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Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study

Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study

patients. Under this condition, the association between fluid intake and mortality is only due to selection bias instead of there being a causal relationship. However, we believe this possibility was relatively low in our study due to two reasons: first, this is a highly select group of patients, and the ability to achieve negative FB may rep- resent more stable hemodynamics and compensated organ function (mainly cardiac and kidney function), at least compared to patients with positive FB; second, we found that both volume of fluid intake and UO were evenly distributed, with a constant rate over the first 48 hours after ICU admission (Fig. 2) and there was strong correlation between them (Pearson correlation, r = 0.69, p < 0.001). Thus, we believe that much of the fluid administration was protocol-driven and not given thera- peutically for confounding factors such as hypotension and blood loss. Thus it is more likely that fluid intake was the leading cause of increased UO in these patients and the association between UO and mortality is a sec- ondary result of association between fluid intake and mortality in this population instead of there being a causal relationship. This conclusion led to our next question: what caused this association between fluid in- take and mortality? We noticed that the difference in FB was small within four fluid intake levels (Table 2). One explanation is that the ability to achieve a similar nega- tive FB volume under a higher dose of fluid intake may suggest better organ function. However, the SOFA score did not differ within the four fluid intake levels and the SAPS II score was even higher in level 4. Based on all this information, we hypothesized that there may be a causal link between increased fluid intake and decreased mortality in this specific population (Table 2), which
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Fluid intake and voiding; habits and health knowledge in a young, healthy population

Fluid intake and voiding; habits and health knowledge in a young, healthy population

This paper is the first to our knowledge to present find- ings regarding the habits and beliefs of young, healthy people regarding healthy fluid intake and voiding habits. Reflective of the larger number of female students study- ing health sciences, more than two thirds of respondents were female, which limits the generalizability of data to both genders; hence data for males and females have been presented separately. However, similar drinking and void- ing habits were noted overall for both males and females. Whilst poor drinking and voiding habits are not commonly engaged in “most or all of the time”, neither are they rou- tinely avoided, with the majority of respondents engaging in poor habits at least occasionally. Furthermore, most respondents believe the common recommendation that they should be drinking at least eight glasses of water a day and also believe common myths about the supposed benefits of
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An increased fluid intake leads to feet swelling in 100-km ultra-marathoners - an observational field study

An increased fluid intake leads to feet swelling in 100-km ultra-marathoners - an observational field study

The present subjects showed a variation of total fluid intake between 2.7 and 20 L during the run with a mean fluid intake of 7.64 L, equal to 0.63 L/h. Fluid intake was significantly and negatively related to post- race plasma [Na + ]. This result supports the findings of the existing data that EAH is associated with fluid over- load [15,17-21,23]. To prevent excessive drinking during endurance exercise, the ‘ Position Statement of Interna- tional Marathon Medical Directors Association ’ pro- motes that marathoners should drink according to their thirst, but no more than 0.4 to 0.8 L/h [45]. The present ultra-marathoners consumed on average 0.63 L/h, which corresponds to these recommendations. Paradoxically, one of the subjects who developed EAH post-race was also the subject who consumed fluid at one of the low- est rate with 0.28 L/h. This subject lost 2 kg (2.9%) body mass during the race, had a pre-race plasma [Na + ] of 136 mmol/L and the foot volume decreased by 53%. He was also among the fastest runners finishing within 582 min (9 h 42 min). This result is not in line with our and other findings that a high fluid intake is correlated with lower post-race plasma [Na + ] [17,19-21]. Possible explanations for this subject developing EAH could be other factors than excessive fluid consumption such as non-osmotic stimulation of arginine vasopressin (AVP)
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Increased salt consumption induces body water conservation and decreases fluid intake

Increased salt consumption induces body water conservation and decreases fluid intake

