RESUMO

Postexercise hydration is fundamental to replace fluid loss from sweat. This study evaluated rehydration and gastrointestinal (GI) symptoms for each of three beverages: water (W), sports drink (SD), and skimmed, lactose-free milk (SLM) after moderate-intensity cycling in the heat. Sixteen college students completed three exercise sessions each to lose ≈2% of their body mass. They drank 150% of body mass loss of the drink assigned in randomized order; net fluid balance, diuresis, and GI symptoms were measured and followed up for 3 hr after completion of fluid intake. SLM showed higher fluid retention (∼69%) versus W (∼40%; p < .001); SD (∼56%) was not different from SLM or W (p > .05). Net fluid balance was higher for SLM (-0.26 kg) and SD (-0.42 kg) than W (-0.67 kg) after 3 hr (p < .001), resulting from a significantly lower diuresis with SLM. Reported GI disturbances were mild and showed no difference among drinks (p > .05) despite ingestion of W (1,992 ± 425 ml), SD (1,999 ± 429 ml), and SLM (1,993 ± 426 ml) in 90 min. In conclusion, SLM was more effective than W for postexercise rehydration, showing greater fluid retention for the 3-hr follow-up and presenting with low-intensity GI symptoms similar to those with W and SD. These results confirm that SLM is an effective option for hydration after exercise in the heat.

Assuntos

Bebidas , Exercício Físico , Hidratação , Gastroenteropatias , Leite , Equilíbrio Hidroeletrolítico , Humanos , Masculino , Adulto Jovem , Feminino , Hidratação/métodos , Exercício Físico/fisiologia , Animais , Lactose/análise , Adulto , Desidratação , Água/administração & dosagem , Estudos Cross-Over , Ingestão de Líquidos , Ciclismo/fisiologia , Diurese , Temperatura Alta , Fenômenos Fisiológicos da Nutrição Esportiva

RESUMO

Background and Objective: Dehydration and hyperhydration impact athletes' performance. Exploring the fluid balance concerning body composition might help estimate individual hydration requirements. This area of research, particularly regarding sodium losses, has been relatively understudied. We evaluated the sweat rate (SR), sweat sodium losses, and their relationship with body composition in professional soccer players in Cali, Colombia. Materials and Methods: Thirty-two male players, aged 24.3 (±5.2) years, from the Colombian main soccer league, underwent high-intensity training at 32 °C (with a relative humidity of 79%). The outcome variables included SR, calculated using weight loss and fluid intake; forearm sweat sodium concentration (FSCC), measured through the direct ion-selective electrode method; and estimated the predicted whole sweat sodium loss (PWSSL) in mmol. Predictor variables (body mass, fat, and muscle masses) were estimated using the Deborah Kerr anthropometry method. The association between predictors and outcomes was assessed using linear regression. Results: The mean FSCC, PWSSL, and SR were 26.7 ± 11.3 mmol/L, 43 ± 15.9 mmol/L, and 1.7 ± 0.5 L/h, respectively. Body mass positively predicted FSCC in unadjusted and age/fat-mass-adjusted models [Beta 1.28, 95% confidence interval (CI) 0.39-2.18, p = 0.006], and continued related to FSCC after adjustment for muscle mass with marginal significance [Beta 0.85, 95% CI -0.02 to 1.73, p = 0.056]. Muscle mass was associated with the PWSSL in unadjusted and age/fat-mass-adjusted models [Beta 2.42, 95% CI 0.58-4.26, p = 0.012] and sustained an association with marginal statistical significance after adjustment for body mass [Beta 1.86, 95% CI -0.35 to 4.09, p = 0.097]. Conclusions: Under hot tropical weather conditions, FSCC was relatively low among the players. Body mass was better associated with the FSSC, and muscle mass better related to the PWSSL. Body and muscle masses could be regarded as potential factors to be explored in the estimation of individual sodium needs. However, further studies are required to validate and contrast our findings.

Assuntos

Futebol , Suor , Humanos , Masculino , Colômbia , Composição Corporal , Antebraço

