Fluid Intake In Patients Research Articles

OPPORTUNITIES FOR TREATMENT WITH A TEMPORARY OBTURATOR MADE OF THERMOPLASTIC FOIL

Prosthetic treatment with a temporary obturator is an intermediate stage in the overall prosthetic rehabilitation of patients with maxillary resection. According to prevailing opinions, treatment with a temporary obturator should start around 2 weeks to 2-3 months after resection and to continue until the final completion of the healing processes in the defect. Due to the dynamic changes in the defect, this treatment stage is associated with many difficulties, requiring frequent correction of the obturator and up to 12-14 clinical visits on average. The aim of the research is to track the opportunity for fabrication of a temporary obturator of thermoplastic foil with vacuum forming apparatus and its efficiency for restoring speech and fluid intake in patients with maxillary resection. For the aim of the study we conducted a treatment of a 45-year-old patient operated a week ago for maxillary carcinoma. As a result, the left alveolar bone and a part of the hard palate with a diameter of 10 mm were resected, with teeth 13 to 23, 16 and 17 preserved. The defect was padded with gauze and an impression with an irreversible hydrocolloid impression material was taken. In the laboratory a grade 4 plaster working model was cast on which the borders of the palatal plate were outlined. For the frontal teeth, these were the cervical areas of the teeth, and for the distal - their equators. In the area of the defect and the missing teeth the border reached the transitional fold, and distally - the soft palate. The plate was made from foil of 1 mm diameter which was drawn onto the model with a vacuum forming apparatus and was cut along the indicated borders. The palatal plate - obturator successfully closed the comunication to the nasal cavity and restored the opportunity for fluid intake, which was the main problem for the patient. The use of a foil with a thickness of 1 mm provided stability and resistance of the construction. As a result of this, the necessary hermetic seal of the defect was achieved and the speech of the patient was normalised. The described treatment methodology with a temporary obturator allows the successful restoration of speech and fluid intake during the healing processes in the defect. The main advantages of the method are the fast and easy fabrication, the opportunity for multiple corrections and the short period of adaptation.

The relationship of the prevalence of caries with the immune status of preschool and schoolage children in the city of Makhachkala

Relevance. The study of the relationship between dental morbidity and immune status is relevant due to the high prevalence of caries and the level of somatic health of children in Makhachkala.Materials and methods. The survey involved 425 children aged 2 to 17 years, long-term residents in Makhachkala. The average value of the CPI index corresponds to 5.5. To determine the relationship between the presence of caries and the immune status of children, 33 patients were selected from the examined to participate in a study to determine immunoglobulins in oral fluid in three age periods (11 children aged 6, 12 and 15 years). Oral fluid intake in patients was carried out 2 hours after meals. Determination of the concentration of immunoglobulins (secretory sIgA, IdA, IgM and IgG) was carried out using a set of reagents for enzyme immunoassay determination of the concentration of secretory immunoglobulins in "Invitro". Statistical analysis of the material was carried out using the IBM SPSS Statistics Standard program.Results. In Makhachkala, an increase in the prevalence of caries with age was revealed in preschoolers (6 years) 78.2 ± 0.3%, in adolescence (12 years) 78.9 ± 0.2%, in children with permanent bite (15 years) reaches 85.2 ± 0.6%. Studies of the immune status showed that immunoglobulins varied individually and by age groups. sIgA immunoglobulin, which allows to control immunity before the disease, decreased by more than 3 times by the period of permanent bite. Immunoglobulin IgA, which plays a protective function in humoral immunity, decreased by more than 70% by the period of permanent bite. IgM immunoglobulin increased by more than 40% in children by the age of 15. Changes also occurred with the content of the enzyme lysozyme, decreasing by the age of 15 years almost 6 times from the norm.Conclusions. The high morbidity rate of the children's population in Makhachkala is associated with anthropogenic impact, poor-quality drinking water, air and indicates the need for early detection of chronic somatic diseases and the organization of preventive and medical-dental care for children from an early age.

A randomized controlled trial of the GLP-1 receptor agonist dulaglutide in primary polydipsia.

