Increased Fluid Intake Research Articles

Does dietary fluid intake affect skin hydration in healthy humans? A systematic literature review.

Associations between daily amounts of drinking water and skin hydration and skin physiology receive increasingly attention in the daily life and in clinical practice. However, there is a lack of evidence of dermatological benefits from drinking increased amounts of water. Pubmed and Web of Science were searched without any restrictions of publication dates. References of included papers and related reviews were checked. Eligibility criteria were primary intervention and observational studies investigating the effects of fluid intake on skin properties in English, German, Spanish or Portuguese language, including subjects being healthy and 18+years. Searches resulted in 216 records, 23 articles were read in full text, and six were included. The mean age of the samples ranged from 24 to 56years. Overall the evidence is weak in terms of quantity and methodological quality. Disregarding the methodological limitations a slight increase in stratum corneum and "deep" skin hydration was observed after additional water intake, particularly in individuals with lower prior water consumption. Reductions of clinical signs of dryness and roughness were observed. The extensibility and elasticity of the skin increased slightly. Unclear associations were shown between water intake and transepidermal water loss, sebum content, and skin surface pH. Additional dietary water intake may increase stratum corneum hydration. The underlying biological mechanism for this possible relationship is unknown. Whether this association also exists in aged subjects is unclear. Research is needed to answer the question whether increased fluid intake decreases signs of dry skin.

A Study of the Effect of Rapid Fluid Intake on Quality of the Bone Scintigraphy Image

Background: Currently the best intervention after injection of 99mTc-HDP is drinking plenty of fluid with no specific amount or time limit. The previous studies did show some but not significant improvement between image qualities of patients who drank water compared to those who did not drink. We aim to investigate if increased and more rapid fluid intake results in better image quality. Methods: In this study, all patients who had a bone scintigram were questioned about how much fluid they had in the two hours between injection and imaging, and how much of that was taken in the first hour post injection The images were acquired two hour +/- 10min post intravenous injection of 99mTc-HDP using GE Infinia Hawkeye 4. The operator, equipment and radiopharmaceutical were the same for all studies and quality was assessed by measuring bone to soft tissue ratio using Xeleris 3 program. Results: 146 adult patients with total of 156 images who had bone scan imaging at Auckland Radiology Group were assessed. These patients aged between 30 and 78 (median, 51), were mostly men (61%) and 10 (about 6.5%) had two bone scans. The overall result, although a small change, was in favor of increasing fluid intake in the first hour which improved the bone to soft tissue ratio by an average of 2.5%. This was especially noticeable in patients who had two scans within few months of each other which could be compared, in this group nearly all the variables remain the same except the amount of fluid intake, this group had an average improvement of 9.65% (range, 2%-19.5%). Conclusion: Rapid hydration post injection of 99mTc-HDP showed a small contribution on the quality of bone scan images however this together with increased likelihood of voiding earlier on post injection, which contributes to reducing radiation dose to the bladder wall, makes this method appealing to adopt for routine use.

The prevalence of peripheral intravenous cannulae and pattern of use: A point prevalence in a private hospital setting.

To determine the prevalence and pattern of use of peripheral intravenous cannulae in hospital wards. Peripheral intravenous cannulae are commonly used in acute health care to directly access the bloodstream for the administration of medications, intravenous fluids and blood products. Peripheral intravenous cannulae are associated with multiple adverse events including hospital-acquired bloodstream infection, thrombophlebitis and pain/discomfort. Administration of intravenous fluids is associated with impaired mobility and nocturia which may increase falls risk in the older people. Observational, point prevalence study. Three private hospitals comprising a total of 1,230 beds participated in the study. Nurses recorded the presence of a peripheral intravenous cannulae, duration of insertion, state of the dressing and whether the peripheral intravenous cannulae was accessed in the previous 24hr and for what purpose. Nurses were also asked whether they would replace the peripheral intravenous cannulae should it fail. Approximately one-quarter of patients had a peripheral intravenous cannulae, the majority of which had been present for <24hr. The major use of the peripheral intravenous cannulae was antibiotic administration. Administration of intravenous fluids occurred in the presence of normal oral fluid intake. Nurses would not replace one-third of peripheral intravenous cannulae in the event of failure. A majority of patients were at increased falls risk, and one-third of these were receiving intravenous fluids. There is room for improvement in the utilisation of peripheral intravenous cannulae, particularly in removal and associated use of intravenous fluids. Alternative strategies for medication administration and timely switch to the oral route may reduce the risks associated with intravenous fluids. Vigilance is required in the use of peripheral intravenous cannulae. Consider transition of medication administration to oral intake where possible to minimise risks associated with the use of invasive devices and increased fluid intake.

