Enteral Sodium Chloride Supplementation and Fluid Balance in Children Receiving Diuretics

The use of sodium chloride (NaCl) supplementation in children being prescribed diuretics is controversial due to concerns that supplementation could lead to fluid retention. This is a single-center retrospective study in which fluid balance and diuretic dosing was examined in children prescribed enteral NaCl supplements for hyponatremia while receiving loop diuretics. The aim of this study was to determine whether significant fluid retention occurred with the addition of NaCl. Fifty-five patients with 68 events were studied. The median age was 5.2 months, and 82% were hospitalized for cardiac disease. Daily fluid balance the seven days prior to NaCl supplementation was lower than the seven days after, with measurement of: median 17 mL/kg/day (7–26) vs. 22 mL/kg/day (13–35) (p = 0.0003). There was no change in patient weight after supplementation (p = 0.63). There was no difference in the median loop diuretic dose before and after supplementation, with the diuretic dose in furosemide equivalents of 3.2 mL/kg/day (2.3–4.4) vs. 3.2 mL/kg/day (2.2–4.7) (p = 0.50). There was no difference in the proportion of patients receiving thiazide diuretics after supplementation (56% before vs. 50% after (p = 0.10)). NaCl supplementation in children receiving loop diuretics increased calculated fluid balance, but weight was unchanged, and this was not associated with an increase in diuretic needs, suggesting clinicians did not consider the increase in fluid balance to be clinically significant.

The Relationship of Aldosterone and the Degree of Obesity in Patients with Type 2 Diabetes Mellitus Associated with Chronic Heart Failure

The aim of the study was to study the relationship between aldosterone and the degree of obesity in patients with type 2 diabetes associated with chronic heart failure.The features of metabolic and hormonal disorders were studied in 65 patients with DM2 and CHF, including 29 women and 36 men.The patients were subjected to anthropometric studies (OT, OB, OT/OB, BMI). The interpretation of BMI indicators was carried out in accordance with WHO recommendations. In the studied groups of subjects, lipid fluctuations varied from normal values to their significant deviations in group 3 of patients with grade 2 obesity.The main physiological effects of aldosterone that are important in CHF are 1) sodium and fluid retention (activation of renal aldosterone receptors); 2) activation of aldosterone-dependent; 3) increased excretion of potassium and magnesium; 4) delayed excretion of norepinephrine.So, our results confirm the results of these studies and require further study.In 54.5% of patients with DM2 and CHF with obesity of the 1st degree and 81.8% of patients with obesity of the 2nd degree, an increased level of plasma aldosterone is determined, accompanied by an increased content of renin, p < 0.05

Analysis of fluid retention zones in heat exchangers with segmental baffle and helical baffle

By using the residence time distribution method (RTD), the fluid retention zones in the shell and tube heat exchanger with segmental baffle (STHX-SB) and the heat exchanger with helical baffle (STHX-HB) are compared and discussed. The flow pattern and fluid retention zone of the similar double helical flow heat exchanger (STHX-SDH) were analyzed by using the same method. The result shows the spiral flow can reduce the fluid retention zone. The flow pattern in the STHX-SDH likes a double helical shape and leads to a very small fluid retention zone. According to the simulation results, the location of the fluid retention zone of STHX-SDH is determined. The verification line method and the zone assessment method were adopted, to discuss the flow velocity of each point on the verification line and the average flow velocities of the selected zones. The change laws of the flow velocities on the verification lines and the average flow velocities of the selected zones at different Reynolds numbers were compared. The result reveals the distribution of the fluid retention zone of the STHX-SDH and the sensitivity of each fluid retention zone to the Reynolds number. By optimization of the angle of the baffle, the volume fraction of the fluid retention zone is reduced to 1.61%, and the heat transfer performance is improved by 13.23%. It is verified that reducing the fluid retention zone can effectively enhance the heat transfer performance. This research method provides a theoretical basis for reducing the fluid retention zone of the heat exchanger and enhancing heat transfer performance.

