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3.
Med. intensiva (Madr., Ed. impr.) ; 43(5): 302-316, jun.-jul. 2019. graf, tab
Article in Spanish | IBECS | ID: ibc-183243

ABSTRACT

La hiponatremia es el trastorno electrolítico más prevalente en las Unidades de Cuidados Intensivos. Se asocia a un aumento de la morbilidad, mortalidad y estancia hospitalaria. La mayoría de los estudios publicados hasta el momento son observacionales, retrospectivos y no incluyen pacientes críticos, lo que dificulta la extracción de conclusiones sólidas. Además, debido a la escasa evidencia científica de calidad, incluso las recomendaciones realizadas por distintas sociedades científicas recientemente publicadas difieren en aspectos importantes como son el diagnóstico o el tratamiento de la hiponatremia. Los mecanismos etiopatogénicos en los pacientes críticos suelen ser complejos. Sin embargo, hay que profundizar en ellos para llegar al diagnóstico más probable y a la pauta de tratamiento más adecuada. Todo ello, ha motivado la realización de esta revisión práctica sobre aspectos útiles en el abordaje de la hiponatremia en las Unidades de Cuidados intensivos, con el objetivo de homogeneizar el manejo de esta entidad y disponer de un algoritmo diagnóstico a nivel nacional


Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient


Subject(s)
Humans , Consensus , Hyponatremia/diagnosis , Critical Care , Intensive Care Units , Hyponatremia/etiology , Diagnosis, Differential , Societies, Medical/standards , Hyponatremia/physiopathology , Algorithms
4.
Med Intensiva (Engl Ed) ; 43(5): 302-316, 2019.
Article in English, Spanish | MEDLINE | ID: mdl-30678998

ABSTRACT

Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient.


Subject(s)
Hyponatremia/diagnosis , Hyponatremia/therapy , Algorithms , Critical Illness , Humans , Practice Guidelines as Topic
5.
Med. intensiva (Madr., Ed. impr.) ; 35(supl.1): 81-85, nov. 2011.
Article in Spanish | IBECS | ID: ibc-136017

ABSTRACT

El paciente con patología cardíaca puede presentar 2 tipos de desnutrición: la caquexia cardíaca, que aparece en situaciones de insuficiencia cardíaca congestiva crónica, y una malnutrición secundaria a complicaciones de la cirugía cardíaca o de cualquier cirugía mayor realizada en pacientes con cardiopatía. Se debe intentar una nutrición enteral precoz si no se puede utilizar la vía oral. Cuando la función cardíaca esté profundamente comprometida la nutrición enteral es posible, pero a veces precisará suplementación con nutrición parenteral. La hiperglucemia aguda sostenida en las primeras 24 h en pacientes ingresados por síndrome coronario agudo, sean o no diabéticos, es un factor de mal pronóstico en términos de mortalidad a los 30 días. En el paciente crítico cardíaco con fallo hemodinámico en situación estable, un soporte nutricional de 20-25 kcal/kg/día es eficaz para mantener un estado nutricional adecuado. El aporte proteico debe ser de 1,2-1,5 g/kg/día. Se administrarán fórmulas poliméricas o hiperproteicas habituales, según la situación nutricional previa del paciente, con restricción de sodio y volumen según su situación clínica. La glutamina es la mayor fuente de energía para el miocito, vía conversión a glutamato, protegiendo además a la célula miocárdica de la isquemia en situaciones críticas. La administración de 1 g/ día de w-3 (EPA+DHA), en forma de aceite de pescado, puede prevenir la muerte súbita en el tratamiento del síndrome coronario agudo y también puede contribuir a una disminución de los ingresos hospitalarios, por eventos cardiovasculares, en la insuficiencia cardíaca crónica (AU)


