RESUMO
O objetivo deste estudo foi evidenciar e discutir as principais alterações hidroeletrolíticas em pessoas com cirrose. Trata-se de uma revisão integrativa, de natureza qualitativa. Os artigos foram selecionados por meio da plataforma Medical Literature Analysis and Retrievel System Online. Os principais achados identificados a partir dos artigos selecionados foram a ocorrência de hiponatremia, o mau prognóstico diante da presença de distúrbios hidroeletrolíticos em relação à sobrevida em pessoas com cirrose e a importância da albumina. Indivíduos com cirrose são suscetíveis ao desenvolvimento de distúrbios hidroeletrolíticos devido às mudanças fisiopatológicas da doença e às condições clínicas apresentadas. A hiponatremia e a hipocalemia são os mais recorrentes, destacando, porém, a necessidade de atenção aos demais distúrbios. (AU)
The objective of this study was to show and discuss the main hydroelectrolytic alterations in cirrhotic patients. This is an integrative review, a qualitative study, in which articles were selected at the Medical literature Analysis and Retrieval System Online. The main findings identified in the articles selected were the occurrence of hyponatremia, the poor prognostic, due to the presence of hydroelectrolytic disorders, regarding cirrhotic individuals survival and the importance of albumin. Individuals with cirrhosis are susceptible to the development of hydroelectrolytic disorders due to the pathophysiological alterations of the disease and because of the clinical status presented. Hyponatremia and hypokalemia are the most recurrent, but attention shall be given to the other disorders too. (AU)
Assuntos
Humanos , Desequilíbrio Hidroeletrolítico/metabolismo , Cirrose Hepática/metabolismo , Prognóstico , Desequilíbrio Ácido-Base/etiologia , Desequilíbrio Hidroeletrolítico/complicações , Desequilíbrio Hidroeletrolítico/etiologia , Análise de Sobrevida , Hipofosfatemia/etiologia , Hipoalbuminemia/etiologia , Pesquisa Qualitativa , Albuminas/uso terapêutico , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Cirrose Hepática/terapia , Deficiência de Magnésio/etiologiaRESUMO
Sodium retention is a major clinical feature of nephrotic syndrome. The mechanisms responsible for sodium retention in this setting have been a subject of debate for years. Excessive sodium retention occurs in some individuals with nephrotic syndrome in the absence of activation of the renin-angiotensin-aldosterone system, suggesting an intrinsic defect in sodium excretion by the kidney. Recent studies have provided new insights regarding mechanisms by which sodium transporters are activated by factors present in nephrotic urine. These mechanisms likely have a role in the development of hypertension in nephrotic syndrome, where hypertension may be difficult to control, and provide new therapeutic options for the management of blood pressure and edema in the setting of nephrotic syndrome.
Assuntos
Hipertensão/metabolismo , Rim/metabolismo , Síndrome Nefrótica/metabolismo , Sódio/metabolismo , Desequilíbrio Hidroeletrolítico/metabolismo , Canais Epiteliais de Sódio/metabolismo , Humanos , Hipertensão/etiologia , Síndrome Nefrótica/complicações , Proteinúria , Desequilíbrio Hidroeletrolítico/complicações , Desequilíbrio Hidroeletrolítico/tratamento farmacológicoRESUMO
The nucleus of the solitary tract (NTS) is the primary site of visceral afferents to the central nervous system. In the present study, we investigated the effects of lesions in the commissural portion of the NTS (commNTS) on the activity of vasopressinergic neurons in the hypothalamic paraventricular (PVN) and supraoptic (SON) nuclei, plasma vasopressin, arterial pressure, water intake, and sodium excretion in rats with plasma hyperosmolality produced by intragastric 2 M NaCl (2 ml/rat). Male Holtzman rats with 15-20 days of sham or electrolytic lesion (1 mA; 10 s) of the commNTS were used. CommNTS lesions enhanced a 2 M NaCl intragastrically induced increase in the number of vasopressinergic neurons expressing c-Fos in the PVN (28 ± 1, vs. sham: 22 ± 2 c-Fos/AVP cells) and SON (26 ± 4, vs. sham: 11 ± 1 c-Fos/AVP cells), plasma vasopressin levels (21 ± 8, vs. sham: 6.6 ± 1.3 pg/ml), pressor responses (25 ± 7 mmHg, vs. sham: 7 ± 2 mmHg), water intake (17.5 ± 0.8, vs. sham: 11.2 ± 1.8 ml/2 h), and natriuresis (4.9 ± 0.8, vs. sham: 1.4 ± 0.3 meq/1 h). The pretreatment with vasopressin antagonist abolished the pressor response to intragastric 2 M NaCl in commNTS-lesioned rats (8 ± 2.4 mmHg at 10 min), suggesting that this response is dependent on vasopressin secretion. The results suggest that inhibitory mechanisms dependent on commNTS act to limit or counterbalance behavioral, hormonal, cardiovascular, and renal responses to an acute increase in plasma osmolality.