A practical approach to the management of nocturia.

SummaryAimTo raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways.MethodsA multidisciplinary group of nocturia experts developed practical advice and recommendations based on the best available evidence supplemented by their own experiences.ResultsNocturia is defined as the need to void ≥1 time during the sleeping period of the night. Clinically relevant nocturia (≥2 voids per night) affects 2%‐18% of those aged 20‐40 years, rising to 28%‐62% for those aged 70‐80 years. Consequences include the following: lowered quality of life; falls and fractures; reduced work productivity; depression; and increased mortality. Nocturia‐related hip fractures alone cost approximately €1 billion in the EU and $1.5 billion in the USA in 2014. The pathophysiology of nocturia is multifactorial and typically related to polyuria (either global or nocturnal), reduced bladder capacity or increased fluid intake. Accurate assessment is predicated on frequency‐volume charts combined with a detailed patient history, medicine review and physical examination. Optimal treatment should focus on the underlying cause(s), with lifestyle modifications (eg, reducing evening fluid intake) being the first intervention. For patients with sustained bother, medical therapies should be introduced; low‐dose, gender‐specific desmopressin has proven effective in nocturia due to idiopathic nocturnal polyuria. The timing of diuretics is an important consideration, and they should be taken mid‐late afternoon, dependent on the specific serum half‐life. Patients not responding to these basic treatments should be referred for specialist management.ConclusionsThe cause(s) of nocturia should be first evaluated in all patients. Afterwards, the underlying pathophysiology should be treated specifically, alone with lifestyle interventions or in combination with drugs or (prostate) surgery.

La fiebre en el niño: una mirada reflexiva a las prácticas de cuidado

Objetivo: Realizar un análisis crítico-reflexivo de las prácticas rutinarias de los profesionales de enfermería y de los cuidadores familiares en el cuidado del niño con fiebre, a fin de incentivar un cuidado basado en evidencia científica que asegure el bienestar infantil.Síntesis de contenido: Se realizó una revisión bibliográfica de artículos científicos publicados entre los años 2007 y 2017, en las bases de datos ebscohost, ScienceDirect, medline, PubMed, cinahl, Web of Science y cuiden®, para lo cual se utilizaron los descriptores y sus combinaciones en español, portugués e inglés Fiebre; Cuidadores; Niño. Se elaboró un compendio de 45 artículos seleccionados y analizados que contenía las prácticas de cuidado con convergencias, divergencias y complementariedades.Los resultados se agruparon en los siguientes cinco temas: Concepción histórica de la fiebre; La fiebrefobia:una concepción en las actuales prácticas de cuidado; El baño de esponja:una práctica ancestral controvertida; El uso de antipiréticos: una rutina en contravía de la salud y la vidade los niños; La fiebre: en busca de una mirada desde su beneficio.Conclusiones: La concepción de la fiebre infantil centrada en el miedo y en el daño permanece. Las acciones de cuidado más comunes, como el baño de esponja y el uso/abuso de antipiréticos, son cuestionadas desde la evidencia científica, demostrando los efectos deletéreos que producen en la salud del niño. El cuidado del niño, después de una evaluación individualizada, deberá enfocarse en el confort, en un ambiente fresco y tranquilo y en el aumento de la ingesta de líquidos para evitar la deshidratación u otras complicaciones.

Effectiveness of Treatment Modalities on Kidney Stone Recurrence.

