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Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Management is largely supportive. Nutrition is important and enteral rather than parenteral nutrition is preferred. Maintaining adequate fluid balance is essential. Arterial blood gases should be measured.
Meeting personal needs: hydration and nutrition
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Healthcare workers must be able to assess and monitor fluid balance (NMC 2018a, 2018b). Fluid balance refers to the amount of fluid that is taken into the body (input) and the amount that is excreted (output). A negative fluid balance is where the output is greater than fluid ingested, and a positive fluid balance is where intake is greater than output.
PerformLyte—A Prodosomed PL425 PEC Phytoceutical-Enriched Electrolyte Supplement—Supports Nutrient Repletion, Healthy Blood pH, Neuromuscular Synergy, Cellular and Metabolic Homeostasis
Published in Abhai Kumar, Debasis Bagchi, Antioxidants and Functional Foods for Neurodegenerative Disorders, 2021
Bernard W. Downs, Manashi Bagchi, Bruce S. Morrison, Jeffrey Galvin, Steve Kushner, Debasis Bagchi
Ideally, the concentration of electrolytes in a human must be maintained within a narrow physiological range, which is essential in conjunction with proper fluid balance9–12 for the maintenance of human health.7–10 Generally, the electrolyte level is determined by blood tests and must remain within the specified narrow range of pH level to protect against adverse anaerobic/hypoxic-induced health injury.7,9,12,14 Note that too little water in the body causes dehydration, and too much water causes overhydration.9–12 Vomiting, sweating, diarrhea, certain medications, and hepatic and nephrotic disorders can strategically upset the fluid balance.9–11,13–16 Accordingly, appropriate electrolyte balance is essential to maintain homeostatic equilibrium in order to balance the rate of excretion vs. elimination. Supplementation of electrolytes is well justified to enable the optimal biochemical and physiological functions.7–12
Transient diabetes insipidus after vasopressin discontinuation in cystic fibrosis with septic shock
Published in Baylor University Medical Center Proceedings, 2023
Natnicha Leelaviwat, Juthipong Benjanuwattra, Ahmed Elkheshen, Nouran Eshak, Marawan Elmassry, Mahmoud Abdelnabi
DI is a condition that affects fluid balance in the body, resulting from either arginine vasopressin deficiency (central DI) or resistance at its site of action in the collecting tubules (nephrogenic DI).1 Typical manifestations of central DI include a variable degree of polyuria, which is defined by excessive urination exceeding 3 L/day, nocturia, and neurological symptoms attributed to dysnatremia.1 Various conditions associated with transient DI have been reported, including organophosphate poisoning,3 pregnancy,4–7 ischemic stroke,8 subarachnoid hemorrhage,9 and cardiopulmonary surgery.10 Numerous medications are also known to cause nephrogenic DI, such as lithium, amphotericin B, cidofovir, foscarnet, demeclocycline, ifosfamide, ofloxacin, orlistat, and didanosine.2
Guidelines for non-transplant chemotherapy for treatment of systemic AL amyloidosis: EHA-ISA working group
Published in Amyloid, 2023
Ashutosh D. Wechalekar, M. Teresa Cibeira, Simon D. Gibbs, Arnaud Jaccard, Shaji Kumar, Giampaolo Merlini, Giovanni Palladini, Vaishali Sanchorawala, Stefan Schönland, Christopher Venner, Mario Boccadoro, Efstathios Kastritis
A multidisciplinary approach to management is crucial with involvement from cardiologists, nephrologists, neurologists, gastroenterologists (depending on the type/extent of organ involvement) in addition to the treating haematologists [14]. Stringent supportive therapy is critical to survival of patients. In cases with renal or cardiac involvement, the key element is meticulous fluid balance. It is important to avoid commonly used drugs for heart failure (like ACE inhibitors, beta blockers or calcium channel blockers) which may worsen symptoms [15]. Patients presenting with severe nephrotic syndrome can have substantial urinary loss of proteins, such as albumin (edema and intravascular volume depletion), immunoglobulins (increasing risk of infections), loss of antithrombin-III and activation of coagulation factors (increased risk of thrombosis) – each needing specific clinical review and intervention if appropriate. Proactive identification and management of cardiac arrhythmias as well as judicious but early use of anticoagulants in patients with atrial fibrillation, poor atrial function as well as those with severe nephrotic syndrome, are important. Patient education in monitoring blood pressure and fluid status can help. There are limited data on use of supportive care measures in AL amyloidosis [14] and these recommendations are based on expert consensus opinion.
Second look hysteroscopy following hysteroscopic septum resection improves reproductive outcomes in patients undergoing ICSI
Published in Journal of Obstetrics and Gynaecology, 2022
Bulat Aytek Sık, Ozkan Ozdamar, Ozan Ozolcay, Alper Sismanoglu, Yilda Arzu Aba, Serkan Oral, Mehmet Koc
The procedure was performed with a resectoscope fitted with a monopolar 90° angle knife electrode and with a 0-degree telescope (Karl Storz, Tuttlingen, Germany). The electrical generator was set at 60–80 W pure cut current. The uterine cavity was distended with a urologic solution (sorbitol 2.7 p/v, mannitol 5.4 p/v) at a constant inflow pressure of 60–90 mm Hg. Fluid balance was recorded by measuring the infused and drained fluid from the hysteroscope. After insertion of the resectoscope, tubal ostia were visualised and the septum was incised across the apex from the lower margin, gradually reducing it with progressive upwards horizontal midline incisions until visualisation of the muscular fibres. The procedure was considered to be complete when a normal cavity was obtained and the endoscope could be moved freely from one tubal ostium to the other. One-month after the hysteroscopic metroplasty, a control 3D TVUSG was performed to evaluate the efficiency of the septum surgery. Women who revealed a residual uterine septum were scheduled for the repeat hysteroscopy.