Insights of dietary electrolyte balance in broilers raised under natural heat stress conditions.

1. Dietary electrolyte balance (DEB) has been used to minimise problems in broiler chickens raised in warm climates. However, there is a need to determine the most appropriate DEB levels in these animals2. This study evaluated the influence of five DEB levels (110, 175, 240, 305 and 370 mEq/kg) on water intake (WI), zootechnical performance (feed intake, weight gain and feed conversion ratio), tibiotarsus bone variables (fresh bone weight, dry bone weight, bone length, mineral matter, Seedor index and bone strength) and intestinal histomorphometry (villus height (VH) and width (VW), crypt height (CH) and width (CW), internal and external muscularis) on broilers in two developmental phases (1-21 and 22-42 d of age). Additionally, the haematological profile (blood count and serum biochemistry), carcass yield, cuts and abdominal fat were assessed.3. Applying 370 mEq/kg DEB increased WI, VW in the jejunum and ileum and number of haemocytes at 21 d, while WI and VW in the duodenum and ileum at 42 d. In contrast, 110 mEq/kg increased chlorine concentrations at 21 d and leukocyte and heterophil numbers at 42 d.4. In summary, the 370 mEq/kg level was the most appropriate for broiler homoeostasis raised under natural heat stress, as the best results were found on WI and VW variables. Therefore, this DEB level was recommended in broilers aged 21 or 42 d.

Influence of Fluid Ingestion on Heart Rate, Cardiac Autonomic Modulation and Blood Pressure in Response to Physical Exercise: A Systematic Review with Meta-Analysis and Meta-Regression.

A systematic review was undertaken to investigate the involvement of hydration in heart rate (HR), HR variability (HRV) and diastolic (DBP) and systolic (SBP) blood pressure in response to exercise. Data synthesis: The EMBASE, MEDLINE, Cochrane Library, CINAHL, LILACS and Web of Science databases were searched. In total, 977 studies were recognized, but only 36 were included after final screening (33 studies in meta-analysis). This study includes randomized controlled trials (RCTs) and non-RCTs with subjects > 18 years old. The hydration group consumed water or isotonic drinks, while the control group did not ingest liquids. For the hydration protocol (before, during and after exercise), the HR values during the exercise were lower compared to the controls (-6.20 bpm, 95%CI: -8.69; -3.71). In the subgroup analysis, "water ingested before and during exercise" showed lower increases in HR during exercise (-6.20, 95%CI: 11.70 to -0.71), as did "water was ingested only during exercise" (-6.12, 95%CI: -9.35 to -2.89). Water intake during exercise only revealed a trend of avoiding greater increases in HR during exercise (-4,60, 95%CI: -9.41 to 0.22), although these values were not significantly different (p = 0.06) from those of the control. "Isotonic intake during exercise" showed lower HRs than the control (-7.23 bpm, 95% CI: -11.68 to -2.79). The HRV values following the exercise were higher in the hydration protocol (SMD = 0.48, 95%CI: 0.30 to 0.67). The values of the SBP were higher than those of the controls (2.25 mmHg, 95%CI: 0.08 to 4.42). Conclusions: Hydration-attenuated exercise-induced increases in HR during exercise, improved autonomic recovery via the acceleration of cardiac vagal modulation in response to exercise and caused a modest increase in SBP values, but did not exert effects on DBP following exercise.

Enteral hydration in cows: Comparison between continuous flow and bolus administration.

BACKGROUND: Enteral hydration in cattle is most commonly performed as a bolus (B) via the ororuminal route, although continuous flow (CF) administration via the nasoesophageal route represents a viable alternative. Currently, no study has compared the effectiveness of these two methods. This study aimed to compare the efficiency of enteral hydration using CF and B to correct water, electrolyte and acid-base imbalances in cows. METHODS: Protocols for the induction of dehydration were applied twice to eight healthy cows, with an interval of 1 week. In a crossover design, two types of enteral hydration were performed using the same electrolyte solution and volume equal to 12% of bodyweight (BW): CF (10 mL/kg/h, between 0 and 12 hours) and B (6% BW, twice, at 0 and 6 hours). Clinical and blood variables were determined at -24, 0, 6, 12 and 24 hours and compared using repeated-measures ANOVA. RESULTS: Induced moderate dehydration and hypochloremic metabolic alkalosis were corrected after 12 hours using the two hydration methods, with no differences observed between the methods. LIMITATIONS: The study was conducted with induced rather than natural imbalances, so the findings should be interpreted cautiously. CONCLUSION: Enteral CF hydration is as effective as B hydration in reversing dehydration and correcting electrolyte and acid-base imbalances.

