Water Requirements, Impinging Factors, and Recommended Intakes
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Mixing Alcohol with Your Diabetes You Can Drink If Your Blood Sugar Is Well Controlled – and You Take the Right Steps to Be Safe
Diabetes Education – #16 Mixing Alcohol with Your Diabetes You can drink if your blood sugar is well controlled – and you take the right steps to be safe. If you have diabetes, you may think that drinking is off limits. Not so! Keeping an eye on how much and what you drink can help you drink more safely. You can avoid the alcohol-related pitfalls: • low blood sugar • weight gain • high blood pressure. Before you have a drink, ask yourself the 3 questions below. The ADA (American Diabetes Association) suggests these: • Is my diabetes in good control? • Does my health care team agree that I can have alcohol? • Do I know how alcohol can affect me and my blood sugar? If you can answer "yes" to all 3 questions, it is likely OK to have a drink. But make sure you know the potential effects of drinking. And, make sure you know your personal limits. What happens when you drink? Between meals and while you sleep, the liver makes new glucose (sugar). The liver then sends this sugar into the bloodstream. Here, it helps to prevent or slow down a low blood sugar reaction. When you drink, it disrupts the process. Substances form when alcohol breaks down in the liver. These substances block the liver from making new glucose. Blood sugars fall and you can quickly become too low. Diabetes Education – #16 Treat hypoglycemia quickly Drinking can affect your blood sugar for up to 12 hours. So test your blood sugar before going to bed. If it is in the 100 – 140 mg/dL range, you may be fine. -
20Mg Spironolactone I.P…..50Mg
For the use only of a Registered Medical Practitioner or Hospital or a Laboratory. This package insert is continually updated: Please read carefully before using a new pack Frusemide and Spironolactone Tablets Lasilactone® 50 COMPOSITION Each film coated tablet contains Frusemide I.P. …….. 20mg Spironolactone I.P…..50mg THERAPEUTIC INDICATIONS Lasilactone® contains a short-acting diuretic and a long-acting aldosterone antagonist. It is indicated in the treatment of resistant oedema where this is associated with secondary hyperaldosteronism; conditions include chronic congestive cardiac failure and hepatic cirrhosis. Treatment with Lasilactone® should be reserved for cases refractory to a diuretic alone at conventional doses. This fixed ratio combination should only be used if titration with the component drugs separately indicates that this product is appropriate. The use of Lasilactone® in the management of essential hypertension should be restricted to patients with demonstrated hyperaldosteronism. It is recommended that in these patients also, this combination should only be used if titration with the component drugs separately indicates that this product is appropriate. POSOLOGY AND METHOD OF ADMINISTRATION For oral administration. The dose must be the lowest that is sufficient to achieve the desired effect. Adults: 1-4 tablets daily. Children: The product is not suitable for use in children. Elderly: Frusemide and Spironolactone may both be excreted more slowly in the elderly. Tablets are best taken at breakfast and/or lunch with a generous amount of liquid (approx. 1 glass). An evening dose is not recommended, especially during initial treatment, because of the increased nocturnal output of urine to be expected in such cases. -
Managing a High Output Ostomy: for Patients with an Ileostomy Or Jejunostomy