Assuntos
Pressão Sanguínea/fisiologia , Ingestão de Líquidos/fisiologia , Rim/fisiologia , Núcleo Solitário/metabolismo , Desequilíbrio Hidroeletrolítico/metabolismo , Animais , Masculino , Concentração Osmolar , Ocitocina , Núcleo Hipotalâmico Paraventricular/citologia , Proteínas Proto-Oncogênicas c-fos/genética , Proteínas Proto-Oncogênicas c-fos/metabolismo , Ratos , Ratos Sprague-Dawley , Núcleo Supraóptico/citologia , VasopressinasRESUMO
The aim of this work was to study the role of local intrarenal angiotensin II (Ang II) and the oxidative stress in the up-regulation of pro-inflammatory cytokines expression observed in rats submitted to an acute sodium overload. Sprague-Dawley rats were infused for 2 h with isotonic saline solution (Control group) and with hypertonic saline solution alone (Na group), plus the AT1 receptor antagonist losartan (10 mg kg(-1) in bolus) (Na-Los group), or plus the superoxide dismutase mimetic tempol (0.5 mg min(-1) kg(-1)) (Na-Temp group). Mean arterial pressure, glomerular filtration rate, and fractional sodium excretion (FE(Na)) were measured. Ang II, NF-kappaB, hypoxia inducible factor-1 alpha (HIF-1 alpha), transforming growth factor beta1 (TGF-beta1), smooth muscle actin (alpha-SMA), endothelial nitric oxide synthase (eNOS), and RANTES renal expression was evaluated by immunohistochemistry. Ang II, NF-kappaB, and TGF-beta1 and RANTES early inflammatory markers were overexpressed in Na group, accompanied by enhanced HIF-1 alpha immunostaining, lower eNOS expression, and unmodified alpha-SMA. Losartan and tempol increased FE(Na) in sodium overload group. Although losartan reduced Ang II and NF-kappaB staining and increased eNOS expression, it did not restore HIF-1 alpha expression and did not prevent inflammation. Conversely, tempol increased eNOS and natriuresis, restored HIF-1 alpha expression, and prevented inflammation. Early inflammatory markers observed in rats with acute sodium overload is associated with the imbalance between HIF-1 alpha and eNOS expression. While both losartan and tempol increased natriuresis and eNOS expression, only tempol was effective in restoring HIF-1 alpha expression and down-regulating TGF-beta1 and RANTES expression. The protective role of tempol, but not of losartan, in the inflammatory response may be associated with its greater antioxidant effects.
Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Antioxidantes/farmacologia , Óxidos N-Cíclicos/farmacologia , Mediadores da Inflamação/metabolismo , Rim/efeitos dos fármacos , Losartan/farmacologia , Nefrite/prevenção & controle , Estresse Oxidativo/efeitos dos fármacos , Desequilíbrio Hidroeletrolítico/tratamento farmacológico , Actinas/metabolismo , Angiotensina II/metabolismo , Animais , Pressão Sanguínea/efeitos dos fármacos , Quimiocina CCL5/metabolismo , Modelos Animais de Doenças , Taxa de Filtração Glomerular/efeitos dos fármacos , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Rim/metabolismo , Rim/fisiopatologia , Masculino , NF-kappa B/metabolismo , Natriurese/efeitos dos fármacos , Nefrite/etiologia , Nefrite/metabolismo , Nefrite/fisiopatologia , Óxido Nítrico Sintase Tipo III/metabolismo , Ratos , Ratos Sprague-Dawley , Solução Salina Hipertônica , Marcadores de Spin , Fatores de Tempo , Fator de Crescimento Transformador beta1/metabolismo , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/metabolismo , Desequilíbrio Hidroeletrolítico/fisiopatologiaRESUMO
Magnesium (Mg) is the main intracellular divalent cation, and under basal conditions the small intestine absorbs 30-50% of its intake. Normal serum Mg ranges between 1.7-2.3 mg/dl (0.75-0.95 mmol/l), at any age. Even though eighty percent of serum Mg is filtered at the glomerulus, only 3% of it is finally excreted in the urine. Altered magnesium balance can be found in diabetes mellitus, chronic renal failure, nephrolithiasis, osteoporosis, aplastic osteopathy, and heart and vascular disease. Three physiopathologic mechanisms can induce Mg deficiency: reduced intestinal absorption, increased urinary losses, or intracellular shift of this cation. Intravenous or oral Mg repletion is the main treatment, and potassium-sparing diuretics may also induce renal Mg saving. Because the kidney has a very large capacity for Mg excretion, hypermagnesemia usually occurs in the setting of renal insufficiency and excessive Mg intake. Body excretion of Mg can be enhanced by use of saline diuresis, furosemide, or dialysis depending on the clinical situation.
