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The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Fluids that may be given to patients by intravenous (IV) infusion may be: Isotonic (having the same concentrations as body cells).Hypertonic (having a higher concentration than body cells)Hypotonic (having a lower concentration than body cells).
Congenital and acquired disorders of coagulation
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
Jeanne M Lusher, Roshni Kulkarni
Side-effects of desmopressin are generally minor (facial flushing and a feeling of facial warmth). However, the drug is a potent antidiuretic agent. Thus, there is a risk of hyponatraemia and water intoxication (which may be manifest by convulsions), especially if the patient is given large amounts of hypotonic fluids. (It is recommended that fluids be somewhat restricted for 18 hours post desmopressin, and that one monitor fluids and electrolytes in postoperative patients.) In view of a greater propensity to fluid balance problems in the very young and the elderly, desmopressin should be used with caution (or not at all) in children under 2 years of age, and in persons over 70. Additionally, in view of sporadic reports of coronary or cerebrovascular thrombosis associated with the use of desmopressin, it seems appropriate to avoid using it in those known to have risk factors for such complications.14
Niemann-Pick disease
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
Neurologic involvement may be first evidenced in a failure to achieve milestones, such as sitting, but some have developed normally for six months [28], or as long as one year [6]. Progression of disease occurs with loss of milestones achieved. Patients may appear weak or hypotonic. Deep tendon reflexes are exaggerated. Neurologic degeneration is progressive to a rigid state with spasticity in which there appears to be no consciousness of the environment. Seizures are not common; the electroencephalograph (EEG) is usually normal. Cherry red or cherry black (dependent on the pigment of the patient) macular spots (Figure 91.6) are seen in about 50 percent of the patients. In one series of patients, [19] all patients had cherry red spots by one year of age. Sometimes, there is a sprinkled salt appearance around the macula, a gray granular appearance, the macular halo syndrome, or melting snow appearance [32–35]. The electroretinogram is abnormal.
Thiazide-associated hyponatremia in internal medicine patients: analysis of epidemiological and biochemical profiles
Published in Postgraduate Medicine, 2022
Since TAH is considered to occur mostly in normovolemic conditions [12,23], the analysis of volume status of TAH patients revealed a surprisingly large group of patients (32.9%) with signs of volume depletion. And this proportion could be possibly higher as we included only patients with osmolality < 280 mmol/kg. Thus, patients with severe hypovolemia, leading to renal failure and increased s-urea, could be excluded even if their effective osmolality is low and they suffer from the true hyponatremia [28]. Only a minority of our patients (2.1%) were classified as hypervolemic and we attribute this mostly to the absence of the two main causes of hypotonic hypervolemic hyponatremia: the ADHF and ascites. A majority of patients with ADHF, that is complicated by hypotonic hyponatremia, are mostly admitted to the Cardiology Department instead of the Internal Medicine Department, and pharmacotherapy of ascites does not usually include thiazide [29].
‘Drink clean, safe water and/or other fluids through-out the day even if you do not feel thirsty’: a food-based dietary guideline for the elderly in South Africa
Published in South African Journal of Clinical Nutrition, 2021
Upasana Mukherjee, Carin Napier, Wilna Oldewage-Theron
Water balance or osmotic pressure is maintained within the body between extra-cellular fluid (ECF) and intra-cellular fluid (ICF) but true equilibrium is never reached. This process can also compensate for small periods of time when fluids are required but are not ingested. In the elderly, due to cellular water loss, the compensation of fluids to compensate for dehydration is also hampered due to loss of body cells. Some other risk factors for the elderly are hypovolemia (extra-cellular water loss), which causes hypotonic and isotonic dehydration due to vomiting and diarrhoea. Hypotonic dehydration causes reduced blood volume and may cause dizziness, fainting and ultimately hypovolemic shock, which may result in death. The other important characteristic of this kind of dehydration is that there is no sensation of thirst associated and thus, if unrecognised by other clinical signs, this can lead to fatal consequences in the elderly. The best way to detect dehydration in the elderly is therefore by laboratory findings of serum osmolality.10
Nasal saline irrigation: prescribing habits and attitudes of physicians and pharmacists
Published in Scandinavian Journal of Primary Health Care, 2021
Jesse Tapiala, Antti Hyvärinen, Sanna Toppila-Salmi, Eero Suihko, Elina Penttilä
In summary, the most popular method for NSI was a Neti pot (n = 477; 80.7%) filled with an isotonic solution (n = 440; 73.9%) that was 30–40 degrees Celsius (n = 417; 70.1%). Hypertonic (n = 18; 3.0%) or hypotonic (n = 11; 1.8%) solutions were rarely administered and the rest did not instruct the tonicity (n = 126; 21.2%). Volumes of 51–100 ml (n = 72; 12.2%) and 101–200 ml (n = 83; 14.0%) were recommended the most, while the majority gave no recommendation at all (n = 316; 53.4%). Many of the respondents recommended homemade solutions (n = 483; 81.2%) as opposed to purchasing ready-to-use nasal solutions from pharmacies (n = 325; 54.6%). Irrigations were most instructed as a daily (n = 222; 37.8%) or twice-a-day (n = 277; 47.2%) therapy. Regular irrigations were recommended by 77 (12.9%) of the respondents, while the rest (n = 518; 87.1%) opted for a short-term usage (mean: 6.52 days, SD = 3.9, min = 1 day and max = 30 days). There was no significant difference in the length of the recommended use between pharmacists and physicians.