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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

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The most common conditions in children that require haemodialysis


Haemodialysis is a fast and efficient method for removing toxins from the body in a straightforward manner. This has been a regular practice at the Paediatric Clinic in Sarajevo, Department of Paediatric Intensive Therapy since January 2009. By December 2014 there were 34 patients treated by haemodialysis, who had undergone 253 haemodialyses in total. There were 18 (52.9%) primary nephrologic patients, while 16 (41.05%) were patients whose renal failure was caused by other etiology. The main objective of this paper is to present the most common conditions in childhood that require haemodialysis in its treatment. The Department of Paediatric Intensive Therapy for this period had hospitalized 1,226 patients in total. Out of this number 2.77% of patients required the application of haemodialysis in their treatment.

The results show that the most common renal causes to perform haemodialysis are: haemolytic uremic syndrome (HUS), chronic renal failure, nephrotic syndrome and congenital bilateral nephrolithiasis. For the others, the most common non-renal causes are multiple organ dysfunction syndrome (MODS) that occurs as a result of cardiac insufficiency, hepatic insufficiency or after surgeries, as well as in hemato-oncologic diseases.

Key words: child, haemodialysis

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Incidence of hyponatraemia in the emergency unit


Hyponatraemia is an electrolyte disorder, defined as a serum sodium concentration (Na) <136 mmol/L. It occurs in up to 30% of hospitalised patients. The purpose of this study was to evaluate the frequency of hyponatraemia among all patients during a one month period in the emergency unit.

During the one month period in 2014, 570 patients were included in this study. The study was approved by local ethics committees and patients provided written informed consent.

Out of the 570 patients, 41 (7%) had hyponatraemia. The median age was 67 (65.02±14.09) years and the majority of the patients were men (M:F = 23:18; 56.1:43.9%). Mild hyponatraemia (serum Na 130-135 mmol/L) was found in 71% (29/41), moderate (serum Na 125-129 mmol/L) in 17% (7/41), severe (serum Na 120-124 mmol/L) in 5% (2/41), and extremely severe (serum Na< 120 mmol/L) in 7% (3/41) of patients. The treatment options included the restriction of fluid intake by administering hypertonic saline and loop diuretics.

We should be alert to acute hyponatraemia, especially in elderly patients with neurological manifestations and poor prognosis. The presented data are an important contribution to the better understanding of the epidemiology of hyponatraemia in Croatia.

Key words: hyponatraemia, emergency unit

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Renal denervation in patients with resistant hypertension – single centre report


Among patients with resistant hypertension, it is very important to select patients most likely to benefit from renal sympathetic denervation, because they represent a very mixed group of diagnoses.

Prior to diagnosing a patient as having resistant hypertension, it is important to document adherence and exclude white-coat hypertension, inaccurate measurements of blood pressure and secondary causes of hypertension.

Renal sympathetic denervation has been demonstrated as an antihypertensive treatment in resistant hypertension patients with additional positive effects on glucose metabolism and insulin sensitivity in type 2 diabetes.

We report a single centre report of renal sympathetic denervation effects in a small cohort of patients with resistant hypertension and stage 2-3 chronic kidney disease.

Blood pressure reduction after renal sympathetic denervation was sustained at consecutive follow-up visits one, three and six months when compared to the baseline: office systolic blood pressure was significantly lower (144 ± 13, 140 ± 17, 141 ± 15 mmHg, p<0.001).

Randomized clinical trials are required to assess the impact of the reported changes.

Key words: resistant hypertension, stepwise screening protocol, renal denervation

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Indications for blood transfusions in critical illness


Transfusion of blood products should improve tissue oxygenation and reduce negative consequences of anaemia. At the same time, adverse effects of transfusion, such as infections, immunologic reactions and mistransfusion, could be deleterious. Most transfusion guidelines suggest looking at the combination of haemoglobin or haematocrit levels in addition to clinical signs in the decision making process for a blood transfusion. The problem with such indications is that the clinical evaluation may be misleading in severely ill patients and haemoglobin levels that impair oxygen delivery cannot be determined easily. Many studies attempted to establish more convenient parameters, such as oxygen saturation from mixed and central venous blood, tissue oxygen extraction and other methods. Although the results from these studies are conflicting, it appears that global oxygenation parameters are a good indicator for a blood transfusion in some categories of critically ill patients.

Key words: haemoglobin concentration, global oxygenation parameters, transfusion, critical illness

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Inadvertent hypothermia during the perioperative period


Inadvertent hypothermia, which is defined as temperature below 36°C, is common in the perioperative setting. Patients under general or regional anaesthesia have impaired temperature regulation/homeostasis. Temperature monitoring should be an established standard for all procedures that last more than 30 minutes. Unfortunately, study shows that it is not a common practice in European hospitals. Passive and active patient warming should be used to prevent and treat hypothermia. Warming should start in the preoperative period and last throughout all perioperative phases. In that way, well-known complication of hypothermia should be prevented. Cardiac event, coagulopathy and wound infection are the leading causes of delayed discharge and more adverse outcomes related to hypothermia. It is especially important to undertake all necessary intervention procedures to prevent hypothermia in a group of patients with known high number of risk factors for hypothermia. Ambient temperature, an important risk factor, should be monitored and maintained at about 21°C. According to reviewed evidence, the protocol to prevent, monitor and treat hypothermia should be established. Further studies about the implementation of temperature monitoring and regulation are needed in order to raise awareness about this issue.

Key words: hypothermia, core temperature, anaesthesia, warming devices, prevention, treatment

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