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Journal of Pediatric Intensive Care Mar 2021Hypervolemia is a condition with an excess of total body water and when sodium (Na) intake exceeds output. It can have different causes, such as hypervolemic... (Review)
Review
Hypervolemia is a condition with an excess of total body water and when sodium (Na) intake exceeds output. It can have different causes, such as hypervolemic hyponatremia (often associated with decreased, effective circulating blood volume), hypervolemia associated with metabolic alkalosis, and end-stage renal disease. The degree of hypervolemia in critically ill children is a risk factor for mortality, regardless of disease severity. A child (under 18 years of age) with hypervolemia requires fluid removal and fluid restriction. Diuretics are able to increase or maintain urine output and thus improve fluid and nutrition management, but their benefit in preventing or treating acute kidney injury is questionable.
PubMed: 33585056
DOI: 10.1055/s-0040-1714703 -
Vnitrni Lekarstvi 2019In acutely ill patients, disturbances of circulating blood volume and water homeostasis are frequently encountered. In order to choose adequate treatment strategy... (Review)
Review
In acutely ill patients, disturbances of circulating blood volume and water homeostasis are frequently encountered. In order to choose adequate treatment strategy a well based diagnostics of these disturbance sis necessary, because fluid therapy possess the potential not only to help but also to worsen patients state. Currently we have at hand several possibilities to diagnose hypovolemia or hypervolemia: besides standard clinical assessment novel approaches as dedicated laboratory markers or sonography. Tests of fluid responsiveness are other mean how to ensure that the acutely ill patient will receive just the right amount of fluids. In this review article we will present the current view of the circulating blood volume pathophysiology as well as contemporary diagnostic tools.
Topics: Fluid Therapy; Humans; Hypovolemia; Water-Electrolyte Imbalance
PubMed: 31088093
DOI: No ID Found -
American Journal of Kidney Diseases :... Oct 2020The management of pain in patients with chronic kidney disease (CKD) is challenging for many reasons. These patients have increased susceptibility to adverse drug... (Review)
Review
The management of pain in patients with chronic kidney disease (CKD) is challenging for many reasons. These patients have increased susceptibility to adverse drug effects due to altered drug metabolism and excretion, and there are limited safety data for use in this population despite a high pain burden. Nonsteroidal anti-inflammatory drugs (NSAIDs) have long been regarded as dangerous for use in patients with CKD because of their risk for nephrotoxicity and thus alternative classes of analgesics, including opioids, have become more commonly used for pain control in this population. Given the well-established risks that opioids and other analgesics pose, further characterization of the risk posed by NSAIDs in patients with CKD is warranted. NSAID use has been associated with acute kidney injury, progressive loss of glomerular filtration rate in CKD, electrolyte derangements, and hypervolemia with worsening of heart failure and hypertension. The risk for these nephrotoxicity syndromes is modified by many comorbid conditions, risk factors, and characteristics of use, and in patients with CKD, the risk differs between levels of glomerular filtration rate. In this review, we offer recommendations for the cautious use of NSAIDs in the CKD population after careful consideration of these risk factors on an individualized basis.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Humans; Kidney Diseases; Pain; Renal Insufficiency, Chronic
PubMed: 32479922
DOI: 10.1053/j.ajkd.2020.03.023 -
Temperature (Austin, Tex.) Sep 2019Tokyo 2020 will likely be the most heat stressful Olympics to date, so preparation to mitigate the effects of humid heat will be essential for performance in several of... (Review)
Review
Tokyo 2020 will likely be the most heat stressful Olympics to date, so preparation to mitigate the effects of humid heat will be essential for performance in several of the 33 sports. One key consideration is heat acclimation (HA); the repeated exposure to heat to elicit physiological and psychophysical adaptations that improve tolerance and exercise performance in the heat. Heat can be imposed in various ways, including exercise in the heat, hot water immersion, or passive exposure to hot air (., sauna). The physical requirements of each sport will determine the impact that the heat has on performance, and the adaptations required from HA to mitigate these effects. This review focuses on one key adaptation, plasma volume expansion (PVE), and how the mode of HA may affect the kinetics of adaptation. PVE constitutes a primary HA-mediated adaptation and contributes to functional adaptations (e.g., lower heart rate and increased heat loss capacity), which may be particularly important in athletes of "sub-elite" cardiorespiratory fitness (., team sports), alongside athletes of prolonged endurance events. This review: i) highlights the ability of exercise in the heat, hot-water immersion, and passive hot air to expand PV, providing the first quantitative assessment of the efficacy of different heating modes; ii) discusses how this may apply to athletes at Tokyo 2020; and iii) provides recommendations regarding the protocol of HA and the prospect for achieving PVE (and the related outcomes).
PubMed: 33015241
DOI: 10.1080/23328940.2019.1653736 -
Frontiers in Veterinary Science 2021Fluid overload (FO) is characterized by hypervolemia, edema, or both. In clinical practice it is usually suspected when a patient shows evidence of pulmonary edema,... (Review)
Review
Fluid overload (FO) is characterized by hypervolemia, edema, or both. In clinical practice it is usually suspected when a patient shows evidence of pulmonary edema, peripheral edema, or body cavity effusion. FO may be a consequence of spontaneous disease, or may be a complication of intravenous fluid therapy. Most clinical studies of the association of FO with fluid therapy and risk of harm define it in terms of an increase in body weight of at least 5-10%, or a positive fluid balance of the same magnitude when fluid intake and urine output are measured. Numerous observational clinical studies in humans have demonstrated an association between FO, adverse events, and mortality, as have two retrospective observational studies in dogs and cats. The risk of FO may be minimized by limiting resuscitation fluid to the smallest amount needed to optimize cardiac output and then limiting maintenance fluid to the amount needed to replace ongoing normal and pathological losses of water and sodium.