The idea is well accepted that increased salt intake induces thirst, thereby leading to increased fluid intake and secondary par- allel elimination of the ingested excess salt and fluid in the urine (14, 15, 30) and supports arguments favoring strategies directed at reducing dietary salt intake in the population (18, 21). To test this hypothesis, we selected salt intake levels of 12 g/d, the value identified in the international worldwide INTERSALT study of approximately 9 g/d (31), as well as the value of 6 g/d or less rec- ommended by guidelines committees (32). The fact that increas- ing salt intake may not increase fluid intake or urine volume has been demonstrated earlier in shorter sodium and water balance studies. Luft et al. varied daily salt intake from 10 mmol/d to 200 and 400 mmol/d for 7 days and found no influence of dietary salt intake levels on water intake or urine volume (29). Even increas- Figure 2. Time series data presentation and mixed linear model analysis to visualize the effect of increasing salt intake and the resulting Na + excretion
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Relationship between bladder cancer and total fluid intake: a meta analysis of epidemiological evidence

Relationship between bladder cancer and total fluid intake: a meta analysis of epidemiological evidence

To explore the source of the heterogeneity, we conducted subgroup meta-analysis by various study characteristics (Table 3). In an analysis stratified by study design, the summary OR from cohort studies (OR 0.98; 95% CI 0.85- 1.13) showed that there was no association for the highest fluid intake with the risk of bladder cancer, but in case- control studies (OR 1.07; 95% CI 0.86-1.33) showed a significant association. When stratified by geographical re- gion, studies conducted in Europe and North America did not change the overall OR of all studies (OR 1.20; 95% CI 1.02-1.42), but there is a statistically significant protective effect of the highest fluid intake on bladder cancer in Asia (OR 0.27; 95% CI 0.10-0.72). When we separated the population-based case-control studies from the hospital- based case-control studies, we found that hospital-based studies markedly changed the summary OR of all studies (OR 0.71, 95% CI 0.44-1.15), in that greater fluid intake was related to decreased bladder cancer risk. Moreover, to avoid inadequate adjustment for tobacco smoking in the included studies, we evaluated the influence of the smok- ing status. The results showed that the smoking status did not influence the summary ORs substantially (Table 3). Interestingly, we found green and black tea have an inverse association for the highest tea intake with the risk of blad- der cancer (OR 0.76, 95% CI 0.66-0.95; OR 0.80, 95% CI 0.65-0.97, respectively), but no statistical significance. The majority of them were not identified as a possible source of heterogeneity among all studies included (Table 3).
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Drinking vessel preferences in older nursing home residents: optimal design and potential for increasing fluid intake

Drinking vessel preferences in older nursing home residents: optimal design and potential for increasing fluid intake

throughout the entire improvement project. No other improvement activities focused on fluid intake at breakfast were being undertaken at this time. Mean fluid intake before and after the introduction of the vessels was calculated and compared using a Mann-Whitney U test. The proportion of residents receiving more than one drink before and after the testing were compared using McNemar test. In line with the improvement paradigm (Health Foundation, 2013), we worked closely with staff and residents to introduce the new vessels and obtain their views on their acceptability and practicality. The opinion of residents, healthcare assistants (HCA) and nursing staff were sought by obtaining verbal responses through face-to-face questioning during and after the interventions. Resident fluid intake and staff and resident opinion were also captured approximately two weeks after introduction of the new drinking vessels to assess their acceptability over a longer period.
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Could Reduced Fluid Intake Cause the Placebo Effect Seen in Overactive Bladder Clinical Trials? Analysis of a Large Solifenacin Integrated Database

Could Reduced Fluid Intake Cause the Placebo Effect Seen in Overactive Bladder Clinical Trials? Analysis of a Large Solifenacin Integrated Database

OAB trials, a large placebo effect has been observed in solifenacin studies. The solifenacin integrated database con- tains a large number of patients ( > 3000) from multiple studies conducted all over the world. Pooled analysis of this large integrated database showed that there was a greater reduction in volume voided over 24 hours in the placebo arm than in the active arms. The logical assumption being that volume voided is a good surrogate measure for fluid intake, one can estimate the impact of reduced fluid intake on MF. It is clear from the results reported here that after adjusting for fluid intake using the statistical correction, the placebo effect almost completely disappears, and the difference between the placebo and active groups becomes bigger.
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Original Article Can prucalopride improve the efficacy and tolerability of colonoscopy preparation?

