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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 [ Outlet Official Site Cheap Pick A Best Sofie Dhoore tie waist midlength dress Deals tuRSrE1dM
]. Colloids are not recommended because of their adverse effects (discussed above) and also because they may be less effective [ Raquel Davidowicz Sal straightleg jeans Hot Sale Sale Fashionable 3dVvgj8P
]. 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 [ 19 ]. 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 [ Outlet Official Max amp; Moi offcentre drawstring coat Outlet Footlocker Finishline Largest Supplier For Sale Clearance Cheapest Price mHTNMr
]. 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 [ By Walid Martha Stripe Print Linen Coat Best Prices For Sale aVVDo
], 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 [ Visa Payment Circled Be Different printed round neck Tshirt Cheap Sale Nicekicks dKlMgnKbv5
]. In addition, because IV fluid therapy can cause fluid overload, and a positive fluid balance in the ICU is associated with higher mortality [ Eres Capture Stud bikini Buy Cheap Cheap 5q1hAFUJsV
], 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 [ 24 ]. Because hyperglycemia is associated with worse outcomes after acute neurological injury, dextrose may need to be avoided especially in this setting [ Jil Sander scoop neck top Outlet Wholesale Price NEmEFI
, 26 ]. When hypoglycemia is a potential risk (e.g., during surgery in children) dextrose levels can be safely reduced from 5 to 1% (Table Karl Lagerfeld cable knit mix hoodie Best Sale Sale Online Low Price Fee Shipping Sale Online F4efa9wJ
) [ 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 ( 42 ). 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 Fendi accordion wallet Shop Buy Cheap Hot Sale I8Tbwo
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). 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 ( Free Shipping Find Great Love Moschino logo mesh jumper In China For Sale Cheap Amazon Sale Amazing Price 4iaexaYg
31 ). SIBO in this setting has been shown to lead to poor carbohydrate absorption and oral vaccine underperformance ( 32 Talbot Runhof long jacquard gown Outlet Newest Outlet Official Quality Free Shipping Outlet Gw3Gv7
). 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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