Assuntos
Compostos de Magnésio/uso terapêutico , Deficiência de Magnésio/complicações , Magnésio/metabolismo , Insuficiência Renal/etiologia , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/terapia , Humanos , Magnésio/farmacocinética , Compostos de Magnésio/sangue , Compostos de Magnésio/urina , Deficiência de Magnésio/metabolismo , Deficiência de Magnésio/terapia , Insuficiência Renal/metabolismo , Insuficiência Renal/terapia , Desequilíbrio Hidroeletrolítico/metabolismoRESUMO
The effects of water and salt overload on the activities of the supraoptic and paraventricular nuclei and the adjacent periventricular zone of the hypothalamus of the snake Bothrops jararaca were investigated by measurements of Fos-like immunoreactivity (Fos-ir). Both water and salt overload resulted in changes in body mass, plasma osmolality, and plasma concentrations of sodium, potassium, and chloride. Hyper-osmolality increased Fos immunoreactivity in the rostral supraoptic nucleus (SON), the paraventricular nucleus (PVN), and adjacent periventricular areas. Both hyper- and hypo-osmolality increased Fos immunoreactivity in the intermediate SON, but not in other areas of the hypothalamus. Immunostaining was abundant in cerebrospinal fluid (CSF)-contacting tanycyte-like cells in the ependymal layer of the third ventricle. These data highlight some features of regional distribution of Fos immunoreactivity that are consistent with vasotocin functioning as a hormone, and support the role of hypothalamic structures in the response to disruption of salt and water balance in this snake.
Assuntos
Bothrops/metabolismo , Hipotálamo/metabolismo , Proteínas Proto-Oncogênicas c-fos/metabolismo , Desequilíbrio Hidroeletrolítico/metabolismo , Animais , Bothrops/sangue , Cálcio/sangue , Cloretos/sangue , Hematócrito , Hipotálamo Anterior/metabolismo , Imuno-Histoquímica , Magnésio/sangue , Concentração Osmolar , Núcleo Hipotalâmico Paraventricular/metabolismo , Potássio/sangue , Sódio/sangue , Terceiro Ventrículo/metabolismo , Desequilíbrio Hidroeletrolítico/sangueRESUMO
En el presente artículo el autor muestra la asociación entre alteraciones metabólicas e Hipoacusia. Muestra las diferentes opciones que hay para llegar a la hipoacusia por alteraciones del medio interno. Se mencionan las alteraciones del metabolismo hidroelectrolítico así como la de los líquidos del oído interno causantes de Hipoacusia. También se describe las alteraciones del calcio, fósforo y magnesio; así como alteraciones de los aminoácidos que conllevan a pérdidas de audición de tipo perceptivo.
This paper reviews the author ´s experience in cases o hypoacusia related to metabolic alterations. The author discusses the relationship between internal milieu and hypoacusia. Hydoelectrolytic metabolism disorders and disorders of liquid milieu in the inner aer are discussed as causes of hypoacusia. Calcium, phosphorus and magnesium disorders as well as aminoacid alterations as causes of hypoacusia are also discussed.
Assuntos
Humanos , Desequilíbrio Hidroeletrolítico/metabolismo , Perda Auditiva/metabolismo , Surdez/metabolismoRESUMO
The present study aimed at describing the profile of defining characteristics in patients with the nursing diagnosis "Fluid volume deficit" related to active loss of fluid secondary to burns. Data were collected by means of a tool, containing 29 possible defining characteristics of this diagnosis. Seven nurses, that worked at the Burnt Unit for at least five years ago, provided opinions about the degree to which each defining characteristic is indicative of this diagnosis. Nurses rated each defining characteristic of diagnosis being tested on a scale of zero to one. The results confirmed all, except one (increased body temperature) defining characteristics presented by NANDA for this diagnosis and indicated 10 new defining characteristics.
Assuntos
Atitude do Pessoal de Saúde , Queimaduras/complicações , Diagnóstico de Enfermagem/normas , Recursos Humanos de Enfermagem Hospitalar/psicologia , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/enfermagem , Humanos , Pesquisa em Avaliação de Enfermagem , Reprodutibilidade dos Testes , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/metabolismoRESUMO
En esta revisión se analizan las características fisiológicas particulares del recién nacidos que influyen en el manejo de líquidos y electrolitos a esta edad, tales como la función renal, la distribución de líquidos y de solutos en períodos fetales y neonatales tempranos, y las características de las pérdidas insensibles de agua en los recién nacidos a término y pretérmino. Así mismo, se analiza la forma de la estimación del déficit, del cálculo de los requerimientos hidroelectrolíticos y de los líquidos de mantenimiento así como de las pérdidas anormales. Se examina el balance ácidobase y se presentan algunas recomendaciones para el control de la efectividad de la terapia hidroelectrolítica. Por último, se analizan algunos trastornos hidroelectrolíticos asociados a condiciones clínicas específicas, haciendo énfasis en el síndrome de dificultad respiratoria y en la diarrea