This article provides a comprehensive overview of electrolyte and water homeostasis in pediatric patients, focusing on some of the common serum electrolyte abnormalities encountered in clinical practice. Understanding pathophysiology, taking a detailed history, performing comprehensive physical examinations, and ordering basic laboratory investigations are essential for the timely proper management of these conditions. We will discuss the pathophysiology, clinical manifestations, diagnostic approaches, and treatment strategies for each electrolyte disorder. This article aims to enhance the clinical approach to pediatric patients with electrolyte imbalance-related emergencies, ultimately improving patient outcomes.Trial registration This manuscript does not include a clinical trial; instead, it provides an updated review of literature.
- MeSH
- Acidosis diagnosis blood therapy MeSH
- Child MeSH
- Electrolytes blood MeSH
- Hypercalcemia therapy blood diagnosis etiology MeSH
- Hyperkalemia therapy diagnosis blood etiology MeSH
- Hypernatremia therapy diagnosis etiology physiopathology MeSH
- Hypocalcemia diagnosis etiology therapy MeSH
- Hypokalemia therapy diagnosis blood etiology MeSH
- Hyponatremia therapy etiology diagnosis MeSH
- Humans MeSH
- Emergencies * MeSH
- Acid-Base Imbalance diagnosis therapy physiopathology MeSH
- Water-Electrolyte Imbalance * therapy MeSH
- Water-Electrolyte Balance physiology MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Volume depletion is a common condition and a frequent cause of hospitalization in children. Proper assessment of the patient includes a detailed history and a thorough physical examination. Biochemical tests may be useful in selected cases. Understanding the pathophysiology of fluid balance is necessary for appropriate management. A clinical dehydration scale assessing more physical findings may help to determine dehydration severity. Most dehydrated children can be treated orally; however, intravenous therapy may be indicated in patients with severe volume depletion, in those who have failed oral therapy, or in children with altered consciousness or significant metabolic abnormalities. Proper management consists of restoring circulatory volume and electrolyte balance. In this paper, we review clinical aspects, diagnosis, and management of children with volume depletion.
- MeSH
- Dehydration * diagnosis etiology therapy MeSH
- Child MeSH
- Physical Examination MeSH
- Humans MeSH
- Fluid Therapy * adverse effects MeSH
- Water-Electrolyte Balance MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
BACKGROUND: Since many acutely admitted older adults display signs of dehydration, treatment using balanced crystalloids is an important part of medical care. Additionally, many of these patients suffer from chronic malnutrition. We speculated that the early addition of glucose might ameliorate the hospital-related drop of caloric intake and modify their catabolic status. METHODS: We included patients 78 years and older, admitted acutely for non-traumatic illnesses. The patients were randomized into either receiving balanced crystalloid (PlasmaLyte; group P) or balanced crystalloid enriched with 100 g of glucose per liter (group G). The information about fluid balance and levels of minerals were collected longitudinally. RESULTS: In the G group, a significantly higher proportion of patients developed signs of refeeding syndrome, i.e., drops in phosphates, potassium and/or magnesium when compared to group P (83.3 vs. 16.7%, p < 0.01). The drop in phosphate levels was the most pronounced. The urinalysis showed no differences in the levels of these minerals in the urine, suggesting their uptake into the cells. There were no differences in the in-hospital mortality or in the 1-year mortality. CONCLUSION: The short-term administration of balanced crystalloids with glucose induced an anabolic shift of electrolytes in acutely admitted older adults.
- MeSH
- Dehydration therapy MeSH
- Glucose * metabolism administration & dosage MeSH
- Crystalloid Solutions administration & dosage MeSH
- Humans MeSH
- Hospital Mortality MeSH
- Dietary Supplements MeSH
- Refeeding Syndrome prevention & control MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Fluid Therapy * methods MeSH
- Water-Electrolyte Balance MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
Sodium is the main osmotically active ion in the extracellular fluid and its concentration goes hand in hand with fluid volume. Under physiological conditions, homeostasis of sodium and thus amount of fluid is regulated by neural and humoral interconnection of body tissues and organs. Both heart and kidneys are crucial in maintaining volume status. Proper kidney function is necessary to excrete regulated amount of water and solutes and adequate heart function is inevitable to sustain renal perfusion pressure, oxygen supply etc. As these organs are bidirectionally interconnected, injury of one leads to dysfunction of another. This condition is known as cardiorenal syndrome. It is divided into five subtypes regarding timeframe and pathophysiology of the onset. Hemodynamic effects include congestion, decreased cardiac output, but also production of natriuretic peptides. Renal congestion and hypoperfusion leads to kidney injury and maladaptive activation of renin-angiotensin-aldosterone system and sympathetic nervous system. In cardiorenal syndromes sodium and water excretion is impaired leading to volume overload and far-reaching negative consequences, including higher morbidity and mortality of these patients. Keywords: Cardiorenal syndrome, Renocardiac syndrome, Volume overload, Sodium retention.