Form: D-8844 Managing a High Output Ostomy: For patients with an ileostomy or jejunostomy Read this brochure to learn: • what is a high output ostomy • why is a high output ostomy a problem • what foods and drinks can help you manage it What is a high output ostomy? A high output ostomy is when your ostomy output (the amount of waste coming out of your stoma) is more than 1.2 litres (about 5 cups) in a day. Signs of a high output ostomy include: • having to empty your stoma bag more than 8 times a day • having watery output Why is it a problem? You may become dehydrated (your body does not get enough water) if you have too much output. Your body may not absorb fluids well when you have a high output ostomy. Signs of dehydration are: • feeling thirsty • peeing less than usual • having dark yellow pee • losing weight • having dry lips and mouth • having a headache, dizziness or fatigue 2 How can I manage a high output ostomy? Making some changes to how you eat and drink can help manage a high output ostomy. Your health care team may also give you medicine to help manage a high output ostomy. 9 Have a small meal every 2 to 3 hours. This helps your body absorb food better and meet your nutrition needs. 9 Chew your food very well. This makes it easier for your body to break down and use the food you eat. 9 Do not drink fluids while you eat. Wait 30 minutes before and after a meal before drinking fluids. -
Medicines That Affect Fluid Balance in the Body
the bulk of stools by getting them to retain liquid, which encourages the Medicines that affect fluid bowels to push them out. balance in the body Osmotic laxatives e.g. Lactulose, Macrogol - these soften stools by increasing the amount of water released into the bowels, making them easier to pass. Older people are at higher risk of dehydration due to body changes in the ageing process. The risk of dehydration can be increased further when Stimulant laxatives e.g. Senna, Bisacodyl - these stimulate the bowels elderly patients are prescribed medicines for chronic conditions due to old speeding up bowel movements and so less water is absorbed from the age. stool as it passes through the bowels. Some medicines can affect fluid balance in the body and this may result in more water being lost through the kidneys as urine. Stool softener laxatives e.g. Docusate - These can cause more water to The medicines that can increase risk of dehydration are be reabsorbed from the bowel, making the stools softer. listed below. ANTACIDS Antacids are also known to cause dehydration because of the moisture DIURETICS they require when being absorbed by your body. Drinking plenty of water Diuretics are sometimes called 'water tablets' because they can cause you can reduce the dry mouth, stomach cramps and dry skin that is sometimes to pass more urine than usual. They work on the kidneys by increasing the associated with antacids. amount of salt and water that comes out through the urine. Diuretics are often prescribed for heart failure patients and sometimes for patients with The major side effect of antacids containing magnesium is diarrhoea and high blood pressure. -
Extreme Hyponatremia with Moderate Metabolic Acidosis During Hysteroscopic Myomectomy -A Case Report
Korean J Anesthesiol 2011 June 60(6): 440-443 Case Report DOI: 10.4097/kjae.2011.60.6.440 Extreme hyponatremia with moderate metabolic acidosis during hysteroscopic myomectomy -A case report- Youn Yi Jo1, Hyun Joo Jeon2, Eunkyeong Choi2, and Yong-Seon Choi2 Department of Anesthesiology and Pain Medicine, 1Gachon University of Medicine and Science Gil Medical Center, Incheon, 2Yonsei University College of Medicine, Seoul, Korea Excess absorption of fluid distention media remains an unpredictable complication of operative hysteroscopy and may lead to lethal conditions. We report an extreme hyponatremia, caused by using an electrolyte-free 5 : 1 sorbitol/ mannitol solution as distention/irrigation fluid for hysteroscopic myomectomy. A 34-year-old female developed severe pulmonary edema and extreme hyponatremia (83 mmol/L) during transcervical endoscopic myomectomy. A brain computed tomography showed mild brain swelling without pontine myelinolysis. The patient almost fully recovered in two