Original Article Can prucalopride improve the efficacy and tolerability of colonoscopy preparation?

dose of preparation. Every hour by which the interval is extended is associated with a 10% decrease in adequate bowel preparation [26]. An interval of more than 5 h from the last pur- gative dose allows new small intestinal effluent to coat the right colonic mucosa, which impairs mucosal visualization [33]. Because of signifi- cant worsening in bowel preparation quality, consideration should be given to not perform- ing colonoscopies with a preparation-to-colo- noscopy interval greater than 7 h [35]. In this study, the lapsed time from the last fluid intake to colonoscopy is (mean ± SD) 384.4±72.2 and 383.6±62.0 min in the PEG group and the pru- calopride group, respectively. No statistical dif- ference was observed in the two groups (P=0.936). Studies found that through reducing residual fluid in the colon, mosapride and ito- pride improved efficacy in patients [15, 16]. In this study, although the overall fluid quantity in the Ottawa scale was lower in the prucalopride group than in the PEG group, the difference was not statistically significant. The lapsed time from the last fluid intake to colonoscopy was too long, allowing new small intestinal effluent to colon may be associated with these.
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COLD DIURESIS IN THE NEWBORN

COLD DIURESIS IN THE NEWBORN

water diuresis in the colder infants was not associated with a relatively greater water intake; mean fluid intake in the non-incu- bated “cold” infants was actually somewhat less than th[r]

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EFFECTS OF VANADIUM COMPOUNDS ON GLYCEMIC CONTROL IN TYPE 2 DIABETES MELLITUS: A META ANALYSIS OF COMPARATIVE STUDY ON RATS

EFFECTS OF VANADIUM COMPOUNDS ON GLYCEMIC CONTROL IN TYPE 2 DIABETES MELLITUS: A META ANALYSIS OF COMPARATIVE STUDY ON RATS

Besides the improvement of elevated blood glucose level in vanadium treated rats, the meta-analysis for food intake and fluid intake also revealed significant variation between vanadium treated and control diabetic rats i.e. The food and fluid intake were much lower in the vanadium treated diabetic rats than controls. Since Polyphagia and polydipsia are among the cardinal sign and symptoms of diabetes mellitus 2 , the meta-analysis noted that vanadium compounds are good enough in averting sign and symptoms of diabetes mellitus.
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Renal Function Correlates of Postnatal Diuresis in Preterm Infants

Renal Function Correlates of Postnatal Diuresis in Preterm Infants

In these infants, urine output, fluid intake rate, output to intake ratio, glomerular filtra- tion rate, and fractional sodium excretion were lowest at 12 to 24 hours of age.. During diu[r]

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High salt intake reprioritizes osmolyte and energy metabolism for body fluid conservation

High salt intake reprioritizes osmolyte and energy metabolism for body fluid conservation

3, A–C, and see Supplemental Figure 3, A and B, for the complete, unedited Western blots). We found a marked increase in medul- lary urea content in the HS+saline mice, which was paralleled by increased UT-A1 expression. We interpret these findings as show- ing that UT-A1–driven urea accumulation in the renal medulla provides the osmotic gradient necessary to reabsorb water when dietary salt is excreted. This water-saving effect of urea osmolyte accumulation is the basis of the concentration mechanism, where- by the kidney excretes salt without major changes in fluid intake or urinary water loss. HS+tap-treated mice showed a similar urine osmolyte excretion and concentration pro file (Table 1) and similar increases in UT-A1 expression in the renal medulla (Supplemental Figure 3, C and D), but no increased glucocorticoid excretion. This finding indicates that the renal natriuretic-ureotelic response was also triggered when free access to water was offered in the diet and that increasing glucocorticoid levels was not necessary to induce the urea-driven renal water conservation process.
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Energy Balance of Triathletes during an Ultra-Endurance Event