Possibilities of bioimpedance method of investigation of elderly patients with chronic heart failure

Introduction. Diagnostics of congestive events in chronic heart failure (CHF) in elderly people is increasingly relevant due to the general aging of the population, which determines the search for new research methods. The aim is to evaluate the diagnostic capabilities of bioimpedance method in determining the severity of congestion in elderly patients with CHF. Materials and methods. 86 elderly patients with CHF of different clinical stages were examined, 36.0% of them were burdened with varicose vein disease of the lower limbs. Total body water content was assessed by active impedance at 50 kHz, extracellular fluid content — at 5 kHz. Results. Active resistance at 50 kHz in patients with CHF II B was 473.92±29.39, with CHF II A - 569.24±58.97, with CHF I — 601.33±24.64 ohms, respectively, at 5 kHz — 555.52±27.44, 633.50±51.32 and 722.50±15.85 ohms respectively. No total and/or extracellular fluid retention was detected in CHF II A without lower limb varicosity, and in 10 (58.8%) patients — in cases of its presence. Retention of total and/or extracellular fluid was detected in 74.4% of CHF stage II B patients, and 48.3% of them had varicose vein disease of the lower limbs. Discussion. Patients with CHF stage II B have the highest amount of total and extracellular fluid in the body compared to patients with CHF stage II A and CHF stage I, but the method is insensitive for diagnosis of fluid retention in the small circle of the circulation and differential diagnosis of the genesis of edema in varicose vein disease of the lower limbs. Conclusion. Bioimpedance imaging can be used for additional diagnostics of CHF in elderly patients in order to estimate the amount of total/extracellular fluid in the body to build personalized treatment and prevention programs.

The efficiency of dapagliflozin as add-on therapy in obese patients with resistant hypertension and chronic kidney disease

Background Obesity, insulin resistance, renal dysfunction, hyperuricemia are some of the most common causes of resistant hypertension (RH). A close relationship exists between RH and fluid retention. Currently, there is no consensus regarding pathogenetic therapy of RH and there are no studies on the effects of sodium–glucose cotransporter-2 (SGLT2) inhibitors in obese patients with RH and chronic kidney disease (CKD). The aim was to evaluate the effects of dapagliflozin (D) in obese P with RH and CKD stages 3a. Methods 45 obese P (mean body mass index (BMI) 34.2 kg/m2, waist circumference (WC) 104 cm) with true RH and CKD 3a (eGFR 45–59 mL/min/1.73m2) were included in the study under conventional therapy full doses of appropriate combinations (mean 3.7 antihypertensive drugs). The D at daily doses of 10 mg was added to previous treatment. The blood pressure (BP) was measured in the office and by ambulatory BP monitoring. Anthropometry, metabolic profile, including oral glucose tolerance test with insulin, homeostatic model assessment HOMA-R, hematocrit (Hct), uric acid, potassium (K), serum creatinine, calculated GFR were performed at baseline and after 12 weeks treatment. Results At baseline were excellent correlations between BMI and SBP (r=0.45, P&lt;0.01), eGFR and DBP (r=−0.33, P&lt;0.05), eGFR and Hct (r=0.31, P&lt;0.05), BMI and HOMA-R (r=0.34, P&lt;0.05). At baseline mean HOMA-R was 2,8±0.7, eGFR 53.50±3.26 ml/min/1.73 m2, uric acid 469±23 nmol/L, K 4,9±0.9 mmol/L. The asymptomatic hyperuricemia was observed in 57%, impaired glucose tolerance in the 37%. After 12 weeks administration of D, the mean 24 h ambulatory BP effectively decreased (−7.6/−4.3 mmHg; P&lt;0.05 for both; respectively. Also, there were significant decreases in BMI (−2,1 kg/m2, P&lt;0.01), WC (−4,8 cm, P&lt;0.01), fasting glucose (−0,8 mmol/L, P&lt;0.01) and uric acid (−42 nmol/L, P&lt;0.01) without changes in insulin secretion and not significant improvement in HOMA-R (2,8±0.7 versus 2.4±0.4). Mean eGFR and K on D remained unchanged, however, the albumin/creatinine ratio decreased significantly (P&lt;0.05). Also, the Hct significantly increased after start of D (P&lt;0.01). By linear regression analysis, the independent associated factor for the change SBP was baseline BMI (P&lt;0.05) and for the change DBP baseline eGFR (P&lt;0.05). Conclusion Dapagliflozin shows an additional antihypertensive effect when added to the prior combination therapy in obese patients with RH and CKD 3a without risk of hyperkalemia. Dapagliflozin increase hematocrit, possibly due to its diuretic effects and hemoconcentration. So, positive antihypertensive effect D is due to natriuretic effect and decrease fluid retention. Furthermore, there is also a strong indication that the BP effect is also influenced by weight loss and dapagliflozin administration decreased body mass index, waist circumference, fasting glucose and uric acid, with a tendency to decrease the insulin resistance without changes in insulin secretion. FUNDunding Acknowledgement Type of funding sources: None.