days. Meticulous attention should be paid to intraoperative massive absorption of fluid distention media, even during a simple hysteroscopic procedure. (Korean J Anesthesiol 2011; 60: 440-443) Key Words: Hyponatremia, Hysteroscopy. Hysteroscopy is a new technique of transcervical endoscopic to death [2]. Although there have been reports of dilutional surgery, which requires the insertion of a scope into the hyponatremia following hysteroscopy [1-3], there have been no uterine cavity and the installation of a suitable distention cases presenting severe hyponatremia of less than 90 mmol/ medium for visualization of the endometrium. The medium L accompanied by metabolic acidosis. We report on a patient and intrauterine pressure opens the potential space of the with an extreme hyponatremia caused by using an electrolyte- otherwise narrow uterine cavity. -
1 Fluid and Elect. Disorders of Serum Sodium Concentration
DISORDERS OF SERUM SODIUM CONCENTRATION Bruce M. Tune, M.D. Stanford, California Regulation of Sodium and Water Excretion Sodium: glomerular filtration, aldosterone, atrial natriuretic factors, in response to the following stimuli. 1. Reabsorption: hypovolemia, decreased cardiac output, decreased renal blood flow. 2. Excretion: hypervolemia (Also caused by adrenal insufficiency, renal tubular disease, and diuretic drugs.) Water: antidiuretic honnone (serum osmolality, effective vascular volume), renal solute excretion. 1. Antidiuresis: hyperosmolality, hypovolemia, decreased cardiac output. 2. Diuresis: hypoosmolality, hypervolemia ~ natriuresis. Physiologic changes in renal salt and water excretion are more likely to favor conservation of normal vascular volume than nonnal osmolality, and may therefore lead to abnormalities of serum sodium concentration. Most commonly, 1. Hypovolemia -7 salt and water retention. 2. Hypervolemia -7 salt and water excretion. • HYFERNATREMIA Clinical Senini:: Sodium excess: salt-poisoning, hypertonic saline enemas Primary water deficit: chronic dehydration (as in diabetes insipidus) Mechanism: Dehydration ~ renal sodium retention, even during hypernatremia Rapid correction of hypernatremia can cause brain swelling - Management: Slow correction -- without rapid administration of free water (except in nephrogenic or untreated central diabetes insipidus) HYPONA1REMIAS Isosmolar A. Factitious: hyperlipidemia (lriglyceride-plus-plasma water volume). B. Other solutes: hyperglycemia, radiocontrast agents,. mannitol. -
Preventing Dehydration
State of New Jersey Department of Human Services Division of Developmental Disabilities DDDDDD PREVENTIONPREVENTION BULLETINBULLETIN Dehydration Dehydration is a loss of too much fluid from the body. The body needs water in order to maintain normal functioning. If your body loses too much fluid - more than you are getting from your food and liquids - your body loses electrolytes. Electrolytes include important nutrients like sodium and potassium which your body needs to work normally. A person can be at risk for dehydration in any season, not just the summer months. It is also important to know that elderly individuals are at heightened risk for dehydration because their bodies have a lower water content than younger people. Why people with Common Causes and a developmental Risk Factors for disability may be Dehydration: at a higher risk for dehydration. v Diarrhea v Vomiting v People with physical limitations may v Excessive sweating not be able to get something to drink on their own and will need the assistance of v Fever others. v Burns v People who cannot speak or whose v Diabetes when blood sugar is too high speech is hard to understand may have a v hard time telling their support staff that Increased urination (undiagnosed diabetes) they are thirsty. v Not drinking enough water, especially on warm and hot days v Some people may have difficulty swal- lowing their food or drinks and may v Not drinking enough during or after exercise refuse to eat or drink. This can make v Some medications (diuretics, blood pressure them more susceptible to becoming meds, certain psychotropic and anticonvul- dehydrated. -
