Adequate Fluid Volume Research Articles

Intraabdominal infection: peritonitis as abdominal sepsis. Principles of intensive therapy

Acute disseminated peritonitis is one of such complex, severe and frequent diseases in abdominal surgery. The lethality of this disease does not decrease below 24–35 %, and with the development of septic shock, it is 60–70 %, and in the case of joining SPON, it reaches 80–100 %. “Abdominal sepsis” (AS) is currently defined as an increase in the SOFA score by ≥ 2 points due to an intra-abdominal infection. If the patient requires the use of vasopressors to maintain an average blood pressure of ≥ 65 mm Hg. (despite adequate fluid volume filling) and a serum lactate level ≥ 2 mmol/l, the clinical situation is defined as septic shock. Monitoring of the level of procalcitonin and the level of C-reactive protein, which solves the problems of verification of the bacterial etiology of sepsis, forecasting its course, and the duration of antibacterial therapy, are among the methods of early diagnosis of abdominal sepsis. Microbiological diagnosis of peritonitis as the main form of AS is mandatory. Effective treatment of IAI is early recognition and elimination of the source, lavage of the abdominal cavity, removal of exudate and interdisciplinary treatment with antibiotics in intensive care.

Observations of Dynamic Blood Electrolyte Concentrations After Administration of Colonic Cleansing Lavages

Introduction: Colonic cleansing lavages are osmotically active solutions, usually containing salts and/or PEG. To optimize efficacy and safety, the cleansing solution composition should be balanced to promote both adequate fluid volume (to induce a cleansing diarrhea) while also minimizing electrolyte losses or gains from the body. Poorly formulated preparations may provide sufficient cleansing volume but can alter electrolyte concentrations due to diarrheal losses increasing the likelihood of hyponatremia and other hematological abnormalities. A balanced formulation provides sufficient electrolyte supplementation to minimize blood electrolyte excursions. Methods: Healthy men (< 50 yoa) were restricted to a clinic on ad-libitum liquid diet. Cohorts of 5 subjects were given FDA approved bowel preparations: an Oral Sulfate Solution (OSS-SUPREP® Bowel Prep Kit, Braintree Laboratories, Inc.), PEG-ELS (NuLYTELY®, Braintree Laboratories, Inc.) or PEG-EA (MoviPrep® Salix Pharmaceuticals, Inc.), administered according to the manufacturer’s instructions in a split dose regimen. Blood samples were collected for analysis before each dose (pre-dose), and at 1 and 2 hour intervals post dosing. Results: Analysis of blood electrolytes from subjects revealed small fluctuations from baseline in Na, Cl and K post-dosing for all preparations. Small decreases in Na (OSS/PEG-ELS) and Cl (OSS) and increases in Na (PEG-EA), Cl (PEG-EA) and K (OSS/PEG-EA), were determined to be statistically significant (P<0.05) however, in all cases, the mean electrolyte concentration did not deviate outside of the normal ranges for this population. Conclusion: The consumption of osmotically active lavage solutions promotes cleansing by maximizing the fluid volume traversing the colon. However, this process has the potential to alter electrolyte concentrations thereby increasing the possibility of hyponatremia and other hematological imbalances. An investigation of the FDA approved bowel preparations OSS, PEG-ELS and PEG-EA, which were specifically formulated to minimize electrolyte shifts, demonstrates minimal impact on overall blood electrolyte concentration over the duration of the experimental period.510_A Figure 1 No Caption available.510_B Figure 2 No Caption available.510_C Figure 3 No Caption available.

Biomarkers of Kidney Damage and Hydration among Nicaraguan Sugarcane Workers

Background: In Central America, an epidemic of chronic kidney disease (CKD) of unknown etiology has been described in young, male agricultural workers. One potential cause is repeated exposure to heat and strenuous labor, coupled with dehydration and chronic volume depletion. Our aims were to explore differences in self-reported hydration by job category among sugarcane workers and evaluate associations with biomarkers of kidney damage. Methods: Our study population included 284 sugarcane workers representing 7 different job categories. Questionnaires were administered to assess hydration practices, and blood and urine samples were collected at the beginning and end of the 6-month harvest season. We measured biomarkers of kidney damage, including serum creatinine (used to estimate glomerular filtration rate (eGFR)) and urine interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), and creatinine. Results: Self-reported consumption of water and bolis (an electrolyte and water solution) differed by job category (p&lt;0.0001), with field workers, particularly cane cutters, consuming more than non-field workers. There were no associations of self-reported fluid consumption with eGFR, NGAL, or IL-18, after controlling for job category, sex, age, years worked at the company, and alcohol consumption. When stratified by job category, for every additional bolis packet consumed among cane cutters (n=51), mean change in eGFR during the harvest increased by 5.9 mL/min/1.73 m2 (95% CI: 0.5 to 11.2 mL/min/1.73 m2) and mean change in NGAL decreased by 21.5 µg/g creatinine (95% CI: -36.6 to -6.3 µg/g creatinine). Conclusions: Increased bolis consumption appeared protective for cane cutters, a high risk population, though this was not observed in the population as a whole. These findings suggest that maintaining adequate fluid volume may be important in the pathogenesis of CKD in Nicaragua.

