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Fluidos

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13 papers 0 to 25 followers
https://www.readbyqxmd.com/read/26880451/treatment-of-hyperkalemia-something-old-something-new
#1
REVIEW
Richard H Sterns, Marvin Grieff, Paul L Bernstein
Treatment options for hyperkalemia have not changed much since the introduction of the cation exchange resin, sodium polystyrene sulfonate (Kayexalate, Covis Pharmaceuticals, Cary, NC), over 50 years ago. Although clinicians of that era did not have ready access to hemodialysis or loop diuretics, the other tools that we use today-calcium, insulin, and bicarbonate-were well known to them. Currently recommended insulin regimens provide too little insulin to achieve blood levels with a maximal kalemic effect and too little glucose to avoid hypoglycemia...
March 2016: Kidney International
https://www.readbyqxmd.com/read/25776532/trial-of-early-goal-directed-resuscitation-for-septic-shock
#2
RANDOMIZED CONTROLLED TRIAL
Paul R Mouncey, Tiffany M Osborn, G Sarah Power, David A Harrison, M Zia Sadique, Richard D Grieve, Rahi Jahan, Sheila E Harvey, Derek Bell, Julian F Bion, Timothy J Coats, Mervyn Singer, J Duncan Young, Kathryn M Rowan
BACKGROUND: Early, goal-directed therapy (EGDT) is recommended in international guidelines for the resuscitation of patients presenting with early septic shock. However, adoption has been limited, and uncertainty about its effectiveness remains. METHODS: We conducted a pragmatic randomized trial with an integrated cost-effectiveness analysis in 56 hospitals in England. Patients were randomly assigned to receive either EGDT (a 6-hour resuscitation protocol) or usual care...
April 2, 2015: New England Journal of Medicine
https://www.readbyqxmd.com/read/25693602/anemia-and-transfusion-in-critical-care-physiology-and-management
#3
Elena Spinelli, Robert H Bartlett
OBJECTIVE: The objective of this report is to review the physiology and management of anemia in critical care. Selected publications on physiology and transfusion related to anemia and critical care, including the modern randomized trials of conservative versus liberal transfusion policy, were used. Anemia is compensated and tolerated in most critically ill patients as long as oxygen delivery is at least twice oxygen consumption. There are risks to blood transfusion which can be minimized by blood banking practice...
June 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/25647203/transfusion-of-plasma-platelets-and-red-blood-cells-in-a-1-1-1-vs-a-1-1-2-ratio-and-mortality-in-patients-with-severe-trauma-the-proppr-randomized-clinical-trial
#4
RANDOMIZED CONTROLLED TRIAL
John B Holcomb, Barbara C Tilley, Sarah Baraniuk, Erin E Fox, Charles E Wade, Jeanette M Podbielski, Deborah J del Junco, Karen J Brasel, Eileen M Bulger, Rachael A Callcut, Mitchell Jay Cohen, Bryan A Cotton, Timothy C Fabian, Kenji Inaba, Jeffrey D Kerby, Peter Muskat, Terence O'Keeffe, Sandro Rizoli, Bryce R H Robinson, Thomas M Scalea, Martin A Schreiber, Deborah M Stein, Jordan A Weinberg, Jeannie L Callum, John R Hess, Nena Matijevic, Christopher N Miller, Jean-Francois Pittet, David B Hoyt, Gail D Pearson, Brian Leroux, Gerald van Belle
IMPORTANCE: Severely injured patients experiencing hemorrhagic shock often require massive transfusion. Earlier transfusion with higher blood product ratios (plasma, platelets, and red blood cells), defined as damage control resuscitation, has been associated with improved outcomes; however, there have been no large multicenter clinical trials. OBJECTIVE: To determine the effectiveness and safety of transfusing patients with severe trauma and major bleeding using plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio...
February 3, 2015: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/25352314/fluid-resuscitation-in-acute-medicine-what-is-the-current-situation
#5
REVIEW
J A Myburgh
The administration of intravenous fluids for resuscitation is the most common intervention in acute medicine. There is increasing evidence that the type of fluid may directly affect patient-centred outcomes. There is a lack of evidence that colloids confer clinical benefit over crystalloids and they may be associated with harm. Hydroxyethyl starch preparations are associated with increased mortality and use of renal replacement therapy in critically ill patients, particularly those with sepsis; albumin is associated with increased mortality in patients with severe traumatic brain injury...
January 2015: Journal of Internal Medicine
https://www.readbyqxmd.com/read/23323867/duodenal-infusion-of-donor-feces-for-recurrent-clostridium-difficile
#6
RANDOMIZED CONTROLLED TRIAL
Els van Nood, Anne Vrieze, Max Nieuwdorp, Susana Fuentes, Erwin G Zoetendal, Willem M de Vos, Caroline E Visser, Ed J Kuijper, Joep F W M Bartelsman, Jan G P Tijssen, Peter Speelman, Marcel G W Dijkgraaf, Josbert J Keller
BACKGROUND: Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. We studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection. METHODS: We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage...