Patients with cardiac disease can develop two types of malnutrition: cardiac cachexia, which appears in chronic congestive heart failure, and malnutrition due to the complications of cardiac surgery or any other type of surgery in patients with heart disease. Early enteral nutrition should be attempted if the oral route cannot be used. When cardiac function is severely compromised, enteral nutrition is feasible, but supplementation with parenteral nutrition is sometimes required. Sustained hyperglycemia in the first 24 hours in patients admitted for acute coronary syndrome, whether diabetic or not, is a poor prognostic factor for 30-day mortality. In critically- ill cardiac patients with stable hemodynamic failure, nutritional support of 20-25 kcal/ kg/ day is effective in maintaining adequate nutritional status. Protein intake should be 1.2-1.5 g/ kg/ day. Routine polymeric or high protein formulae should be used, according to the patient’s prior nutritional status, with sodium and volume restriction according to the patient’s clinical situation. The major energy source for myocytes is glutamine, through conversion to glutamate, which also protects the myocardial cell from ischemia in critical situations. Administration of 1 g/ day of omega-3 (EPA+DHA) in the form of fish oil can prevent sudden death in the treatment of acute coronary syndrome and can also help to reduce hospital admission for cardiovascular events in patients with chronic heart failure (AU)


Subject(s)
Humans , Enteral Nutrition/methods , Enteral Nutrition/standards , Heart Diseases/complications , Heart Diseases/metabolism , Heart Diseases/therapy , Critical Care/methods , Societies, Medical/standards , Societies, Scientific/standards , Parenteral Nutrition/methods , Parenteral Nutrition/standards , Myocytes, Cardiac/metabolism , Acute Coronary Syndrome/drug therapy , Cachexia/etiology , Cachexia/prevention & control , Cachexia/therapy , Cardiac Surgical Procedures , Critical Illness/therapy , Death, Sudden, Cardiac/prevention & control , Diet, Sodium-Restricted , Dietary Proteins/administration & dosage , Energy Metabolism , Fatty Acids, Omega-3/administration & dosage , Fatty Acids, Omega-3/therapeutic use , Food, Formulated , Glutamine/administration & dosage , Glutamine/therapeutic use , Malnutrition/etiology , Malnutrition/prevention & control , Malnutrition/therapy , Postoperative Complications/etiology
6.
Nutr. hosp ; 26(supl.2): 76-80, nov. 2011.
Article in English | IBECS | ID: ibc-104847

ABSTRACT

Patients with cardiac disease can develop two types of malnutrition: cardiac cachexia, which appears in chronic congestive heart failure, and malnutrition due to the complications of cardiac surgery or any other type of surgery in patients with heart disease. Early enteral nutrition should be attempted if the oral route cannot be used. When cardiac function is severely compromised, enteral nutrition is feasible, but supplementation with parenteral nutrition is sometimes required. Sustained hyperglycemia in the first 24 hours in patients admitted for acute coronary syndrome, whether diabetic or not, is a poor prognostic factor for 30-daymortality. In critically-ill cardiac patients with stable hemodynamic failure, nutritional support of 20-25kcal/kg/day is effective in maintaining adequate nutritional status.Protein intake should be 1.2-1.5 g/kg/day. Routine polymeric or high protein formulae should be used, according to the patient’s prior nutritional status, with sodium and volume restriction according to the patient’s clinical situation. The major energy source for myocytes is glutamine, through conversion to glutamate, which also protects them yocardial cell from ischemia in critical situations. Administration of 1 g/day of omega-3 (EPA+DHA) in the form of fish oil can prevent sudden death in the treatment of acute coronary syndrome and can also help to reduce hospital admission for cardiovascular events in patients with chronic heart failure (AU)


