The contribution of intravenous medicines to water and sodium intake in upper and lower gastrointestinal surgical patients

OBJECTIVE: The quantitative importance of prescribed intravenous medicines to water and sodium intake in routine clinical practice is undocumented, with uncertain influence on clinical outcomes. The present study aimed to redress this issue in surgical patients with gastrointestinal problems. RESEARCH METHODS & PROCEDURES: Prescription and administration of intravenous medicines and fluids were retrospectively reviewed for water and sodium over 24-hour periods in 86 patients in upper and lower gastrointestinal surgical wards in two teaching hospitals. Changes over five years were assessed in the same two wards using the same methodology. RESULTS: Among the 90.7% of patients prescribed intravenous medicines the median (range) intake was 272 (40–2687) mL water/day and 27 (2–420) mmol sodium/day, with no significant difference between hospitals or ward type. In 28.2% of those receiving any infusates the only source of water and sodium was intravenous medicines, and in 14.3% the medicines provided more sodium than other infusates. Antibiotics and paracetamol accounted for 58.3% of water and 52.3% of sodium in intravenous medicines. ‘Historic’ data of intravenous medicine-related salt and water intake did not differ significantly from ‘current’ data. The literature suggests clinical outcomes can be modulated by variations in water and sodium intake, are well within the range provided by intravenous medicines. CONCLUSIONS: Intravenous medicine prescriptions, particularly antibiotics and paracetamol, can make substantial and clinically relevant contributions to daily water and sodium intake. They have persisted over time, and should be considered during routine assessment of fluid balance and interventions aiming to improve clinical outcomes

Hand grip endurance test relates to clinical state and prognosis in COPD patients better than 6-minute walk test distance

Miroslav Kovarik,1,2 Vera Joskova,1,2 Anna Patkova,1,2 Vladimir Koblizek,3 Zdenek Zadak,2 Miloslav Hronek1,2 1Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; 2Department of Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; 3Department of Pulmonary Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic Purpose: Patients with COPD present peripheral muscle dysfunction and atrophy, expressed as muscle strength and endurance reduction. The goal of this study was direct dynamometric assessment of hand grip endurance and strength in relation to the stage of disease, multidimensional predictors of mortality, and 6-minute walk test (6MWT). To the best of our knowledge, there has been no previous study determining these parameters.Patients and methods: In this observational study, 58 consecutive outpatients with stable COPD and 25 volunteers without respiratory problems were compared. All COPD subjects underwent a comprehensive examination to determine COPD severity, prognostic scales, and 6MWT. Body composition, basic spirometric parameters, and hand grip strength and endurance were determined in all study participants.Results: Patients in the COPD group had a 15% decrease in maximum strength (P=0.012) and a 28% decrease in area under the force/time curve (AUC) of the endurance test (P<0.001) compared to the control group. Dynamometric parameters were significantly negatively associated with the stage of disease and values of multivariable prediction indexes, and positively associated with the results of 6MWT. In most cases, closer associations were found with AUC than with 6MWT and in the gender-specific groups.Conclusion: Both hand grip strength and endurance are impaired in COPD patients in comparison with the control group. In particular, AUC could be considered as an attractive option not only to assess exercise capacity but also as a predictive marker with a better prognostic value than 6MWT in COPD patients. This is the first study to observe the dependence of hand grip endurance on combined COPD assessment. Keywords: dynamometry, muscle strength, muscle endurance, BODE inde

Grapevine European catalogue: towards a comprehensive list

Contact: [email protected] european catalogue: towards a comprehensive lis