Avaliação de soluções eletrolíticas e vias da administração sobre o teor de umidade das fezes de equinos desidratados experimentalmente / Evaluation of electrolyte solutions and administration routes on the moisture content of feces of experimentally dehydrated horses

A ocorrência de processos fisiopatológicos que cursam com desidratação da ingesta no trato gastrointestinal dos equinos é comum na rotina clínica. Fatores como diminuição da motilidade intestinal e sobrecarga intraluminal de conteúdo desidratado podem levar a compactação em segmentos como estômago, ceco e cólons. Este estudo objetivou realizar a comparação entre soluções eletrolíticas enterais hipotônica (SeHIPO) e isotônica (SeISO) e a solução Ringer com lactato de sódio (RL IV) sobre o teor de umidade das fezes de equinos submetidos a um período de desidratação experimental (PD). Foram utilizados seis equinos adultos, todas fêmeas com idades entre 10 e 15 anos, média de 440 kg de peso corpóreo. O PD constou de 36 horas de jejum hídrico e alimentar associadas a duas administrações intravenosas de furosemida, sendo a primeira imediatamente no início (T-36) e a segunda 12 horas após o início do PD. Os tratamentos utilizados foram: SeHIPO e SeISO, ambas administradas por via nasogástrica em fluxo contínuo (HETfc), e RL IV administrada pela via intravenosa. Todos os tratamentos foram administrados a uma taxa de infusão contínua de 15mL kg-1 h-1 durante 8 horas consecutivas. O delineamento experimental utilizado foi o crossover6x3, onde cada animal foi submetido, em sistema de rodízio, aos três tratamentos em momentos distintos. As soluções eletrolíticas enterais demonstraram maior eficácia na recomposição do teor de umidade das fezes quando comparadas à terapia RL IV. A hidratação enteral com soluções isotônicas e hipotônicas administrada em fluxo contínuo são eficazes em restaurar o teor de umidade das fezes, podendo ofertar uma opção econômica, segura e eficiente na reidratação de pacientes e nas afecções que cursam como obstruções intraluminais simples.

The occurrence of pathophysiological processes that curse with digesta dryness in the gastrointestinal tract of horses is common in clinical routine, factors such as decreased intestinal motility and intraluminal overload of dry content can lead to compaction in segments such as cecum and colon. This study aimed to compare a hypotonic enteral solution (SeHIPO), an isotonic enteral solution (SeISO) and a Ringer with sodium lactate solution (RL IV) over the moisture content of equine feces submitted to an experimental dehydration protocol. Six adult horses were used, all females aged between 10 and 15 years, average body weight of 440 kg. The PD consisted of a 36 hours period of water and food fasting associated with two intravenous administrations of furosemide, the first immediately at the beginning (T-36) and the second 12 hours after the beginning of the PD. The treatments used were: SeHIPO (hypotonic enteral solution administered via nasogastric), SeISO (enteral isotonic solution administered via nasogastric) and RL IV (Ringer's solution with sodium lactate administered intravenously), all treatments were administered by continuous infusion at a rate of 15mL kg-1 h-1 for 8 consecutive hours. The experimental design used was the 6x3 crossover, where each animal is submitted, in a rotation system, to the three treatments at different times. Enteral fluid therapy with isotonic and hypotonic solutions administered in continuous flow are effective in restoring the moisture content of feces, and may offer an economical, safe, and efficient option for rehydrating patients and in conditions that progress as simple intraluminal obstructions.

Hypotonic enteral electrolyte solutions administered by nasoesophageal tube in continuous flow in dogs dehydrated by water restriction: Part 1 / Soluções eletrolíticas enterais hipotônicas administradas por sonda nasoesofágica em fluxo contínuo em cães desidratados por restrição hídrica: Parte 1

The present study assessed and compared the effects of hypotonic enteral electrolyte solutions administered by nasoesophageal tube in continuous flow in dogs submitted to water restriction on packed cell volume; total serum protein and serum osmolarity concentrations; blood volume; plasma glucose and lactate levels; blood gas analysis, anion gap, and strong ion difference. Six adult dogs were used (four males and two females). All animals were submitted to both proposed treatments in a crossover design 6×2. The treatments were as follows: ESmalt consisting of 5g sodium chloride, 1g potassium chloride, 1g calcium acetate, 0.2g magnesium pidolate, and 9.6g maltodextrin that were diluted in 1.000mL water (measured osmotic concentration of 215mOsm L−1) and ESdext consisting of 5g sodium chloride, 1g potassium chloride, 1g calcium acetate, 0.2g magnesium pidolate, and 9.6g dextrose that were diluted in 1.000mL water (measured osmotic concentration of 243mOsm L−1). All solutions were administered at 15ml kg−1 h−1 for 4 hours. Both solutions increased the plasma volume in dehydrated dogs without causing adverse effects. However, ESmalt was more effective in promoting the increase in blood volume.(AU)