Nephrolithiasis is highly prevalent across all demographic groups in the Western world and beyond, and its incidence rates are rising. In addition to the morbidity of the acute event, stone disease often becomes a lifelong problem that requires preventative therapy to diminish ongoing morbidity. Across the majority of stone types, increased fluid intake and targeted dietary modifications are mainstays of therapy. Specific dietary interventions associated with reduced calcium stone risk include adequate dietary calcium intake and restriction of sodium, protein, and oxalate intake, among others. Pharmaceutical therapy may be required if lifestyle changes are insufficient to minimize risk of stone recurrence, and must be targeted to the specific metabolic abnormalities portending risk for a given patient. Therapeutic options for idiopathic calcium stone disease include thiazides, citrate salts, and uric acid-lowering agents. Alkali salts are also the treatment of choice for uric acid stone disease. Management of struvite stone disease is largely surgical, but acetohydroxamic acid is a proven second line therapy. Cystinuria requires lifestyle modifications and may call for thiol-binding agents. Significant heterogeneity of the clinical population with stone disease has previously limited opportunities for large randomized controlled trials. However, as clinical phenotypes and genotypes are increasingly clarified, there are mounting opportunities for targeted randomized controlled trials in stone prevention. In the meantime, the currently available evidence for both lifestyle and pharmacologic interventions is reviewed herein.

Cardiovascular Disease in Clozapine-Treated Patients: Evidence, Mechanisms and Management

Myocarditis occurs in about 3% of those initiated on clozapine but monitoring reduces the risk of serious outcome. Cardiomyopathy may develop after myocarditis, or from prolonged tachycardia. Monitoring using echocardiography is not deemed cost effective. Tachycardia, orthostatic hypotension and reduced heart rate variability are a group of clozapine-related adverse effects associated with autonomic dysfunction and may have serious consequences in the long term. Elevated heart rate and poor heart rate variability can be treated with a β-blocker or a non-dihydropyridine calcium channel blocker, while orthostatic hypotension can be alleviated by increased fluid intake and abdominal binding, but may require pharmacological intervention. Adequate correction for heart rate may show that clozapine does not prolong the QT interval. Other cardiovascular effects, pulmonary embolism, metabolic syndrome, sudden cardiac death and particularly the excessive mortality from cardiovascular disease events may be more strongly associated with the combination of mental illness, lifestyle factors and poor treatment of cardiovascular disease and its risk factors than with clozapine treatment. In view of the efficacy of clozapine and the evidence of reduced mortality relative to other antipsychotics, clozapine should be prescribed when indicated and recipients should be enrolled in lifestyle programmes to increase exercise and improve diet, and referred for diagnosis and treatment of cardiovascular disease and its risk factors.

Role of the diet in urinary stone formation and prevalence

In Hungary and in the developed countries urinary stones occur more often due to nutritional habits, obesity and sedentary lifestyle beside the endocrine and metabolic causes. In the daily urological and family doctor practice prevention should have an important role. Prevention is based not only on body weight control, physical exercise and medical treatment, but on proper diet as well. The nutritional components can change the consistence of urine, causing supersaturation, which is essential in stone formation. Specific nutritional components can either prevent stone formation (increased fluid intake, citrate, magnesium, fruits and vegetables) or either increase stone formation (decreased fluid intake, proteins, carbohydrates, oxalate, salt, increased calcium intake, ascorbic-acid etc). We summarized evidence-based practical dietary suggestions on the primary and secondary prevention of urinary stones. Orv Hetil. 2017; 158(22): 851-855.

Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study

BackgroundCompared to positive fluid balance (FB), negative FB is associated with improved clinical outcomes in critically ill patients. However, as to whether achieving more negative FB can further improve outcomes has not been investigated. This study aimed to investigate whether more negative FB and restricted fluid intake were associated with improved outcomes in critically ill patients.MethodData were extracted from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. Patients achieving negative FB at 48 hours after intensive care unit (ICU) admission were screened. The primary outcome was hospital mortality. Logistic models were built to explore the association between FB, fluid intake and mortality, using FB and fluid intake (both four levels) as design variables and using the linear spline function method.ResultsThere were 2068 patients meeting the inclusion criteria. Compared to slight negative FB (level 1), there was a decreased tendency towards mortality with FB level 2 (OR 0.88, 95% CI 0.69–1.11) and level 3 (OR 0.79, 95% CI 0. 65–1.11); however, only extreme negative FB (level 4) was significant (OR 0.56, 95% CI 0. 33–0.95). Fluid intake and urine output were evenly distributed over the first 48 hours after ICU admission. Fluid intake was inversely associated with hospital mortality, with the OR decreased stepwise from level 2 (OR 0.73, 95% CI 0.56–0.96) to level 4 (OR 0.47, 95% CI 0.30–0.74), referred to level 1. Urine output also showed a similar pattern. Diuretic use was associated with higher mortality in both models.ConclusionIn critically ill patients with negative FB, both increased fluid intake and urine output were associated with decreased hospital mortality. However, compared to slight FB, achieving more negative FB was not associated with reduced mortality.

Protocolo diagnóstico y terapéutico de las alteraciones del ritmo intestinal en el paciente oncológico

IntroductionBowel disturbances are common in oncology patients, since poor control of symptoms can compromise therapeutic adherence, and in serious cases, threaten survival EpidemiologyFifteen percent of the general population suffer constipation. Malignant intestinal obstruction is a major and common complication in tumours of the colon, ovary and stomach. Diarrhoea occurring in oncology patients is principally caused by chemotherapy. AetiologyThe main cause of oncological constipation is the use of opioids. Intestinal obstruction depends on the type and mechanism of obstruction and the intestinal portion affected. Diarrhoea occurring in cancer is caused by treatment (radiotherapy and chemotherapy), infections and the specific manifestations of each tumour. Clinical manifestations and diagnosisConstipation and as a consequence passing dry, hard faeces can cause pain. Intestinal obstruction can cause, vomiting, abdominal pain, fever and signs of perforation, with haemodynamic instability. Diarrhoea can cause hydroelectrolytic changes and renal failure. TreatmentChanges in diet and increased fluid intake in the main. The most commonly used drugs are laxatives or loperamide. Cases of faecal retention, intestinal obstruction and complicated diarrhoea require admission to hospital.

Factors Associated with Compliance to Increased Fluid Intake and Urine Volume Following Dietary Counseling in First-Time Kidney Stone Patients.

Increasing fluid intake to achieve a urine volume (UV) of >2.5 L/day decreases stone events. We assessed compliance rates and demographic and clinical variables associated with increased fluid intake and UV in patients with urolithiasis following dietary counseling. In a retrospective study, patients with a low baseline UV (<2.5 L/day) on an initial 24-hour urine collection during metabolic stone evaluation were identified between 2010 and 2015. Patients received detailed standardized dietary counseling, including increasing fluid intake to >3 L/day and titrating it to achieve UV >2.5 L/day. A follow-up 24-hour urine collection was performed at 6 months (FU1) and 18 months (FU2) to assess compliance (UV >2.5 L/day) and predictors associated with it. Our cohort contained 363 patients, 53.4% men and 46.6% women. The mean UV of baseline, FU1, and FU2 urine collections was 1.63, 2.52, and 2.48 L, respectively. The compliance rate of obtaining UV of >2.5 L was 50.1% at 6 months. On logistic regression, male sex (odds ratio [OR] 3.27, 95% confidence interval [CI] 1.94, 5.52, p < 0.001), urolithiasis-related procedures such as ureteroscopy (OR 2.31, 95% CI 1.20, 4.42, p = 0.01) or percutaneous nephrolithotomy (OR 3.48, 95% CI 1.58, 7.63, p = 0.002), and baseline 24-hour UV >1 L (OR 3.00, 95% CI 1.02, 8.76, p = 0.04) were associated with greater odds of compliance. Age >58 years (OR 0.39, 95% CI 0.20, 0.75, p = 0.005) and presence of lower urinary tract symptoms (OR 0.50, 95% CI 0.26, 0.95, p = 0.03) were associated with lower odds of compliance. Ethnicity, body mass index, renal function, marital status, renal stone burden, stone type, and household income were not associated with compliance. In stone formers, compliance to fluid intake recommendations as measured by 24-hour UV is roughly 50%. Understanding risk factors for noncompliance, especially in at risk patients, can be used for quality improvement initiatives and reducing stone events.

