The development of pediatric fluid resuscitation: an interview with Dr. Frederic A. ‘Fritz’ Berry

Dr. Frederic A. ‘Fritz’ Berry (1935), Professor Emeritus of Anesthesiology and Pediatrics at the University of Virginia, has played a pioneering role in the development of pediatric anesthesiology through training generations of anesthesiologists. He identifies his early advocacy of balanced electrolyte solution for perioperative fluid resuscitation as his defining contribution. Based on his clinical experiences, he pushed to extend the advances in adult fluid resuscitation into pediatric practice. He imparted these and other insights to his colleagues although textbooks, book chapters, original journal publications, and decades of Refresher Course Lectures at the American Society of Anesthesiologists' annual meetings. A model educator, clinician, and researcher, he shaped the careers of hundreds of physicians‐in‐training while advancing the field of pediatric anesthesiology.     

Electrolyte disturbances in chronic heart failure: Metabolic and clinical aspects

The pathophysiology of congestive heart failure (CHF) includes conditions (e.g., activation of the renin-angiotensin-aldosterone system) which, when combined with CHF therapies, make patients afflicted with this syndrome quite susceptible to electrolyte disturbances. The most commonly encountered are hyponatremia, hypokalemia, and hypomagnesemia. These derangements are of vast clinical importance; their development not only represents an immediate threat to the CHF patient (e.g., dysrhythmias secondary to hypokalemia), but are also indicative of underlying pathophysiologic events, an unfavorable clinical course, and occasionally an adverse therapeutic response. The optimal care of the CHF patient includes the recognition and management of these electrolyte disturbances.     

Symptomatic hyponatremia induced by low-dose cyclophosphamide in patient with systemic lupus erythematosus: A case report

Rationale:Cyclophosphamide (CY) is an alkylating agent used widely to treat cancer and autoimmune diseases. Hyponatremia is a common adverse effect of high-dose and moderate-dose of intravenous CY, but is rare in patients treated with low-dose (<15 mg/kg).Patient concerns:A 52-year-old woman with new-onset systemic lupus erythematosus (SLE) was treated with low-dose cyclophosphamide (8 mg/kg, CY), but showed sudden headaches, disorientation and weakness. Laboratory examinations revealed severe isovolumic hyponatremia along with low-serum osmolality and high urine osmolality.Diagnosis:The acute hyponatremia was consistent with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and was an adverse event of low-dose CY, with no evidence of endocrine, cancer, pulmonary, or cerebral abnormalities relevant to the SIADH.Intervention:The hyponatremia was resolved after the supplementation of NaCl solution.Outcomes:The hyponatremia was resolved without any complications.Lessons:Hyponatremia induced by low-dose CY should be recognized as an underlying life-threatening complication in clinical practice.     

神经外科低钠血症的鉴别诊断和处理

目的探讨各型低钠血症的诊断和处理原则。方法回顾性分析562例低钠血症的临床资料,分出不同的类型给以不同的处理。结果562例中因利尿引起430例,补钠不足46例,尿崩症56例,抗利尿激素分泌不当综合征18例,恼性盐耗综合征11例,1例由肾小管损伤引起。结论因补钠不足或利尿引起的补钠即可,尿崩症以补充抗利尿激素为主,抗利尿激素分泌不当综合征应以限水为主,脑性盐耗综合征须采取综合治疗,肾小管损伤低钠血症会随着肾小管功能恢复而纠正。     

术前应用非那雄胺对经尿道前列腺电切术手术效果的影响

目的探讨接受经尿道前列腺电切手术(TURP)前应用非那雄胺对降低良性前列腺增生患者经尿道电切综合征(TURS)效果及其作用机制。方法将接受TURP的良性前列腺增生患者180例随机分成两组,治疗组术前服用非那雄胺,对照组不服用药物。对比两组术中失血情况、术中血钠值,术后免疫组化法检测前列腺组织中血管内皮生长因子(VEGF)表达情况。结果治疗组术中失血量、前列腺组织中VEGF计数低于对照组(P<0.05),术中血钠值高于对照组(P<0.05)。结论术前服用非那雄胺能够防止和减少TURS的发生。     