Children with malignancies and septic shock - an attempt to understand the risk factors

Abstract Objectives: To explain the high mortality of septic shock in children with cancer. Methods: A retrospective cohort from 2016 to 2020, of children aged 0 to 18 years, and septic shock. Results: The authors included 139 patients. Acute lymphocytic leukemia was the most frequent diagnosis (16.5%), and Gram-negative bacteria were the most frequent blood culture isolates (22.3%). There were 57 deaths in ICU (41%), 10 in the first 24 hours of shock (early death). A LASSO model with variables: neutropenia (coefficient 0.215), respiratory (0.81), hematological (1.41), and neurological (0.72) dysfunctions, age (-0.002) and solid tumor recurrence (0.34) generated AUC = 0.79 for the early death outcome. Survivors had significant differences in the PRISM-IV score (mean ± SD 10.9 ± 6.2 in the survivors, 14.1 ± 6.5 in the deceased, p = 0.004), and in the mean number of organ dysfunctions (3.2 ± 1.1 in the survivors, 3.8 ± 6.5 in the deceased, p < 0.001). A positive fluid balance in the first 24 hours of sepsis between 2% and 6% of body weight showed a reduction effect on the probability of death in ICU (hazard ratio 0.47, 95% CI 0.24-0.92, p = 0.027). The recurrence of any cancer was a predictor of in-hospital death, regardless of severity. Conclusions: Recurrence of any cancer is an important risk of sepsis-related death. A positive fluid balance between 20 and 60 mL/kg or 2% and 6% of body weight in the first 24 hours after the onset of sepsis is related to lower mortality.

Children with malignancies and septic shock - an attempt to understand the risk factors.

OBJECTIVES: To explain the high mortality of septic shock in children with cancer. METHODS: A retrospective cohort from 2016 to 2020, of children aged 0 to 18 years, and septic shock. RESULTS: The authors included 139 patients. Acute lymphocytic leukemia was the most frequent diagnosis (16.5%), and Gram-negative bacteria were the most frequent blood culture isolates (22.3%). There were 57 deaths in ICU (41%), 10 in the first 24 hours of shock (early death). A LASSO model with variables: neutropenia (coefficient 0.215), respiratory (0.81), hematological (1.41), and neurological (0.72) dysfunctions, age (-0.002) and solid tumor recurrence (0.34) generated AUC = 0.79 for the early death outcome. Survivors had significant differences in the PRISM-IV score (mean ± SD 10.9 ± 6.2 in the survivors, 14.1 ± 6.5 in the deceased, p = 0.004), and in the mean number of organ dysfunctions (3.2 ± 1.1 in the survivors, 3.8 ± 6.5 in the deceased, p < 0.001). A positive fluid balance in the first 24 hours of sepsis between 2% and 6% of body weight showed a reduction effect on the probability of death in ICU (hazard ratio 0.47, 95% CI 0.24-0.92, p = 0.027). The recurrence of any cancer was a predictor of in-hospital death, regardless of severity. CONCLUSIONS: Recurrence of any cancer is an important risk of sepsis-related death. A positive fluid balance between 20 and 60 mL/kg or 2% and 6% of body weight in the first 24 hours after the onset of sepsis is related to lower mortality.

Administración de fluidos a pacientes graves y su relación con la mortalidad / Fluids administration to seriously ill patients and its relationship with mortality

Introducción: La administración de fluidos constituye uno de los pilares de tratamiento en pacientes que ingresan en Unidades de Cuidados Intensivos, en quienes la reanimación inadecuada y la sobrecarga de volumen empeoran el pronóstico. Objetivo: Caracterizar el estado de la administración de fluidos a pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital General Docente Dr. Antonio Luaces Iraola de Ciego de Ávila y su relación con la mortalidad. Métodos: Se realizó un estudio descriptivo analítico y prospectivo de 147 pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital General Docente Dr. Antonio Luaces Iraola de Ciego de Ávila durante el primer semestre de 2020, para lo cual se evaluaron 598 pruebas de fluidos, algunas variables hemodinámicas y el balance de líquidos en las primeras 72 horas del ingreso. Resultados: El promedio de edad fue de 48,3 años, predominaron las mujeres (55,8 %), la puntuación de APACHE II al ingreso resultó ser de 14,2 puntos y fallecieron 22,4 % de los afectados. Para administrar fluidos prevaleció el criterio clínico (57,2%); mientras que la presión venosa central, la frecuencia cardíaca, la presión arterial media y la diuresis fueron similares en vivos y fallecidos. El balance acumulado de fluidos fue significativamente superior en el grupo de pacientes fallecidos (1984,70 mL vs 260mL). Conclusiones: Los cambios en los parámetros vitales después de administrar fluidos no fueron útiles para evaluar la respuesta al volumen. El balance acumulado de fluidos se relacionó de forma significativa con la mortalidad.