El paciente con patología cardíaca puede presentar 2tipos de desnutrición: la caquexia cardíaca, que aparece en situaciones de insuficiencia cardíaca congestiva crónica, y una malnutrición secundaria a complicaciones de la cirugía cardíaca o de cualquier cirugía mayor realizada en pacientes con cardiopatía. Se debe intentar una nutrición enteral precoz si no se puede utilizar la vía oral. Cuando la función cardíaca esté profundamente comprometida la nutrición enteral esposible, pero a veces precisará suplementación con nutrición parenteral. La hiperglucemia aguda sostenida en las primeras 24 h en pacientes ingresados por síndrome coronario agudo, sean o no diabéticos, es un factor de mal pronóstico en términos de mortalidad a los 30 días. En el paciente crítico cardíaco con fallo hemodinámico en situación estable, un soporte nutricional de 20-25 kcal/kg/día es eficaz para mantener un estado nutricional adecuado. El aporte proteico debe ser de 1,2-1,5 g/kg/día. Se administrarán fórmulas poliméricas o hiperproteicas habituales, según la situación nutricional previa del paciente, con restricción de sodio y volumen según su situación clínica. La glutamina es la mayor fuente de energía para el miocito, vía conversión a glutamato, protegiendo además a la célula miocárdica de la isquemia en situaciones críticas. La administración de 1 g/día de w-3 (EpA+DHA), en forma de aceite de pescado, puede prevenir la muerte súbita en el tratamiento del síndrome coronario agudo y también puede contribuir a una disminución de los ingresos hospitalarios, por eventos cardiovasculares, en la insuficiencia cardíaca crónica (AU)


Subject(s)
Humans , Cachexia/diet therapy , Fatty Acids, Omega-3/administration & dosage , Hyperglycemia/diet therapy , Heart Failure/diet therapy , Heart Diseases/complications , Critical Illness/therapy , Nutritional Support/methods , Evidence-Based Practice/methods , Practice Patterns, Physicians'
7.
Med Intensiva ; 35 Suppl 1: 81-5, 2011 Nov.
Article in Spanish | MEDLINE | ID: mdl-22309760

ABSTRACT

Patients with cardiac disease can develop two types of malnutrition: cardiac cachexia, which appears in chronic congestive heart failure, and malnutrition due to the complications of cardiac surgery or any other type of surgery in patients with heart disease. Early enteral nutrition should be attempted if the oral route cannot be used. When cardiac function is severely compromised, enteral nutrition is feasible, but supplementation with parenteral nutrition is sometimes required. Sustained hyperglycemia in the first 24 hours in patients admitted for acute coronary syndrome, whether diabetic or not, is a poor prognostic factor for 30-day mortality. In critically-ill cardiac patients with stable hemodynamic failure, nutritional support of 20-25 kcal/kg/day is effective in maintaining adequate nutritional status. Protein intake should be 1.2*-1.5 g/kg/day. Routine polymeric or high protein formulae should be used, according to the patient's prior nutritional status, with sodium and volume restriction according to the patient's clinical situation. The major energy source for myocytes is glutamine, through conversion to glutamate, which also protects the myocardial cell from ischemia in critical situations. Administration of 1 g/ day of omega-3 (EPA+DHA) in the form of fish oil can prevent sudden death in the treatment of acute coronary syndrome and can also help to reduce hospital admission for cardiovascular events in patients with chronic heart failure.


Subject(s)
Critical Care , Enteral Nutrition/standards , Heart Diseases/therapy , Parenteral Nutrition/standards , Societies, Medical/standards , Societies, Scientific/standards , Acute Coronary Syndrome/drug therapy , Cachexia/etiology , Cachexia/prevention & control , Cachexia/therapy , Cardiac Surgical Procedures , Critical Care/methods , Critical Illness/therapy , Death, Sudden, Cardiac/prevention & control , Diet, Sodium-Restricted , Dietary Proteins/administration & dosage , Energy Metabolism , Enteral Nutrition/methods , Fatty Acids, Omega-3/administration & dosage , Fatty Acids, Omega-3/therapeutic use , Food, Formulated , Glutamine/administration & dosage , Glutamine/therapeutic use , Heart Diseases/complications , Heart Diseases/metabolism , Humans , Malnutrition/etiology , Malnutrition/prevention & control , Malnutrition/therapy , Myocytes, Cardiac/metabolism , Parenteral Nutrition/methods , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Postoperative Complications/therapy , Spain
8.
Nutr Hosp ; 26 Suppl 2: 76-80, 2011 Nov.
Article in English | MEDLINE | ID: mdl-22411526