Iatrogenic hydrohemothorax during percutaneous nephrolithotomy: A case report

Background: Percutaneous nephrolithotomy (PNL) is a widely used surgical method for renal stone management. However, it can be associated with several complications. Case: We report an acute hemothorax during PNL in 57-year-old male patient with a stone. After observing air bubbles at the diaphragm on the laparoscopic screen, we considered pulmonary complications. A chest radiograph demonstrated a shade that measured 130 mm wide and 70 mm long and fluid retention on the right side of the chest. During drainage of 200 ml of blood through a chest tube, the patient’s vital signs became unstable. After the patient received hydration and intravenous injection of vasopressor, his vital signs stabilized. Conclusions: Pulmonary complications due to pleural injury during PNL can result in death, but the complications can be managed by early diagnosis and treatment. Close cooperation between surgeon and anesthesiologist and routine chest radiographs after PNL can reduce the pulmonary complications.

Cyclic Progesterone Therapy in Androgenic Polycystic Ovary Syndrome (PCOS)—A 6-Month Pilot Study of a Single Woman’s Experience Changes

Background and Objectives: Women with androgenic Polycystic Ovary Syndrome (PCOS) have increased endometrial cancer risk that cyclic progesterone will prevent; it may also reverse PCOS’s neuroendocrine origins. This pilot study’s purpose was to document 6-month experience changes in a woman with PCOS taking cyclic progesterone therapy because she was intolerant of combined hormonal contraceptive therapy, the current PCOS standard of care. A 31-year-old normal-weight woman with PCOS had heavy flow, irregular cycles, and was combined hormonal contraceptives-intolerant. She was prescribed cyclic oral micronized progesterone (OMP) (300 mg/h.s. cycle days 14–27). She kept Menstrual Cycle Diary© (Diary) records, starting with the 1st treatment cycle for six cycles; she was on no other therapy. Statistical analysis a priori hypothesized progesterone decreases high estradiol (E2) experiences (flow, cervical mucus, fluid retention, front-of-the-breast tenderness and anxiety); analysis focused on these. Our objectives: (1) changes from cycles 1 to 6 in E2-related experiences; and (2) follicular phase E2-related changes from cycle 1 (no therapy) to cycles 3 and 6. Materials and Methods: Data from consecutive Diaries were entered into an SPSS database and analyzed by Wilcoxon Signed Rank Test (Objective #1) within-person whole cycle ordinal data, and (Objective #2 follicular phase) repeated measures ANOVA. Results: Cyclic OMP was associated with regular, shorter cycles (±SD) (28.2 ± 0.8 days). Comparison of cycles 1–6 showed decreased fluid retention (p = 0.001), breast tenderness (p = 0.002), and cervical mucus (p = 0.048); there were no changes in flow or anxiety. Fluid retention in the follicular phase also significantly decreased over time (F (1.2, 14.7) = 6.7, p = 0.017). Conclusions: Pilot daily Diary data suggest women with PCOS have improved everyday experiences on cyclic progesterone therapy. Larger prospective studies with more objective outcomes and randomized controlled trials of this innovative PCOS therapy are needed.

Myocardial Expression of Estrogen Receptor-mRNA Is Associated With Lower Markers of Post-operative Organ Damage in Young Patients With Congenital Cardiac Defect

Background: Estrogen receptors (ERs) relate to cardio-protection in adults, but their role in younger patients is not known. We aimed to assess the myocardial expression of ERα- and ERβ- mRNA in young patients with congenital cardiac disease and to analyze their putative protective role.Patients and Methods: Twenty children and young adults (seven females and 13 males) with a median age of 13.8 years (interquartile range: 12.3 years) were enrolled in this prospective study. The myocardial expression of ER-mRNA and genes involved in inflammation, growth, and stress response was assessed by real-time PCR and was correlated to post-operative (po) outcome.Results: ER-mRNA was detected in the myocardium of all patients, independently of gender and age. The expression of ER-mRNA correlated with that of mRNA coding for brain natriuretic peptide and for all cytokines tested. A higher ERα-mRNA expression correlated with lower troponin T concentrations at 24 h po (p = 0.032), higher PaO2/FiO2 ratio at 4 h po (p = 0.059), lower fluid retention at 4 h po (p = 0.048), and lower aspartate aminotransferase (AST) levels at 24 h po (p = 0.047). A higher ERβ-mRNA expression was also correlated with lower fluid retention at 24 h po (p = 0.048).Patients in whom the levels of ERα- and ERβ-mRNA were &gt;P50 had lower troponin T (p = 0.003, respectively) and lower AST concentrations at 24 h po (p = 0.043, respectively) than the others.Conclusions: The expression of ERα- and ERβ-mRNA is present in the myocardium of children and young adults with congenital cardiac defect and is associated with lower markers of po organ damage. This suggests that ERs may provide perioperative organ protection in this population.