Introduction: Fluids administration constitutes one of the treatment pillars in patients admitted to Intensive Care Unit in which the inadequate reanimation and overload of volume worsen the prognosis. Objective: To characterize the state of fluid administration to patients admitted to the Intensive Cares Units of Dr. Antonio Luaces Iraola Teaching General Hospital in Ciego de Ávila and its relationship with mortality. Methods: An analytic and prospective descriptive study of 147 patients admitted to the Intensive Cares Units of Dr. Antonio Luaces Iraola Teaching General Hospital was carried out in Ciego de Ávila during the first semester of 2020, for which 598 tests of fluids, some hemodynamic variables and the balance of liquids were evaluated in the first 72 hours of admission. Results: The average age was 48.3 years, there was a prevalence of women (55.8 %), the punctuation of APACHE II at admission was 14.2 points and 22.4 % of those affected died. To administer fluids the clinical approach prevailed (57.2 %); while the central venous pressure, heart frequency, the mean arterial pressure and diuresis were similar in alive and dead patients. The accumulated balance of fluids was significantly higher in the group of dead patients (1984.70 mL vs 260 mL). Conclusions: The changes in the vital parameters after administering fluids were not useful to evaluate the response to the volume. The accumulated balance of fluids was related to mortality in a significant way.

Descongestión durante la Insuficiencia Cardíaca Aguda: importancia y monitorización / Monitoring decongestion in acute heart failure

Persistent congestion following an episode of acute heart failure is associated with higher morbidity and mortality. Monitoring diuretic therapy is essential to guide effective decongestion before patient discharge. Unfortunately, there are no markers which can predict on their own, the exact point in which euvolemia is achieved. Cardiothoracic and extra thoracic ultrasound are other tools to consider when evaluating hemodynamic and interstitial components of congestion. However, the question of which and how many parameters must be used for this purpose, is still unanswered.

Effect of an ionic antineoplastic agent Cytoreg on blood chemistry in a Wistar rat model.

Cytoreg is an ionic therapeutic agent comprising a mixture of hydrochloric, sulfuric, phosphoric, hydrofluoric, oxalic, and citric acids. In diluted form, it has demonstrated efficacy against human cancers in vitro and in vivo. Although Cytoreg is well tolerated in mice, rats, rabbits, and dogs by oral and intravenous administration, its mechanism of action is not documented. The acidic nature of Cytoreg could potentially disrupt the pH and levels of ions and dissolved gases in the blood. Here, we report the effects of the intravenous administration of Cytoreg on the arterial pH, oxygen and carbon dioxide pressures, and bicarbonate, sodium, potassium, and chloride concentrations. Our results demonstrate that Cytoreg does not disturb the normal blood pH, ion levels, or carbon dioxide content, but increases oxygen levels in rats. These data are consistent with the excellent tolerability of intravenous Cytoreg observed in rabbits, and dogs. The study was approved by the Bioethics Committee of the University of the Andes, Venezuela (CEBIOULA) (approval No. 125) on November 3, 2019.

Analysis of performance, bone characteristics, and expression of genes involved in the balance of ionic concentrations in broilers subjected to dietary electrolyte balance levels.

1. Sodium bicarbonate (NaHCO3), potassium carbonate (K2CO3), and ammonium chloride (NH4Cl) are commonly used to correct dietary electrolyte balance (DEB) in birds. However, there are many gaps in the knowledge of their effects when used simultaneously. This study investigated the effect of DEB levels on performance, femur bone characteristics and the expression of genes related to the balance of ionic concentrations in broilers at 21 days of age.2. Male Cobb broiler chickens (n = 245), aged 1-21 d, were divided into groups based on a completely randomised design with five DEB levels (110 mEq/kg, 175 mEq/kg, 240 mEq/kg, 305 mEq/kg, and 370 mEq/kg).3. The performance characteristics measured included body weight (BW), body weight gain (BWG), feed intake (FI), feed conversion (FCR) and body weight birds slaughtered (BWS).4. The bone variables assessed in the femur were weight (WE), relative bone weight (RBWE), length (L), width (WI), maximum load supported (MLS), bone-breaking resistance (BR), and Seedor index (SI). In addition, the expression of CHP1, SLC9A1, and SLC24A3 in the livers, intestines and kidneys of birds was evaluated.5. The DEB level of 370 mEq/kg, at Na+ content of 0.48%, resulted in the highest averages for L, MLS, and BR of the femur. This DEB level increased the expression of SLC9A1 in the liver and SLC24A3 in the intestine. A 240 mEq/kg DEB level decreased the expression of CHP1 in the liver, while supplementation with 110 mEq/kg increased the expression of SLC24A3 in the kidney.6. In conclusion, 370 mEq/kg DEB improved FCR and increased the mean bone characteristics of the femur (L, MLS, and BR) and the expression of SLC9A1 and SLC24A3 in the liver and intestine, respectively. These findings should be considered in future assessments of the effects of DEB levels on broilers.

