- Email: [email protected]
Changes in urinary output and free water clearance in patients with acute circulatory failure (shock)
260
ABSTRACTS
ripheral vasculature are all vasodilatory. This last characteristic of isuprel may be of benefit if the patient is maximally vasoconstricted. The dose in infants is 0.5-1.0 ml. of a 1: 50,000 solution IV., and may be repeated every three to 5 minutes or given as a continuous infusion. C) Calcium. To increase myocardial contractibility. Calcium chloride is more effective than other calcium salts. The dose is 0.5-1.0 ml. of the 10 per cent solution given I.V. to infants. The maximum rate is 1-2 ml./minute. The dose may be repeated from every three to five minutes. D) Atropine is useful in patients who have ineffective cardiac action in the prescence of A-V block. The dose is 0.03 mg./Kg. for infants. E) Electrical Pacemaker may be used if there is evidence of response to the above measures, but lack of sustained effect. Pacing should be between 10&120/minute in infants. III. Ventricular Fibrillation: Use of D.C. fibrillator with pediatric electrodes. Initial shock is delivered at 25-50 W. sec. in infants; this may be gradually increased for older children. It may be useful to deliver two shocks in rapid succession. If fibrillation is still present, and fibrillatory waves are of low amplitude, epinephrine may convert the waves to a coarser form of fibrillation which is more amenable to electrical conversion. Calcium chloride also may be effective and the continued administration of bicarbonate is necessary because metabolic acidosis interferes with defibrillation. Resistence of fibrillation may be overcome by procainamide (Pronestyl) 6-8 mg./Kg. IV. or lidocaine (XyloCaine) 0.5-2.0 mg./Kg. I.V. followed electrical defibrillation.-“Aichel by Gilbert. MONITORING MASSIVE FLUID THERAPY IN INFANTS. J. Alex Hailer, Jr., James L. Talbert and John I. White. Southern Med. J. 62: 1334-1336 (November) 1969.
The lability of an infant’s response to stress and trauma requires utmost vigilance.
Infants often require massive and rapid fluid replacement in extensive thermal bums, generalized peritonitis, trauma associated with soft tissue injury and in intestinal obstruction and sepsis. Specialized technics for evaluating a patient’s response are necessary for proper management and are vital in an infant where the margin for error is small. Percutaneous placement of a central venous pressure catheter via the subclavian vein, which is a common technic in adults, has not been satisfactory in infants because of the small size of this vein and the frequency of pneumothorax incident to its use. In general, direct catheterization of the external jugular vein has been satisfactory for this purpose. Occasionally in newborn infants it has been necessary to cannulate the internal jugular vein. The overall trend in the serial determination of central venous pressure rather than an isolated observation is the critical factor in judging response to massive fluid replacement. A small, accurate hand refractometer is available which offers a reliable means for estimating total serum solids. Concentration of serum solids is a very precise measure of the degree of hydration. Urinary volume is usually a reliable index of renal perfusion, but a newborn infant is limited in both his ability to increase volume and to concentrate urine. Serial testing of urine specific gravity gives an excellent estimate of the degree of hydration and complements a measure of urine volume. Infants seem to have a striking response to hypovolemia. They undergo profound peripheal vasoconstriction. This enhances the effects of metabolic acidosis by further decreasing delivery of oxygen to peripheral tissues. The authors have found it helpful to use serial determination of central venous pressure, total serum solids, hematocrit, urinary output and specific gravity and serum electrolytes and pH at six hourly intervals as a guide for the management of massive fluid replacement in infants.-George WV. Holcomb,
Jr.
CHANGES WATER ACUTE L. W.
IN URINARY OUTPUT AND FREE CLEARANCE IN PATIENTS WITH CIRCULATORY FAILURE (SHOCK). Jones and M. H. Weil. J. Urol.
102: 121-125 (August) This study evaluates
1969. the free water clear-
261
ABSTRACTS
ante as a method of assessing renal function during shock state. It is based on the difference in plasma urine osmolality and the calculation of free water clearance using the formula of Smith. It was noted that although a normal urine flow can be maintained with patients whose mean arterial pressure was reduced to 60 mm. Hg or less, none could excrete hyposmolar urine. Those with persistent oliguria and who had probable renal insufficiency, had hyposmolar urine regardless of arterial pressure. On the other hand, statistical analysis of the group of patients in the study comparing the mean urine output in patients with arterial pressures of more than 60 mm. Hg showed no significant difference. It is concluded that the measurement of urine flow in patients in a shock state is an incomplete index of renal function, but when the calculation of free water clearance is added, then a more valuable estimate of function can be obtained.--Bruce M. Henderson. EARLY NEUROLOGICALDISTURBANCESFOLLOWING RELATNELY MINOR BURNS IN CHILDREN. C. P. Warlow and Pamela Hinton. Lancet 2:978-982 (November 8)
1969. Six cases of burn encephalopathy occurring in children aged between 17 months and 10 years are described. The extent of the burns ranged from nine per cent to 33 per cent of body surface. Two children died. Signs of neurological disturbance began 1% 40 hours after injury. Features included rapid fluctuations in level of consciousness, twitching and respiratory arrest. In the fatal cases, autopsy revealed cerebral oedema. The pathogenesis of the complication is discussed but no firm opinion is possible. It is concluded that burn encephalopathy is a fairly common condition of varying grades of severity and is rarely fatal.-‘. H. Johston.