Role of Fluid and Sodium Retention in Experimental Ventilator-Induced Lung Injury

Background: Ventilator-induced lung injury (VILI) via respiratory mechanics is deeply interwoven with hemodynamic, kidney and fluid/electrolyte changes. We aimed to assess the role of positive fluid balance in the framework of ventilation-induced lung injury.Methods:Post-hoc analysis of seventy-eight pigs invasively ventilated for 48 h with mechanical power ranging from 18 to 137 J/min and divided into two groups: high vs. low pleural pressure (10.0 ± 2.8 vs. 4.4 ± 1.5 cmH2O; p &lt; 0.01). Respiratory mechanics, hemodynamics, fluid, sodium and osmotic balances, were assessed at 0, 6, 12, 24, 48 h. Sodium distribution between intracellular, extracellular and non-osmotic sodium storage compartments was estimated assuming osmotic equilibrium. Lung weight, wet-to-dry ratios of lung, kidney, liver, bowel and muscle were measured at the end of the experiment.Results: High pleural pressure group had significant higher cardiac output (2.96 ± 0.92 vs. 3.41 ± 1.68 L/min; p &lt; 0.01), use of norepinephrine/epinephrine (1.76 ± 3.31 vs. 5.79 ± 9.69 mcg/kg; p &lt; 0.01) and total fluid infusions (3.06 ± 2.32 vs. 4.04 ± 3.04 L; p &lt; 0.01). This hemodynamic status was associated with significantly increased sodium and fluid retention (at 48 h, respectively, 601.3 ± 334.7 vs. 1073.2 ± 525.9 mmol, p &lt; 0.01; and 2.99 ± 2.54 vs. 6.66 ± 3.87 L, p &lt; 0.01). Ten percent of the infused sodium was stored in an osmotically inactive compartment. Increasing fluid and sodium retention was positively associated with lung-weight (R2 = 0.43, p &lt; 0.01; R2 = 0.48, p &lt; 0.01) and with wet-to-dry ratio of the lungs (R2 = 0.14, p &lt; 0.01; R2 = 0.18, p &lt; 0.01) and kidneys (R2 = 0.11, p = 0.02; R2 = 0.12, p = 0.01).Conclusion: Increased mechanical power and pleural pressures dictated an increase in hemodynamic support resulting in proportionally increased sodium and fluid retention and pulmonary edema.

Predictive Factors of Acute Complicated Appendicitis: A Retrospective Study

Background: Complicated appendicitis is an indication for emergency surgery. Therefore, the predictive factors for appendicitis based on the patient background needs identification. Previously, factors predicting non-complicated and complicated appendicitis were reported. However, most of those reports were deemed unsuitable as a standard for emergency use, since those comprised too many items as predictors. We previously reported three items that preoperatively predicted complicated appendicitis (body temperature, C-reactive protein, and fluid retention around the appendix). In this study, we re-evaluated different cases to confirm the usefulness of these three items can for accurately predicting complicated appendicitis preoperatively. In addition, we compared the effectiveness of these predictor items with those reported by other researchers.Methods: We retrospectively evaluated 417 adult patients who underwent surgery for acute appendicitis between January 2013 and December 2019, and compared our predictor items with those used in previous reports on the preoperative prediction of complicated appendicitis (criteria A consisting of eight predictor items and criteria B consisting of seven predictor items). Results: The area under the receiver operating characteristic curve (AUC) for the sensitivity to diagnose complicated appendicitis according to our criteria, criteria A, and criteria B were 0.823, 0.839, and 0.856, respectively. The AUC of our criteria and criteria A were similar (P = 0.356); those of criteria A and B were also similar (P = 0.352). However, the AUC of criteria B was statistically higher than that of our criteria (P < 0.05).Conclusion: Diagnostic criteria B were statistically the best predictor items for characterizing complicated and uncomplicated appendicitis. However, like criteria A and B, the AUC of our criteria exceeded 0.8, and only involved three predictor items; therefore, they can be considered useful predictors.