O balanço hídrico pós-extubação se associa com falha da extubação: um estudo de coorte / Postextubation fluid balance is associated with extubation failure: a cohort study

RESUMO Objetivo: Avaliar se há associação entre o balanço hídrico nas 48 horas após a extubação e a falha da extubação. Métodos: Este é um estudo de coorte prospectiva que incluiu os pacientes admitidos à unidade de terapia intensiva de um hospital terciário no sul do Brasil entre março e dezembro de 2019. Incluíram-se os pacientes que necessitaram de ventilação mecânica por pelo menos 24 horas e foram extubados durante o período do estudo. O desfecho primário foi falha da extubação, considerada como necessidade de reintubar dentro das primeiras 72 horas após a extubação. O desfecho secundário foi um desfecho combinado de falha da extubação ou necessidade de ventilação não invasiva terapêutica. Resultados: Foram incluídos 101 pacientes. Observou-se falha da extubação em 29 (28,7%) deles. Na análise univariada, pacientes com balanço hídrico negativo acima de 1L no período de 48 horas após a extubação tiveram menor taxa de falha da extubação (12,0%), em comparação a pacientes com balanço hídrico negativo nas 48 horas após a extubação menor que 1L (34,2%; p = 0,033). A duração da ventilação mecânica e o balanço hídrico negativo nas 48 horas após a extubação inferior a 1L se associaram com falha da extubação na análise multivariada quando corrigido pelo Simplified Acute Physiology Score 3. Quando avaliou-se o desfecho combinado, apenas o balanço hídrico nas 48 horas pós-extubação inferior a 1L manteve associação, quando corrigido pelo Simplified Acute Physiology Score 3 e duração da ventilação mecânica. Conclusão: O balanço hídrico nas 48 horas após a extubação se associa com falha da extubação. São necessários mais estudos para avaliar se evitar um balanço hídrico positivo nesse período poderia melhorar os desfechos do desmame.

ABSTRACT Objective: To assess whether there is an association between 48-hour postextubation fluid balance and extubation failure. Methods: This was a prospective cohort study that included patients admitted to the intensive care unit of a tertiary hospital in southern Brazil from March 2019 to December 2019. Patients who required mechanical ventilation for at least 24 hours and who were extubated during the study period were included. The primary outcome was extubation failure, considered as the need for reintubation in the first 72 hours after extubation. The secondary outcome was a combined outcome with extubation failure or the need for therapeutic noninvasive ventilation. Results: A total of 101 patients were included. Extubation failure was observed in 29 (28.7%) patients. In univariate analysis, patients with a negative 48-hour postextubation fluid balance higher than one liter had a lower rate of extubation failure (12.0%) than patients with a negative 48-hour postextubation fluid balance lower than 1L (34.2%; p = 0.033). Mechanical ventilation duration and negative 48-hour postextubation fluid balance lower than one liter were associated with extubation failure when corrected for Simplified Acute Physiology Score 3 in multivariate analysis. When we evaluated the combined outcome, only negative 48-hour postextubation lower than 1L maintained an association when corrected for for Simplified Acute Physiology Score 3 and mechanical ventilation duration. Conclusion: The 48-hour postextubation fluid balance is associated with extubation failure. Further studies are necessary to assess whether avoiding positive fluid balance in this period might improve weaning outcomes.

Modeling the performance of broilers under heat stress.

A meta-analysis was developed to model performance depression in heat stress (HS), to analyze the influence of HS type (cyclic or constant), and to assess the correlation between dietary electrolyte balance (DEB) and HS in broilers. Two databases (Dat) with performance and temperature were constructed (initial phase - up to 21 d of age - 14 articles, 7,667 animals, average replicate number treatment-ARN/T, 5 and growing phase - over 21 d of age - 74 articles and 25,145 broilers, ARN/T, 7). The criteria for article selection were (1) experiments using at least 2 temperatures (thermoneutral and high temperature); (2) results of ADFI and ADG; (3) feed and water ad libitum during the experiment. Each treatment was classified as cyclic or constant HS and the HS group response was calculated relative to the thermoneutral group. Performance was evaluated as raw data or as relativized information (indicated as "HS effect or ≠"), expressed as a percentage of the difference between results. The models to predict "HS effect" showed that for the initial phase, only ADG was influenced by HS, while for the grower phase, prediction equations were created for ADFI and ADG. Considering the simplest models, there was a reduction of 1.4% in ADFI and 2.1% in ADG for each unit (°C) above the upper critical temperature for broilers older than 21 d. Feed conversion (FC) was not affected by HS in any of the studied phases. Constant HS proved to be more negative than cyclic HS to broiler performance after 21 d of age. The relation between DEB and performance of broilers under HS was analyzed considering broilers over 21 d of age, and very weak correlations were observed. It was concluded that HS affects broilers over 21 d more, although FC is not affected. ADFI is the most important variable affected by HS and the relation between the DEB of the diet and HS is very weak. The empirical models generated in this study accurately predicted ADG and ADFI of broilers exposed to HS and can be used to minimize those effects on poultry production.