BackgroundPrimary polydipsia, characterized by excessive fluid intake, carries the risk of water intoxication and hyponatremia, but treatment options are scarce. Glucagon-like peptide 1 (GLP-1) reduces appetite and food intake. In experimental models, GLP-1 has also been shown to play a role in thirst and drinking behavior. The aim of this trial was to investigate whether GLP-1 receptor agonists reduce fluid intake in patients with primary polydipsia.MethodsIn this randomized, double-blind, placebo-controlled, 3-week crossover trial, 34 patients with primary polydipsia received weekly dulaglutide (1.5 mg, Trulicity) in one treatment segment and placebo (0.9% sodium chloride) in the other. During the last treatment week, patients attended an 8-hour evaluation visit with free access to water. The primary endpoint was total fluid intake during the evaluation visits. Treatment effects were estimated using linear mixed-effects models. In a subset of 15 patients and an additional 15 matched controls, thirst perception and neuronal activity in response to beverage pictures were assessed by functional MRI.RESULTsPatients on dulaglutide reduced their fluid intake by 490 mL (95% CI: -780, -199; P = 0.002), from 2950 mL (95% CI: 2435, 3465) on placebo to 2460 mL (95% CI: 1946, 2475) on dulaglutide (model estimates), corresponding to a relative reduction of 17%. Twenty-four-hour urinary output was reduced by -943 mL (95% CI: -1473, -413; P = 0.001). Thirst perception in response to beverage pictures was higher for patients with primary polydipsia than for controls, and lower for patients on dulaglutide versus placebo, but functional activity was similar among groups and treatments.CONCLUSIONSGLP-1 receptor agonists reduce fluid intake and thirst perception in patients with primary polydipsia and could therefore be a treatment option for these patients.Trial registrationClinicaltrials.gov NCT02770885.FundingSwiss National Science Foundation (grant 32473B_162608); University Hospital and University of Basel; Young Talents in Clinical Research grant from the Swiss Academy of Medical Sciences and the Gottfried & Julia Bangerter-Rhyner Foundation; Top-up Grant from the PhD Programme in Health Sciences, University of Basel.

Assessment and Impact of Intravenous Medication Fluid Administration in Critically Ill Patients With Acute Respiratory Failure.

Positive fluid balance early in critical illness is associated with poor outcomes. Reducing intravenous medication volume may mitigate volume overload. Objective: Assessment of fluid and medication administration and clinical outcomes in acute respiratory failure. Single-center, prospective observational study of hemodynamically stable adult patients in a medical intensive care unit (MICU) with acute respiratory failure. Median cumulative total intake volume was 12 890 (interquartile range [IQR] = 8654-22 221) mL (n = 27), and median cumulative intravenous medication volume was 3563 (IQR = 2371-9412) mL over the first 7 days. Medication volume accounted for 27.6% of aggregate fluid volume. Median daily intravenous medication volume administered was 591 (IQR = 339-1082) mL. Cumulative fluid volume was associated with reduced ventilator-free days (r2 = -0.393; P = 0.043), and cumulative fluid volumes during the first 3 and 7 days were associated with increased MICU length of stay (LOS ± standard error 0.73 ± 0.35 d/L, P = 0.047, and 0.38 ± 0.16 d/L, P = 0.021, respectively). Cumulative medication volume administered significantly reduced the likelihood of mechanical ventilator liberation (hazard ratio [HR] = 0.917; 95% CI: 0.854, 0.984; P = 0.016) and MICU discharge (HR = 0.911; 95% CI: 0.843, 0.985; P = 0.019). Small-volume infusion may decrease cumulative intravenous medication volume by 38%. Intravenous medication diluent contributes substantially to total fluid intake in patients with acute respiratory failure and is associated with poor outcomes. Reduction of intravenous medication fluid volume to improve clinical outcomes should be further investigated.