ABSTRACT

Patients with cardiac disease can develop two types of malnutrition: cardiac cachexia, which appears in chronic congestive heart failure, and malnutrition due to the complications of cardiac surgery or any other type of surgery in patients with heart disease. Early enteral nutrition should be attempted if the oral route cannot be used. When cardiac function is severely compromised, enteral nutrition is feasible, but supplementation with parenteral nutrition is sometimes required. Sustained hyperglycemia in the first 24 hours in patients admitted for acute coronary syndrome, whether diabetic or not, is a poor prognostic factor for 30-day mortality. In critically-ill cardiac patients with stable hemodynamic failure, nutritional support of 20-25 kcal/kg/day is effective in maintaining adequate nutritional status. Protein intake should be 1.2-1.5 g/kg/day. Routine polymeric or high protein formulae should be used, according to the patient's prior nutritional status, with sodium and volume restriction according to the patient's clinical situation. The major energy source for myocytes is glutamine, through conversion to glutamate, which also protects the myocardial cell from ischemia in critical situations. Administration of 1 g/day of omega-3 (EPA+DHA) in the form of fish oil can prevent sudden death in the treatment of acute coronary syndrome and can also help to reduce hospital admission for cardiovascular events in patients with chronic heart failure.


Subject(s)
Critical Illness/therapy , Heart Diseases/therapy , Nutritional Support/methods , Consensus , Dietary Carbohydrates/administration & dosage , Dietary Fats/administration & dosage , Energy Intake , Fatty Acids, Omega-3/administration & dosage , Fatty Acids, Omega-3/therapeutic use , Food, Formulated , Humans , Hyperglycemia/therapy , Malnutrition/etiology , Malnutrition/therapy , Micronutrients/administration & dosage , Nutritional Support/standards
9.
Nutr Hosp ; 19(3): 175-7, 2004.
Article in Spanish | MEDLINE | ID: mdl-15211727

ABSTRACT

Situations of cardiac arrest have been reported in under-nourished patients with protein and calorie deficits when the provision of nutrients was initiated in an uncontrolled manner. The recognition of the association between the provision of food in these circumstances and the serious clinical consequences, generally heartbeat disorders, has led this condition to be described as "re-feeding syndrome". The case presented here is of severe acute respiratory failure and cardiogenic shock in a 44-year-old female patient with severe protein and calorie malnutrition associated with the start of hyperproteic nutritional support. Treatment with inotropic-vasoactive drugs and diuretics together with a progressive nutritional programme brought about the complete reversal of her heart failure and the concomitant endocrine-metabolic syndrome.


Subject(s)
Diet Therapy/adverse effects , Shock, Cardiogenic/etiology , Adult , Female , Humans , Syndrome
10.
Nutr. hosp ; 19(3): 175-177, mayo 2004.
Article in Es | IBECS | ID: ibc-32731

ABSTRACT

Se han comunicado situaciones de paro cardíaco en pacientes con desnutrición proteico-calórica en los que se iniciaba aporte de nutrientes de manera incontrolada. El reconocimiento de la asociación entre el aporte de alimentos en estas circunstancias y los eventos clínicos graves, generalmente trastornos del ritmo cardíaco, llevó a describirlo como “síndrome de realimentación”. Presentamos un caso de influencia respiratoria aguda grave y shock cardiogénico en una paciente de 44 años con desnutrición proteico-calórica grave asociado al inicio de un soporte nutricional hiperproteico. El tratamiento con drogas inotrópicas-vasoactivas y diuréticos junto con un programa nutricional progresivo consiguió la reversión completa de la insuficiencia cardíaca y del síndome endocrino-metabólico concomitante (AU)