Balanço hídrico em unidade de terapia intensiva / Balance hídrico en una unidad de cuidados intensivos / Water balance in an intensive care unit

Objetivo: Discorrer e analisar o preenchimento dos impressos de balanço hídrico de pacientes internados em uma Unidade de Terapia Intensiva pela equipe de enfermagem. Método: Estudo transversal, realizado de fevereiro a dezembro de 2016. Amostra aleatória simples, composta de 220 impressos de balanço hídrico, aprovado no Comitê de Ética em Pesquisa, Protocolo nº. 2.494.058. Análise por meio do SPSS Statistics 22.0 (IBM), utilizando-se estatística descritiva, cálculo de distribuição de frequência, medidas de tendência central e de dispersão. Resultados: 92,7% dos balanços hídricos foram concluídos. Deste total, 54,5% apresentaram erros de cálculos; 37,30%, uso de caneta imprópria; 53,20%, letra ilegível; 84,1%, rasuras; 78,6% erros de registro de dados; 50,50%, anotações inadequadas em colunas. Há 40,7% de chances de um balanço hídrico correto se não houver falhas nos registros e o mesmo for concluído. Conclusão: Os resultados evidenciam a necessidade de capacitação da equipe de enfermagem e de revisão do protocolo assistencial.(AU)

Objective: To discuss and analyze the filling out of fluid balance forms for patients admitted to an Intensive Care Unit by the nursing team. Method: A cross-sectional study, conducted from February to December 2016. A simple random sample, composed of 220 water balance forms, approved by the Research Ethics Committee, Protocol No. 2.494.058. Analysis using SPSS Statistics 22.0 (IBM), using descriptive statistics, calculation of frequency distribution, measures of central tendency and dispersion. Results: A total of 92.7% of the hydric balances were completed. Of this total, 54.5% presented calculation errors; 37.30%, use of improper pen; 53.20%, illegible handwriting; 84.1%, erasures; 78.6% data registration errors; 50.50%, inadequate annotations in columns. There is a 40.7% chance of a correct water balance if there are no flaws in the records and it is completed. Conclusion: The results show the need for training of the nursing team and revision of the care protocol(AU)

Objetivo: Describir y analizar el balance hídrico realizado por el personal de enfermería en una Unidad de Cuidados Intensivos. Método: Estudio transversal, celebrada de febrero a diciembre de 2016. Muestra aleatoria simple, compuesta por 220 balances hídricos, aprobada por el Comité de Ética en Investigación, Protocolo nº. 2.494.058. Análisis a través del SPSS Statistics 22.0 (IBM), utilizando estadística descriptiva, cálculo de distribución de frecuencias, medidas de tendencia central y dispersión. Resultados: 92,7% de los balances hídricos. De este total, el 54,5% tuvo errores de cálculo; 37,30%, utilizando un bolígrafo inadecuado; 53,20%, caligrafía ilegible; 84,1%, tachaduras; 78,6% de errores de entrada de datos; 50,50%, anotaciones de columna inapropiadas. Hay un 40,7% de probabilidad de un correcto balance hídrico si no hay errores en los registros y se completa el mismo. Conclusión: Los resultados muestran la necesidad de capacitar al personal de enfermería y revisar el protocolo de atención.(AU)

Comparison of Electrolyte Composition and Crystallization Patterns in Bird and Reptile Tears.

To compare tear electrolytes and tear crystallization patterns in birds and reptiles, tears were sampled by Schirmer tear test from 10 animals each of Ara ararauna, Amazona aestiva, Tyto alba, Rupornis magnirostris, Chelonoidis carbonaria, and Caiman latirostris, and 5 of Caretta caretta. The aliquots were pooled to assess concentrations of total protein, chloride, phosphorus, iron, sodium, potassium, calcium, and urea. For the tear ferning test, samples of each species were observed under a polarized light microscope at room temperature and humidity. Crystallization patterns were graded according Rolando and Masmali scales. There was more total protein and urea in owl and sea turtle tears, respectively, than in the other animals tested. Electrolyte balance was similar for all species, with higher sodium, chloride, and iron. In birds, Rolando-scale grades of tear crystallization patterns ranged from I to II, and from 0 to 2 using the Masmali scale; in reptiles, grades were II to IV (Rolando) and 2 to 4 (Masmali). Crystallization arrangements of some species had higher scores, as caimans and sea turtles, possibly due to different the tear composition. Marine and lacustrine species presented higher. The ionic balance of lacrimal fluids of birds and reptiles was similar to that in humans, with higher values of sodium and chloride. However, a similar tear composition did not influence the crystal morphology. Crystallization classification suggested that higher grades and types are due to the different microelements present in the tears of wild species.