Energy Balance of Triathletes during an Ultra-Endurance Event

Additionally, a significant and negative correlation between losses of TBW and ECW and performance during the cycling stage was found in this study. Although this fact corroborates the well-known fact that hydration is a key point for exercise performance, it is also important to note that losses of TBW were mainly linked to a reduction of ECW. An overload of ECW is a risk factor to develop hyponatremia [7,8,10]. Importantly, in the current study none of the athletes showed an increase of ECW. Furthermore, despite the fact that hyponatremia is an electrolyte disorder affecting serum sodium concentration (<135 mmol/L), the consumption of high amounts of sodium during exercise does not reduce the risk of developing hyponatremia [31]. Fluid overload is considered the main risk factor in the pathogenesis of hyponatremia and this is controlled by fluid intake during exercise as well as by the activity of renal hormones such as vasopressin [11,12]. The mean sodium intake reported by the current triathletes (2152 ± 1124 mg) was within the Recommended Dietary Intake and above the mean sodium ingestion indicated by Kimber et al. [3] in a previous study. This can be explained by the higher content of sodium of some sport food and sport drinks consumed by participants of this study during the event. None of the participants consumed sodium in the form of supplementation. This finding shows that it is possible to meet sodium recommendations through normal food and drinks in ultra-endurance events and, consequently, sodium supplementation is not needed. These data are in agreement with another recent study investigating sodium intake of ultra-endurance runners during a multi-stage race in a hot environment [32].
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Original Article The accuracy and effectiveness of goal directed fluid therapy in plateau-elderly gastrointestinal cancer patients: a prospective randomized controlled trial

Original Article The accuracy and effectiveness of goal directed fluid therapy in plateau-elderly gastrointestinal cancer patients: a prospective randomized controlled trial

In clinical work, fluid infusion therapy during surgery is always one of the most important issues that attracting more attention of anes- thesia doctors [15-17]. The harmful sequelae of severe patients and patients undergoing complex operations have a close relation to fluid overload or fluid deficiency [18]. GDFT could maintain the stability of hemodynamics during surgery, increase the oxygen delivery and reduce the incidence of post operation complications and mortality [8, 19]. Li et al. [20] revealed that GDFT could make the body achieve the optimal circulating functional state through fluid loading by a study on 60 cases of radical resection of gastric cancer in elderly hypertension patients. In this study, patients undergoing GDFT accepted lower total fluid intake during the operation. And GDFT cou- ld provide more stable hemodynamics and enhance tissue perfusion and oxygen metabo-
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Dysnatremia among runners in a half marathon performed under warm and humid conditions

Dysnatremia among runners in a half marathon performed under warm and humid conditions

Methods A cross-sectional study was performed among randomly selected runners in the 2017 Cali half marathon. Runners on diuretic therapy or with a known history of kidney disease were excluded. Participants went through a 2-day assessment. Previous medical history, training history, body mass index and running history were determined in the first assessment. Symptoms of dysnatremia and level of fluid consumption during the race were registered during the second assessment and post- run blood sampling for serum [Na+] was also undertaken.  results 130 runners were included in the study. The complete 2-day assessment was performed on 81 participants (62%) that were included in the final analysis. No cases of hyponatremia were found; instead, there were six cases of asymptomatic hypernatremia (7.4%). This hypernatremia had a statistically significant association with lower frequency (p=0.01) and volume of fluid intake during the race (water: p=0.02, Gatorade: p=0.04).  Conclusion Hyponatremia has been associated with high fluid intake in races performed under cool weather, such as the Boston Marathon during spring. In contrast, hypernatremia was found in a half marathon in warm and humid weather, which was associated with lower volume and frequency of fluid intake, suggesting that under warm and humid conditions, a median fluid intake of 900 mL during the race could prevent this event.
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INVESTIGATING THE IMPACT OF SUGAR FREE GUM ON THE THIRST AND DRY MOUTH OF PATIENTS UNDERGOING HEMODIALYSIS

INVESTIGATING THE IMPACT OF SUGAR FREE GUM ON THE THIRST AND DRY MOUTH OF PATIENTS UNDERGOING HEMODIALYSIS

of the patients 14 . Patients with head and neck cancer undergoing radiotherapy suffer from a decrease in the flow of saliva and dry mouth, improved simply by sucking candy. Since the results of former studies showed the inefficacy of various methods, such as using ice chip, in reducing the intensity of thirst and fluid intake in hemodialysis patients and using sugar-free gum turned out to be an uncomplicated and unproblematic method, the present study was conducted to investigate the impact of sugar free gum on the thirst and dry mouth of patients undergoing hemodialysis in Zabol city.
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Gastroesophageal Reflux: A Critical Review of Its Role in Preterm Infants