Situations of cardiac arrest have been reported in under-nourished patients with protein and calorie deficits when the provision of nutrients was initiated in an uncontrolled manner. The recognition of the association between the provision of food in these circumstances and the serious clinical consequences, generally heartbeat disorders, has led this condition to be described as "re-feeding syndrome". The case presented here is of severe acute respiratory failure and cardiogenic shock in a 44-year-old female patient with severe protein and calorie malnutrition associated with the start of hyperproteic nutritional support. Treatment with inotropic-vasoactive drugs and diuretics together with a progressive nutritional programme brought about the complete reversal of her heart failure and the concomitant endocrine-metabolic syndrome (AU)


Subject(s)
Female , Adult , Humans , Syndrome , Shock, Cardiogenic , Diet Therapy
11.
Gastroenterol Hepatol ; 22(1): 7-10, 1999 Jan.
Article in Spanish | MEDLINE | ID: mdl-10089704

ABSTRACT

The aim of this study was to verify the early effects that the transjugular intrahepatic portosystemic shunt (TIPS) produces on thrombocytopenia and its possible relationship to portal pressure and the size of the spleen. A TIPS was placed in 24 cirrhotic patients (11 women and 13 men) with a mean age of 57.6 +/- 12.3 years. Prior to the test the platelets count, the size of the spleen and the portocaval gradient were determined. The same parameters were evaluated one day and one month afterwards. A significant increase was observed in then number of platelets following the placement of the prosthesis (87.6 +/- 55.2 vs 97 +/- 66.8 x 10(9)/l) (p < 0.05) which was maintained in the monthly control without achieving statistical significance (99.5 +/- 60.8 x 10(9)/l). A significant decrease was also observed in the size of the spleen from 156.7 +/- 28.7 mm during the previous control to 144.5 +/- 19.9 mm in the monthly control (p < 0.05). The portocaval gradient was significantly reduced following the procedure with the values being 23.25 +/- 3.86 mmHg prior to the TIPS, 10.29 +/- 3.84 mmHg in the immediate control and 10.37 +/- 4.81 mmHg at the one month control. A statistically significant correlation was observed between the size of the spleen and the number of platelets in both the previous control (r = 0.7264; p < 0.001) and in the monthly control (r = 0.5764; p < 0.05), between the size of the spleen and the portocaval gradient prior to the test (r = 0.5285; p < 0.05) and at one month (r = 0.7185; p < 0.01) and between the portocaval gradient and the number of platelets before the prosthesis (r = 0.5060; p < 0.05). TIPS may improve the thrombocytopenia in correlation with the decrease in portal pressure.


Subject(s)
Hypersplenism/physiopathology , Portasystemic Shunt, Transjugular Intrahepatic , Adult , Aged , Evaluation Studies as Topic , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/blood , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Humans , Hypersplenism/blood , Liver Cirrhosis/blood , Liver Cirrhosis/complications , Liver Cirrhosis/surgery , Male , Middle Aged , Portasystemic Shunt, Transjugular Intrahepatic/methods , Portasystemic Shunt, Transjugular Intrahepatic/statistics & numerical data , Statistics, Nonparametric , Thrombocytopenia/blood , Thrombocytopenia/physiopathology , Time Factors
12.
An Med Interna ; 13(3): 122-4, 1996 Mar.
Article in Spanish | MEDLINE | ID: mdl-8679840

ABSTRACT

Bronchioloalveolar carcinoma is an infrequent malignant lung tumor, specially in patients younger than 50. Diagnosis is difficult and usually late, because its clinical and radiologic features are similar to other lung diseases and because its poor histopathologic differentiation from other primitive o metastatic adenocarcinoma. We report a case of multinodular, diffuse and bilateral bronchioloalveolar carcinoma in a young woman without previous lung disease which suspected diagnosis was by broncho-aspirated cytology and open lung biopsy was necessary for its confirmation.


Subject(s)
Adenocarcinoma, Bronchiolo-Alveolar , Lung Neoplasms , Adenocarcinoma, Bronchiolo-Alveolar/diagnosis , Adenocarcinoma, Bronchiolo-Alveolar/pathology , Adult , Biopsy , Bronchoscopy , Diagnosis, Differential , Female , Humans , Lung/pathology , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology
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