O presente estudo avaliou e comparou os efeitos de soluções eletrolíticas enterais hipotônicas, administradas por sonda nasoesofágica em fluxo contínuo em cães submetidos a restrição hídrica, sobre o hematócrito, proteínas totais séricas, osmolaridade sérica, volemia, glicose e lactato plasmáticos, hemogasometria, ânion gap e DIF. Foram utilizados seis cães adultos (quatro machos e duas fêmeas). Todos os animais foram submetidos aos dois tratamentos propostos, em um delineamento crossover 6×2. Os tratamentos foram os seguintes: SEmalt - 5g de cloreto de sódio, 1g de cloreto de potássio, 1g de acetato de cálcio, 0,2g de pidolato de magnésio e 9,6g de maltodextrina, diluídos em 1.000mL de água (osmolaridade mensurada: 215mOsm L -1 ); SEdext - 5g de cloreto de sódio, 1g de cloreto de potássio, 1g de acetato de cálcio, 0,2g de pidolato de magnésio e 9,6g de dextrose, diluídos em 1.000mL de água (osmolaridade mensurada: 243mOsm L -1 ). Todas as soluções foram administradas no volume de 15mL kg -1 hora -1 , durante quatro horas, em fluxo contínuo. Ambas as soluções aumentaram o volume plasmático em cães desidratados, sem gerar o aparecimento de efeitos adversos. Porém, a SEmalt foi mais eficaz em promover a expansão da volemia.

Efeito de soluções eletrolíticas enterais com diferentes osmolaridades sobre o perfil eletrolítico e bioquímico de equinos / Horses treated with enteral electrolyte solutions with differents osmolarities

Foram comparados os efeitos de soluções eletrolíticas com diferentes osmolaridades administradas via enteral por sonda nasoesofágica de pequeno calibre, em fluxo contínuo, sobre o perfil bioquímico em equinos. Foram utilizadas seis fêmeas adultas em dois quadrados latinos 6x3 simultâneos em modelo misto. Os animais foram distribuídos em três grupos e cada grupo submetido aos seguintes tratamentos: HipoMalt - 5g de cloreto de sódio, 0,5g de cloreto de potássio, 0,2g de pidolato de magnésio, 1g de gluconato de cálcio e 10g de maltodextrina diluídos em 1.000mL de água (181mOsmol L-1), HipoDext - 5g de cloreto de sódio, 0,5g de cloreto de potássio, 0,2g de pidolato de magnésio, 1g de gluconato de cálcio e 10g de dextrose diluídos em 1.000mL de água (228mOsmol L-1) e IsoProp - 5g de cloreto de sódio, 0,5g de cloreto de potássio, 0,2g de pidolato de magnésio e 10g de propionato de cálcio diluídos em 1.000mL de água (282mOsm L-1). As soluções contendo dextrose (HipoDext) e maltodextrina (HipoMalt) foram mais eficazes em aumentar a taxa glicêmica sem ocasionar desequilíbrio eletrolítico. Já o tratamento com propionato de cálcio (IsoProp) além de aumentar o lactato plasmático não teve efeito sobre a glicemia.

We compared the effects of electrolyte solutions with different osmolarities administered through enteral route by naso-esophageal probe of small-caliber with continuos flow on the electrolytic and biochemical profile in horses. Six adult females were used in two simultaneous 6x3 Latin squares mixed model. The animals were divided into three groups and received the following treatments: HipoMalt - 5g of sodium chloride, 0.5g of potassium chloride, 0.2g of magnesium pidolate, 1g of calcium gluconate and 10g of maltodextrin diluted in 1.000mL of water (181mOsmol L-1); HipoDext - 5g of sodium chloride, 0.5g of potassium chloride, 0.2g of magnesium pidolate, 1g of calcium gluconate and 10g of dextrose diluted in 1.000mL of water (228mOsmol L-1); IsoProp - 5g of sodium chloride, 0.5g of potassium chloride, 0.2g of magnesium pidolate, 1g of calcium gluconate and 10g of calcium propionate diluted in 1.000mL of water (282mOsm L-1). The hypotonic electrolyte solutions containing dextrose (HipoDext) and maltodextrin (HipoMalt) were more effective in increase the rate glucose without causing electrolyte imbalance. Treatment with calcium propionate (IsoProp) besides increasing plasma lactate had no effect on blood glucose.