Fluid and hemodynamic management in hemodialysis patients: challenges and opportunities / Manejo hídrico e hemodinâmico em pacientes em hemodiálise: desafios e oportunidades

Abstract Fluid volume and hemodynamic management in hemodialysis patients is an essential component of dialysis adequacy. Restoring salt and water homeostasis in hemodialysis patients has been a permanent quest by nephrologists summarized by the 'dry weight' probing approach. Although this clinical approach has been associated with benefits on cardiovascular outcome, it is now challenged by recent studies showing that intensity or aggressiveness to remove fluid during intermittent dialysis is associated with cardiovascular stress and potential organ damage. A more precise approach is required to improve cardiovascular outcome in this high-risk population. Fluid status assessment and monitoring rely on four components: clinical assessment, non-invasive instrumental tools (e.g., US, bioimpedance, blood volume monitoring), cardiac biomarkers (e.g. natriuretic peptides), and algorithm and sodium modeling to estimate mass transfer. Optimal management of fluid and sodium imbalance in dialysis patients consist in adjusting salt and fluid removal by dialysis (ultrafiltration, dialysate sodium) and by restricting salt intake and fluid gain between dialysis sessions. Modern technology using biosensors and feedback control tools embarked on dialysis machine, with sophisticated analytics will provide direct handling of sodium and water in a more precise and personalized way. It is envisaged in the near future that these tools will support physician decision making with high potential of improving cardiovascular outcome.

Resumo O volume de fluidos e o controle hemodinâmico em pacientes em hemodiálise é um componente essencial da adequação da diálise. A restauração da homeostase do sal e da água em pacientes em hemodiálise tem sido uma busca constante por parte dos nefrologistas, no que condiz à abordagem do "peso seco. Embora essa abordagem clínica tenha sido associada a benefícios no desfecho cardiovascular, recentemente tem sido questionada por estudos que mostram que a intensidade ou agressividade para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos.para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos. Uma abordagem mais precisa é necessária para melhorar o desfecho cardiovascular nessa população de alto risco. A avaliação e monitorização do estado hídrico baseiam-se em quatro componentes: avaliação clínica, ferramentas instrumentais não invasivas (por exemplo, US, bioimpedância, monitorização do volume sanguíneo), biomarcadores cardíacos (e.g. peptídeos natriuréticos), algoritmos e modelagem de sódio para estimar a transferência de massa. O manejo otimizado do desequilíbrio hídrico e de sódio em pacientes dialíticos consiste em ajustar a remoção de sal e líquido por diálise (ultrafiltração, dialisato de sódio), e restringir a ingestão de sal e o ganho de líquido entre as sessões de diálise. Tecnologia moderna que utiliza biosensores e ferramentas de controle de feedback, hoje parte da máquina de diálise, com análises sofisticadas, proporcionam o manejo direto sobre o sódio e a água de uma maneira mais precisa e personalizada. Prevê-se no futuro próximo que essas ferramentas poderão auxiliar na tomada de decisão do médico, com alto potencial para melhorar o resultado cardiovascular.

Relación entre sobrecarga hídrica y mortalidad en niños conshock séptico / Relation between fluid overload and mortality in children with septic shock

El shock séptico es una de las principales causas que puede llevar a la muerte. La reanimación hídrica constituye un destacado tratamiento para poder disminuir la mortalidad. Objetivo: determinar la relación entre el porcentaje de sobrecarga hídrica (%SH) y la mortalidad en niños con shock séptico. Métodos. Estudio de cohorte en pacientes con shock séptico de entre 1 y 17 años, posterior a la reanimación hídrica con presión venosa central ≥ 5 mmHg con monitoreo invasivo y registro completo de %SH hasta las 96 h. El seguimiento y la variable de desenlace se completaron hasta el día 28. Se registraron las siguientes variables del shock séptico, shock refractario, causa de la insuficiencia renal aguda, anemia, desnutrición, el tiempo de inicio de antimicrobiano, presión oncótica y puntaje de gravedad. Análisis estadístico: Se calculó el hazard ratio (HR) y se construyeron tres modelos pronósticos por riesgos proporcionales de Cox. Resultados. La población fue de 263 pacientes; con un promedio de edad de 8 ± 3 años y con mortalidad del 33 %. El %SH ≥ 10,1 acumulado a las 96 h fue el único asociado; el HR (IC 95 %) ajustado fue perfil hemodinámico HR = 2,6 (1,95,6); por shock refractario, HR = 2,5 (1,6-5,6) y por desnutrición, HR = 8,3 (3,5-14). Conclusiones. El %SH > 10,1 % se relacionó con una mayor mortalidad a 28 días de ajustado al perfil hemodinámico, la refractariedad del shock y el estado nutricional.