Conservative Measures for Managing Constipation in Patients Living With a Colostomy.

The purpose of this study was to determine the effect of a conservative regimen for the treatment of constipation in persons living with a colostomy. Prospective, noncontrolled, single-center study. The study sample comprised 35 patients with a colostomy who were diagnosed with constipation. Subjects with morphologic changes causing constipation such as stomal stenosis and neoplastic and inflammatory changes were excluded. The study was conducted in the Proctology and Stoma Outpatient Clinic at Poznan University of Medical Sciences. Patients at our Stoma Outpatient Clinic underwent baseline evaluation, and those with symptoms of constipation (prolonged periods between bowel movements, passage of pasty or hardened fecal effluent, and associated symptoms such as abdominal discomfort or bloating, flatulence, and pain with passage of effluent into the stoma) received individualized dietary recommendations that typically included an increase in dietary fiber and fluid intake, along with increased fluid intake. The outcomes of dietary changes were evaluated during a follow-up visit 3 months later. If dietary changes alone did not improve constipation symptoms, we prescribed a psyllium-based bulk-forming agent, an osmotic stool softener, and a probiotic, with or without a prokinetic agent such as metoclopramide taken 3 times daily. Dietary interventions alone were deemed successful in 60% of study subjects (n = 21); the remaining 14 patients required additional treatment. Dietary modifications alone relieved constipation in more than half of a group of 35 patients with constipation. We therefore recommend a trial of dietary modifications prior to the initiation of pharmacotherapy in patients with a colostomy.

General Population Knowledge about Extreme Heat: A Cross-Sectional Survey in Lisbon and Madrid.

Extreme heat is associated with an increased mortality and morbidity. National heat plans have been implemented to minimize the effect of extreme heat. The population’s awareness and knowledge of national heat plans and extreme heat is essential to improve the community’s behavior and adaptation. A general population survey was conducted in Lisbon and in Madrid to assess this knowledge. We used a questionnaire to interview passers-by. Results were compared between Lisbon and Madrid and between locals and foreigners, using Pearson Chi-square tests and Fisher's exact test. We conducted 260 interviews in six locations of different socio-economic backgrounds in each city. The most frequently mentioned extreme heat-related risk groups were the elderly (79.2%), children (49.6%) and babies (21.5%). The most frequently reported protective measures were increased fluid intake (73.1%) and avoiding exposure to the sun (50.8%). Knowledge about the heat plan was higher in Lisbon (37.2%) than in Madrid (25.2%) (p-value = 0.03). Foreigners had less knowledge of risk groups compared to locals. Heat plans were not widely known in Madrid and Lisbon. Nonetheless, knowledge of practical concepts to face extreme heat, such as certain risk groups and protective measures, was found. Our results were similar to comparable surveys where specific respondents’ groups were identified as less knowledgeable. This highlighted the importance of addressing these groups when communicating public health messages on heat. Foreigners should be specifically targeted to increase their awareness.

Hospital-acquired Hyponatremia in Pediatric Intensive Care Unit.

Objective:The objective of the study was to evaluate the etiology of hospital-acquired hyponatremia (HAH) and its effects on morbidity and mortality in the Pediatric Intensive Care Unit (PICU) patients.Design:This study design was a prospective observational case–control study.Setting:this study was conducted at tertiary care PICU.Materials and Methods:All consecutive cases admitted with at least one measured serum sodium (PNa) value were evaluated. Those with normal admission PNa were followed till they develop hyponatremia (PNa < 35 mEq/L) 7 days or PICU discharge whichever was earlier.Results:During the study period, 123 (19.6%) cases developed HAH and 126 patients remained isonatremic (control group). The admission PNa 138.8 ± 3.03 mEq/L decreased to 132 ± 2.58 mEq/L (drop of 6.68 ± 3.39 mEq/L, P < 0.001) in HAH cases. The use of antidiuretic hormone (ADH)-stimulating drugs (odds ratio [OR]: 2.83, P = 0.01), postsurgical status (OR: 2.95, P = 0.006), and fluid intake ml/kg (OR: 1.0, P = 0.001) were found to be significant risk factors in HAH group on multivariate analysis. HAH cases had prolonged PICU stay (P = 0.000) and mechanical ventilation (P = 0.01), but no difference in the mortality when compared to controls.Conclusions:HAH is associated with increased fluid intake, presence of ADH-stimulating drugs or conditions, and postsurgical status and has an adverse effect on the outcome of PICU patients.

