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Table 1

Indications for intravenous fluids

Table 2

Complications of intravenous fluids

Table 3

Composition of commonly used intravenous fluids

All in mmol/l, except for osmolality in mOsm/kg. not available

Buffers consist of bicarbonate (plasma, NaHCO), lactate (lactated Ringer’s), acetate (27mmol/l in PlasmaLyte, 24mmol/l in Sterofundin), gluconate (23mmol/l in PlasmaLyte), and maleate (5mmol/l in Sterofundin)

IV fluids are so ubiquitous in clinical medicine that one would almost forget considering its indications (Table 1 ). An important classification is the distinction between replacement and maintenance IV fluids. Patients requiring replacement IV fluids have a degree of volume depletion that may be due to hemorrhagic or non-hemorrhagic causes. For both categories, the rapid infusion of isotonic saline is indicated for resuscitation (e.g., 500ml in 10min, repeated as needed). Isotonic IV fluids expand the intravascular compartment more effectively than hypotonic IV fluids. No studies are available to address whether balanced crystalloids offer advantages in this setting [ Cheap Sale Fashionable Cheap New Styles Maison Margiela micro pied de poule blazer Amazing Price Onkd4H
]. Colloids are not recommended because of their adverse effects (discussed above) and also because they may be less effective [ 18 ]. In less severe volume depletion, the goal of replacement therapy is to correct existing abnormalities in fluid, electrolyte, or acid-base balance. Furthermore, IV fluids may be used in patients with pre-renal azotemia in the context of AKI or acute on chronic renal insufficiency. The fractional excretion of urea rather than sodium may be useful to select patients eligible for a trial of fluid repletion [ Outlet 2018 Newest High Quality Fabiana Filippi gathered ankle trousers Nicekicks Sale Online eA2re
]. Maintenance IV fluids are usually given when the patient cannot drink for a prolonged period of time. Owing to immobility, hospitalized patients often require less than a liter of water per day. However, this rough estimate can change dramatically in circumstances with increased loss due to fever, sweating, burns, tachypnea, gastro-intestinal losses, drains, or polyuria. Conversely, non-osmotic stimuli may be present for the release of vasopressin (the antidiuretic hormone), resulting in renal water retention [ Free Shipping Latest The Seafarer faded flared jeans Discount Cheap Online lRbJkjh3Rs
]. Changes in body weight and the serum sodium concentration (as measure of water balance) are useful parameters to assess water balance and, accordingly, plan initial IV fluid therapy. Other parameters should also guide the selection of IV fluid therapy, including blood pressure, acid-base status, kidney function, and the presence of diabetes. In general, isotonic IV fluids are recommended for maintenance [ 20 ], but specific settings may require tailored therapy. Recommended average rates of infusion are 100–120ml/h, but should be decreased (25ml/h in oligoanuric states, 40–60ml/h in edematous states) or increased (>120ml/h with urinary concentrating defect) depending on the clinical context [ 20 ]. The tendency towards isotonic maintenance IV fluids may be related to previous cases of acute hyponatremia, for example due to the combination of post-operative vasopressin release and the use of hypotonic IV fluids [ Free Shipping Pay With Visa Sale Online Boucheron cateye sunglasses Cheap Sale Best Prices UVZlXsO7
]. In addition, because IV fluid therapy can cause fluid overload, and a positive fluid balance in the ICU is associated with higher mortality [ 22 ], the need for giving maintenance fluids should always be critically reviewed [ 23 ]. Although IV fluids often contain glucose, it offers a poor source of long-term nutrition, which should usually come from enteral tube feeding. Alternatively, in patients with compromised gut function, total parental nutrition may be indicated. These considerations raise the question if glucose should be part of maintenance IV fluids. This practice differs per country and no large studies are available comparing isotonic maintenance fluids with or without dextrose. One randomized trial in the peri-operative setting did show that 72% of patients receiving IV fluids containing dextrose developed transient hyperglycemia, whereas those without dextrose remained normoglycemic [ Oscar de la Renta brooch embellished column gown Pay With Paypal Cheap Online Free Shipping Sneakernews Buy Cheap Buy Cheap Sale Latest Collections Official Sale Online IkddI
]. Because hyperglycemia is associated with worse outcomes after acute neurological injury, dextrose may need to be avoided especially in this setting [ Fast Shipping Pre Order For Sale Marc Ellis Tracy tote Outlet Online Best Sale Cheap Online w7r2dqvD
, 26 ]. When hypoglycemia is a potential risk (e.g., during surgery in children) dextrose levels can be safely reduced from 5 to 1% (Table Oscar de la Renta cutout floral flared dress Outlet Cheap Prices VtmFl0J
) [ 27 ].

This work is the first to investigate factors that may predispose developing world children with no known gastrointestinal pathology to SIBO. The significance of growth stunting in our model demonstrates an association between linear growth delay and overgrowth independent of diarrheal disease and sanitation. However, in the absence of longitudinal analysis, the details of this association remain unclear. Given the known nutritional consequences of SIBO in other settings, it is biologically plausible that SIBO plays a causative role in growth stunting. It is also possible that a variable we did not measure in our analysis leads to both SIBO and declining LAZ and thus is acting as a confounder in our model.

We designed our regression model to investigate two competing hypotheses on why children would develop SIBO from their environment. The first hypothesis was that children develop SIBO due to lumenal stasis secondary to gastroparesis or ileus after recent or recurrent enteric infection. This is biologically plausible given that children in Bangladesh have a mean of 4.7 diarrheal episodes and a median of 3.3 enteric pathogens identified in nondiarrheal stools in the first year of life alone ( Fashion Style Online Fendi Kan I Logo small shoulder bag Shop For Real Sale With Credit Card M5MUOw
). The second hypothesis that has been suggested is that children develop a functional motility disorder with a hypoactive migrating motor complex and decreased intestinal contractility due to constant lipopolysaccharide exposure from an unsanitary environment ( 43 ). This phenomenon has been shown to occur in animal models and in women with late radiation enteropathy ( 44 46 ). Our analysis suggests that recent or frequent enteric infection does not predispose to SIBO, while measures of environmental contamination do. Although we did not test motility in this study, our results suggest this endeavor might be fruitful in future investigation.

To date, literature on environmentally derived SIBO in the developing world is sparse. It has been shown that SIBO occurs in the lower socioeconomic strata of developing world countries with increased prevalence compared to countries with greater financial means ( 29 Clearance Ebay Original Zadigamp;Voltaire Eva zip jeans Free Shipping Excellent Free Shipping Low Cost Cheap For Sale IATk7c
). SIBO in this setting has been shown to lead to poor carbohydrate absorption and oral vaccine underperformance ( Amazon Footaction Purchase Sale Online Tibi velvet drape sleeve top f77VmM
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34 ). It has also been shown to have increased prevalence in severe malnutrition ( 47 ). Much of our understanding of the pathogenesis of SIBO comes from studies in the developed world in patients with underlying gastrointestinal pathology. While these studies are extremely informative, it is important to understand that the pathogenesis and pathophysiology of SIBO in developing world children with no underlying gastrointestinal disease may be different from those of patients in industrialized countries.

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