Development of palliative medicine in the United Kingdom and Ireland
Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita in Textbook of Palliative Medicine and Supportive Care, 2015
Key learning points Hydration in palliative care is a controversial topic with divergent opinions.Fluid deficits can cause confusion and renal failure.Hydration research is inconclusive in guiding clinical care.Hypodermoclysis is an excellent alternative for rehydration in palliative care populations.Diverse clinical and sociocultural circumstances need to be considered.Evidence recommends that if terminally ill patients are not rehydrated, medications should be decreased to avoid accumulation and side effects.Rehydration may be helpful in some individual situations.Patient and family preferences need to be understood and incorporated into the treatment plan.
Maintaining Hydration in the Short Bowel Patient
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
If parenteral fluids are prescribed to be given “as needed,” how do patients or their care provider know when these are needed? In other words, what signs and symptoms indicate inadequate hydration? Whereas serum sodium, blood urea nitrogen (BUN), creatinine, and other electrolytes quickly become hemoconcentrated in the setting of intravascular volume depletion/dehydration in people with normal GI anatomy, this is not always the case in those with SBS. Only after several days of poor hydration, when the SBS patient is significantly volume depleted, do these numbers start to indicate a problem [1]. This occurs because decreased renal blood flow and/or decreased serum sodium activates the renin–angiotensin–aldosterone system, causing a cascade of activity that ultimately leads to, among other things, increased reabsorption of sodium and water and the maintenance of blood volume. Thus, the kidneys do an exquisite job of maintaining blood volume even when total body water is being significantly depleted via GI losses. As a result, the BUN to creati-nine ratio will belie dehydration and patients and clinicians must learn to rely on other markers of hydration status, the most important of which are urine output and swift change in weight in combination with an assessment for standard signs and symptoms of dehydration (Table 11.2).
Campylobacter Jejuni Infection
Meera Chand, John Holton in Case Studies in Infection Control, 2018
Symptomatic patients may become dehydrated and should be managed by fluid replacement. The infection is usually self-limiting, lasting about seven days, and does not require antibiotics. Antimicrobial agents decrease the duration of symptoms and bacterial shedding if administered early in the course of disease. Antibiotic therapy (azithromycin or ciprofloxacin) may be required if the condition is severe, with frequent episodes of bloody diarrhoea, high temperature, or failure to improve after a week of symptoms, or if the patient is deteriorating or is immunocompromised. Rates of antibiotic resistance have risen greatly in the past decade and high rates of resistance are now seen in many countries. Resistance to erythromycin is about 5% in many countries, whereas resistance to quinolones is about 20% and in some countries as high as 60%. Alternative agents are tetracycline or clindamycin.
Revisiting the role of sucrose in PLGA-PEG nanocarrier for potential intranasal delivery
Published in Pharmaceutical Development and Technology, 2018
A. Bonaccorso, T. Musumeci, C. Carbone, L. Vicari, M. Rosaria Lauro, G. Puglisi
Nanoprecipitation method was used to prepare surfactant free NPs. The colloidal nanosuspensions were characterized by low storage stability; in fact, aggregation phenomena occurred after one month of storage (increase of mean size and PDI >0.4). Freeze-drying is a very useful process to obtain long storage stability of nanocarriers. Several studies report the use of disaccharides for their cryoprotective effect on NPs. Among these, the most used are trehalose and sucrose because of their capability of stabilizing a wide range of colloidal systems (Abdelwahed et al. 2006). We choose sucrose for some advantages compared to the other: (i) easy rehydration; (ii) good price/quality ratio; (iii) potential use as “surfactant-like.” (Wang et al. 2009; Ohtake & Wang 2011) Furthermore, oppositely to trehalose, sucrose does not increase the viscosity, even at higher concentration, as described by Sola-Penna and Meyer-Fernandes (1998).
Ad libitum drinking prevents dehydration during physical work in the heat when adhering to occupational heat stress recommendations
Published in Temperature, 2022
Hayden W. Hess, Macie L. Tarr, Tyler B. Baker, David Hostler, Zachary J. Schlader
Occupational heat stress can be exacerbated by pre-workday dehydration or the development of dehydration (i.e. loss in body water) throughout the workday [4], which reduces a worker’s capacity for evaporative heat loss (i.e. sweating) [14,15] and the ability to maintain a relatively constant core body temperature across the workday. Therefore, hydration recommendations are issued for workers exposed to heat stress to prevent dehydration (defined as ≥2% body mass loss [16]). For instance, NIOSH recommends drinking 237 mL (1 cup) of a cool sport drink every 15 to 20 minutes during work in the heat that exceeds 2 hours [8]. This drinking regimen is based on the premise that ad libitum drinking (or “drinking to thirst”) typically results in progressive dehydration due to inadequate drinking [17], particularly during long-duration work and/or heat stress [14,16–19]. However, to our knowledge, this hydration recommendation has not been directly examined in the background of compliance to the heat stress recommendations that, theoretically, are being practiced in the healthy workplace. Therefore, the purpose of the present study was to test the hypothesis that ad libitum drinking during heat stress recommendation compliant work in the heat will result in >2% body mass loss.
Handgrip Strength and Its Association With Hydration Status and Urinary Sodium-to-Potassium Ratio in Older Adults
Published in Journal of the American College of Nutrition, 2020
Joana Mendes, Patrícia Padrão, Pedro Moreira, Alejandro Santos, Nuno Borges, Cláudia Afonso, Rita Negrão, Teresa F. Amaral
In relation to the methodology used in the present study, previous research showed that urinary indices, such as urinary osmolality and particularly FWR, represented body water loss as well as, or better than, plasma osmolality (46). Among the urinary indices, FWR is more advantageous than urinary osmolality, because FWR represents a volume, considering the loss of renal capacity with aging, while urinary osmolality is only a measure of concentration, which depends on gender and diet (22). On the other hand, some authors defend serum measures as the gold standard for a definitive diagnosis (47), but there is a lack of consensus regarding the relative efficacy of plasma osmolality versus other hydration status indices (22, 33). In fact, there is no universally accepted method for measuring the hydration status (22), particularly in older people, in whom the early diagnosis of dehydration can be difficult. In older adults, classical physical signs of dehydration, such as weight loss, skin turgor, dry mouth, and capillary refill time may be absent or misleading (48).
Related Knowledge Centers
- Cholera
- Dehydration
- Rotavirus
- Gastroenteritis
- Diarrhea
- Oral Rehydration Therapy
- Intravenous Therapy
- Murphy Drip
- Subcutaneous Administration
- Solution