RESUMO
La morbimortalidad materno-neonatal es un problema de salud pública en el Perú. El Ministerio de Salud ha diseñado diversas intervenciones que permiten enfrentar este problema tales como planificación familiar, atención del parto por profesional de salud y atención prenatal reenfocada; las cuales son parte del Programa Presupuestal (PP) Salud Materno Neonatal que es ejecuta en los establecimientos de salud del país del MINSA y de los Gobiernos Regionales.
Neonatal maternal morbidity and mortality is a public health problem in Peru. The Ministry of Health (MINSA) has designed various interventions to address this problem, such as family planning, delivery care by a health professional, and refocused prenatal care; which are part of the Budgetary Program (PP) Maternal Neonatal Health that is executed in the health establishments of the country of the MINSA and the Regional Governments.
RESUMO
Mannitol overuse-induced acute renal failure (ARF) has rarely been described. We report four cases, all male, between the ages of 20 and 42 years, who developed acute renal failure (3 anuric, 1 nonoliguric) after receiving mannitol 1,172 +/- 439 g (mean +/- SD) during a time period of 58 +/- 28 h. The infusion rate was 0.25 +/- 0.02 g/kg/h. The onset of acute renal failure was detected 48 +/- 22 h after infusion. In 2 of the 3 cases in which urinary cytology was evaluated, the presence of vacuole-containing renal tubular cells was observed. All patients had hyponatremia (120 +/- 11 mEq/l), and hyperosmolality (osmolar gap 70 +/- 11 mosm/kg water). No other factors could be pointed to as causing acute renal failure. In the 3 anuric cases in which hemodialysis was performed, immediate recovery of diuresis was observed. Two patients recovered renal function on the fifth and sixth days, and 2 died due to endocranial hypertension - one of them while recovering - on the fourth and sixth days. In the present report, mannitol-induced ARF occurred at clustered doses of 0.25 mg/kg/h.
