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Study Investigates The Role Of Fluid Resuscitation In Treatment Of Life-Threatening Infections

Dehydration is a common phenomenon in those suffering from infectious diseases, particularly if the diseases cause vomiting and/or diarrhea. We are all familiar with having the “stomach flu,” “traveler’s diarrhea,” or food poisoning. However, severe infections of all sorts can cause profound illness, debilitation, and fluid losses. In many developing countries, very large numbers of small children are afflicted with non-gastrointestinal infectious diseases that rapidly cause relatively large fluid losses, and therefore profound, life-threatening dehydration, which is manifested in part by dangerously low blood pressure and subsequent failure to deliver precious liquid, nutrients and oxygen to the tissues of the body. This is called “shock.”

The following discussion is cutting edge information, but not simplistic or necessarily easy to understand or apply. However, I have learned that my readers are often volunteers in settings where intensive care medicine must be applied, and want to read more than simple approaches to therapy. So, I am going to do my best to interpret for you what has recently been published in the New England Journal of Medicine in an article entitled “Mortality after Fluid Bolus in African Children with Severe Infection” (N Engl J Med 2011; 364:2483-95) written by Kathryn Maitland and her colleagues.

The focus of their investigation was Read more »

This post, Study Investigates The Role Of Fluid Resuscitation In Treatment Of Life-Threatening Infections, was originally published on Healthine.com by Paul Auerbach, M.D..

Tips To Beat The Heat

Dehydrated, cramped, limping? on a bike. Road nationals 2010.

People who exercise outdoors face a new threat.

It’s unrelenting.

Consistent.

Inescapable.

Perhaps, even more dangerous than distracted or mean motorists.

It’s the heat. Gosh, is it hot. If only I had a dollar for every time I heard someone say, “Doctor M, you aren’t riding in this heat; are you?”

Well…Other than the fortunate souls smart (or lucky) enough to live in cooler climates, most of us are facing an extreme wave of hotness. As a Kentuckian, I live in the epicenter of this summer’s cauldron. Louisville sits in a wind-protected valley alongside the heat sink that is the Ohio River. Think hot and steamy.

The excessive heat smacked me hard last evening. Normally, my highly-veined skin and northern European heritage serves me well in the heat. But last night, while riding in sight of our city’s skyline, it started: My mouth grew dry and my breathing labored. And why was that helmet feeling so tight? Next came the sensation of tingles—not the pleasant kind of tingles, like when your teenager hugs you. And then came the deal-breaker: chills. I stopped, swallowed my pride and called for a ride home. (Here’s an always for you all: When it’s ninety degrees out and you feel cold–stop exercising, immediately.)

After last night’s brush with heat exhaustion, I thought it reasonable to ramble on about the dangers of exercising in the heat. And of course, I will offer some nuggets of wisdom for beating the heat. Read more »

*This blog post was originally published at Dr John M*

5 Avoidable Air Travel Health Risks

For those of you planning air travel to your next medical conference (and ACP Internist isn’t too shameless to plug Internal Medicine 2011 — we hope to see you there), TIME reports that there are five health risks that are rare yet have recently happened. Tips on avoiding these maladies include:

E. Coli and MRSA on the tray table. Microbiologists found these two everywhere when they swabbed down flights. Bring your own disinfecting wipes.

Bedbugs in the seat. British Airways fumigated two planes after a passenger posted pictures online about her experience. Wrap clothes in plastic and wash them.

Sick seatmates. Everyone has experienced (or been) this person. Wash your hands.

Deep vein thrombosis (DVT). Tennis star Serena Williams experienced a pulmonary embolism, possibly related to recent foot surgery. But DVT can happen to anyone restrained to a cramped position for long periods of time. Move around in-flight (but not during the beverage service, of course.)

Dehydration. Dry cabin air may make it more difficult to fight off infections. Drink more water.

*This blog post was originally published at ACP Internist*

Be Aware Of Heat Dangers In Young Athletes

Young athleteWith back-to-school time around the corner, the Centers for Disease Control and Prevention has issued a warning about the risk for heat-related illness in young athletes, especially football players, the Los Angeles Times reports.

Coaches and parents should be aware of the signs and symptoms of heat stroke, dehydration and other problems, and fluid replacement formulas should be used during practices and workouts, among other precautions, the LA Times said.

*This blog post was originally published at ACP Internist*

Spit Test To Determine Hydration Status

I’m often asked about technologies that are amenable to research applied in outdoor or wilderness settings. A company called Cantimer has developed and made available one of these technologies.

Cantimer is a privately–held, development–stage company commercializing a patented, proprietary, sensor technology platform based on a convergence of micro electromechanical systems (MEMS) technology and advanced polymer science. According to the website, the Company’s first commercial product will be an innovative, hand–held device for non-invasive measurement and monitoring of human hydration status from the osmolality of saliva.

This past October (2008), there was a press release issued by the Company. To paraphrase:

“Cantimer, Inc. Delivers First Alpha Instruments for Real-Time, Non-Invasive, Incident-Scene Assessment of Dehydration in Firefighters

Devices to be used for field testing in structural fire environments and search and rescue operations.

Cantimer, Inc. announced that it has shipped ten alpha instruments for real-time, non-invasive assessment of human hydration to the U.S. Government’s Technical Support Working Group (TSWG). The units will be used for incident-scene assessment of dehydration in firefighters. Dr. Christina Baxter, from TSWG, commented, ‘The focus over the last several months has been on laboratory work that adds to the body of knowledge regarding salivary osmolality as a useful measure of human hydration or dehydration status. That work has gone very well. We are now looking forward to using these new devices for actual field testing in structural firefighting or search and rescue operations – with more of an emphasis on implementation, ergonomics and the user experience.’

Maintaining an optimal level of hydration is a major health concern for firefighters and other emergency scene first responders. Progressive acute dehydration associated with physical exertion in heat-stressed environments significantly increases the risks of temperature-related health problems, with resulting losses of productivity and, in some cases, death. It has been shown that fluid losses of as little as 2% of total body weight (3.5 pounds in a normally 175 pound individual) can lead to noticeable compromises in physical and cognitive performance.

Dehydration and resulting temperature-related health problems among firefighters are preventable through adequate on-scene hydration management. Cantimer’s devices, incorporating the Company’s proprietary sensing technology, enable convenient, field-deployable, real-time measurement, and therefore management, of hydration status from an easily-obtained sample of saliva.

Although easy to treat if identified early, dehydration is a pervasive condition that contributes to a large number of preventable hospitalizations in the U.S. every year. Cantimer believes that the availability of a hand-held device that aims to make it as easy to determine a person’s state of hydration as it is to take their body temperature will have significant benefits, not only for the health and safety of firefighters and other first-responders, but for military personnel, athletes at all levels, the elderly, the very young and those suffering from a wide range of medical conditions.”

The wilderness and outdoor medicine literature is replete with opinions and arguments about conditions predisposing to dehydration and the determination of hydration status. We presume dehydration in the field by clinical diagnosis (e.g., signs and symptoms), but do not generally deploy an actual quantifiable measurement to determine its presence. So, with the advent of the technology espoused by Cantimer, we may finally have a convenient tool with which to begin to diagnose, as opposed to predict, dehydration, during virtually any activity for which the physical environment will allow its use. This will hopefully also allow us to test different hydration/rehydration strategies, including various fluids, electrolyte concentrations, and so forth.

This post, Spit Test To Determine Hydration Status, was originally published on Healthine.com by Paul Auerbach, M.D..

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