GLP1 Receptor Agonists Reduce Fluid Intake in Primary Polydipsia

Background Primary polydipsia, characterized by excessive fluid intake, carries the risk of water intoxication and hyponatremia, but treatment options are scarce. Glucagon-like peptide-1 (GLP-1) reduces appetite and food intake. In experimental models, they also play a role in thirst and drinking behavior in. The aim of this trial was to investigate whether GLP-1 receptor agonists reduce fluid intake in patients with primary polydipsia. Methods: In this randomized, double-blind, placebo-controlled, 3-week crossover-trial, 34 patients with primary polydipsia received weekly dulaglutide (Trulicity®) 1.5mg and placebo (0.9% sodium chloride). During the last treatment week, patients attended an 8-hour evaluation visit with free water access. The primary endpoint was total fluid intake during the evaluation visits. The treatment effect was estimated using a linear mixed-effects model. In a subset of 15 patients and matched controls, thirst perception and neuronal activity in response to beverage pictures were assessed by functional MRI. Results Median [IQR] total fluid intake was 2250ml [1600-2600] on dulaglutide versus 2400ml [1850-3400] on placebo. Patients on dulaglutide reduced fluid intake by 490ml [95%-CI -780, -199], p=0.002, corresponding to a relative reduction of 17%. 24-hour urinary output was reduced by -943ml [95%-CI -1473, -413]. Thirst perception in response to beverage pictures was higher in patients with primary polydipsia versus controls and lower on dulaglutide versus placebo, but functional neuronal activity was similar between groups and treatments. Conclusion: GLP-1 receptor agonists reduce fluid intake and thirst perception in patients with primary polydipsia and could therefore be a novel treatment option for these patients.

Individualized fluid administration for critically ill patients with sepsis with an interpretable dynamic treatment regimen model

Fluid strategy is the key to the successful management of patients with sepsis. However, previous studies failed to consider individualized treatment strategy, and clinical trials typically included patients with sepsis as a homogeneous study population. We aimed to develop sequential decision rules for managing fluid intake in patients with sepsis by using the dynamic treatment regimen (DTR) model. A retrospective analysis of the eICU Collaborative Research Database comprising highly granular data collected from 335 units at 208 hospitals was performed. The DTR model used a backward induction algorithm to estimate the sequence of optimal rules. 22,868 patients who had sepsis according to the Acute Physiology and Chronic Health Evaluation (APACHE) IV diagnosis group were included. Optimal fluid management (liberal [> 40 ml/kg/d] versus restricted [< 40 ml/kg/d]) strategy were developed on the Day 1, 3 and 5 after ICU admission according to current states and treatment history. Important determinants of optimal fluid strategy included mean blood pressure, heart rate, previous urine output, previous fluid strategy, ICU type and mechanical ventilation. Different functional forms such as quadratic function and interaction terms were used at different stages. The proportion of subjects being inappropriately treated with liberal fluid strategy (i.e. those actually received liberal fluid strategy, but could have longer survival time if they received restricted fluid strategy) increased from day 1 to 5 (19.3% to 29.5%). The survival time could be significantly prolonged had all patients been treated with optimal fluid strategy (5.7 [2.0, 5.9] vs. 4.1 [2.0, 5.0] days; p < 0.001). With a large volume of sepsis data, we successfully computed out a sequence of dynamic fluid management strategy for sepsis patients over the first 5 days after ICU admission. The decision rules generated by the DTR model predicted a longer survival time compared to the true observed strategy, which sheds light for improving patient outcome with the aim from computer-assisted algorithm.

Evaluation of Iranian CRF and ESRD Patients admitted to Medical Centers of Mecca &amp; Medina in Hajj travel of 2012 &amp;2013; Causes &amp; Outcome