The Effect of Dehydration, Hyperthermia, and Fatigue on Landing Error Scoring System Scores
ABSTRACT THE EFFECT OF DEHYDRATION, HYPERTHERMIA, AND FATIGUE ON LANDING ERROR SCORING SYSTEM SCORES Purpose: To examine the effects of exercise-induced dehydration, hyperthermia, and fatigue on Landing Error Scoring System (LESS) scores during a jump-landing task, and the effectiveness of a personalized hydration plan. Methods: Five recreationally active heat-acclimatized males 25.4 y (SD=5.7) completed two trials: with fluid replacement, (EXP) and without fluid (CON), in a counterbalanced, randomized, cross-over fashion. Exercise was terminated when gastrointestinal temperature (Tgi) = 39.5°C and fatigue ≥ 7/10, or 90 min of exercise. Percent dehydration was determined by body mass change from pre- exercise (PRE) and post-exercise (POST). Tgi, heart rate (HR), and perceived fatigue were measured PRE, during exercise, and POST. Three jump-landing tasks were filmed in the frontal and sagittal planes. An experienced grader evaluated jump-landing tasks using the LESS. Statistical Analysis: Repeated measures ANOVA assessed primary dependent and independent variables while a priori dependent t-tests evaluated pairwise comparisons. Results: No interaction, group, or time main effects were observed for LESS scores (p=0.437). POST dehydration (%) was greater in CON (M=2.59, SD=0.52) vs. EXP (M=0.92, SD=0.41; p<0.001), whereas hyperthermia (°C) (CON, M=39.29, SD=0.31, EXP, M=39.03, SD=0.61; p=0.425), and fatigue (CON, M=9, SD=1, EXP, M=9, SD=2; p=0.424) were similar. Conclusion: LESS scores were not affected by exercise-induced dehydration, hyperthermia, and fatigue, nor by a personal hydration plan. -
Dehydration: Pediatric ______Gastrointestinal
Dehydration: Pediatric _____________________________ Gastrointestinal Clinical Decision Tool for RNs with Effective Date: December 1, 2019 Authorized Practice [RN(AAP)s] Review Date: December 1, 2022 Background Dehydration can occur with many childhood illnesses and is defined as an abnormal decrease in the volume of circulating plasma (Cellucci, 2019; Richardson, 2020). Dehydration implies loss of water from both extracellular (intravascular and interstitial) and intracellular spaces and most often leads to elevated plasma sodium and osmolality (Cellucci, 2019; Richardson, 2020). Hypovolemia is a generic term encompassing volume depletion and dehydration (Cellucci, 2019; Richardson, 2020). Volume depletion is the loss of salt and water from the intravascular space (Cellucci, 2019; Richardson, 2020). Mild, moderate, and severe dehydration corresponds to deficits of three to five percent, six to nine percent, and ≥ 10% weight loss, respectively (Cellucci, 2019; Richardson, 2020). The assessment and management of dehydration should take into consideration the degree of dehydration, maintenance fluid requirements, and ongoing fluid losses (Cellucci, 2019; Richardson, 2020). The mechanisms of dehydration may be broadly divided into three categories: 1) increased fluid loss, 2) decreased fluid intake, or 3) both (Cellucci, 2019). Pediatric dehydration is frequently the result of increased output from gastroenteritis, characterized by vomiting, diarrhea, or both (Cellucci, 2019). Other causes of dehydration may include metabolic diseases (e.g., diabetic ketoacidosis), cutaneous losses (e.g., excessive sweating, fever, burns), or third-space losses (e.g., bowel obstruction, ileus) (Cellucci, 2019). Decreased fluid intake is especially worrisome when the client is vomiting, or when there is concurrent fever or tachypnea as both symptoms increase insensible fluid losses (Cellucci, 2019). -
How Do You Look After a Vomiting Drunk Friend?