RESUMO

BACKGROUND: To evaluate fluid balance, biomarkers of renal function and its relation to mortality in patients with acute kidney injury (AKI) diagnosed before, or within 24 h of intensive care unit admission. METHODS: A prospective cohort study considered 773 critically ill patients observed over six years. Pre-intensive care unit-onset AKI was defined as AKI diagnosed before, or within 24 h of intensive care unit admission. Body weight-adjusted fluid balance and fluid balance-adjusted biomarkers of renal function were measured daily for the first three days of intensive care unit admission. Primary outcome was mortality in the intensive care unit. RESULTS: Prevalence of pre-intensive care unit-onset AKI was 55.1%, of which 55.6% of cases were hospital-acquired and 44.4% were community-acquired. Fluid balance was higher in AKI patients than in non-AKI patients (p < 0.001) and had a negative correlation with urine output (p < 0.01). Positive fluid balance and biomarkers of renal function were independently related to mortality. Multivariate analysis identified the following AKI-related variables associated with increased mortality: (1) In AKI patients: type 1 cardiorenal syndrome (OR 2.00), intra-abdominal hypertension (OR 1.71), AKI stage 3 (OR 2.15) and increase in AKI stage (OR 4.99); 2) In patients with community-acquired AKI: type 1 cardiorenal syndrome (OR 5.16), AKI stage 2 (OR 2.72), AKI stage 3 (OR 4.95) and renal replacement therapy (OR 3.05); and 3) In patients with hospital-acquired AKI: intra-abdominal hypertension (OR 2.31) and increase in AKI stage (OR 4.51). CONCLUSIONS: In patients with pre-intensive care unit-onset AKI, positive fluid balance is associated with worse renal outcomes. Positive fluid balance and decline in biomarkers of renal function are related to increased mortality, thus in this subpopulation of critically ill patients, positive fluid balance is not recommended and renal function must be closely monitored.

Assuntos

Injúria Renal Aguda , Biomarcadores , Estado Terminal , Unidades de Terapia Intensiva , Equilíbrio Hidroeletrolítico , Humanos , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/terapia , Estudos Prospectivos , Masculino , Feminino , Biomarcadores/sangue , Idoso , Pessoa de Meia-Idade , Unidades de Terapia Intensiva/estatística & dados numéricos , Fatores de Tempo , Mortalidade Hospitalar , Rim/fisiopatologia , Admissão do Paciente , Fatores de Risco , Idoso de 80 Anos ou mais

RESUMO

Replacement of fluid losses (dehydration) during sports activities in the heat has been investigated with different beverages. Bovine milk has been recommended for post-exercise rehydration, but its use during exercise may provoke gastrointestinal disorders. This study compared voluntary fluid intake, hydration, and incidence and severity of gastrointestinal (GI) disorders during exercise in the heat under three conditions: no drink (ND), water (W), and skimmed lactose-free milk (SM). Sixteen physically active university students exercised at 32 °C and 70% RH for 90 min at 60-75% HRmax while drinking W or SM ad libitum, or ND assigned at random. A questionnaire explored possible GI disorders. Ad libitum intake was higher (p < 0.05) for water (1206.2 mL) than milk (918.8 mL). Dehydration showed significant differences for SM versus W and ND (W = 0.28% BM; SM = -0.07% BM; ND = 1.38% BM, p < 0.05). Urine volume was significantly higher (p < 0.05) in the W condition (W = 220.4 mL; SM = 81.3 mL; ND = 86.1 mL). Thick saliva, belching, and abdominal pain were higher for SM, but scores were low. Skimmed lactose-free milk is a suitable, effective alternative to be consumed as a hydration beverage during moderate-intensity cycling in the heat for 90 min.

Assuntos

Desidratação , Temperatura Alta , Animais , Humanos , Desidratação/prevenção & controle , Hidratação , Leite , Água

RESUMO

BACKGROUND: Dopamine has a favorable therapeutic profile but has not been widely used to treat hypotension during microvascular breast reconstruction. The purpose of this study was to evaluate outcomes in patients who received dopamine during breast reconstruction using deep inferior epigastric perforator (DIEP) free flaps and compare them with patients who did not receive dopamine. METHODS: A single-center retrospective review was performed for patients who underwent breast reconstruction with DIEP free flaps between October 2018 and March 2020. Patient demographics, comorbidities, fluid balance, hospital stay, and adverse outcomes were compared between patients who received at least 1 h of dopamine (DA) and patients who did not receive dopamine (ND). Subgroup analyses were performed for bilateral procedures and patients who received dopamine. RESULTS: Twenty-five patients in the DA group and 43 patients in the ND group met the inclusion criteria. There were no flap-related complications. Patients who had dopamine initiated to maintain blood pressures had a higher total volume of intravenous fluid (ND:3.81L vs. DA:5.04L, p = 0.005). However, DA patients exhibited decreased fluid requirements (ND:839 mL/h vs. DA:479 mL/h, p = 0.004) and increased urine output (ND:98.0 mL/h vs. DA:340 mL/h, p = <0.001) once dopamine was initiated. Intraoperative urine output (ND:1.37 L vs. DA:3.48 L, p < 0.001) and rate (ND:1.9 ml/kg/h vs. DA:3.7 ml/kg/h, p < 0.001) were increased in the DA group. The fluid balance of patients undergoing bilateral procedures was closer to neutral for patients who received dopamine (ND:+3.43 L vs. DA:+2.26 L, p = 0.03). CONCLUSION: Dopamine is safe to use in microvascular breast reconstruction. It may be beneficial for hemodynamically labile patients by stabilizing blood pressure and facilitating a neutral fluid balance.

