first few days of life, fluid balance must be closely monitored because inadequate therapy related to overload may result in serious complications such as patent ductus arteriosus and pulmonary edema. Very low birth weight infants have significant change in body water balance in early neonatal period secondary to a large insensible water loss (IWL) and immaturity of renal function. Consequently these infants tend to have a high incidence of fluid overload so that fluid restriction with high humidification is effective during especially the first week of life. In infants with bronchopulmonary dysplasia, diuretics such as furosemide may act directly to improve lung mechanics by reabsorption of lung fluid, but chronic use may cause electrolyte imbalance, nephrocalcinosis and hearing deficit. In the early phase of perinatal asphyxia with oliguria, fluid restriction to amount equal to urine output and IWL is critical in order to prevent volume excess and potassium should not be given to avoid hyperkalemia. Blood components should always be infused through transfusion set with standard filter. To minimize adverse reactions of transfusion, basic rules must be observed. Moreover, storage of blood cells in small aliquots, using leukocyte removal filters and irradiation of blood can be helpful to prevent multiple donor exposure, cytomegalovirus infection, alloimmunization, and graft-versus-host rejection.

The Effect of Demeclocycline on the Management of Syndrome of Inappropriate Secretion of Antidiuretic Hormone in Brain Injured Patient

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a frequent complication of severe head trauma. Fluid restriction is treatment choice of SIADH in patients with traumatic brain injury (TBI), but fluid restriction is limited because they need sufficient calories. We described a patient who, on the four months after a head injury, presented with deterioration of consciousness, which coincided with the development of the SIADH, and which rapidly reversed with the correction of the hyponatremia by demeclocycline with minimal fluid restriction. We suggest that SIADH should be included in the differential diagnosis of deterioration of consciousness during the recovery period of the patients suffering from head injury because unexpected clinical deterioration may often have a reVersible cause. Also, demeclocycline will be useful, which allows for increased fluid liberalization and for provision of adequate calories, in the treatment of the SIADH in patients with TBI.

Effect of Fluid Restriction Through High Humidification on the Management of Very Low Birth Weight Infant

PURPOSE: The aim of this study is to investigate the effects of high humidification of nearly 100% on insensible water loss and total fluid requirement in very low birth weight infants during their first week of life. METHODS: We retrospectively compared twenty-five infants (GA 28.1+/-1.7 wk, and BW 970+/-186 g) who were cared for in a double walled incubator with high humidification with 24 infants (GA 27.6+/-2.2 wk, and BW 972+/-186 g) who were in a double walled incubator without raised humidity during the first week of their life. We analyzed the changes in body weight, total fluid intake, insensible water loss, urine output, input of sodium and potassium, serum levels of sodium and potassium, and the incidence of complications during the hospitalization in the high humidified group and the control group. RESULTS: High humidification during the first week of life in very low birth weight infants reduced insensible water loss and total fluid requirement. However the imbalance of serum electrolyte or oliguria did not increase. The high humidification group (n=25) acquired more physiologic weight loss during the first two weeks of life than the control group (n=24) but gained more weight than the control group (n=24) on the third month of life. Infants nursed with high humidification showed an increased tendency toward spontaneous closure of the patent ductus arteriosus and a decreased tendency toward surgical ligation of the patent ductus arteriosus and intraventricular hemorrhage without the evidence of an increase in infection. No significant differences were noted in the incidence of patent ductus arteriosus, bronchopulmonary dysplasia and retinopathy of prematurity. CONCLUSION: The high humidification of nearly 100% and fluid restriction therapy during the first week of life were effective in the fluid and electrolyte management of very low birth weight infants.

Effect of fluid restriction on postnatal weight and outcome in very low birth weight infants

No abstract available.

Effect of fluid restriction on postnatal weight and outcome in very low birth weight infants

No abstract available.