Background: Chronic renal failure (CRF) and end-stage renal disease (ESRD) are among the underlying reasons for the hospitalization of expeditionary pilgrims to Mecca. This study aimed to evaluate the reasons and consequences of sending the patients with CRF and ESRD to Mecca to perform rites of pilgrimage. Methods: This retrospective cross-sectional study assessed the profiles of all pilgrims in 2012 and 2013. The independent variables were awareness and unawareness of the patients with CRF and patients on dialysis; moreover, the dependent variables were reasons for referral and hospitalization in hospital, probable death rate, and indications of dialysis in an emergency. Results: Out of all Pilgrims, 2416 (1.76% of the total pilgrims’ population) cases had CRF, out of whom 1.15%, 10.47%, and 88.36% of the patients were on dialysis, aware, and unaware of their disease, respectively. Furthermore, 93 (3.9%) patients with CRF were hospitalized during Hajj. Cardiovascular disease (41%) and respiratory diseases (20%) were the most common reasons for patients’ hospitalization. Conclusion: It is suggested that the glomerular filtration rate of the pilgrims be calculated before sending them to Hajj; moreover, the patients with CRF should be screened accurately. Proper vaccination and cardio check-up are necessary before the Hajj expedition. Considering low-salt diet and adequate fluid intake in patients with CRF during Hajj can minimize patients' referral to hospitals.

Effects of Auricular Acupressure in Patients on Hemodialysis.

Although studies on the effectiveness of self-management in limiting fluid intake in patients on hemodialysis have been conducted extensively, xerostomia, which is a powerful stimulus of fluid intake, has received scarce attention. The purpose of this study was to examine the effects of a 4-week auricular acupressure treatment on xerostomia, salivary flow rate, interdialytic weight gain, constipation, and diet-related quality of life in patients on hemodialysis in Korea. This was a randomized controlled trial. Sixty patients on hemodialysis were randomly assigned to either the experimental group (n = 30) or the control group (n = 30). The experimental group received an auricular acupressure intervention, which included the application of skin tape with a Semen vaccariae seed on the five auricular acupoints, including the large intestine (CO7), San Jiao (CO17), middle triangular fossa (TF3), spleen (CO13), and upper tragus (TG1), for 4 weeks. The control group received only the application of skin tape without a seed on the same auricular acupoints for the same period. The outcome variables were as follows: xerostomia, measured using the visual analog scale; salivary flow rate, measured using the unstimulated whole saliva absorbed in oral cotton; interdialytic weight gain; the constipation assessment scale score; and the Quality of Life Related to Dietary Change Questionnaire results. The experimental group scored significantly better than the control group in terms of xerostomia (p = .004), salivary flow rate (p = .010), constipation (p = .009), and diet-related quality of life (p < .001). Auricular acupressure may be an important tool for alleviating the negative symptoms of xerostomia and for improving quality of life in patients on hemodialysis. Nurses caring for patients on hemodialysis with both xerostomia and constipation may teach auricular acupressure to help patients self-manage their discomfort.

INCREASED FLUID INTAKE IN PATIENTS WITH CHRONIC KIDNEY DISEASE UNDERGOING HEMODIALYSIS

Introduction: Some of the main nursing problems that arise in patients with chronic kidney failure undergoing hemodialysis are problems with excess fluid volume.The aim of this study was to describe increased fluid intake in patients with chronic kidney disease undergoing hemodialysis at Ulin General Hospital of Banjarmasin.Methods: This was a descriptive cross sectional study. 80 respondents were taken using consecutive sampling. The instruments used in this study were questionnaire of demographic, knowledge, attitude, family support, involvement of health workers and Inter-Dialytic Weight Gain (IDWG) calculation sheets.Results: The results showed that the majority of respondents were women (53.8%), the education of respondents was high school (28.8%), the average age of respondents was 48.19 years old, most respondents had been undergoing hemodialysis for less than 12 months (57.5%), the frequency of hemodialysis was 2 times each week (93.8%), the level of knowledge was good (42.5%) and moderate (42.5%), the family support was good (86.3%), the attitude was positive (55%), the involvement of health workers was good (60%), and the majority of respondents had moderate IDWG criteria (47.5%).Conclusion: Almost half of patients with chronic kidney disease who were undergoing hemodialysis at Ulin General Hospital of Banjarmasin had moderate IDWG. Further study is needed to investigate related factors of excessive fluid intake in patients undergoing hemodialysis.