Assuntos

Neoplasias da Mama , Hipotensão , Mamoplastia , Retalho Perfurante , Neoplasias da Mama/etiologia , Neoplasias da Mama/cirurgia , Dopamina/uso terapêutico , Artérias Epigástricas/cirurgia , Feminino , Humanos , Hipotensão/tratamento farmacológico , Hipotensão/etiologia , Hipotensão/cirurgia , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Retalho Perfurante/irrigação sanguínea , Estudos Retrospectivos

RESUMO

Fluid overload (FO) is associated with higher rates of mortality and morbidity in pediatric and adult populations. The aim of this systematic review and meta-analysis was to investigate the association between FO and mortality in critically ill neonates. Systematic search of Ovid MEDLINE, EMBASE, Cochrane Library, trial registries, and gray literature from inception to January 2021. We included all studies that examined neonates admitted to neonatal intensive care units and described FO and outcomes of interest. We identified 17 observational studies with a total of 4772 critically ill neonates who met the inclusion criteria. FO was associated with higher mortality (OR, 4.95 [95% CI, 2.26-10.87]), and survivors had a lower percentage of FO compared with nonsurvivors (WMD, - 4.33 [95% CI, - 8.34 to - 0.32]). Neonates who did not develop acute kidney injury (AKI) had lower FO compared with AKI patients (WMD, - 2.29 [95% CI, - 4.47 to - 0.10]). Neonates who did not require mechanical ventilation on postnatal day 7 had lower fluid balance (WMD, - 1.54 [95% CI, - 2.21 to - 0.88]). FO is associated with higher mortality, AKI, and need for mechanical ventilation in critically ill neonates in the intensive care unit. Strict control of fluid balance to prevent FO is essential. A higher resolution version of the Graphical abstract is available as Supplementary information.

Assuntos

Injúria Renal Aguda , Insuficiência Cardíaca , Desequilíbrio Hidroeletrolítico , Adulto , Criança , Estado Terminal , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Equilíbrio Hidroeletrolítico

RESUMO

INTRODUCTION: Positive fluid status has been associated with a worse prognosis in intensive care unit (ICU) patients. Given the potential for errors in the calculation of fluid balance totals and the problem of accounting for indiscernible fluid losses, measurement of body weight change is an alternative non-invasive method commonly used for estimating body fluid status. The objective of the study is to compare the measurements of fluid balance and body weight changes over time and to assess their association with ICU mortality. METHODS: This prospective observational study was conducted in the 34-bed multidisciplinary ICU of a tertiary teaching hospital in southern Brazil. Adult patients were eligible if their expected length of stay was more than 48 hours, and if they were not receiving an oral diet. Clinical demographic data, daily and cumulative fluid balance with and without indiscernible water loss, and daily and total body weight changes were recorded. Agreement between daily fluid balance and body weight change, and between cumulative fluid balance and total body weight change were calculated. RESULTS: Cumulative fluid balance and total body weight change differed significantly among survivors and non survivors respectively, +2.53L versus +5.6L (p= 0.012) and -3.05kg vs -1.1kg (p= 0.008). The average daily difference between measured fluid balance and body weight was +0.864 L/kg with a wide interval: -3.156 to +4.885 L/kg, which remained so even after adjustment for indiscernible losses (mean bias: +0.288; limits of agreement between -3.876 and +4.452 L/kg). Areas under ROC curve for cumulative fluid balance, cumulative fluid balance with indiscernible losses and total body weight change were, respectively, 0.65, 0.56 and 0.65 (p= 0.14). CONCLUSION: The results indicated the absence of correspondence between fluid balance and body weight change, with a more significant discrepancy between cumulative fluid balance and total body weight change. Both fluid balance and body weight changes were significantly different among survivors and non-survivors, but neither measurement discriminated ICU mortality.