Septic shock is one of the main causes of mortality. Fluid replacement stands out as the treatment of choice to reduce mortality. Objective. To determine the relation between the percentage of fluid overload (%FO) and mortality in children with septic shock. Methods. Cohort study in patients aged 1-17 years with septic shock, after fluid replacement with central venous pressure ≥ 5 mmHg, invasive monitoring, and complete recording of %FO up to 96 h. Follow-up and outcome measures were recorded up to day 28. The following outcome measures of septic shock were recorded: refractory shock, cause of acute kidney injury, anemia, malnutrition, time to antibiotic initiation, oncotic pressure, and severity score. Statistical analysis. The hazard ratio (HR) was estimated and three Cox proportional hazard models were developed. Results. The population included 263 patients; their average age was 8 ± 3 years. Mortality was 33 %. A %FO ≥ 10.1 % accumulated at 96 h was the only associated outcome measure; the HR (95 % confidence interval) was adjusted for hemodynamic profile, HR = 2.6 (1.95.6); refractory shock, HR = 2.5 (1.6-5.6); and malnutrition, HR = 8.3 (3.5-14). Conclusions. A %FO > 10.1 % was related to a higher mortality at 28 days of adjustment for hemodynamic profile, refractory shock, and nutritional status.

Relation between fluid overload and mortality in children with septic shock. / Relación entre sobrecarga hídrica y mortalidad en niños conshock séptico.

INTRODUCTION: Septic shock is one of the main causes of mortality. Fluid replacement stands out as the treatment of choice to reduce mortality. OBJECTIVE: To determine the relation between the percentage of fluid overload (%FO) and mortality in children with septic shock. METHODS: Cohort study in patients aged 1-17 years with septic shock, after fluid replacement with central venous pressure ≥ 5 mmHg, invasive monitoring, and complete recording of %FO up to 96 h. Follow-up and outcome measures were recorded up to day 28. The following outcome measures of septic shock were recorded: refractory shock, cause of acute kidney injury, anemia, malnutrition, time to antibiotic initiation, oncotic pressure, and severity score. STATISTICAL ANALYSIS AND METHODS: The hazard ratio (HR) was estimated and three Cox proportional hazard models were developed. RESULTS: The population included 263 patients; their average age was 8 ± 3 years. Mortality was 33 %. A %FO ≥ 10.1 % accumulated at 96 h was the only associated outcome measure; the HR (95 % confidence interval) was adjusted for hemodynamic profile, HR = 2.6 (1.95.6); refractory shock, HR = 2.5 (1.6-5.6); and malnutrition, HR = 8.3 (3.5-14). CONCLUSIONS: A %FO > 10.1 % was related to a higher mortality at 28 days of adjustment for hemodynamic profile, refractory shock, and nutritional status.

El shock séptico es una de las principales causas que puede llevar a la muerte. La reanimación hídrica constituye un destacado tratamiento para poder disminuir la mortalidad. Objetivo: determinar la relación entre el porcentaje de sobrecarga hídrica (%SH) y la mortalidad en niños con shock séptico. Métodos. Estudio de cohorte en pacientes con shock séptico de entre 1 y 17 años, posterior a la reanimación hídrica con presión venosa central ≥ 5 mmHg con monitoreo invasivo y registro completo de %SH hasta las 96 h. El seguimiento y la variable de desenlace se completaron hasta el día 28. Se registraron las siguientes variables del shock séptico, shock refractario, causa de la insuficiencia renal aguda, anemia, desnutrición, el tiempo de inicio de antimicrobiano, presión oncótica y puntaje de gravedad. Análisis estadístico: Se calculó el hazard ratio (HR) y se construyeron tres modelos pronósticos por riesgos proporcionales de Cox. Resultados. La población fue de 263 pacientes; con un promedio de edad de 8 ± 3 años y con mortalidad del 33 %. El %SH ≥ 10,1 acumulado a las 96 h fue el único asociado; el HR (IC 95 %) ajustado fue perfil hemodinámico HR = 2,6 (1,95,6); por shock refractario, HR = 2,5 (1,6-5,6) y por desnutrición, HR = 8,3 (3,5-14). Conclusiones. El %SH > 10,1 % se relacionó con una mayor mortalidad a 28 días de ajustado al perfil hemodinámico, la refractariedad del shock y el estado nutricional.