Ensayo clínico aleatorizado sobre la administración de una solución de mantenimiento intravenosa hipotónica comparada contra una isotónica en pacientes pediátricos críticos: a randomized control trial / Hypotonic versus isotonic maintenance fuids in critically ill pediatric patients

Introducción. Las soluciones hipotónicas se han vinculado a la producción de hiponatremia iatrogénica. Objetivos. Evaluar las variaciones en el sodio sérico (NaS) tras la administración de una solución de mantenimiento intravenosa isotónica (NaCl al 0,9% en dextrosa al 5%) en comparación con una solución de mantenimiento hipotónica (NaCl al 0,45% en dextrosa al 5%). Material y métodos. Ensayo clínico aleatorizado, doble ciego y controlado. Se enrolaron pacientes pediátricos con una estadía esperada en la unidad de cuidados intensivos mayor de 24 horas, NaS normal y líquidos intravenosos > 80% de los líquidos totales de mantenimiento. La concentración sérica de Na se midió antes de colocar la solución de mantenimiento y al reducir la administración de ésta a < 80% del total del aporte. Resultados. Se incorporaron 63 pacientes, que fueron asignados en forma aleatoria a recibir una solución de mantenimiento hipotónica (n= 32) o isotónica (n= 31). Las características basales fueron similares en ambos grupos. No hubo diferencias con respecto a la cantidad de solución administrada (grupo hipotónico 865 ± 853 ml; grupo isotónico 778 ± 649 ml, p= 0,654) o el tiempo de infusión (grupo hipotónico: 24 ± 10,8 horas; grupo isotónico: 27,6 ± 12,8 horas, p= 0,231). Se encontró una diferencia en el NaS luego de la administración de las soluciones de mantenimiento (grupo hipotónico: 137,8 ± 4,3 mmol/L; grupo isotónico: 140,0 ± 4,1 mmol/L, p= 0,04). Ninguna de las dos soluciones de mantenimiento aumentó el riesgo de hiponatremia (Na 145 mmol/L). Conclusiones. Ambas soluciones de mantenimiento, en 24 horas de infusión, no aumentaron el riesgo de producir hiponatremia iatrogénica.

Introduction. Hypotonic fluids have been associated with the development of iatrogenic hyponatremia. Objectives. To assess variations in serum sodium (sNa) following the intravenous administration of isotonic maintenance fuids (0.9% NaCl/5% dextrose) compared to hypotonic maintenance fuids (0.45% NaCl/5% dextrose). Material and Methods. Randomized, controlled, double-blind clinical trial. Pediatric patients with an expected length of stay in the intensive care unit of more than 24 hours were enrolled, with normal serum Na, and IV fuids >80% of total maintenance fuids. Serum Na level was measured before administering maintenance fuids and when reducing the administration to <80% of total fuids. Results. The study included 63 patients who were randomly assigned to receive hypotonic (n= 32) or isotonic (n= 31) maintenance fuids. Baseline characteristics were similar in both groups. There were no differences in terms of volume of fuid administered (hypotonic group: 865 ± 853 mL; isotonic group: 778 ± 649 mL; p= 0.654) or infusion duration (hypotonic group: 24 ± 10.8 hours; isotonic group: 27.6 ± 12.8 hours; p= 0.231). A difference was found in the serum Na following the administration of maintenance fuids (hypotonic group: 137.8 ± 4.3 mmol/L; isotonic group: 140.0 ± 4.1 mmol/L, p= 0.04). None of these two maintenance fuids increased the risk of hyponatremia (Na 145 mmol/L). Conclusions. Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.

Hypotonic versus isotonic maintenance fluids in critically ill pediatric patients: a randomized controlled trial / Hypotonic versus isotonic maintenance fluids in critically ill pediatric patients: a randomized controlled trial.

INTRODUCTION: Hypotonic fluids have been associated with the development of iatrogenic hyponatremia. OBJECTIVES: To assess variations in serum sodium (sNa) following the intravenous administration of isotonic maintenance fluids (0.9

dextrose) compared to hypotonic maintenance fluids (0.45

dextrose). MATERIAL AND METHODS: Randomized, controlled, double-blind clinical trial. Pediatric patients with an expected length of stay in the intensive care unit of more than 24 hours were enrolled, with normal serum Na, and IV fluids >80

of total maintenance fluids. Serum Na level was measured before administering maintenance fluids and when reducing the administration to <80

of total fluids. RESULTS: The study included 63 patients who were randomly assigned to receive hypotonic (n= 32) or isotonic (n= 31) maintenance fluids. Baseline characteristics were similar in both groups. There were no differences in terms of volume of fluid administered (hypotonic group: 865 ± 853 mL; isotonic group: 778 ± 649 mL; p= 0.654) or infusion duration (hypotonic group: 24 ± 10.8 hours; isotonic group: 27.6 ± 12.8 hours; p= 0.231). A difference was found in the serum Na following the administration of maintenance fluids (hypotonic group: 137.8 ± 4.3 mmol/L; isotonic group: 140.0 ± 4.1 mmol/L, p= 0.04). None of these two maintenance fluids increased the risk of hyponatremia (Na 145 mmol/L). CONCLUSIONS: Neither hypotonic nor isotonic maintenance fluids increased the risk of developing iatrogenic hyponatremia with the 24 hour infusion.