HEAD
AND
NECK
CONGENITALPITS OF THE LOWER LIP WITH CLEFT LIP AND PALATE. H. Gordon, Darsid Davies and S. Friedberg. S. Afr.
Med. J. 43:1275-1279
(Oct. 18) 1969.
The authors discuss the clinical and genetic features of lower lip pits which occur with cleft lip and/or cleft palate. This
condition is the result of an autosomal mutant gene with dominant effect, a high degree of penetrance and variable phenotypic expression. A person with a cleft lip and/or palate accompanied by congenital pits in the lower lip or whose close relatives have such pits will have children whose risk of having an oral cleft may be as high as 40 per cent. In the usual case of cleft lip and/or palate without lower lip pits the risk of having affected children is three to six per cent. The importance of this information in counseling parents of children with oral clefts as regards future children is emphasized.-Hug11 V. Firor. RECURRENT PAROTITIS IN CHILDREN. M. Katzen. S. Afr. J. Surg. 7:37-42 (April-
June)
1969.
The author has investigated 26 new cases of recurrent parotitis and followed up 44 cases previously reported. From this he believes a more precise classification has evolved as well as some clarification of pathogenesis. All patients were under 13 years of age. With correlation of clinical
findings and sialograms cases into three groups:
he classifies
these
Allergic
Parotitis-Five patients were so classified. Attacks of swelling had a seasonal incidence, there were always other allergic symptoms, the attacks were not severe and never lasted more than two days, and sialograms were normal. All patients remained free of attacks while on long term antihistamine therapy. Mait Dllct Obstruction-Four patients were SO classified. Obstruction was demonstrated
by sialograms. Each patient had a different cause for the obstruction. In one there was extrinsic pressure from an accessory parotid gland, removal of which relieved the obstruction. A second had a stricture of the duct thought to be inflammatory, relieved by dilatation. A third had stenosis of unknown origin also relieved by dilatation. A fourth had obstruction secondary to a diverticulum of the duct plus a foreign body. This responded to meatotomy and removal of the foreign body. “idiopathic”
Recllrrent
Parotitis-Sixty-one
patients were so classified. Attacks were bilateral in 27 patients, right sided in 18 and left sided in 16. In bilateral cases simultaneous attacks on both sides were rare.
ABSTRACTS
ripheral vasculature are all vasodilatory. This last characteristic of isuprel may be of benefit if the patient is maximally vasoconstricted. The dose in infants is 0.5-1.0 ml. of a 1: 50,000 solution IV., and may be repeated every three to 5 minutes or given as a continuous infusion. C) Calcium. To increase myocardial contractibility. Calcium chloride is more effective than other calcium salts. The dose is 0.5-1.0 ml. of the 10 per cent solution given I.V. to infants. The maximum rate is 1-2 ml./minute. The dose may be repeated from every three to five minutes. D) Atropine is useful in patients who have ineffective cardiac action in the prescence of A-V block. The dose is 0.03 mg./Kg. for infants. E) Electrical Pacemaker may be used if there is evidence of response to the above measures, but lack of sustained effect. Pacing should be between 10&120/minute in infants. III. Ventricular Fibrillation: Use of D.C. fibrillator with pediatric electrodes. Initial shock is delivered at 25-50 W. sec. in infants; this may be gradually increased for older children. It may be useful to deliver two shocks in rapid succession. If fibrillation is still present, and fibrillatory waves are of low amplitude, epinephrine may convert the waves to a coarser form of fibrillation which is more amenable to electrical conversion. Calcium chloride also may be effective and the continued administration of bicarbonate is necessary because metabolic acidosis interferes with defibrillation. Resistence of fibrillation may be overcome by procainamide (Pronestyl) 6-8 mg./Kg. IV. or lidocaine (XyloCaine) 0.5-2.0 mg./Kg. I.V. followed electrical defibrillation.-“Aichel by Gilbert. MONITORING MASSIVE FLUID THERAPY IN INFANTS. J. Alex Hailer, Jr., James L. Talbert and John I. White. Southern Med. J. 62: 1334-1336 (November) 1969.
The lability of an infant’s response to stress and trauma requires utmost vigilance.