A survey of reprocessing methods, residual viable bioburden, and soil levels in patient-ready endoscopic retrograde choliangiopancreatography duodenoscopes used in Canadian centers.

To obtain information about current reprocessing practices and to obtain samples from the biopsy channel to quantitate soil levels and bioburden in patient-ready flexible duodenoscopes used for endoscopic retrograde choliangiopancreatography (ERCP). Participating centers were sent a questionnaire and a kit for on-site collection of samples from the biopsy channel of the duodenoscope. Thirty-seven hospitals from across Canada participated. The only criterion was that they currently used and reprocessed flexible duodenoscopes for ERCP procedures. The questionnaire obtained information on reprocessing practices. The kit included a detailed instruction booklet outlining sample collection and all of the tubes, sterile water, and brushes needed for it. Samples were collected on-site from all ERCP scopes in each center on Monday morning and shipped by overnight courier on ice to the research center. Each sample was assayed by routine microbiologic methods for total viable count and protein, blood, carbohydrate, and endotoxin levels. Microbial overgrowth was present in 7% of 119 scope samples. Cleaning appeared to be reasonably well done in most of the centers, and 43% of the centers were in total compliance with basic national guidelines. The data from the scope samples indicated that there was significantly greater buildup of protein, carbohydrate, and endotoxin associated with ERCP scopes from centers using glutaraldehyde, compared with those using peracetic acid. Carbohydrate was the soil component detected most frequently and in the highest concentration in scope channels. Although cleaning was generally well done, areas for improvement included ensuring the availability of written reprocessing protocols, immersion of scopes during manual cleaning, use of adequate fluid volume for rinsing, adequate drying of scopes prior to storage, and the separation of ERCP valves from scopes during storage.

Neuroendocrine control of blood volume, blood pressure and cardiovascular function in horses

SummarySeveral body systems make critical contributions to the defence of blood volume, mean arterial pressure and plasma tonicity. These mechanisms ensure adequate blood flow to the working muscles and vital tissues along with the provision of adequate fluid volume for sweating and thermoregulation. The present paper integrates data from several recent studies that examined the neuroendocrine control of cardiovascular function in exercising horses. These studies focused on the effects of exercise on plasma concentrations of atrial natriuretic peptide (ANP), arginine vasopressin (AVP), plasma renin activity (PRA) and aldosterone (ALDO), hormones associated with the regulation of blood pressure, the distribution of blood flow and the long term control of vascular fluid volume. Data were collected during incremental and endurance exercise, following frusemide administration and after splenectomy. Increases in ANP during exercise were associated with increased atrial pressure and stretching of the atrium. Increases in PRA and ALDO are correlated with increases in sympathetic activity during incremental exercise and with decreases in plasma Na+ and CI− concentrations. Plasma AVP increases later in exercise in response to fluid losses, increases in plasma osmolality, and decreases in right atrial pressure. AVP has a minimal effect on renal function during exercise and may be more important during recovery, when it stimulates thirst and drinking. Frusemide and splenectomy decrease atrial pressure, resulting in lower plasma ANP and greater plasma AVP concentrations during steady‐state submaximal exercise. The ANP and AVP responses are part of the neuroendocrine action of the cardiopulmonary baroreflex which appears to mediate the accommodation of the mobilised splenic reserve in the horse. In summary, exercise induced increases in ANP, AVP, PRA and ALDO in the horse appear to play an important role in cardiovascular homeostasis.