Gastroesophageal Reflux: A Critical Review of Its Role in Preterm Infants

ABSTRACT. There is widespread concern about gas- troesophageal reflux (GER) in preterm infants. This arti- cle reviews the evidence for this concern. GER is com- mon in infants, which is related to their large fluid intake (corresponding to 14 L/day in an adult) and supine body position, resulting in the gastroesophageal junction’s be- ing constantly “under water.” pH monitoring, the stan- dard for reflux detection, is of limited use in preterm infants whose gastric pH is >4 for 90% of the time. New methods such as the multiple intraluminal impedance technique and micromanometric catheters may be prom- ising alternatives but require careful evaluation before applying them to clinical practice. A critical review of the evidence for potential sequelae of GER in preterm in- fants shows that 1) apnea is unrelated to GER in most infants, 2) failure to thrive practically does not occur with GER, and 3) a relationship between GER and chronic airway problems has not yet been confirmed in preterm infants. Thus, there is currently insufficient evidence to justify the apparently widespread practice of treating GER in infants with symptoms such as recurrent apnea or regurgitation or of prolonging their hospital stay, un- less there is unequivocal evidence of complications, eg, recurrent aspiration or cyanosis during vomiting. Objec- tive criteria that help to identify those presumably few infants who do require treatment for GER disease are urgently needed. Pediatrics 2004;113:e128 –e132. URL: http://www.pediatrics.org/cgi/content/full/113/2/e128; lower esophageal sphincter, regurgitation, treatment indi- cations.
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HISTOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY OF PANCREATIC ISLET BETA CELLS OF DIABETIC RATS TREATED WITH ORAL VANADYL SULPHATE

HISTOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY OF PANCREATIC ISLET BETA CELLS OF DIABETIC RATS TREATED WITH ORAL VANADYL SULPHATE

of the treatment. All of the animals had free access to food during the period of study. Plasma glucose and fluid intake were monitored frequently during and after with­ drawal of the treatment. Normoglycemia in DT rats was defined as plasma glucose levels in the range of 90-170 mg/dL. Under these conditions, more than 90% of dia­ betic rats receiving vanadyl sulphate became normoglycemic during the three months of treatment. We continued treatment until permanent normoglycemia ap­ peared. With the vanadyl sulphate treated rats, �IO% were excluded from the experiment because they re­ mained hyperglycemic during the period of treatment. Diabetic treated animals were killed after normoglycemia appeared and had remained for two months after vanadyl withdrawal.
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IDIOPATHIC HYPONATREMIA IN AN INFANT WITH DIFFUSE CEREBRAL DAMAGE

IDIOPATHIC HYPONATREMIA IN AN INFANT WITH DIFFUSE CEREBRAL DAMAGE

served rise of concentration of sodium in the serum to normal when the fluid intake of the infant was restricted, and the prompt fall when fluid intake was increased (sodium. intake was [r]

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An exploration of the hydration care of older people: A qualitative study

An exploration of the hydration care of older people: A qualitative study

Given the diminished sense of thirst in older people (Kenney and Chiu, 2001) other cues and opportunities for drinking become more significant. This study suggests mealtimes were not used effectively as an opportunity to promote drinking despite mealtimes being the way people spontaneously choose to drink (Kenney and Chiu, 2000, McKiernan et al., 2008). Similarly, the opportunity to promote fluid consumption with medication was overlooked in both settings, despite being significant in achieving adequate fluid intake (Chidester and Spangler, 1997, Simmons et al., 2001). Further opportunities to boost fluid intake by offering drinks with snacks (Posthauer, 2005, Zizza et al., 2009) and in association with therapy or recreational activities (Frazer, 2008) were evident in the care home although not in the hospital setting. Nurses and HCAs, but not older people were aware that certain foods were a useful source of fluid (Begum and Jonhson, 2010, Benelam and Wyness, 2010). Taken together these findings suggest that the range of opportunities for promoting hydration was not given sufficient emphasis in practice.
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