Intravenous Crystalloid Fluid Research Articles

Purple urine bag syndrome.

A 44-year-old man with Down's syndrome and neurogenic bladder which required a suprapubic catheter presented with fever and change in his urine color for one day. Physical examination revealed a temperature of 38.3°C, blood pressure of 60/30 mmHg, pulse rate of 120/min and urine with purple discoloration in the urine catheter and bag (Figure 1). A urine dipstick test indicated the presence of leukocytes, positive nitrate and a pH value of 8.5. The patient was resuscitated with intravenous crystalloid fluid and empiric antibiotics (vancomycin and piperacillin/tazobactam) were started. The patient's urine culture subsequently grew Enterococcus faecalis. His antibiotic was changed to levofloxacin as per sensitivity analysis. The patient responded well to treatment as his fever subsided and improved and his urine color gradually returned to yellow. Fig. 1. Purple discoloration of urine in the urine catheter and bag. Purple urine bag syndrome (PUBS) is a rare condition characterized by purple discoloration of urine in a urine catheter and bag typically seen in patients with chronic debilitation with a history of long-term indwelling urinary catheter [1]. The pathogenesis of this discoloration is associated with tryptophan's metabolism as intestinal bacteria metabolize tryptophan to indole and later converted to indican by the liver. Indican, in turn, is excreted and broken down in the urine into indirubin (red) and indigo (blue) in an alkaline environment by sufatase or phosphatase-containing bacteria, such as Providencia stuartii, Providencia rettgeri, Proteus mirabilis, Klebsiella pneumoniae, Escherichia coli, Enterococcus spp., etc. [2] PUBS is generally a benign process but it provides a clue to the presence of an underlying urinary tract infection. The discoloration usually gradually disappears after antibiotic treatment and good urologic sanitation, as seen in our patient [1, 3].

Effect of rapid fluid resuscitation using crystalloids or colloids on hemostasis in piglets

Impairment of blood coagulation is one of the main side effects of volume replacement, particularly if artificial colloids such as hydroxyethyl starch (HES) and gelatine preparations are used. This animal study aimed to evaluate the effect of a single fast intravenous crystalloid or colloid fluid bolus on blood coagulation as measured by rotation thromboelastometry (ROTEM). Thirty-two anesthetized piglets were infused with a rapid 20 ml·kg(-1) fluid bolus of either normal saline (NS), 4% gelatine, 5% albumin or 6% HES 130/0.4 (n = 8 per group) over a period of 2 min. Hemostasis was assessed by ROTEM before and 1 min after fluid administration. Within-group differences were analyzed by Wilcoxon test, and additionally overall Kruskal-Wallis test followed by posthoc Mann-Whitney U-test were applied to detect differences between groups. All fluids caused a significant weakening of clot strength within groups. HES and gelatine showed a significantly stronger impairment of clot growth and maximum clot firmness as compared with albumin and normal saline. Impairment of fibrin polymerization was more pronounced following HES as compared with all other fluids. After moderate but very fast volume loading, HES and gelatine impair blood coagulation to a larger extent as compared with albumin or normal saline, while no significant differences were observed between both artificial colloids.

Overview and controversies in the medical management of pit viper envenomation in the dog

To provide a review and update on the medical management of pit viper envenomation in dogs. Pit viper snake (Crotalidae) envenomation in dogs is a common emergency in the United States. At least 50 enzymes contribute to snake venom potency that causes soft tissue damage, vasculotoxicity, coagulopathy, cytotoxicity, and necrosis. Snakebite envenomation may be identified by fang puncture wounds but primarily as a focal site with a rapid onset of severe swelling, hemorrhage, pain, and potentially necrosis. Crotalid venom causes hematologic abnormalities, local tissue damage, hypotension, and occasionally neurological impairment. The most marked hematologic abnormalities include thrombocytopenia, hemolytic anemia, and various forms of coagulopathy, including defibrination without disseminated intravascular coagulation (in North America), summarized as a venom-induced coagulopathy. The mainstay of treatment includes intravenous crystalloid fluid therapy, antivenom, and analgesic medications. Currently available antivenom products include a mixed polyvalent Antivenin (Crotalidae) Polyvalent (ACP(a)), and Crotalinae polyvalent immune Fab (Crofab(b)). There are products from Mexico and Costa Rica that have limited availability, a similar imported Fab product (Antivipmyn(c)), and a polyspecific antivenom (Polyvet-ICP(d)), respectively. Glucocorticoids, nonsteroidal antiinflammatory drugs (NSAIDs) and antihistamines are not included in the majority of recommended treatment protocols by world authorities; however, there are some reports that describe their use. Antimicrobial therapy and blood products are used only when clinically indicated. There is a vaccine available, but at present, it is of unknown efficacy because of a lack of documented scientific information. Mortality from North American crotalid envenomation is generally rare and is influenced by several variables, including the amount of venom injected, the size and species of snake, the size of the victim, the location of the bite, time elapsed until treatment, and the therapy initiated. Mortality rates range from 1% to 30%.