GRANTING OF EDUCATION STRUCTURED NUTRITION AND ELECTROLYTE (ESNE) ON CHANGING INTERDIALYTIC WEIGHT GAIN IN CHRONIC CALCULATION FAILURE PATIENTS

ABSTRACT&#x0D; &#x0D; GRANTING OF EDUCATION STRUCTURED NUTRITION AND ELECTROLYTE (ESNE) ON CHANGING INTERDIALYTIC WEIGHT GAIN IN CHRONIC CALCULATION FAILURE PATIENTS&#x0D; By Lutfi Wahyuni, Ika Ainur rofiah, Mochammad Achwandi&#x0D; Chronic kidney disease is a condition when kidney function begins to decline gradually. The condition of the decline in kidney function occurs due to many factors, one of which is because the kidney damage that has occurred intensely for many years. Patients with chronic renal failure need a management or hemodialysis therapy, which is the cleansing process of blood from waste substances, through a screening process outside the body using an artificial kidney in the form of a dialysis machine. Hemodialysis therapy is needed in the management of patients with chronic renal failure who cannot be treated again (terminal). The success of hemodialysis is based on various elements, one of which is compliance with fluid restrictions. Limitation of fluid intake in patients with chronic renal failure is very important. The provision of structured education can be given to patients with chronic kidney failure who are undergoing hemodialysis therapy. Education structured nutrition and electrolyte (ESNE) is a structured health education on nutrition and electrolyte management for chronic renal failure patients undergoing hemodialysis. ESNE is done to improve patients' understanding of diet and electrolyte compliance to prevent an increase in IDWG and to improve patient compliance with fluid restrictions. The stages of service activities that have been carried out are to explain fluid requirements and fluid restriction in patients with chronic renal failure using the Education structured nutrition and electrolyte (ESNE) method, the next recourse is an evaluation after continuous or ESNE administration of respondents given treatment and respondents who were not treated. Keywords: Diet, Chronic Kidney Disease, Hemodialysis

POJOK BACA (BALANCE CAIRAN) UNTUK SURVIVOR HEMODIALISIS

Background: Management of end-stage renal failure patients one of the treatments is hemodialysis. Complications that arise with respect to fluid overload in patients with kidney failure can be prevented through effective and efficient fluid intake restrictions. Efforts to create restrictions on fluid intake in patients with kidney failure can be done through monitoring fluid intake per day. Fluid restriction program in patients in order to prevent complications and maintain quality of life, it is necessary to analyze practices related to intervention in controlling the amount of fluid intake through recording the amount of fluid taken and urine released every day. Pojok Balance Cairan (BACA) is one way to help hemodialysis patients learn how to calculate fluid needs in their body and help determine dietary settings for hemodialysis patients where in the reading corner will be explained related to how to calculate fluid balance and how the right diet in patients hemodialysis according to the severity of the disease. Method of implementation: lectures and demonstrations. Conclusion: POJOK BACA can prolong the life of patients undergoing hemodialysis because it can reduce the risk of complications that arise such as shortness of breath.Keywords: Hemodialysis, Liquid, Pojok Baca

Changes in renal papillary density after hydration therapy in calcium stone formers

BackgroundPrevious studies have shown that, compared with non-stone formers, stone formers have a higher papillary density measured with computer tomography (CT) scan. The effect of increased hydration on such papillary density in idiopathic calcium stone formers is not known.MethodsPatients with recurrent calcium oxalate stones undergoing endourological procedures for renal stones at our Institution from June 2013 to June 2014 were considered eligible for enrolment. Enrolled patients underwent a baseline unenhanced CT scan before the urological procedure; after endoscopic removal of their stones, the patients were instructed to drink at least 2 L/day of a hypotonic, oligomineral water low in sodium and minerals (fixed residue at 180 °C < 200 mg/L) for at least 12 months. Finally, the patients underwent a follow-up unenhanced CT scan during hydration regimen.ResultsTwenty-five patients were prospectively enrolled and underwent baseline and follow-up CT scans. At baseline, mean papillary density was 43.2 ± 6.6 Hounsfield Units (HU) (43.2 ± 6.7 for the left kidney and 42.8 ± 7.1 HU for the right kidney). At follow-up and after at least 12 months of hydration regimen, mean papillary density was significantly reduced at 35.4 ± 4.2 HU (35.8 ± 5.0 for the left kidney and 35.1 ± 4.2 HU for the right kidney); the mean difference between baseline and follow-up was − 7.8 HU (95% confidence interval − 10.6 to − 5.1 HU, p < 0.001).ConclusionsIncreased fluid intake in patients with recurrent calcium oxalate stones was associated with a significant reduction in renal papillary density.Trial registrationNCT03343743, 15/11/2017 (Retrospectively registered).

