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The Cochrane Database of Systematic... Apr 2005Hyperkalaemia occurs in outpatients and in between 1% and 10% of hospitalised patients. When severe, consequences include arrhythmia and death. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hyperkalaemia occurs in outpatients and in between 1% and 10% of hospitalised patients. When severe, consequences include arrhythmia and death.
OBJECTIVES
To review randomised evidence informing the emergency (i.e. acute, rather than chronic) management of hyperkalaemia
SEARCH STRATEGY
We searched MEDLINE (1966-2003), EMBASE (1980-2003), The Cochrane Library (issue 4, 2003), and SciSearch using the text words hyperkal* or hyperpotass* (* indicates truncation). We also searched selected journals and abstracts of meetings. The reference lists of recent review articles, textbooks, and relevant papers were reviewed for additional potentially relevant titles.
SELECTION CRITERIA
All selection was performed in duplicate. Articles were considered relevant if they were randomised, quasi-randomised or cross-over randomised studies of pharmacological or other interventions to treat non-neonatal humans with hyperkalaemia, reporting on clinically-important outcomes, or serum potassium levels within the first six hours of administration.
DATA COLLECTION AND ANALYSIS
All data extraction was performed in duplicate. We extracted quality information, and details of the patient population, intervention, baseline and follow-up potassium values. We extracted information about arrhythmias, mortality and adverse effects. Where possible, meta-analysis was performed using random effects models.
MAIN RESULTS
None of the studies of clinically-relevant hyperkalaemia reported mortality or cardiac arrhythmias. Reports focussed on serum potassium levels. Many studies were small, and not all intervention groups had sufficient data for meta-analysis to be performed. On the basis of small studies, inhaled beta-agonists, nebulised beta-agonists, and intravenous (IV) insulin-and-glucose were all effective, and the combination of nebulised beta agonists with IV insulin-and-glucose was more effective than either alone. Dialysis is effective. Results were equivocal for IV bicarbonate. K-absorbing resin was not effective by four hours, and longer follow up data on this intervention were not available from RCTs.
AUTHORS' CONCLUSIONS
Nebulised or inhaled salbutamol, or IV insulin-and-glucose are the first-line therapies for the management of emergency hyperkalaemia that are best supported by the evidence. Their combination may be more effective than either alone, and should be considered when hyperkalaemia is severe. When arrhythmias are present, a wealth of anecdotal and animal data suggests that IV calcium is effective in treating arrhythmia. Further studies of the optimal use of combination treatments and of the adverse effects of treatments are needed.
Topics: Adrenergic beta-Agonists; Albuterol; Bicarbonates; Emergency Treatment; Glucose; Humans; Hyperkalemia; Hypoglycemic Agents; Infusions, Intravenous; Insulin; Randomized Controlled Trials as Topic; Renal Dialysis
PubMed: 15846652
DOI: 10.1002/14651858.CD003235.pub2 -
The Cochrane Database of Systematic... 2004Iodine deficiency is the main cause of potentially preventable mental retardation in childhood, as well as causing goitre and hypothyroidism in people of all ages. It is... (Review)
Review
BACKGROUND
Iodine deficiency is the main cause of potentially preventable mental retardation in childhood, as well as causing goitre and hypothyroidism in people of all ages. It is still prevalent in large parts of the world.
OBJECTIVES
To assess the effects of iodine supplementation overall, and of different forms and dosages of iodine supplementation separately, in the prevention of iodine deficiency disorders in children.
SEARCH STRATEGY
The Cochrane Library, MEDLINE, EMBASE and reference lists, databases of ongoing trials and the Internet were searched. Date of latest search: October 2003.
SELECTION CRITERIA
We included randomised controlled trials and prospective controlled trials not using randomisation of iodine supplementation in children living in areas of iodine deficiency.
DATA COLLECTION AND ANALYSIS
Two reviewers did the initial data selection and quality assessment of trials independently. As the studies identified were not sufficiently similar and not of sufficient quality, we did not do a meta-analysis but summarised the data in a narrative format.