Buprenorphine–Induced Urinary Hesitancy is Common and Managed with Ease: A Retrospective Chart Review

Buprenorphine is a partial agonist at the mu opioid receptor. As compared to methadone, it has the advantage of being used in office based treatment setting, making this a preferred treatment option for opioid dependence. While opioid-induced urinary retention and hesitancy are well known, urinary hesitancy in patients who receive buprenorphine treatment may go unrecognized and untreated. Objectives: The current study is a retrospective chart review of 104 charts of patients with a diagnosis of opioid dependence who received buprenorphine/naloxone treatment to examine the incidence of urinary hesitancy and identify the relationship of symptoms, if any, with the dose and duration of treatment and other patient and treatment factors. Results: Forty-five percent of patients reported no side effects, while 26% of the subjects reported urinary hesitancy symptoms at some point in treatment. Urinary symptoms were reported as early as one day and predominantly in the first 2 weeks after initiation of bup/nlx treatment. Conclusion: Urinary hesitancy occurs with buprenorphine is often under reported and may go untreated. It may lead to significant discomfort and could possibly interfere with patient compliance to buprenorphine treatment. In most cases the symptoms are mild and transient and can easily be treated with increased fluid intake and use of bethanechol, a cholinergic drug that has long been used for non-obstructive urinary hesitancy or retention, at low doses. Education of providers and patients regarding this early and tr

Using Behavior Change Techniques to Guide Selections of Mobile Applications to Promote Fluid Consumption

To determine the extent to which validated techniques for behavior change have been infused in commercially available fluid consumption applications (apps). Coders evaluated behavior change techniques represented in online descriptions for 50 fluid consumption apps and the latest version of each app. Apps incorporated a limited range of behavior change techniques (<20% of taxonomy). The number of techniques varied by operating system but not as a function of whether apps were free or paid. Limitations include the lack of experimental evidence establishing the efficacy of these apps. Patients with urolithiasis can choose from many apps to support the recommended increase in fluid intake. Apps for iOS devices incorporate more behavior change techniques compared to apps for the Android operating system. Free apps are likely to expose patients to a similar number of techniques as paid apps. Physicians and patients should screen app descriptions for features to promote self-monitoring and provide feedback on discrepancies between behavior and a fluid consumption goal.

Consumo de refrigerante reduz a ingestão de alimentos em ratos Wistar

Aims: To evaluate the effect of caloric and non-caloric soft drink intake on food consumption, body weight and composition, and metabolic parameters in rats. Methods: Controlled experimental study in which 30 male Wistar rats were divided into three groups and given food and beverage ad libitum during 17 weeks. The groups were as follows, according to the offered food: Control group – standard chow and water; Caloric soft drink group – standard chow, caloric soft drink, and water; and Non-caloric soft drink group – standard chow, non-caloric soft drink, and water. Results: There was no statistical difference in total energy intake, body weight, and fat deposition between groups. However, the chow energy intake was 45% lower in the caloric soft drink group compared to the control and non-caloric soft drink groups (198.7±0.7 kJ vs. 349.4±2.0 and 373.0±1.3 kJ, respectively), with 46% of the energy provided by the soft drink. The caloric soft drink group consumed 22% more carbohydrate, especially sucrose, compared to the control group (p<0.05). Macronutrient intake was not different between the control and non-caloric soft drink groups, but the caloric soft drink group consumed less protein and lipids when compared to the other groups (3.5±1.0 g of protein vs. 6.2±0.1 and 6.7±0.1 g, respectively; 0.7±0.01 g of lipids vs. 1.3±0.02 g and 1.4±0.02 g, respectively). Consumption of non-caloric soft drinks increased total sodium intake and consumption of both soft drinks decreased water intake. Although body weight varied during the experiment, there was no significant difference between groups at the end of the experiment, and no difference in fat deposition, fasting glucose, insulin and leptin, insulin resistance index, and lipid profile. Conclusions: The consumption of both types of soft drinks did not affect energy intake, body weight and composition, or metabolic parameters; however, it increased fluid intake and decreased water ingestion. Caloric soft drink intake influenced the amount and the quality of solid food consumed, compromising diet quality.