PubMed: 34268347
DOI: 10.3389/fvets.2021.668688 -
Journal of Nephrology 2004This paper reviews the evaluation of volume status in peritoneal dialysis (PD) and the epidemiology of protocols assessing the hydration status in PD patients, in... (Review)
Review
This paper reviews the evaluation of volume status in peritoneal dialysis (PD) and the epidemiology of protocols assessing the hydration status in PD patients, in addition the factor contributing to fluid overload in PD patients, among them the peritoneal transport characteristics, being the most important, are discussed. Long term structural and functional alteration in the membrane occur which may affect the peritoneal ultrafiltration capacity. Finally, the most important therapeutic options to treat hypervolemia in PD patients are discussed, including dietary salt restriction, the prescription of loop diuretics and the application of low sodium dialysate and polyglucose solutions.
Topics: Hemodialysis Solutions; Humans; Membranes, Artificial; Peritoneal Dialysis; Peritoneum; Water-Electrolyte Imbalance
PubMed: 15599888
DOI: No ID Found -
American Family Physician Mar 2015Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Sodium disorders are associated with an increased risk of morbidity and...
Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Sodium disorders are associated with an increased risk of morbidity and mortality. Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Hyponatremia and hypernatremia are classified based on volume status (hypovolemia, euvolemia, and hypervolemia). Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status. Treatment is based on symptoms and underlying causes. In general, hyponatremia is treated with fluid restriction (in the setting of euvolemia), isotonic saline (in hypovolemia), and diuresis (in hypervolemia). A combination of these therapies may be needed based on the presentation. Hypertonic saline is used to treat severe symptomatic hyponatremia. Medications such as vaptans may have a role in the treatment of euvolemic and hypervolemic hyponatremia. The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit.
Topics: Diagnosis, Differential; Diuresis; Fluid Therapy; Humans; Hypernatremia; Hyponatremia; Isotonic Solutions; Saline Solution, Hypertonic; Sodium
PubMed: 25822386
DOI: No ID Found -
Clinical Nephrology Apr 2008Here we review the existing data on hypertension, volume overload and volume control in peritoneal dialysis (PD) patients and comment on the impact of these factors on... (Review)
Review
Here we review the existing data on hypertension, volume overload and volume control in peritoneal dialysis (PD) patients and comment on the impact of these factors on residual renal function and cardiovascular disease in PD patients.
Topics: Cardiovascular Diseases; Humans; Hypertension; Kidney; Peritoneal Dialysis; Plasma Volume
PubMed: 18397696
DOI: 10.5414/cnp69233 -
Transplantation Aug 2014The prevalence and consequences of hypervolemia in kidney transplant recipients (KTRs) have not been investigated. Specifically, its impact on blood pressure (BP) and...
BACKGROUND
The prevalence and consequences of hypervolemia in kidney transplant recipients (KTRs) have not been investigated. Specifically, its impact on blood pressure (BP) and relationship with N-terminal fragment of prohormone B-type natriuretic peptide (NT-proBNP) are unknown. The objectives of this study were to establish the prevalence of hypervolemia among clinically stable KTRs, investigate the predictors of posttransplant hypervolemia, assess its impact on blood pressure, and determine its relationship with NT-proBNP.
METHODS
This single-center cross-sectional study enrolled 123 clinically stable KTRs. Extracellular volume status was determined by multifrequency bioimpedance analysis. Mild and severe hypervolemia were defined as percentage volume expansion of greater than 7% and greater than 15%, respectively. Systolic BP (SBP) and diastolic BP (DBP) were measured, with mean arterial pressure (MAP) calculated. Serum NT-proBNP was quantified using a noncompetitive immunoluminometric assay. Potential demographic, nutritional, and clinical predictors of extracellular volume status, BP, and NT-proBNP levels were assessed.
RESULTS
Hypervolemia was present in 30% of KTRs, with 5% classified as severe hypervolemia. Significant predictors of volume expansion were increased sodium intake, advancing age, and reduced fat mass (P<0.01 for all associations). Hypervolemia was the only independent predictor of elevated MAP, SBP, and DBP (P<0.001 for all associations). Raised NT-proBNP levels were independently associated with both hypervolemia (P=0.01) and allograft dysfunction (P=0.03).
CONCLUSIONS
Hypervolemia is unexpectedly common among clinically stable KTRs. It is closely associated with elevated BP. The relationship with increased sodium intake signals potential therapeutic focus. Further study is warranted to prospectively investigate objective measures of extracellular volume status among KTRs.
Topics: Adult; Aged; Allografts; Blood Pressure; Cross-Sectional Studies; Extracellular Fluid; Female; Humans; Kidney Transplantation; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Plasma Volume
PubMed: 24770615
DOI: 10.1097/TP.0000000000000066 -
Ugeskrift For Laeger Nov 2022This is a case report of an observation of bradycardia and inverted T-waves anteroseptally on the electrocardiogram along with cardiac symptoms, in a previously healthy...
This is a case report of an observation of bradycardia and inverted T-waves anteroseptally on the electrocardiogram along with cardiac symptoms, in a previously healthy 35-year-old woman with post-partum pre-eclampsia. Initially, she had no hypertension or proteinuria, which delayed the time of diagnosis. A possible explanation of bradycardia is a baroreceptor-mediated response to hypertension and hypervolaemia. The changes on the electrocardiogram can be explained by pectus excavatum, an enlarged uterus and endothelial dysfunction. One should always consider peri-partum as well as post-partum pre-eclampsia.
Topics: Pregnancy; Female; Humans; Adult; Pre-Eclampsia; Bradycardia; Proteinuria; Hypertension; Chest Pain
PubMed: 36345902
DOI: No ID Found