The minimum amount of fluids needed to achieve the fastest time to reach permissible level for release in well-differentiated thyroid patients undergoing high-dose I-131 therapy.

Radioiodine (131I) therapy is the mainstay of treatment for patients who had undergone total thyroidectomy for well differentiated thyroid carcinoma. Increased fluid intake has always been encouraged to minimize the risk of non-target organ exposure to I-131radiation. This study aimed to determine the minimum amount of fluids needed for patients to have the fastest time to achieve permissible level for release after high dose I-131therapy. Methodology: All the patients who were treated with high dose I-131from 18th January 2016 till 31st December 2016 in Hospital Pulau Pinang, Malaysia were recruited. The data from 126 patients on thyroxine hormone withdrawal (THW) group and 18 patients on recombinant human thyroid stimulating hormone (rhTSH) group were analysed. There is no change in patient management in terms of preparation, dose or post therapy whole-body scan. Fluid intake of patients were monitored strictly and whole-body retention of I-131are measured using ionizing chamber meter immediately after ingestion of I-131then at 1 hour, 24 hours, 48 hours, 72 hours and 96 hours. Results: The median time to achieve permissible release limit (50 μSV/hr at 1 meter) was 21.6 hours and 22.1 hours post-ingestion of I-131in the THW and rhTSH group respectively. The minimum amount of fluid needed to reach permissible release limit in the fastest time was 2,103 ml and 2,148ml for the THW and TSH respectively. Conclusion: Clinicians would be able to evidently advise their patient on the amount of fluid to consume and utilize their isolation wards faster to treat more patients.

Is it Safe to Reduce Water Intake in the Overactive Bladder Population? A Systematic Review

Overactive bladder imposes a significant socioeconomic burden on the health care system. It is a commonly held belief that increased fluid intake (8glasses of water per day) is beneficial for health. However, increased fluid intake exacerbates overactive bladder symptoms. Thus, it is imperative that clinicians appropriately educate patients for whom increased water intake may be detrimental (women with overactive bladder), in contrast to patients with comorbidities that necessitate increased water intake (nephrolithiasis). We systematically reviewed the literature to determine the potential health advantages of increased water intake and identify specific subpopulations that need increased hydration. We systematically reviewed published articles from 1972 through 2017 on PubMed® and the Cochrane Library. The data were reviewed independently by 2 individuals. Studies were included if they explored water intake in relation to the risk of a particular disease. Level 1 evidence supported increased fluid intake in patients with nephrolithiasis. There was no available evidence to support increased fluid intake in patients with cardiovascular disease, constipation, venous thromboembolism, headaches, cognitive function or bladder cancer. Dehydration may exacerbate some conditions, specifically chronic constipation and headache intensity. Increased fluid intake may have a role in preventing stroke recurrence but not in preventing primary stroke. The available reviewed literature suggests no benefit to drinking 8 glasses of water per day in patients without nephrolithiasis. Also, excess fluid intake can exacerbate symptoms of overactive bladder.

HYPNODIALYSIS FOR ANXIETY RELIEF AND ADHERENCE TO MEDICATION, KIDNEY DIET AND FLUID INTAKE IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: To examine the effectiveness of hypnodialysis on anxiety levels and adherence to medication, kidney diet and fluid intake in patients with chronic kidney disease.&#x0D; Methods: This was a randomized controlled trial study conducted from November to December 2016. Thirty respondents recruited using simple random sampling, which 17 respondents assigned randomly in the experiment and control group. The Hamilton Anxiety Rating Scale (HARS), Morisky scale, adherence to kidney diet questionnaire, adherence to fluid intake questionnaire were used as instruments for this study. Paired t-test and repeated ANOVA were used for data analysis.&#x0D; Results: Findings showed that there was a statistically significant effect of hypnodialysis in reducing anxiety levels and improving adherence to medication, kidney diet, and fluid intake in patients with chronic kidney disease with p-value 0.000 (&lt;0.05), which its effect started from day 7 (posttest 1).&#x0D; Conclusion: Hypnodialysis may decrease anxiety levels and improve medication adherence, kidney diet and fluid intake. Therefore, hypnodialyis can be alternative treatment for patients with chronic kidney disease.