Diet and Nutritional Management in Functional Gastrointestinal Disorder: Constipation

Constipation is a common functional gastrointestinal symptom, the medical treatment of which is established. However, knowledge of diet and nutritional management for constipation is lacking. Based on current studies, fiber is effective in managing chronic constipation, but care should be taken in constipated patients with gaseous bloating. Increased fluid intake is controversial but may be beneficial, especially in conjunction with a stool-bulking agent. Other diet treatments lack high-quality evidence. A well-designed study to validate the effectiveness of diet, especially Korean diet, in the treatment of chronic constipation is needed. (Korean J Med 2016;90:111-114)

Diet and polycystic kidney disease: A pilot intervention study

Dietary sodium, protein, acid precursors, and water have been linked to cyst growth in polycystic kidney disease; yet, no studies in patients have examined the feasibility of using a dietary intervention that controls all of these factors. The aim of this study was to determine if a diet, appropriate for persons of most ages, reduces the excretion of sodium, urea, acid, and decreases mean urine osmolality while gaining acceptance by patients with autosomal dominant polycystic kidney disease (ADPKD). Twelve adults with ADPKD enrolled in a pre-post pilot feasibility study and served as their own controls. Individuals consumed their usual diet for one week then for four weeks followed an isocaloric diet lower in sodium and protein and higher in fruits, vegetables, and water. Three-day diet records and two 24-h urine samples were collected at baseline, week 2, and week 4 visits; blood pressure, weight, and serum were obtained at all three visits. A modified nutrition hassles questionnaire was completed on the last visit. During the dietary intervention, subjects (n=11) consumed less sodium, protein, and dietary acid precursors 36%, 28%, and 99%, respectively, and increased fluid intake by 42%. Urinary sodium, urea, net acid excretion, osmoles, and osmolality decreased 20%, 28%, 20%, 37%, and 15%, respectively; volume increased 35%. Urine changes were in accord with the diet record. Ninety-one percent of participants reported that none of the hassles were worse than "somewhat severe", and most participants felt "somewhat confident" or "very confident" that they could manage the new diet. A majority of adult patients with ADPKD successfully prepared and followed a composite diet prescription with decreased sodium, protein, acid precursors, and increased fluid intake. This trail was registered at ClinicalTrials.gov (NCT01810614).

Metabolic Evaluation in Paediatric Urolithiasis: A 4-Year Open Prospective Study.

Children with urolithiasis are associated with considerable morbidity and commonly associated with metabolic abnormalities. By treating these abnormalities stone formation is prevented. To study the metabolic risk factors of urolithiasis in children and compare them with literature. In open, prospective and observational study, 75 children were evaluated from August 2010 to June 2014. In all patients' dietary history, water intake and results of laboratory findings were recorded. All urine samples obtained from patients were without dietary restrictions. Reference paediatric 24 hour urinary parameter was used according to western literature. We investigated 75 patients with urolithiasis. Low urine volume was found in 49 patients which is comparable with previous studies indicating simple intervention as to increase water intake. Low calcium intake was found in 44 patients suggesting that low calcium intake is associated with higher incidence of urolithiasis due to increased intestinal oxalate absorption. Hypocalcaemia was found in 32 patients and 24 hour urinary abnormality was found in only 16 patients'. Both these finding does not support previous literature. Stone analysis finding does not correlate with urinary finding. Low urine volume secondary to low water intake is predominant finding. Hypocalcaemia is major metabolic abnormality in contradiction to western literature. There are no nomograms for urinary excretion of Calcium, uric acid, oxalate and citrate in Indian children. Keeping the optimum blood calcium level & increased fluid intake can prevent stone formation in children.