Alcohol and Young People How do you look after a vomiting drunk friend? Vomiting can be life-threatening even when The police do not routinely attend an ambulance alcohol is not involved. If a vomiting person call, even if there are illegal drugs involved. The has been drinking alcohol, it can cause them to only reason the police will usually attend is if the lose a natural response called the ‘gag reflex’. paramedics ask them to be there. This is usually With no gag reflex, a person is in danger of due to another crime taking place or the threat of choking on their own vomit, particularly if they violence. lose consciousness. Helping a drunk friend can be difficult and potentially Whether you are drinking alcohol or not, there dangerous. Often, the person may be aggressive are some simple things you can do to look after a and uncooperative. While it is important to try to vomiting, drunk friend: keep your friend safe, the first priority must always stay with them and monitor them closely be your personal safety. Never be afraid to pass the problem over to someone else, particularly if they keep them as upright as possible and never become violent. If in doubt, call 000. lay them down give them a plastic bucket or bowl and make ALWAYS REMEMBER, YOU ARE A FRIEND, sure they are somewhere safe where they NOT A DOCTOR can be watched get them to rinse their mouth out regularly keep them warm reassure them if in doubt, call 000 immediately What causes vomiting? sheet ‘Alcohol Poisoning’). -
Hyperchloremia – Why and How
Document downloaded from http://www.elsevier.es, day 23/05/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. n e f r o l o g i a 2 0 1 6;3 6(4):347–353 Revista de la Sociedad Española de Nefrología www.revistanefrologia.com Brief review Hyperchloremia – Why and how Glenn T. Nagami Nephrology Section, Department of Medicine, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, United States a r t i c l e i n f o a b s t r a c t Article history: Hyperchloremia is a common electrolyte disorder that is associated with a diverse group of Received 5 April 2016 clinical conditions. The kidney plays an important role in the regulation of chloride concen- Accepted 11 April 2016 tration through a variety of transporters that are present along the nephron. Nevertheless, Available online 3 June 2016 hyperchloremia can occur when water losses exceed sodium and chloride losses, when the capacity to handle excessive chloride is overwhelmed, or when the serum bicarbonate is low Keywords: with a concomitant rise in chloride as occurs with a normal anion gap metabolic acidosis Hyperchloremia or respiratory alkalosis. The varied nature of the underlying causes of the hyperchloremia Electrolyte disorder will, to a large extent, determine how to treat this electrolyte disturbance. Serum bicarbonate Published by Elsevier Espana,˜ S.L.U. on behalf of Sociedad Espanola˜ de Nefrologıa.´ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/). -
Water Intoxication Resulting in Ventricular Arrythmias Ventriküler Aritmilere Neden Olan Su Zehirlenmesi
188 CASE REPORT OLGU SUNUMU Water Intoxication Resulting in Ventricular Arrythmias Ventriküler Aritmilere Neden Olan Su Zehirlenmesi Pınar TÜRKER BAYIR, Burcu DEMİRKAN, Serkan DUYULER, Ümit GÜRAY, Halil Lütfi KISACIK Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara SUMMARY ÖZET Water intoxication, defined as excessive water ingestion within a Ağız yoluyla kısa sürede aşırı su alımı ciddi nörolojik ve kardiyak short period of time, may cause severe neurologic and cardiac symp- semptomlara yol açabilir ve su zehirlenmesi olarak adlandırılır. Bu toms. This condition is commonly seen in psychiatric patients, how- durum psikiyatrik hastalarda sıklıkla görülmektedir ancak intihar ever the ingestion of excessive water is an infrequent method for at- amaçlı aşırı su alımı oldukça enderdir. Bu olgu sunumunda intihar tempting suicide. In this case report we present a 51-year-old woman amaçlı aşırı su alımının yol açtığı elektrolit dengesizliğine bağ- with ventricular fibrillation due to electrolyte imbalance caused by lı ventriküler fibrilasyon gelişen 51 yaşındaki hastayı sunuyoruz. excessive water ingestion during a suicide attempt. The patient was Hasta acil kliniğimize bilinç değişikliği ve ajitasyon ile başvurdu. admitted to our emergency clinic with altered consciousness and ag- Hasta hipertansifti ve nörolojik muayenesinde lateralizasyon bul- itation. She was hypertensive and neurological examination revealed gusu yoktu. Hastanede takibi esnasında ventriküler aritmi kardiyo- no lateralizing signs. Ventricular arrhythmias, cardiopulmonary arrest pulmoner arrest ve tonik klonik nöbet gözlendi. Kan biyokimya- and tonic-clonic seizure were observed during hospitalization. Blood sında hastanın 4 saat içerisinde 12 litre su içmesiyle uyumlu olan chemistry showed hyponatremia and hypokalemia relevant to the hiponatremi ve hipokalemi mevcuttu. Elektrolit bozukluğunun patient’s history of ingestion of 12 liters of water in 4 hours time.