MAIN RESULTS
Twenty-six prospective controlled trials were related to our question, assessing a total of 29613 children. Twenty of them were classified as being of low quality, six of moderate quality. Most studies used iodised oil as a supplement, but other supplements were also used. The intervention groups were compared to a non-supplemented control group, different doses or different forms of iodine supplementation. There was a clear tendency towards goitre reduction with iodine supplementation; this was significant in several studies. Significant differences in physical development were not seen, except in one study. Results for differences in cognitive and psychomotor measures were mixed, with only few studies showing a positive intervention effect. One study suggested that infant mortality was lowered after iodine supplementation. Most studies showed a significant increase in urinary iodine excretion and levels recommended by the WHO were reached in most cases after supplementation. Thyroid-stimulating hormone (TSH) levels were significantly reduced in one study. In 1.8% of the children investigated, adverse effects were found, most of them were minor and transient.
REVIEWERS' CONCLUSIONS
Despite most of the included studies being of low quality, the results suggest that iodine supplementation, especially iodised oil, is an effective means of decreasing goitre rates and improving iodine status in children. Indications of positive effects on physical and mental development and mortality were seen, although results were not always significant. Adverse effects were generally minor and transient. Insufficient evidence was available on non-oil supplements. High quality controlled studies investigating relevant long term outcome measures are needed to address the question of the best form of iodine supplementation in different population groups and settings.
Topics: Child; Congenital Hypothyroidism; Controlled Clinical Trials as Topic; Dietary Supplements; Goiter; Humans; Iodates; Iodine; Iodized Oil; Myxedema; Potassium Compounds; Potassium Iodide; Sodium Chloride, Dietary
PubMed: 15106221
DOI: 10.1002/14651858.CD003819.pub2 -
The Cochrane Database of Systematic... 2002Oral rehydration solution (ORS) has reduced childhood deaths from diarrhoea in many countries. Recent studies suggest that the currently recommended formulation of ORS... (Review)
Review
BACKGROUND
Oral rehydration solution (ORS) has reduced childhood deaths from diarrhoea in many countries. Recent studies suggest that the currently recommended formulation of ORS recommended by the World Health Organization (WHO) may not be optimal, and solutions that contain lower concentrations of sodium and glucose may be more effective.
OBJECTIVES
To compare reduced osmolarity ORS with WHO standard ORS in children with acute diarrhoea.
SEARCH STRATEGY
The Cochrane Collaboration Trials Register (on The Cochrane Library, Issue 2, 2001), MEDLINE (1966 to June 2001), EMBASE (1988 to May 2001), and Current Contents (June 2001) were searched. Additional trials were identified by hand searching. Content experts were contacted.
SELECTION CRITERIA
Randomized controlled trials comparing reduced osmolarity ORS with the WHO standard ORS formulation. The primary outcome was unscheduled intravenous fluid infusion. Secondary outcomes were measures of clinical illness.
DATA COLLECTION AND ANALYSIS
Two reviewers extracted data. We tested for heterogeneity using the Chi-square statistic, conducted sensitivity analysis by allocation concealment, and the regression approach to assess funnel plot asymmetry from selective trial publication.
MAIN RESULTS
The primary outcome, unscheduled intravenous fluid infusion, was reported in 11 trials. In a meta-analysis of 8 trials, reduced osmolarity ORS was associated with fewer unscheduled intravenous fluid infusions compared with WHO standard ORS (Mantel Haenzel odds ratio 0.59, 95% confidence interval 0.45 to 0.79) with no evidence for heterogeneity between trials. No unscheduled intravenous fluid infusion therapy was required in any participant in three trials. Eleven trials reported stool output, and data suggested less stool output in the reduced osmolarity ORS group. Vomiting was less frequent in the reduced osmolarity group in the six trials reporting this. Six trials sought hyponatraemia, with events in three studies, but no obvious difference between the two arms.