January 31, 2013: New England Journal of Medicine
https://www.readbyqxmd.com/read/25956718/restrictive-versus-liberal-blood-transfusion-for-acute-upper-gastrointestinal-bleeding-trigger-a-pragmatic-open-label-cluster-randomised-feasibility-trial
#7
RANDOMIZED CONTROLLED TRIAL
Vipul Jairath, Brennan C Kahan, Alasdair Gray, Caroline J Doré, Ana Mora, Martin W James, Adrian J Stanley, Simon M Everett, Adam A Bailey, Helen Dallal, John Greenaway, Ivan Le Jeune, Melanie Darwent, Nicholas Church, Ian Reckless, Renate Hodge, Claire Dyer, Sarah Meredith, Charlotte Llewelyn, Kelvin R Palmer, Richard F Logan, Simon P Travis, Timothy S Walsh, Michael F Murphy
BACKGROUND: Transfusion thresholds for acute upper gastrointestinal bleeding are controversial. So far, only three small, underpowered studies and one single-centre trial have been done. Findings from the single-centre trial showed reduced mortality with restrictive red blood cell (RBC) transfusion. We aimed to assess whether a multicentre, cluster randomised trial is a feasible method to substantiate or refute this finding. METHODS: In this pragmatic, open-label, cluster randomised feasibility trial, done in six university hospitals in the UK, we enrolled all patients aged 18 years or older with new presentations of acute upper gastrointestinal bleeding, irrespective of comorbidity, except for exsanguinating haemorrhage...
July 11, 2015: Lancet
https://www.readbyqxmd.com/read/21278718/pathophysiology-and-management-of-hypokalemia-a-clinical-perspective
#8
REVIEW
Robert J Unwin, Friedrich C Luft, David G Shirley
Potassium (K(+)) ions are the predominant intracellular cations. K(+) homeostasis depends on external balance (dietary intake [typically 100 mmol per day] versus excretion [95% via the kidney; 5% via the colon]) and internal balance (the distribution of K(+) between intracellular and extracellular fluid compartments). The uneven distribution of K(+) across cell membranes means that a mere 1% shift in its distribution can cause a 50% change in plasma K(+) concentration. Hormonal mechanisms (involving insulin, β-adrenergic agonists and aldosterone) modulate K(+) distribution by promoting rapid transfer of K(+) across the plasma membrane...
February 2011: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/25551526/disorders-of-plasma-sodium-causes-consequences-and-correction
#9
REVIEW
Richard H Sterns
New England Journal of Medicine, Volume 372, Issue 1, Page 55-65, January 2015.
January 1, 2015: New England Journal of Medicine
https://www.readbyqxmd.com/read/25372090/integration-of-acid-base-and-electrolyte-disorders
#10
REVIEW
Julian L Seifter
No abstract text is available yet for this article.
November 6, 2014: New England Journal of Medicine
https://www.readbyqxmd.com/read/22403272/differential-diagnosis-of-nongap-metabolic-acidosis-value-of-a-systematic-approach
#11
REVIEW
Jeffrey A Kraut, Nicolaos E Madias
Nongap metabolic acidosis is a common form of both acute and chronic metabolic acidosis. Because derangements in renal acid-base regulation are a common cause of nongap metabolic acidosis, studies to evaluate renal acidification often serve as the mainstay of differential diagnosis. However, in many cases, information obtained from the history and physical examination, evaluation of the electrolyte pattern (to determine if a nongap acidosis alone or a combined nongap and high anion gap metabolic acidosis is present), and examination of the serum potassium concentration (to characterize the disorder as hyperkalemic or hypokalemic in nature) is sufficient to make a presumptive diagnosis without more sophisticated studies...
April 2012: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/22871240/evaluation-and-treatment-of-respiratory-alkalosis
#12
Biff F Palmer
Respiratory alkalosis is the most frequent acid-base disturbance encountered in clinical practice. This is particularly true in critically ill patients, for whom the degree of hypocapnia directly correlates with adverse outcomes. Although this acid-base disturbance often is considered benign, evidence suggests that the alkalemia of primary hypocapnia can cause clinically significant decreases in tissue oxygen delivery. Mild respiratory alkalosis often serves as a marker of an underlying disease and may not require therapeutic intervention...
November 2012: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/24463187/a-critical-appraisal-of-intravenous-fluids-from-the-physiological-basis-to-clinical-evidence
#13
REVIEW
David Severs, Ewout J Hoorn, Maarten B Rookmaaker
Fluid management has been a vital part of routine clinical care for more than 180 years. The increasing number of available fluids has generated controversy about the optimal choice of resuscitation fluid. In this review, we provide a critical overview of the different fluids available, their composition, the relevant physiology as well as the published evidence on clinical outcomes to guide their use. Commonly used infusion fluids include semisynthetic colloids and crystalloids; the latter comprises both normal saline (NaCl 0...
February 2015: Nephrology, Dialysis, Transplantation
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