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Home > Effects of Hypo and Iso - Tonic Intravenous Maintenance Fluids on Plasma Sodium Level in Hospitalized Children. a Double Blind Randomized Clinical Trial

Effects of Hypo and Iso - Tonic Intravenous Maintenance Fluids on Plasma Sodium Level in Hospitalized Children. a Double Blind Randomized Clinical Trial

Thesis Info

Author

Ismail Ahmed

Department

Paediatrics and Child Health (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2011

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728048649

Similar


Background: Hypotonic fluids are widely used in pediatrics and are the standard of care when giving maintenance fluids. However, there are several reports of risk of iatrogenic hyponatremia attributed to this practice in the literature. There is therefore uncertainty as to whether isotonic fluids would be the more appropriate fluid. Objectives: The primary objective was to compare effects of hypotonic and isotonic maintenance fluids on plasma sodium levels in children between the ages of 2 months and 15 years admitted at Aga Khan University Hospital (AKUH). The secondary objective was to compare effects of hypotonic and isotonic maintenance fluids on other plasma electrolytes and need for additional fluid boluses in the same population of patients. Study design: Double blind randomized controlled trial of isotonic vs hypotonic maintenance intravenous fluids in children. Methods: One hundred and fifty two children with serum sodium levels between 130-150 mEq/L who required intravenous maintenance fluids were randomized to receive either 0.9% dextrose normal saline or hypotonic maintenance fluids as per normal practice. Hypotonic solution which was used in the control group, had sodium concentration between 20 and 100 mEq/L corresponding to 4mEq/Kg/24hr. Children aged between 2 months and 15 years requiring hospitalization at AKUH were eligible only when their physician prescribed intravenous maintenance fluid therapy. Patients with chronic or acute kidney failure/disease, at risk of cerebral edema (diabetic ketoacidosis or cranio- encephalic trauma), neonates (age <2month >old), sickle cell, with plasma sodium levels at hospital admission <130mEq/L or >150mEq/L, and/or cerebral malaria or severe malnutrition ( Z score <-3) and who refused to consent were excluded. Children were clinically monitored as per standard protocol. Blood electrolytes were obtained before commencement of v infusions to determine those eligible for inclusion and repeated after 24 hours or when fluids were stopped whichever was earlier. Any undesirable side effects were documented and managed as per standard practice. Primary outcome: Proportion of children with hyponatremia at 24hours after administration of maintenance fluids. Results: A total of 152 subjects were enrolled after obtaining informed consent. Of these, 78 and 74 were randomized to isotonic and hypotonic groups respectively. Overall, 25 (16.4%) patients dropped out of the study for various reasons. Hyponatremia occurred in 16.4% of the patients at 24 hours and a higher proportion of patients (23%) in the hypotonic group experienced hyponatremia compared to the isotonic group (10.3%) that was statistically significant (p = 0.03). The relative risk of
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عقیدت محبت دی شاعری

عقیدت ومحبت دی شاعری

(رت،ریت تے ردا)

جگت دے رچے ساہت اُتے جھات پایے تاں اک حیرانی والا پکھ سامنے آؤندا اے کہ ہر ساہت دا مڈٖھلا ساہت تے وڈٖا بھنڈٖار دھرمی رنگن وچ رنگیا ملدا اے، ایس دا مکھ کارن کہ منکھی حیاتی دا کوئی پکھ وی دھرم دی ولگن توں باہر نئیں اے۔ دھرم جمن توں مرن تائیں ساہنوں ہر پکھ بارے کجھ نہ کجھ سکھاؤندا رہندا اے۔ دھرمی آگو جو پر چارک کم کردے نیں ، منکھ اوہناں وی حیاتی تے کم توں متاثروی ہوندا اے تے پریرینا وی لیندا اے۔ جے کر اوہناں دھرمی ہستیاں نے کوئی وڈا کم کیتا ہووے ، جو اتہاس وچ اج تئیں زندہ ہووے تاں ہر کوی تے لکھاری اوس نال اپنی عقیدت و محبت دا اظہار کرن لئی اوہناں دی شان وچ کجھ نہ کجھ لکھدا رہندا اے ۔ واقعہ کربلا اسلامی اتہاس دی اجیہی گھٹنا ہے، جس پوری منکھتا دی سوچ نوں متاثر کیتا ۔ ایس واقعہ توں بعد اسلام دھرم وچ کئی تحریکاں چلیاں تے کئی نویں خیالاں دا جنم ہویا ، ایہناں خیالاں نوں ظاہر کرن لئی کئی نویاں اصناف سخن دی سامنے آئیاں ، ہرنویں لکھاری تے کوی نے اپنے اپنے انداز وچ واقعہ کربلا دے شہیداں نوں بھرواں خراج عقیدت پیش کیتا۔ اجیہاکم کرن والیاں وچوں اک ناں ارشادڈیروی ہوراں داوی اے ، اوہناں اپنی عقیدت نوں بہت ای سوہنے ڈھنگ وچ سوہنے سرنانویں ’’رت، ریت رِدا‘‘ ہیٹھ پڑھن والے دے سامنے رکھیا لکھت دے سرنانویں وچ اک ادبی چاشنی موجودا اے ، جو پڑھن والے دی پوری توجہ اپنے ول کھچ دی اے۔ کربلا دی تتی ریت اتے ڈُلھن والے پوتر خون دی کہانی اکھاں سامنے آجاندی اے ۔ رِدا اسلامی رہتل دا اک شعار جس دی راکھی ہر سمے کیتے گئی تے کیتیی جاندی...