Diferença entre volume de fluidos cristaloides intravenosos prescritos e infundidos em pacientes no pós-operatório precoce

The aim of this study was to audit the real amount of crystalloid intravenous fluids infused in patients underwent major abdominal operations in a University hospital. The whole intravenous crystalloid fluid load (CHT) infused from the 1st to the 4th postoperative day in 31 patients underwent major abdominal operations was registered. This amount was compared to the volume daily prescribed (CHP) by the physician. CHT was defined as the sum of CHP plus diluents and intravenous drugs received by the patients. Hydration protocol of the service was 30-50 mL/Kd/day for patient with nil per os prescription. Comparisons between CHT and CHP was done in each postoperative day using paired T test. A 5% level was established as significant. CHT summed from 1st to 4th PO days was (mean and range) 12.8 (6.4-17.5) L corresponding to 9.5 L (74.3%) of CHP and 3.3 L (25.7%) of diluents and intravenous drugs. In each postoperative day, CHT was significantly greater than CHP (p<0.001). Until the 3rd PO day patients received a CHT greater than 50 mL/Kg/day. . Medical prescription does not contain the real amount of crystalloid intravenous fluids infused. Diluents and intravenous drug may reach 25% of the intravenous fluids load.

Clinical Benefits After the Implementation of a Protocol of Restricted Perioperative Intravenous Crystalloid Fluids in Major Abdominal Operations

Perioperative fluid replacement is a challenging issue in surgical care. The purpose of the present study was to investigate the effect of two different perioperative hydration protocols on the outcome in patients undergoing major abdominal operations. This was a prospective study involving 61 patients (42 men/19 women; mean age: 52 years; age range: 18-81 years) who underwent major abdominal operations. The study had two distinct phases: before (conventional group; administered 30-50 ml/kg per day of crystalloid fluids; n = 33) and after the implementation of a protocol of restricted use of intravenous fluids (restricted group; administered less than 30 ml/kg per day of crystalloid fluids; n = 28). The total volume of intravenous crystalloid fluids infused was recorded until postoperative day (POD) 4. Morbidity, mortality, and the length of postoperative hospital stay were the main clinical variables. Mortality was 4.9% (p > 0.05 between groups). Intravenous therapy in the restricted group was terminated earlier (p < 0.001) and the patients received 2.4 l less crystalloid fluid than did those in the conventional group from POD 1 through POD 4 (p < 0.001). The adoption of the restricted protocol shortened the postoperative hospital stay by 2 days (p = 0.02) and diminished the morbidity by 25% (p = 0.04). Restriction of perioperative intravenous crystalloid fluid is associated with reductions in morbidity and length of postoperative hospital stay after major abdominal operations.

Severe Hypernatremia After Cesarean Delivery Secondary to Transient Diabetes Insipidus of Pregnancy

BACKGROUND Transient diabetes insipidus is an uncommon complication of pregnancy, usually manifesting with polydipsia and polyuria. This condition is considered to result from excess placental vasopressinase activity and is managed with deamino D arginine vasopressin. CASE While on restricted oral intake after cesarean delivery, the patient gradually became disoriented and agitated in conjunction with markedly increased urine output disproportional to her intravenous crystalloid fluid intake. Marked hypernatremia of 178 mEq/dL was noted. Urine osmolality was low at 248 mOsm/L. The clinical presentation and electrolyte abnormalities were considered consistent with transient diabetes insipidus of pregnancy. The patient responded well to nasal-spray-administered deamino D arginine vasopressin and increased intravenous fluid intake, with resolution of symptoms and gradual normalization of serum sodium levels. CONCLUSION Transient diabetes insipidus of pregnancy should be considered in the differential diagnosis of severe hypernatremia in obstetric patients with restricted oral intake after operative delivery.

Circumferential External Counterpressure by Abdominal Wrapping and Its Effect on Simulated Intra‐abdominal Hemorrhage

Intra-abdominal hemorrhage was simulated by abdominal aortic cannulation through the femoral artery with shunting of blood into the peritoneal cavity via a transabdominal Foley catheter. Intravenous isotonic crystalloid fluid was administered to replace the blood lost. Hemorrhage was allowed to proceed to homeostasis with a compressive abdominal bandage in five dogs and without a bandage in three dogs. Placement of the compressive bandage decreased the fall in mean arterial pressure, slowed or stopped hemorrhage, slowed the rate of hemodilution, and increased survival time compared with unbandaged control dogs. Increases in pulmonary artery pressure and pulmonary capillary wedge pressure were not observed. Total peripheral resistance was elevated following wrapping. Cardiac index decreased in the bandaged group over time, but the change was not statistically significant. Cardiac index was significantly higher in the wrapped dogs. No gross abdominal organ damage was found. Compressive abdominal wraps composed of common bandaging materials were found to be effective in limiting blood loss and supporting mean arterial pressure in dogs with massive intra-abdominal hemorrhage. LTHOUGH FIRST investigated in 1903,' pneumatic