- MeSH
- Homeostasis * physiology MeSH
- Cardio-Renal Syndrome * metabolism physiopathology MeSH
- Kidney metabolism physiopathology MeSH
- Humans MeSH
- Sodium * metabolism MeSH
- Water metabolism MeSH
- Water-Electrolyte Imbalance metabolism physiopathology MeSH
- Water-Electrolyte Balance * physiology MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Osmoregulation is the homeostatic mechanism essential for the survival of organisms in hypoosmotic and hyperosmotic conditions. In freshwater or soil dwelling protists this is frequently achieved through the action of an osmoregulatory organelle, the contractile vacuole. This endomembrane organelle responds to the osmotic challenges and compensates by collecting and expelling the excess water to maintain the cellular osmolarity. As compared with other endomembrane organelles, this organelle is underappreciated and under-studied. Here we review the reported presence or absence of contractile vacuoles across eukaryotic diversity, as well as the observed variability in the structure, function, and molecular machinery of this organelle. Our findings highlight the challenges and opportunities for constructing cellular and evolutionary models for this intriguing organelle.
- MeSH
- Eukaryota * physiology MeSH
- Osmoregulation physiology MeSH
- Vacuoles * MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Parenterální nutrice je nedílnou součástí komplexní péče o novorozence nezralé, s velmi nízkou porodní hmotností, kriticky nemocné nebo neschopné přijímat stravu. Složení parenterální výživy by mělo být sestavováno individuálně pro každého pacienta na základě jeho aktuálního zdravotního stavu a s ohledem na možné komplikace. Podává se tak dlouho, dokud není pacient schopen přijímat stravu v množství dostatečném pro pokrytí nutričních potřeb. Následující série článků má za cíl představit jednotlivé komponenty parenterální nutrice a praktický význam individualizované parenterální výživy na neonatologickém nebo pediatrickém oddělení. První část cyklu je věnovaná úvodu do problematiky, vodě a elektrolytům.
Parenteral nutrition is an integral part of comprehensive care for preterm infants, very low birth weight or critically ill infants, or those unable to take oral nutrition. The composition of parenteral nutrition should be individually tailored for each patient based on their current health status and taking into account possible complications. It is administered until the patient is capable of taking oral nutrition in an amount sufficient to meet nutritional needs. The following series of articles aims to introduce the individual components of parenteral nutrition and the practical significance of individualized parenteral nutrition in neonatology or pediatric departments. The first part of the series is dedicated to an introduction to the topic, water and electrolytes.
- MeSH
- Infant Nutritional Physiological Phenomena MeSH
- Humans MeSH
- Minerals MeSH
- Infant, Premature * MeSH
- Infant, Newborn MeSH
- Parenteral Nutrition * MeSH
- Water-Electrolyte Balance MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Review MeSH
- MeSH
- Adrenergic beta-Antagonists MeSH
- Early Diagnosis MeSH
- Drug Combinations MeSH
- Glaucoma * diagnosis etiology drug therapy classification MeSH
- Carbonic Anhydrase Inhibitors pharmacology therapeutic use MeSH
- Humans MeSH
- Ophthalmic Solutions * MeSH
- Osmoregulation drug effects MeSH
- Prostaglandins pharmacology therapeutic use MeSH
- Sympathomimetics pharmacology therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Background and Objectives: The effect of individualized hemodynamic management on the intraoperative use of fluids and other hemodynamic interventions in patients undergoing spinal surgery in the prone position is controversial. This study aimed to evaluate how the use of individualized hemodynamic management based on extended continuous non-invasive hemodynamic monitoring modifies intraoperative hemodynamic interventions compared to conventional hemodynamic monitoring with intermittent non-invasive blood pressure measurements. Methods: Fifty adult patients (American Society of Anesthesiologists physical status I-III) who underwent spinal procedures in the prone position and were then managed with a restrictive fluid strategy were prospectively randomized into intervention and control groups. In the intervention group, individualized hemodynamic management followed a goal-directed protocol based on continuously non-invasively measured blood pressure, heart rate, cardiac output, systemic vascular resistance, and stroke volume variation. In the control group, patients were monitored using intermittent non-invasive blood pressure monitoring, and the choice of hemodynamic intervention was left to the discretion of the attending anesthesiologist. Results: In the intervention group, more hypotensive episodes (3 (2-4) vs. 1 (0-2), p = 0.0001), higher intraoperative dose of ephedrine (0 (0-10) vs. 0 (0-0) mg, p = 0.0008), and more positive fluid balance (680 (510-937) vs. 270 (196-377) ml, p < 0.0001) were recorded. Intraoperative norepinephrine dose and postoperative outcomes did not differ between the groups. Conclusions: Individualized hemodynamic management based on data from extended non-invasive hemodynamic monitoring significantly modified intraoperative hemodynamic management and was associated with a higher number of hemodynamic interventions and a more positive fluid balance.
- MeSH
- Adult MeSH
- Hemodynamics * MeSH
- Humans MeSH
- Patient Positioning * MeSH
- Prone Position MeSH
- Prospective Studies MeSH
- Water-Electrolyte Balance MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