RESUMO

Decapods have successfully colonized changing coastal habitats throughout the world by adapting their behavior, physiology, and biochemistry. Biochemical reserves, such as lipids and fatty acids (FAs), play fundamental roles in this adaptation process. These energy reserves are key for the development of decapods and their composition mainly depends on the type and quality of food available in their habitats. This study evaluated the lipid content and FA composition of three tissues (hepatopancreas, gills, and muscle) in two widely distributed, semi-terrestrial coastal crab species in Chile, Cyclograpsus cinereus from the upper intertidal and Hemigrapsus crenulatus from estuaries. This evaluation aimed to assess the physiological role of the bioenergetic reserves of these crabs, which tolerate fluctuating environmental conditions. Our results showed that both species had a higher lipid content in the hepatopancreas and a lower lipid content in its gills and muscle. All three of the evaluated tissues in C. cinereus showed high contents of saturated fatty acids (SFAs), and its hepatopancreas displayed the highest contents of monounsaturated (MUFAs) and polyunsaturated fatty acids (PUFAs). In turn, H. crenulatus had the highest contents of MUFAs and PUFAs in its gills and muscle tissues, including an important amount of eicosapentaenoic acid (EPA). The FA content of C. cinereus may indicate an adaptive physiological response aimed at maintaining its cellular fluid balance during periods of desiccation in the upper intertidal zone. In contrast, the FAs found in H. crenulatus may be linked to the high activity of the sodium­potassium pump in its gills, in order to maintain osmoregulation in estuaries.

Assuntos

Adaptação Fisiológica , Braquiúros/fisiologia , Ácidos Graxos/química , Lipídeos/química , Aclimatação , Animais , Ecossistema , Ácido Eicosapentaenoico/metabolismo , Ácidos Graxos/metabolismo , Ácidos Graxos Insaturados/metabolismo , Brânquias/metabolismo , Hepatopâncreas/metabolismo , Masculino , Modelos Biológicos , Músculos/metabolismo , Osmorregulação , Salinidade , Equilíbrio Hidroeletrolítico

RESUMO

Vasopressin has been used to augment blood pressure; however, cardiovascular effects after cardiac surgery have not been well established. The primary objective of this study was to survey the current literature and quantify the pooled effect of vasopressin on hemodynamic parameters in children after pediatric cardiac surgery. A systematic review was conducted to identify studies characterizing the hemodynamic effects of vasopressin after pediatric cardiac surgery. Studies were assessed and those of satisfactory quality with pre- and post-vasopressin hemodynamics for each patient were included in the final analyses. 6 studies with 160 patients were included for endpoints during the first 2 h of infusions. Patients who received vasopressin infusion had greater mean, systolic, and diastolic blood pressures and lower heart rates at 2 h after initiation. 8 studies with 338 patients were included for the effects at 24 h. Patients who received vasopressin infusion had lower central venous pressures and decreased lactate concentrations 24 h after initiation. A subset analysis for children with functionally univentricular hearts found significant decrease in inotrope score and central venous pressure. A subset analysis for neonates found significant decrease in inotrope score and fluid balance. Vasopressin leads to decrease in heart rate and increase in blood pressure in the first 2 h of initiation. Later effects include decrease in inotrope score, central venous pressure, fluid balance, and in lactate within the first 24 h. Findings vary in neonates and in those with functionally univentricular hearts although beneficial effects are noted in both.

Assuntos

Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias Congênitas/cirurgia , Vasoconstritores/administração & dosagem , Vasopressinas/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Pré-Escolar , Feminino , Cardiopatias Congênitas/tratamento farmacológico , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Humanos , Lactente , Recém-Nascido , Infusões Intravenosas , Ácido Láctico/sangue , Masculino , Cuidados Pós-Operatórios/métodos

RESUMO

OBJECTIVES: Positive fluid balance is frequent in critically ill patients and has been considered a potential biomarker for acute kidney injury (AKI). This study aimed to evaluate positive fluid balance as a biomarker for the early detection of AKI in critically ill patients. METHODS: This was a prospective cohort study. The sample was composed of patients ≥18 years old who stayed ≥3 days in an intensive care unit. Fluid balance, urinary output and serum creatinine were assessed daily. AKI was diagnosed by the Kidney Disease Improving Global Outcome criteria. RESULTS: The final cohort was composed of 233 patients. AKI occurred in 92 patients (40%) after a median of 3 (2-6) days following ICU admission. When fluid balance was assessed as a continuous variable, a 100-ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI (OR 1.04; 95% CI 1.01-1.08). Positive fluid balance categorized using different thresholds was always significantly associated with subsequent detection of AKI. The mixed effects model showed that increased fluid balance preceded AKI by 4 to 6 days. CONCLUSION: These results suggest that a positive fluid balance might be an early biomarker for AKI development in critically ill patients.

Assuntos

Humanos , Adulto , Estado Terminal , Injúria Renal Aguda/diagnóstico , Equilíbrio Hidroeletrolítico , Biomarcadores , Estudos Prospectivos , Unidades de Terapia Intensiva