Infants often require massive and rapid fluid replacement in extensive thermal bums, generalized peritonitis, trauma associated with soft tissue injury and in intestinal obstruction and sepsis. Specialized technics for evaluating a patient’s response are necessary for proper management and are vital in an infant where the margin for error is small. Percutaneous placement of a central venous pressure catheter via the subclavian vein, which is a common technic in adults, has not been satisfactory in infants because of the small size of this vein and the frequency of pneumothorax incident to its use. In general, direct catheterization of the external jugular vein has been satisfactory for this purpose. Occasionally in newborn infants it has been necessary to cannulate the internal jugular vein. The overall trend in the serial determination of central venous pressure rather than an isolated observation is the critical factor in judging response to massive fluid replacement. A small, accurate hand refractometer is available which offers a reliable means for estimating total serum solids. Concentration of serum solids is a very precise measure of the degree of hydration. Urinary volume is usually a reliable index of renal perfusion, but a newborn infant is limited in both his ability to increase volume and to concentrate urine. Serial testing of urine specific gravity gives an excellent estimate of the degree of hydration and complements a measure of urine volume. Infants seem to have a striking response to hypovolemia. They undergo profound peripheal vasoconstriction. This enhances the effects of metabolic acidosis by further decreasing delivery of oxygen to peripheral tissues. The authors have found it helpful to use serial determination of central venous pressure, total serum solids, hematocrit, urinary output and specific gravity and serum electrolytes and pH at six hourly intervals as a guide for the management of massive fluid replacement in infants.-George WV. Holcomb,
Jr.
CHANGES WATER ACUTE L. W.
IN URINARY OUTPUT AND FREE CLEARANCE IN PATIENTS WITH CIRCULATORY FAILURE (SHOCK). Jones and M. H. Weil. J. Urol.
102: 121-125 (August) This study evaluates
1969. the free water clear-
261
ABSTRACTS
ante as a method of assessing renal function during shock state. It is based on the difference in plasma urine osmolality and the calculation of free water clearance using the formula of Smith. It was noted that although a normal urine flow can be maintained with patients whose mean arterial pressure was reduced to 60 mm. Hg or less, none could excrete hyposmolar urine. Those with persistent oliguria and who had probable renal insufficiency, had hyposmolar urine regardless of arterial pressure. On the other hand, statistical analysis of the group of patients in the study comparing the mean urine output in patients with arterial pressures of more than 60 mm. Hg showed no significant difference. It is concluded that the measurement of urine flow in patients in a shock state is an incomplete index of renal function, but when the calculation of free water clearance is added, then a more valuable estimate of function can be obtained.--Bruce M. Henderson. EARLY NEUROLOGICALDISTURBANCESFOLLOWING RELATNELY MINOR BURNS IN CHILDREN. C. P. Warlow and Pamela Hinton. Lancet 2:978-982 (November 8)
1969. Six cases of burn encephalopathy occurring in children aged between 17 months and 10 years are described. The extent of the burns ranged from nine per cent to 33 per cent of body surface. Two children died. Signs of neurological disturbance began 1% 40 hours after injury. Features included rapid fluctuations in level of consciousness, twitching and respiratory arrest. In the fatal cases, autopsy revealed cerebral oedema. The pathogenesis of the complication is discussed but no firm opinion is possible. It is concluded that burn encephalopathy is a fairly common condition of varying grades of severity and is rarely fatal.-‘. H. Johston.
HEAD
AND
NECK
CONGENITALPITS OF THE LOWER LIP WITH CLEFT LIP AND PALATE. H. Gordon, Darsid Davies and S. Friedberg. S. Afr.
Med. J. 43:1275-1279
(Oct. 18) 1969.
The authors discuss the clinical and genetic features of lower lip pits which occur with cleft lip and/or cleft palate. This
condition is the result of an autosomal mutant gene with dominant effect, a high degree of penetrance and variable phenotypic expression. A person with a cleft lip and/or palate accompanied by congenital pits in the lower lip or whose close relatives have such pits will have children whose risk of having an oral cleft may be as high as 40 per cent. In the usual case of cleft lip and/or palate without lower lip pits the risk of having affected children is three to six per cent. The importance of this information in counseling parents of children with oral clefts as regards future children is emphasized.-Hug11 V. Firor. RECURRENT PAROTITIS IN CHILDREN. M. Katzen. S. Afr. J. Surg. 7:37-42 (April-
June)
1969.
The author has investigated 26 new cases of recurrent parotitis and followed up 44 cases previously reported. From this he believes a more precise classification has evolved as well as some clarification of pathogenesis. All patients were under 13 years of age. With correlation of clinical
findings and sialograms cases into three groups:
he classifies
these
Allergic
Parotitis-Five patients were so classified. Attacks of swelling had a seasonal incidence, there were always other allergic symptoms, the attacks were not severe and never lasted more than two days, and sialograms were normal. All patients remained free of attacks while on long term antihistamine therapy. Mait Dllct Obstruction-Four patients were SO classified. Obstruction was demonstrated
by sialograms. Each patient had a different cause for the obstruction. In one there was extrinsic pressure from an accessory parotid gland, removal of which relieved the obstruction. A second had a stricture of the duct thought to be inflammatory, relieved by dilatation. A third had stenosis of unknown origin also relieved by dilatation. A fourth had obstruction secondary to a diverticulum of the duct plus a foreign body. This responded to meatotomy and removal of the foreign body. “idiopathic”
Recllrrent
Parotitis-Sixty-one
patients were so classified. Attacks were bilateral in 27 patients, right sided in 18 and left sided in 16. In bilateral cases simultaneous attacks on both sides were rare.