Induction of transient hyperglycaemia in cancer patients

Serum glucose levels up to 700 mg/dl were achieved and maintained for 3 h in patients with advanced metastatic cancer by infusion of concentrated glucose solutions. Even with infusions of large amounts of glucose, the maximum sustainable level of serum glucose did not exceed 700 mg/dl. The apparent ceiling of serum glucose level appeared to be due to a large and rapid loss of glucose from the kidneys. With adequate fluid volume replacement there was no rebound hypoglycaemia and there was no significant changes in haematocrit or electrolytes.

Impact of residual amniotic fluid volume in patients receiving parenteral tocolysis after premature rupture of the membranes

The inhibition of labor subsequent to premature rupture of the membranes remains controversial. To evaluate the possibility that diminished amniotic fluid volume impacts on the latent period in patients receiving tocolytic therapy after premature rupture of the membranes, we reviewed our recent clinical experience with premature rupture of the membranes and the use of tocolytic agents. Between January 1985 and June 1988, 70 singleton pregnancies with premature rupture of the membranes between 25 and 34 weeks of gestation without prior tocolytic therapy were included. Ritodrine (n = 22), magnesium sulfate (n = 37), or both agents (n = 11) were administered and followed by oral terbutaline if tocolysis was achieved. Ultrasonographic examination was performed after admission and patients were grouped on the basis of estimates of residual amniotic fluid volume. Fourteen patients had adquate fluid volume; 20 had diminished fluid volume, and 36 had oligohydramnios. Patients with adequate fluid volume had a significantly longer interval between tocolytic therapy and delivery when compared with the other two categories (analysis of variance, p < 0.001), and proportionately more patients remained undelivered for >1 week (adequate 8 of 14 vs. diminished 3 of 20 and oligohydramnios 3 of 36; p < 0.001). In the 18 patients with premature rupture of the membranes before 30 weeks' gestation, adequate fluid volume was associated with the longest latent period (adequate 14.0 days; diminished 12.6 days, and oligohydramnios 2.8 days; analysis of variance, p < 0.05). We conclude that tocolytic therapy is of little benefit in the presence of oligohydramnios. If additional prospective studies of tocolytic efficacy in pregnancies complicated by premature rupture of the membranes are undertaken, inclusion of residual amniotic fluid volume as an independent variable before randomization should be considered.

Atrial natriuretic peptide and other vasoactive hormones during treatment of severe diabetic ketoacidosis in children

Plasma concentrations of atrial natriuretic peptide (ANP), arginine vasopressin (AVP), renin activity (PRA), aldosterone, norepinephrine, and cortisol, and renal functions were investigated in nine children with diabetic ketoacidosis. Before therapy, blood glucose concentration was 608.4 +/- 142.2 mg/dL and base excess -21 +/- 1.9 mmol/L. The calculated volume depletion was 2505 +/- 1005 mL/1.73 m2. At the onset of the study, the plasma concentration of ANP (5.3 +/- 1.2 fmol/L) was low, and concentrations of AVP (159 +/- 44 pg/mL), PRA (59 +/- 19 ng angiotensin l/mL/hr), aldosterone (114 +/- 11 ng/dL), norepinephrine (430 +/- 67 pg/mL), and cortisol (33 +/- 2.1 micrograms/dL) were markedly elevated. Fluid replacement raised plasma ANP concentration, which reached physiologic levels on the first day of therapy. PRA, aldosterone, norepinephrine, and cortisol also normalized during the first 24 hours of therapy, whereas AVP remained above the physiologic range at 20.4 +/- 6.8 pg/mL on the third day. Our data indicate that in diabetic ketoacidosis, volume depletion, enhanced sodium excretion, and hyponatremia activated vasoconstrictor and sodium-retaining hormone systems and that secretion of the natriuretic and vasodilator hormone ANP is suppressed. All of these hormonal alterations seem directed at maintaining adequate fluid volume and sodium homeostasis.

The role of ultrasound assessment of amniotic fluid volume in the management of the postdate pregnancy

Antepartum assessments of amniotic fluid volumes and their relationship to nonstress test patterns and pregnancy outcomes were retrospectively analyzed in 234 postdate pregnancies. The incidence of clinical oligohydramnios and a nonstress test revealing fetal heart rate deceleration or bradycardia was found to increase as the sonographic estimates of the amniotic fluid volume decreased. Furthermore, the postdate pregnancy with sonographic evidence of an adequate amniotic fluid volume had a significantly better perinatal outcome than the pregnancy without an adequate fluid volume. These results suggest that the postdate pregnancy with evidence of reduced amniotic fluid volume should be considered for a trial of labor with continuous electronic fetal monitoring.