REVIEWER'S CONCLUSIONS
In children admitted to hospital with diarrhoea, reduced osmolarity ORS when compared to WHO standard ORS is associated with fewer unscheduled intravenous fluid infusions, lower stool volume post randomization, and less vomiting. No additional risk of developing hyponatraemia when compared with WHO standard ORS was detected.
Topics: Bicarbonates; Child, Preschool; Dehydration; Diarrhea; Fluid Therapy; Glucose; Humans; Infant; Osmolar Concentration; Potassium Chloride; Rehydration Solutions; Sodium Chloride
PubMed: 11869639
DOI: 10.1002/14651858.CD002847 -
BMJ (Clinical Research Ed.) Jul 2001To compare reduced osmolarity oral rehydration solution with standard World Health Organization oral rehydration solution in children with acute diarrhoea. (Review)
Review
OBJECTIVES
To compare reduced osmolarity oral rehydration solution with standard World Health Organization oral rehydration solution in children with acute diarrhoea.
DESIGN
Systematic review of randomised controlled trials.
STUDIES
15 randomised controlled trials including 2397 randomised patients.
OUTCOMES
The primary outcome was unscheduled intravenous infusion; secondary outcomes were stool output, vomiting, and hyponatraemia.
RESULTS
In a meta-analysis of nine trials for the primary outcome, reduced osmolarity rehydration solution was associated with fewer unscheduled intravenous infusions compared with standard WHO rehydration solution (odds ratio 0.61, 95% confidence interval 0.47 to 0.81). Three trials reported that no patients required unscheduled intravenous infusion. Trials reporting secondary outcomes suggested that in the reduced osmolarity rehydration solution group, stool output was lower (standardised mean difference in the log scale -0.214 (95% confidence interval -0.305 to -0.123; 13 trials) and vomiting was less frequent (odds ratio 0.71, 0.55 to 0.92; six trials). Six trials sought presence of hyponatraemia, with events in three studies, but no significant difference between the two arms.
CONCLUSION
In children admitted to hospital with dehydration associated with diarrhoea, reduced osmolarity rehydration solution is associated with reduced need for unscheduled intravenous infusions, lower stool volume, and less vomiting compared with standard WHO rehydration solution.
Topics: Administration, Oral; Bicarbonates; Child, Preschool; Cholera; Dehydration; Diarrhea; Fluid Therapy; Glucose; Humans; Infant; Infusions, Intravenous; Osmolar Concentration; Potassium Chloride; Rehydration Solutions; Sodium Chloride; Treatment Outcome
PubMed: 11451782
DOI: 10.1136/bmj.323.7304.81 -
The Cochrane Database of Systematic... 2001Oral rehydration solution (ORS) has reduced childhood deaths from diarrhoea in many countries. Recent studies suggest that the currently recommended formulation of ORS... (Review)
Review
BACKGROUND
Oral rehydration solution (ORS) has reduced childhood deaths from diarrhoea in many countries. Recent studies suggest that the currently recommended formulation of ORS recommended by the World Health Organization (WHO) may not be optimal, and solutions that contain lower concentrations of sodium and glucose may be more effective.
OBJECTIVES
In children with acute diarrhoea, to compare reduced osmolarity glucose-based oral rehydration salt solution with international WHO formulation.
SEARCH STRATEGY
The Cochrane Collaboration Trials Register, MEDLINE, and EMBASE were searched. Additional trials were identified by hand searching. Content experts were contacted.
SELECTION CRITERIA
Randomised controlled trials comparing reduced osmolarity ORS solution with the WHO formulation. Outcomes sought were unscheduled intravenous fluid infusion therapy and measures of clinical illness.
DATA COLLECTION AND ANALYSIS
Data were extracted by two reviewers. We tested for heterogeneity using the chi-square statistic, conducted sensitivity analysis by allocation concealment, and the regression approach to assess funnel plot asymmetry from selective trial publication.