Effectiveness of a fluid chart in outpatient management of suspected dengue fever: A pilot study.

IntroductionDengue infection is the fastest spreading mosquito-borne viral disease in the world. One of the complications of dengue is dehydration which, if not carefully monitored and treated, may lead to shock, particularly in those with dengue haemorrhagic fever. WHO has recommended oral fluid intake of five glasses or more for adults who are suspected to have dengue fever. However, there have been no published studies looking at self-care intervention measures to improve oral fluid intake among patients suspected of dengue fever.ObjectiveTo assess the feasibility and effectiveness of using a fluid chart to improve oral fluid intake in patients with suspected dengue fever in a primary care setting.MethodsThis feasibility study used a randomized controlled study design. The data was collected over two months at a primary care clinic in a teaching hospital. The inclusion criteria were: age > 12 years, patients who were suspected to have dengue fever based on the assessment by the primary healthcare clinician, fever for > three days, and thrombocytopenia (platelets < 150 x 109/L). Both groups received a dengue home care card. The intervention group received the fluid chart and a cup (200ml). Baseline clinical and laboratory data, 24-hour fluid recall (control group), and fluid chart were collected. The main outcomes were: hospitalization rates, intravenous fluid requirement and total oral fluid intake.FindingsAmong the 138 participants who were included in the final analysis, there were fewer hospital admissions in the intervention group (n = 7, 10.0%) than the control group (n = 12, 17.6%) (p = 0.192). Similarly, fewer patients (n = 9, 12.9%) in the intervention group required intravenous fluid compared to the control group (n = 15, 22.1%), (p = 0.154). There was an increase in the amount of daily oral fluid intake in the intervention group (about 3,000 ml) compared to the control group (about 2,500 ml, p = 0.521). However, these differences did not reach statistical significance.ConclusionThis is a feasible and acceptable study to perform in a primary care setting. The fluid chart is a simple, inexpensive tool that may reduce hospitalization and intravenous fluid requirement in suspected dengue patients. A randomized controlled trial with larger sample size is needed to determine this conclusively.Trial registrationInternational Standard Randomized Controlled Trial Number (ISRCTN) Registry ISRCTN25394628 http://www.isrctn.com/ISRCTN25394628

Promoting fluid intake for patients with dementia or visual impairments

Promoting fluid intake for patients with dementia or visual impairments

Night diuresis stimulation increases efficiency of alarm intervention

The prevalence of primary monosymptomatic nocturnal enuresis (PMNE) varies from 1.6% to 15%. Although treatment with enuretic alarms has been used for a long period of time, there are many disadvantages, including the necessity for long-term use and the high percentage of children who are resistant to such therapy. We hypothesized that more intense use of the alarm system would accelerate the process of forming the conditioned response to awakening, caused by the desire to urinate and, probably, increase the percentage of patients with positive results. Increased fluid intake will cause more frequent awakenings, so the use of alarm system will be more intense (Figure). To study the effect of increased fluid intake, prior to going to bed, on the efficacy of alarm therapy. The treatment group consisted of 294 children (178 boys) average age: 11.3 (9.1-11.9) years. All participants completed an overactive bladder questionnaire (OAB-q) and a bladder diary, and underwent uroflowmetry, blood and urine testing. Group A (n = 141, mean age 10.9 (9.1-11.6) years), used the alarm system traditionally (Wet Stop/BYE-WET, USA). Group В (n = 153, mean age 11.5 (9.3-11.9) years) drank either water or any other transparent non-colored fluid (any table mineral water with mineralization of less than 1 g per dm³) once immediately prior to sleep at a volume of 4-5 ml/kg of body weight. The effectiveness of therapy was assessed by the change in frequency of urination episodes during sleep per week, episodes of spontaneous awakenings, caused by the desire to urinate per week. Data were analyzed using JMP SAS Statistical Discovery 8.0.2. Wilcoxon criterion was used for comparison of results between groups; correlation of changes in groups was analyzed using the Spearman coefficient. Complete resolution of NE, 2 weeks after the end of alarm therapy, was found in 34 patients (24%) in Group A and 59 (39%) in Group B. This difference was statistically significant with a confidence level of 95%. Having searched the publication databases, including PubMed and Scopus, we failed to find any publication presenting evidence or recommendations on the ideal management of fluid intake in patients with PMNE. Although a limitation of fluid intake is commonly recommended, there is no evidence showing an increase in dry night frequency when such fluid restriction is used as monotherapy. In contrast, our study has shown an improvement in outcome when an increased fluid intake is used in combination with enuretic alarm therapy. We were able to prove that increased fluid intake improved the efficiency of alarm therapy intervention during the treatment of PMNE in children.