معاصر خانقاہی نظام میں خانقاہ سراجیہ کے امتیازات

Mawlānā abu Sa'ad Ahmed Khan's sincerity, piety, adherence to the sunnah of the prophet and simplicity in his lifetime made this monastery a unique city in the subcontinent and a centre of universal growth and guidance. Gave after him Mawlānā Abdullah Ludhianvi, Khwaja Khan Muhammad and Khwaja Khalil Ahmad continued his mission. In addition to reforming the human population, the shuyūkh of this monastery has been following the sunnah of the prophet, reforming society, promoting education, preserving the belief at the end of prophethood, patronage of madrassas and religious parties, charitable work and promoting Naqshbandiyya.  And the emperors and officials have done their best to play their role in the implementation of the Islamic system and the establishment of the justice system in the country. Mashaikh of the monastery broke the intellectual statement of the religious schools by imparting practical training, Self-purification, spiritual asceticism, religious support, prophetic politics and modern insights. On the other hand, volunteer religious services and selfless sacrifice to bring the right path to the people, as well as the public meetings, strong character and perseverance religious influenced by source. Through his voluntary religious services and selfless sacrifices, he tried to bring them to the right… In this way, these gentlemen addressed the masses through Zikr, strong character and religious perseverance, influenced by source.

On Designing Efficient High-Speed Wireless Lans

In the last decade, wireless LANs (WLANs) based on the IEEE 802.11 standards have become ubiquitous in our daily lives. During this time we have seen more than 10-fold increase in usage and the number of wireless devices. To satisfy ever increasing demands, physical layer (PHY) data rates in WLANs have scaled from a few Mbits/sec in 802.11g to hundreds of Mbits/sec in IEEE 802.11n to over Gbits/sec in the IEEE 802.11ac standard. In addition, due to the emergence of popular online services, such as YouTube and Netflix, there has been persistent traffic growth due to real-time applications (e.g., video streaming). These trends bring about new performance challenges that are likely to become problematic for high-speed WLANs: These challenges include (a) achieving high user-level throughputs at high PHY data rates and (b) meeting the quality of service requirements of diverse applications (e.g., video streaming, web surfing, and bulk transfers) when they co-exist in a WiFi network. Due to the shared nature of the wireless medium, a carrier sensing based random access protocol is used in all 802.11-based standards. To arbitrate access to the channel, wireless access protocols introduce overheads like backoffs, preambles, and acknowledgements that lower performance efficiency at high data rates thereby resulting in low throughput. To address this inefficiency, recentWiFi standards (e.g., 802.11n/ac) allow (a) frame aggregation, whereby multiple frames are transmitted as a single aggregate frame on every channel access, and (b) block acknowledgements, whereby a single frame is to used for acknowledging the receipt of several frames. These features amortize the contention overhead over multiple frames and thus improve efficiency. At high data rates, frame aggregation introduces two challenges. First, sending large aggregate frames in a single transmission increases the opportunity cost of losing a frame, which leads to greater degradation in performance. In WiFi networks, frame losses can occur due to a weak signal, collisions, or hidden nodes. The MAC layer should respond differently to different types of losses. To achieve high performance, it is essential to infer the cause of frame loss accurately. We propose, implement and evaluate BLMon, a framework for loss differentiation that uses loss patterns within aggregate frames and their retries to achieve loss differentiation accurately and with low overhead. The second challenge arises in the presence of a mix of traffic, ranging from delay sensitive real-time applications to bulk file transfers that require high throughput. We show that using QoS mechanisms in high-speed WLANs presents a tradeoff between maximizing the performance of real-time applications and achieving high throughput. We design SlickFi; a service differentiation scheme that addresses this tradeoff and simultaneously maximizes the performance of real-time applications and network throughput. SlickFi achieves this by (a) isolating different types of traffic in non-overlapping parts of the spectrum by mapping them to different radios; and (b) adapting channel width on a per-frame basis to make efficient use of the wireless channel. The proposed solutions are readily deployable on commodity devices using only software level changes. We demonstrate the validity of our solutions by performance evaluation over a real testbed in diverse scenarios.