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Chronic Liver Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Julia M. Boster, Kelly A. Klaczkiewicz, Shikha S. Sundaram
Ensuring optimal nutrition in a patient with CF-related liver disease is important, as liver disease can compound the malabsorption and malnutrition already associated with CF. Dietary therapy is consistent with typical treatment of CF, following high-energy, high-protein diet with fat-soluble vitamin supplementation, but now with emphasis on even more fat and MCTs, along with adequate pancreatic enzymes for optimal absorption. Fat is preferred over carbohydrate for increasing energy intake to decrease the risk for CF-related diabetes. Salt supplementation is limited, as it can lead to ascites. Medication may be used to increase bile flow and diuretics may be used to decrease fluid retention. Additional information about the nutrition management of CF can be found in Chapter 19.
Pulmonary Lymph and Lymphatics
Published in Waldemar L. Olszewski, Lymph Stasis: Pathophysiology, Diagnosis and Treatment, 2019
When protective factors are overcome, fluid retention may become excessive (see Table 1). Extravascular pulmonary fluid accumulates due to impaired removal of fluid, increased production of fluid, or a combination of both factors. Increased capillary pressure, decreased osmotic pressure, altered permeability, and lymphatic pathology are some of the principal mechanisms that may be involved in the process of fluid accumulation.
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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Most common adverse effects of dasatinib include fluid retention, gastrointestinal disturbances, and bleeding. Fluid retention may be severe, and can result in pleural and pericardial effusion, pulmonary oedema and ascites.
Potential clinical value of catheters impregnated with antimicrobials for the prevention of infections associated with peritoneal dialysis
Published in Expert Review of Medical Devices, 2023
Hari Dukka, Maarten W. Taal, Roger Bayston
Peritonitis is associated with significant morbidity and mortality. The treatment of peritonitis requires intra-peritoneal (IP) antibiotics such as vancomycin, second-generation cephalosporins, or aminoglycosides. IP antibiotics are needed for at least 2 weeks and if dialysate white cell count remains greater than 100/µL after day 5 of treatment, then catheter removal is indicated [16]. Catheter removal is generally needed for fungal peritonitis, as it has a high mortality risk [16]. Management of peritonitis is usually conducted in an outpatient setting, unless a patient is septic and/or needs catheter removal. About 20% of peritonitis cases require catheter removal, which is more commonly associated with S. aureus and gram-negative organisms. In one study, peritonitis was associated with a 95% increase in all-cause mortality [5,24]. This is more commonly associated with S. aureus, gram-negative organisms, and fungal peritonitis. Catheter removal also requires transfer to HD at least on a temporary basis, which may compromise a patient’s quality of life especially if they are elderly and comorbid. Peritonitis may also lead to decreased volume of fluid removal due to change in transport status of the peritoneal membrane [25]. This may be temporary or a permanent effect and may lead to significant fluid retention in patients, which has a high risk of mortality.
Subjective Global Assessment of Nutritional Status in Head and Neck Cancer Patients Treated with Radiotherapy – A Prospective Observational Study from North East India
Published in Nutrition and Cancer, 2022
Hima Bora, Mouchumee Bhattacharyya, Apurba Kumar Kalita, Partha Pratim Medhi, Gautam Sarma, Jyotiman Nath, Manoj Kalita, Dimi Ingtipi, Biswajit Sarma
Physical examination: Three features suggestive of nutritional deficiency were to be noted and graded during physical examination of patients. These were, firstly, the Loss of Subcutaneous Fat- to be evaluated over the triceps, under the eyes, at the mid-axillary line over lower ribs, lower back and sides of the trunk. Secondly, the Loss of bulk and tone of muscles (Muscle Wasting) over the temple, clavicle, shoulder, scapula/ribs, quadriceps and interosseous muscle of hand were observed. Lastly, the Presence of edema over the ankles and/or sacral region along with presence of ascites was to be recorded as features of fluid retention. The presence of ascites was verified with 3 weekly whole abdomen ultrasonography. The findings were classified as None, Mild/Moderate and Severe for all the three features as described in SGA form.
Cardiovascular involvement in patients affected by multiple myeloma: a comprehensive review of recent advances
Published in Expert Review of Hematology, 2021
Massimiliano Camilli, Giulia La Vecchia, Rosa Lillo, Giulia Iannaccone, Priscilla Lamendola, Rocco Antonio Montone, Stefan Hohaus, Nadia Aspromonte, Massimo Massetti, Gaetano Antonio Lanza, Filippo Crea, Francesca Graziani, Antonella Lombardo
An implantable cardioverter-defibrillator may be indicated if LVEF remains at or below 35% despite optimal medical therapy, and cardiac resynchronization therapy should be considered with a QRS duration ≥150 ms with LBBB morphology (class I, level of evidence A). Diuretics may be used to relieve the symptoms of fluid retention under close control of electrolytic imbalance. All patients treated with MM regimens that may lead to cardiotoxicity or at higher risk of HF should be monitored for evidence of volume overload, especially if treated with carfilzomib, according to European recommendations [22]. Patients with anthracycline-induced cardiotoxicity have been shown a better cardiac outcome when treated with ACE-i and/or BB early after detection of LV dysfunction, and combination therapy seemed to be more effective than either treatment alone [5,15]. Of interest, BBs, ACE-i, and ARBs have also been evaluated in randomized trials for prevention of anthracycline-induced cardiotoxicity. The recent Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA) study was placebo controlled and used Cardiac Magnetic Resonance to quantify LVEF change in patients with breast cancer [109]. According to PRADA results, candesartan initiated prior to anthracycline chemotherapy was associated with protection against early decline in LVEF. Smaller randomized clinical studies with carvedilol, nebivolol, carvedilol, and enalapril in combination have demonstrated similar protection from LVEF decline following treatment compared with untreated patients and all regimens tested resulted safe and well-tolerated [110–113].