MAIN RESULTS
The primary outcome was reported in 12 trials. In a meta-analysis of nine trials, reduced osmolarity ORS was associated with fewer unscheduled infusions compared with standard WHO ORS (Mantel Haenzel odds ratio 0.61, 95% confidence interval 0.47 to 0.81) with no evidence for heterogeneity between trials. No unscheduled intravenous fluid infusion therapy was required in any participant in three trials. Thirteen trials reported stool output, and data suggested less stool output in the reduced osmolarity ORS group. Vomiting was less frequent in the reduced osmolarity group in the six trials reporting this. Six trials sought hyponatraemia, with events in three studies, but no obvious difference between the two arms.
REVIEWER'S CONCLUSIONS
In children admitted to hospital with diarrhoea, reduced osmolarity ORS when compared to WHO ORS is associated with fewer unscheduled intravenous infusions, smaller stool volume post randomisation, and less vomiting. No additional risk of developing hyponatraemia when compared with WHO ORS was detected.
Topics: Bicarbonates; Child, Preschool; Dehydration; Diarrhea; Fluid Therapy; Glucose; Humans; Infant; Osmolar Concentration; Potassium Chloride; Rehydration Solutions; Sodium Chloride
PubMed: 11406049
DOI: 10.1002/14651858.CD002847 -
The Cochrane Database of Systematic... 2001Dentine hypersensitivity may be defined as the pain arising from exposed dentine, typically in response to external stimuli, and which cannot be explained by any other... (Review)
Review
BACKGROUND
Dentine hypersensitivity may be defined as the pain arising from exposed dentine, typically in response to external stimuli, and which cannot be explained by any other form of dental disease. Many treatment regimes have been recommended over the years, and in recent years particular attention has been focused on toothpastes containing potassium nitrate.
OBJECTIVES
To compare the effectiveness of potassium nitrate containing toothpastes with placebo toothpastes in reducing dentine hypersensitivity.
SEARCH STRATEGY
The following databases were cross searched via the database host DIALOG: MEDLINE, EMBASE, ELSEVIER BIOBASE, BIOSIS PREVIEWS, CAB HEALTH, SCI SEARCH, CURRENT CONTENTS until 1 April 2000. The specialised Cochrane Oral Health Group Trials Register was also searched. Bibliographies of clinical studies and reviews identified in the electronic search were checked for studies published outside the electronically searched journals.
SELECTION CRITERIA
Randomised clinical trials (RCTs) in which the effect on dentine hypersensitivity of potassium nitrate toothpastes were tested against non-potassium nitrate containing placebo toothpastes.
DATA COLLECTION AND ANALYSIS
Two of the reviewers independently recorded the results of the included trials using a specially designed chart. Sensitivity was assessed by using thermal, tactile, air blast, and subjective methods. The quality of all RCTs, that fulfilled the inclusion criteria, was acceptable with Jadad scores ranging from 3 to 4 (Jadad 1998).
MAIN RESULTS
Out of the eight studies that initially fulfilled the criteria to be included in the review, four studies did not present mean and standard deviations and could thus not be included in the meta-analysis. Three of these did not show an effect on any of the measurements of dentine hypersensitivity, while one did. Four studies were included in the meta-analysis which showed statistically significant effect of potassium nitrate toothpaste on air blast and tactile sensitivity, e.g. the meta analysis of air blast sensitivity showed a standardized mean difference in sensitivity score of -1.51 (95% CI: -2.09 to -0.94) in favour of treatment. The subjective assessment failed to show a significant effect at the six to eight week assessment.
REVIEWER'S CONCLUSIONS
No strong evidence is available supporting the efficacy of potassium nitrate toothpaste for dentine hypersensitivity.
Topics: Adult; Dentin Sensitivity; Humans; Nitrates; Potassium Compounds; Toothpastes
PubMed: 11405992
DOI: 10.1002/14651858.CD001476