Intravenous fluid therapy for hospitalized and critically ill children: rationale, available drugs and possible side effects.
Anaesthesiol Intensive Ther. 2017 Nov 18;:
Authors: Langer T, Limuti R, Tommasino C, van Regenmortel N, Duval ELIM, Caironi P, Malbrain MLNG, Pesenti A
Human beings are constituted mainly of water. In particular, children's total body water might reach 75-80% of their body weight, compared to 60-70% in adults. It is therefore not surprising, that children, especially hospitalized newborns and infants, are markedly prone to water and electrolyte imbalances. Parenteral fluid therapy is a cornerstone of medical treatment and is thus of exceptional relevance in this patient population. It is crucial to appreciate the fact that intravenous fluids are drugs with very different characteristics, different indications, contraindications and relevant side effects. In the present review, we will summarize the physiology and pathophysiology of water and electrolyte balance, underlining the importance and high prevalence of non-osmotic antidiuretic hormone release in hospitalized and critically ill children. Furthermore, we will discuss the characteristics and potential side effects of available crystalloids for the paediatric population, making a clear distinction between fluids that are hypotonic or isotonic as compared to normal plasma. Finally, we will review the current clinical practice regarding the use of different parenteral fluids in children, outlining both the current consensus on fluids employed for resuscitation and replacement and the ongoing debate concerning parenteral maintenance fluids.
PMID: 29151001 [PubMed - as supplied by publisher]
Reproductive factors in relation to heart failure in women: A systematic review.
Maturitas. 2017 Dec;106:57-72
Authors: Bolijn R, Onland-Moret NC, Asselbergs FW, van der Schouw YT
BACKGROUND: The biological mechanisms underlying the sex-related differences in risk of heart failure are still not well understood. The aim of this review was to provide an overview of the current evidence on the association between reproductive factors and risk of heart failure in women.
METHODS: A systematic review of the literature was conducted. PubMed and Embase databases were searched for publications on the following reproductive factors as potential risk factors for heart failure in women: age at menarche, duration and frequency of the menstrual cycle, reproductive lifespan, use of contraception, polycystic ovarian syndrome (PCOS), pregnancy characteristics (e.g. parity), pregnancy complications (e.g. preeclampsia), induced abortion, history of breastfeeding, fertility status, use of assisted reproductive methods, hysterectomy, age at menopause, and use of hormone replacement therapy (HRT).
RESULTS: Twenty-one studies were eligible for inclusion. Hypertensive pregnancy disorders, preterm delivery or small-for-gestational-age (SGA) infants, shorter reproductive duration, and early menopause were risk factors for heart failure in women. It was suggested that PCOS, fertility therapy, gestational diabetes, and age at first pregnancy were not related to risk of heart failure, but a potential relation cannot be fully excluded as most studies were not of sufficient quality. Conflicting results were found for the associations between risk of heart failure and hysterectomy, gravidity and parity, and HRT.
CONCLUSION: Although some reproductive factors were considered risk factors for heart failure in women, the results were mostly conflicting or inconclusive. Further research is needed to confirm and expand the current evidence on the association between reproductive factors and risk of heart failure.
PMID: 29150167 [PubMed - in process]
Economy class syndrome: what is it and who are the individuals at risk?
Rev Bras Hematol Hemoter. 2017 Oct - Dec;39(4):349-353
Authors: Dusse LMS, Silva MVF, Freitas LG, Marcolino MS, Carvalho MDG
The term 'economy class syndrome' refers to the occurrence of thrombotic events during long-haul flights that mainly occur in passengers in the economy class of the aircraft. This syndrome results from several factors related to the aircraft cabin (immobilization, hypobaric hypoxia and low humidity) and the passenger (body mass index, thrombophilia, oral contraceptives or hormone replacement therapy, cancer), acting together to predispose to excessive blood coagulation, which can result in venous thromboembolism. Several risk factors, both genetic and acquired, are associated with venous thromboembolism. The most important genetic risk factors are natural anticoagulant deficiencies (antithrombin, protein C and protein S), factor V Leiden, prothrombin and fibrinogen gene mutations and non-O blood group individuals. Acquired risk factors include age, pregnancy, surgery, obesity, cancer, hormonal contraceptives and hormone replacement therapy, antiphospholipid syndrome, infections, immobilization and smoking. People who have these risk factors are predisposed to hypercoagulability and are more susceptible to suffer venous thromboembolism during air travel. For these individuals, a suitable outfit for the trip, frequent walks, calf muscle exercises, elastic compression stockings and hydration are important preventive measures. Hence, it is essential to inform about economic class syndrome in an attempt to encourage Brazilian health and transport authorities to adopt measures, in partnership with the pharmaceutical industry, to prevent venous thromboembolism.
PMID: 29150108 [PubMed]