乙肝肝硬化失代偿期腹水患者血钠水平与其并发症及临床预后的关系

目的:探求乙肝肝硬化失代偿期腹水患者血钠水平与其并发症及临床预后的关系.方法:回顾性分析2015年5月至2016年10月年收治的乙型肝炎肝硬化失代偿期伴腹水患者98例病例资料,据血钠水平分为低钠血症组与正常组,通过分层分析,对比不同组别患者入院时肝肾功能、血清白蛋白含量、Child-pugh评分、肝纤维化程度及并发症情况,治疗2周后,对比两组患者腹水疗效及出院后预后.结果:98例患者中血钠水平＜130 mmol/L者41例(41.8％).低钠血症组入院时转氨酶、血肌酐、总胆红素、凝血酶原时间、Child-pugh评分均明显高于正常组,血清白蛋白含量则低于血钠水平正常组,差异均具有统计学意义(P＜0.05).低钠血症组与正常组入院时伴肝性脑病、肝肾综合征、消化道出血、自发性腹膜炎比例差异均具有统计学意义(分别为24.4％ vs.7.0％,19.5％vs.5.3％,26.8％ vs.10.5％及24.4％vs.8.8％;P＜0.05).入院14d,两组腹水治疗效果中显效比例分别为73.2％,89.5％(x2=4.421,P=0.036);出院后12个月随访期间内,两组病死率分别为36.6％,15.8％(x2=5.577,P=0.018).结论:血钠水平与肝硬化失代偿期病情密切相关,低钠血症患者病情较重,疗效与预后较差.     

护理干预对颈髓损伤后低钠血症的影响

目的探讨护理干预对颈髓损伤后低钠血症的影响。方法 60例颈髓损伤伴低血钠患者分成对照组(n=30)和护理干预组(n=30)。对照组未给予相关低钠血症的护理干预,护理干预组由责任护士给予相关低钠血症的护理干预。对1个月后两组的血清钠值及病程进行分析。结果 1个月后护理干预组血钠值明显高于对照组(P<0.01),并且护理干预组病程较对照组明显缩短(P<0.01),病情反复病例较对照组少(P<0.05)。结论护理干预有利于改善颈髓损伤患者的低钠血症。     

EVEREST study: Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan

Acute heart failure syndromes are a common cause of emergency department visits and hospitalization in North America and Europe. Although in-hospital mortality is relatively low, the postdischarge mortality and rehospitalization rates can be as high as 10–15 and 30%, respectively, within 60–90 days following discharge. It appears that the main reason for admission and readmission for heart failure is related to congestion manifested by dyspnea, jugular venous distension and edema. Often, congestion is associated with dilutional hyponatremia that is difficult to treat. Hyponatremia is an important predictor of increased mortality and the available therapies to treat congestion and/or hyponatremia are often ineffective and/or unsafe. Accordingly, there is an unmet need to develop a new agent that effectively relieves congestion due to high filling pressure without worsening renal function and improving or normalizing serum sodium in hyponatremic patients. This paper provides an overview of a new compound, tolvaptan, an oral selective V₂-vasopressin antagonist in light of the recently published Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial. The biochemical and pharmacological properties are discussed in conjunction with its clinical efficacy and safety, exploring the potential role of tolvaptan in the management of acute heart failure syndromes presenting with or without hyponatremia.     

Impact of preoperative serum sodium concentration in living donor liver transplantation

Background and Aims: The importance of hyponatremia in deceased donor liver transplantation (DDLT) has been recently discussed frequently. However, its impact on the outcomes in living donor liver transplantation (LDLT) has not yet been elucidated. The current study was designed to demonstrate the impact of pre‐transplant sodium concentration on postoperative clinical outcomes. Methods: One hundred and thirty‐four patients who underwent LDLT for end‐stage liver diseases were examined to evaluate the significance of pre‐transplant hyponatremia (Na ≤ 130 mEq/L) on the short‐term clinical outcomes and the efficacy of the Model for End‐Stage Liver Disease and serum sodium (MELD‐Na) score using the sodium concentration and original MELD score. Results: The preoperative sodium and MELD score for all patients were 133.9 mEq/L (range: 109–142) and 16.2 (range: 6–38), respectively. According to a multivariate analysis, not only the MELD score (P = 0.030) but also the sodium concentration (P = 0.005) were found to be significant predictive factors for short‐term graft survival. Preoperative hyponatremia was a significant risk factor for the occurrence of sepsis (P < 0.001), renal dysfunction (P < 0.001) and encephalopathy (P = 0.026). The MELD‐Na score was 19.6 (range: 6–51) and the area under the receiver–operator curve of that (c‐statistics: 0.867) was higher than MELD score and sodium concentration (c‐statistics: 0.820 and 0.842, respectively). Conclusion: Preoperative hyponatremia was a significant risk for postoperative complications and short‐term graft loss. The addition of sodium concentration to MELD score might therefore be an effective predictor for post‐transplant short‐term mortality in LDLT.