External Jugular Venous Distension with Severe Volume Depletion

One of the basic components of intensive treatment of patients with an urgent abdominal pathology is perioperative infusion therapy. To analyze the perioperative dynamics of the water sectors of a body in the patients with a high surgical risk with acute abdominal pathology, a targeted regimen of infusion therapy was used to examine 35 patients. Perioperative targeted infusion therapy was carried out with balanced crystalloid solutions. With the non−invasive bioelectric rheography, the indices of water sectors of a body were studied. On the first day, the extracellular sector volume overflow was established due to an increase in interstitial volume. From the second day, the excess volumes of intravascular fluid and plasma were determined. On the third day there was a deficit of all the studied indices. On the fifth day of the post−surgery period, volumetric depletion of mild degree was noted. From the seventh to the tenth days, all the studied parameters to normal were reliably restored. A targeted regimen of infusion therapy in such patients was concluded to correct a moderate volume depletion on the tenth day after surgery by an excessive increase in plasma volume after six hours of treatment, the development of interstitial edema in the first two days, and the formation of mild volumetric depletion from third to seventh day. Key words: water sectors, goal−direct infusion therapy, depletion, urgent surgery, high surgical risk.

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Does this patient have jugular venous distension? Vein finder‐enhanced assessment of jugular venous pressure

Clinical Case Reports ◽

10.1002/ccr3.3747 ◽

2021 ◽

Author(s):

Dean Bricker

Keyword(s):

Venous Pressure ◽

Jugular Venous Pressure ◽

Jugular Venous Distension

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Patient-reported symptoms during dialysis: the effect of pre-dialysis extracellular water and change in extracellular water post-dialysis

Renal Replacement Therapy ◽

10.1186/s41100-021-00321-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Suree Yoowannakul ◽

Surachet Vongsanim ◽

Kamonwan Tangvoraphonkchai ◽

Ahmed Mohamed ◽

Andrew Davenport

Keyword(s):

Extracellular Water ◽

Volume Depletion ◽

Dialysis Treatment ◽

Lower Tertile ◽

Patient Reported ◽

Low Blood Pressure ◽

Symptom Scores ◽

Recovery Times ◽

Patient Groups

Abstract Background Quality of life for haemodialysis (HD) patients may be affected by symptoms during dialysis treatments, and patient groups have highlighted the need to improve post-dialysis fatigue and dialysis-related symptoms. As changes in extracellular water (ECW) may lead to cramps and other symptoms, we wished to determine whether there was an association between ECW and intra-dialytic symptoms. Methods We reviewed the hospital records of HD patients who completed a self-reported intra-dialytic symptom questionnaire, using a visual analogue scale, who had contemporaneous pre- and postdialysis bioimpedance ECW measurements adjusted to height (aECW). Results We studied dialysis sessions of 506 patients, 314 (62.1%) male, 226 (44.7%) diabetic, mean age 64.6 ± 15.7 years, weight 69.9 ± 17.4 kg, and duration of dialysis treatment 26 (9.6–60.1) months. We divided patients into three groups according to pre-dialysis aECW, and total dialysis symptom scores were greater for those in the lower tertile (25 (10–41) vs middle 18 (8.5–34) vs upper 20 (7–31), p < 0.05). Only feeling cold, dizziness, and low blood pressure were statistically different between the three pre-dialysis aECW groups, and there was no difference in post-dialysis recovery times. We analysed the effect of the fall in aECW pre-to post-dialysis. Patients in the group with the greatest fall in aECW did not report more intra-dialytic symptoms or longer recovery times. Conclusion We found that patients starting dialysis with lower relative ECW were more likely to report intra-dialytic symptoms than those with greater amounts of fluid to remove, and most commonly reported symptoms were associated with intra-vascular volume depletion.

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Incidence and risk predictors of acute kidney injury among HIV-positive patients presenting with sepsis in a low resource setting

BMC Nephrology ◽

10.1186/s12882-021-02451-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Davis Kimweri ◽

Julian Ategeka ◽

Faustine Ceasor ◽

Winnie Muyindike ◽

Edwin Nuwagira ◽

...

Keyword(s):

Acute Kidney Injury ◽

Significant Risk ◽

Kidney Injury ◽

Significant Risk Factor ◽

Hiv Positive ◽

Volume Depletion ◽

Adjusted Risk ◽

Adjusted Analysis ◽

Resource Setting ◽

Risk Predictors

Abstract Background Acute kidney injury (AKI) is a frequently encountered clinical condition in critically ill patients and is associated with increased morbidity and mortality. In our resource-limited setting (RLS), the most common cause of AKI is sepsis and volume depletion. Sepsis alone, accounts for up to 62 % of the AKI cases in HIV-positive patients. Objective The major goal of this study was to determine the incidence and risk predictors of AKI among HIV-infected patients admitted with sepsis at a tertiary hospital in Uganda. Methods In a prospective cohort study, we enrolled adult patients presenting with sepsis at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between March and July 2020. Sepsis was determined using the qSOFA criteria. Patients presenting with CKD or AKI were excluded. Sociodemographic characteristics, physical examination findings, and baseline laboratory values were recorded in a data collection tool. The serum creatinine and urea were done at admission (0-hour) and at the 48-hour mark to determine the presence of AKI. We performed crude and multivariable binomial regression to establish the factors that predicted developing AKI in the first 48 h of admission. Variables with a p < 0.01 in the adjusted analysis were considered as significant predictors of AKI. Results Out of 384 patients screened, 73 (19 %) met our inclusion criteria. Their median age was 38 (IQR 29–46) years and 44 (60.3 %) were male. The median CD4 T-cell count was 67 (IQR 35–200) cells, median MUAC was 23 (IQR 21–27) cm and 54 (74.0 %) participants were on a regimen containing Tenofovir Disoproxil Fumarate (TDF). The incidence of AKI in 48 h was 19.2 % and in the adjusted analysis, thrombocytopenia (Platelet count < 150) (adjusted risk ratio 8.21: 95 % CI: 2.0–33.8, p = 0.004) was an independent predictor of AKI. Conclusions There is a high incidence of AKI among HIV-positive patients admitted with sepsis in Uganda. Thrombocytopenia at admission may be a significant risk factor for developing AKI. The association of thrombocytopenia in sepsis and AKI needs to be investigated.

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Central indomethacin enhances volume-dependent vasopressin release

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1984.247.6.r1017 ◽

1984 ◽

Vol 247 (6) ◽

pp. R1017-R1021

Author(s):

D. P. Brooks ◽

L. Share ◽

J. T. Crofton ◽

A. Nasjletti

Keyword(s):

Blood Pressure ◽

Prostaglandin E2 ◽

Mean Arterial Blood Pressure ◽

Inhibitory Effect ◽

Volume Depletion ◽

Vasopressin Release ◽

Arterial Blood ◽

Ventriculocisternal Perfusion ◽

Severe Hemorrhage ◽

Vasopressin Secretion

The effect of centrally administered indomethacin on hemorrhage-induced vasopressin release was studied in the morphine-sedated, urethan/chloralose-anesthetized dog. Ventriculocisternal perfusion of indomethacin 1) significantly reduced the amount of prostaglandin E2 in the effluent from the cisterna magna, 2) significantly enhanced the vasopressin response to volume depletion, and led to a greater fall in mean arterial blood pressure during severe hemorrhage. The results suggest that central prostaglandins may have an inhibitory effect on vasopressin secretion during volume depletion.

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