Techniques to Minimize the Effects of Acute Heat Stress or Chronic in Broilers

High environmental temperature is limiting factor in broiler production. In order to minimize the undesirable consequences of acute or chronic heat stress, the techniques of fixed dietary electrolyte balance and early heat conditioning were evaluated. The objective of this study was to evaluate the possible interactions and effects of dietary electrolyte balance and early heat conditioning on feed intake, body weight, feed conversion ratio, mortality, energy bioeconomic index, fecal moisture, abdominal fat, and breast meat color (L*a*b*) of broilers submitted to chronic or acute heat stress. In total, 1280 chicks, were equally divided in experiment I (chronic heat stress, 6h/day at 32ºC from 35 to 39 d of age) and II (acute heat stress, 36 ºC for 6h at 38 days of age). The data of both experiments were combined and analyzed according to a 2x2x2 factorial arrangement (early heat conditioning (ETC) or not; fixed dietary electrolyte balance (EB) or not; and exposure to acute or chronic heat stress). ETC consisted of exposing 5-d-old birds to 36.0 °C for 24 hours. No interaction among the evaluated factors was detected. Birds exposed to acute heat stress presented significantly higher compared with chronic heat stress. Fixed dietary EB resulted in significantly higher fecal moisture. Lower abdominal fat percentage was obtained in birds exposed to chronic relative to acute heat stress. Higher breast meat L* and b* values were observed in birds exposed to acute heat stress than those submitted to chronic heat stress, indicating worse meat quality.

Techniques to Minimize the Effects of Acute Heat Stress or Chronic in Broilers

High environmental temperature is limiting factor in broiler production. In order to minimize the undesirable consequences of acute or chronic heat stress, the techniques of fixed dietary electrolyte balance and early heat conditioning were evaluated. The objective of this study was to evaluate the possible interactions and effects of dietary electrolyte balance and early heat conditioning on feed intake, body weight, feed conversion ratio, mortality, energy bioeconomic index, fecal moisture, abdominal fat, and breast meat color (L*a*b*) of broilers submitted to chronic or acute heat stress. In total, 1280 chicks, were equally divided in experiment I (chronic heat stress, 6h/day at 32ºC from 35 to 39 d of age) and II (acute heat stress, 36 ºC for 6h at 38 days of age). The data of both experiments were combined and analyzed according to a 2x2x2 factorial arrangement (early heat conditioning (ETC) or not; fixed dietary electrolyte balance (EB) or not; and exposure to acute or chronic heat stress). ETC consisted of exposing 5-d-old birds to 36.0 °C for 24 hours. No interaction among the evaluated factors was detected. Birds exposed to acute heat stress presented significantly higher compared with chronic heat stress. Fixed dietary EB resulted in significantly higher fecal moisture. Lower abdominal fat percentage was obtained in birds exposed to chronic relative to acute heat stress. Higher breast meat L* and b* values were observed in birds exposed to acute heat stress than those submitted to chronic heat stress, indicating worse meat quality.(AU)

Fluid and Electrolyte Management Across the Age Continuum.

Optional function of body systems depends upon fluid and electrolyte balance; however, across the lifespan, disorders of fluid and electrolytes offset this, and the causative factors are varied. Nurses play a major role in the management of fluid and electrolyte balance. This article focuses on the role total body water content, plasma proteins, kidney function, and drug metabolism have on the age-related physiology impacting fluid and electrolyte balance, and on nursing implications.

Urinary Exosomes and Their Cargo: Potential Biomarkers for Mineralocorticoid Arterial Hypertension?

Arterial hypertension (AHT) currently affects approximately 40% of adults worldwide, and its pathological mechanisms are mainly related to renal, vascular, and endocrine systems. Steroid hormones as aldosterone and cortisol are highly relevant to human endocrine physiology, and also to endocrine hypertension. Pathophysiological conditions, such as primary aldosteronism, affect approximately 10% of patients diagnosed with AHT and are secondary to a high production of aldosterone, increasing the risk also for cardiovascular damage and heart diseases. Excess of aldosterone or cortisol increases the activity of the mineralocorticoid receptor (MR) in epithelial and non-epithelial cells. Current research in this field highlights the potential regulatory mechanisms of the MR pathway, including pre-receptor regulation of the MR (action of 11BHSD2), MR activating proteins, and the downstream genes/proteins sensitive to MR (e.g., epithelial sodium channel, NCC, NKCC2). Mineralocorticoid AHT is present in 15-20% of hypertensive subjects, but the mechanisms associated to this condition have been poorly described, due mainly to the absence of reliable biomarkers. In this way, steroids, peptides, and lately urinary exosomes are thought to be potential reporters of biological processes. This review highlight exosomes and their cargo as potential biomarkers of metabolic changes associated to mineralocorticoid AHT. Recent reports have shown the presence of RNA, microRNAs, and proteins in urinary exosomes, which could be used as biomarkers in physiological and pathophysiological conditions. However, more studies are needed in order to benefit from exosomes and the exosomal cargo as a diagnostic tool in mineralocorticoid AHT.