Adipsic diabetes insipidus in pediatric patients.

To present symptoms, complications and proposition of management protocol in children diagnosed with adipsic diabetes insipidus (aDI). Clinical and biochemical analysis of six pediatric patients diagnosed with aDI, four boys aged 5, 13, 16, and 17 y and two girls aged 2.5 and 10 y. The etiology of aDI was germinoma (n = 2), extensive surgery due to optic glioma (n = 1) and astrocytoma (n = 1), congenital brain malformations (n = 1) and complications secondary to bacterial meningitis (n = 1). Two patients had severely impaired vision and two had hemiparesis. In all the patients, loss of thirst reflex was observed. The serum electrolytes in all patients showed sodium concentration from 159 to 176.6 mmol/L with plasma osmolality from above 297 mOsmol/kg. Polyuria was absent in three most severely dehydrated patients on admission. In two patients in whom DDAVP (1-desamino-8-D-arginine vasopressin; Desmopressin) therapy was withdrawn based on lack of polyuria deep venous thrombosis developed. Lack of polydipsia and polyuria, the key symptoms of diabetes insipidus (DI), may delay the diagnosis of aDI and may lead to severe complications of chronic hyperosmolar status. The fluid intake in patients diagnosed with aDI need to be supervised daily based on calculated constant volume of oral fluids, daily measurements of fluid balance, body weight and sodium levels, especially in patients whose vision is compromised or who are physically unable to take care of themselves.

Food and fluid intake and palliative sedation in palliative care units: A longitudinal prospective study

BackgroundDivergent opinions exist on what is correct and morally acceptable when it comes to the management of patients who are terminally ill and unable to maintain their own nutritional and hydration needs. This issue becomes even more problematic when it concerns patients for whom palliative sedation is considered. The aim of this study is to describe the evolution of oral and artificial food and fluid intake of patients residing in Flemish palliative care units and the possible effect of palliative sedation.MethodsA prospective longitudinal and descriptive design was used. Each patient admitted in one of the eight participating units was included if they met the inclusion criteria and gave written informed consent.ResultsTwo hundred and sixty-six patients were included. The incidence of palliative sedation was 7.5%.The oral food and fluid intake of these patients decreased during their stay and was reduced to a minimum a few days before death. With regard to the artificial food/fluid intake, this study reveals that only 28% of patients received artificial food and/or fluid. Moreover, it shows that the withdrawal is not a standard policy but is always based on a profound and individual decision-making process. An effect of initiating palliative sedation on the fluid intake is found, but is of no clinical relevance, in the sense that it would shorten the life of the patient.ConclusionsThis longitudinal prospective study does not support the argument that palliative sedation amounts to ‘slow euthanasia’ because it entails the withholding or withdrawing of substantial amounts of food and or fluids, thus having a clear life-shortening effect. This study shows that palliative sedation, in specialized palliative care units, is not slow euthanasia but advanced symptom control during the final days of terminally ill patients’ lives who are confronted with refractory suffering.