PSI-11 Effects of a supplemental water source and trace-mineral based electrolyte drinking solution on intake and blood cell count of newly received feedlot calves

Oral hydration therapy has been used to improve performance and health of newly received feedlot calves; however, little is known regarding water intake (WI) following arrival at the feedlot. Our objective was to evaluate WI of newly received feedlot calves provided a supplemental water source or a novel nutritional rehydration solution during initial 3 days following arrival. Crossbred heifers (n=180; initial BW = 237 ± 23 kg) were individually weighed after 16 h fasting and sorted into 12 pens (4 pens/treatment). Treatments were: 1) Control (CON): water provided through standard in-pen automatic waterer only (Richie CM480; one waterer/pen); 2) Supplemental water (SUPW): CON + water provided with one additional stock tank/pen; 3) Novel nutritional rehydration solution (NRS): trace-mineral based drinking solution provided with one stock tank/pen as the only water source. Treatments were provided from days 0 to 3 after which supplemental tanks were removed. From days 4 to 14 all heifers had access to the standard in-pen automatic waterer only. The WI was measured daily throughout the trial and BW was recorded at days 0 and 14. Whole blood was collected (5 heifers/pen) on days 0, 3, and 14. Treatments had no effect on DMI or ADG (P ≥ 0.15). SUPW and NRS had greater WI than CON from days 0 to d 3 (P ≤ 0.001), but not from days 4 to 14 nor from days 0 to 14 (P = 0.69). No treatment effect or treatment × day interactions were observed for total red (RBC) or white blood cell counts (WBC; P ≥ 0.19); however, a day effect was present (P < 0.001) and RBC and WBC linearly decreased from day 0 to 14 (P < 0.05). Our preliminary results indicate that providing a supplemental source of water during the initial 3 d after arrival increased total WI and may facilitate rehydration in stressed calves following transit.

Hydration therapy in oligohydraminos in Ain Shams University Maternity Hospital: Randomized Controlled Clinical Trial

Background Amniotic fluid surrounds the fetus within first gestational weeks. acts physiologically and anatomically in a protective manner preventing fetal and umbilical cord compressive forces, besides have antibacterial features keeping the fetal temperature stable, and avoiding adhesive attachment to developing fetal membrane system. Amniotic fluid volume and constituents continuously change in a dynamic manner as the gestation progresses. Sufficient amniotic fluid volume is crucial for fetal mechanophysiological well-being adding in normal musculoskeletal wellbeing besides aminiotic fluid consituents refelect physiological integrity of fetal systems particularly the renal and gastrointestinal systems. Objective The aim of this study is to find out if there is significant increase in amniotic fluid index after acute maternal hydration in pregnant women with oligohydraminos and to evaluate therapeutic effectiveness of two different modalities of hydration therapy. Methods We conducted randomized controlled open labeled clinical trial on 300 cases with oligohydraminos admitted to Ain Shams University Maternity Hospital (ASUMH) in the period from September 2019 to March 2020. These patients were classified to three groups, Patients in group A were Oral hydration group: 100 participants while Patients in group B were Intravenous hydration group: 100 participants, patients in Group 3 No hydration group: 100 participants. Results The demographic data analysis of the current study have shown that there was no statistical significant difference between the investigated research groups as regards the demographic characteristics (age, BMI, Parity gestational age p values 0.171,0.370,0.840,0.290 consecutively). The study results also showed that oligoydramnios recurrence frequency was highest among control group, followed by intravenous group and least in oral group, the differences were statistically nonsignificant. Conclusion Hydration can be considered an effective way of decreasing the chance of oligohydraminos because maternal dehydration increases the chance of the condition. Therefore both serum and oral hydration therapies are hypothesized to be effective treatment for oligohydraminos. Previous studies have supported this hypothesis. Maternal hydration may theoretically increase amniotic fluid volume may by causing fetal diuresis.

Palliative medicine education—Bed Race, The End of Life Board Game in undergraduates

BackgroundEducational board games facilitate active learning to conceptualise knowledge, and, promote collaborative learning and team work. Despite increasing interest in them, use in palliative and end of life care has been very limited to date.MethodIn ‘Bed race, The End of Life Game’, participants are divided into four teams who move a model hospital bed around a board to collect items (syringe driver; Do Not Attempt Resuscitation form; oral hydration gel; a ‘heart’; Just In Case medicines). To obtain items at themed ‘checkpoints’, each team needs to answer quiz questions, which require application of clinical knowledge and/or communication skills. Pregame and postgame quiz scores and feedback were collected from 12 game sessions involving 251 year 5 medical students.Results169 (67%) of students completed pregame and postgame anonymous quiz questions and free-text feedback. Postgame quiz scores were higher for each topic, and the difference in the paired pregame and postgame questionnaires was statistically significant (p<0.05). Themes from the free-text feedback included ‘engaging and fun’; ‘relevant learning’; ‘peer learning and team work’.ConclusionsEducational board games are not a new panacea for education, but the concept can be successfully applied in palliative care.

Oral Hydration as a Safe Prophylactic Measure To Prevent Post-Contrast Acute Kidney Injury in Oncologic Patients with Chronic Kidney Disease (IIIb) Referred for Contrast-Enhanced Computed Tomography: Subanalysis of The Oncological Group of The NICIR Study.

Background The objective of this study is to evaluate oral hydration compared to intravenous (i.v.) hydration in the prevention of post-contrast acute kidney injury (PC-AKI) in the oncologic subgroup of patients with stage IIIb chronic kidney disease (CKD) included in the NICIR study referred for elective contrast-enhanced computed tomography (CE-CT). Material and Methods We performed a retrospective subanalysis of the oncological subgroup (174/228 patients, 74%) from a continuous prospective database of patients included in the recently published non-inferiority NICIR study. Patients received prophylaxis against PC-AKI with either oral hydration (500 mL of water two hours before and 2000 mL during the 24 hours after CE-CT) or i.v. hydration (sodium bicarbonate (166 mmol/L)3 mL/kg/h starting one hour before and 1 mL/kg/h during the first hour after CE-CT). The primary outcome was to compare the proportion of PC-AKI in the first 48 to 72 hours after CE-CT in the two hydration groups. Secondary outcomes were to compare persistent PC-AKI, the need for hemodialysis, and the occurrence of adverse events related to prophylaxis in each group. Results Of 174 patients included in the subanalysis, 82 received oral hydration and 92 received i.v. hydration. There were no significant differences in clinical characteristics or risk factors between the two study arms. Overall the PC-AKI rate was 4.6% (8/174 patients), being 3.7% in the oral hydration arm (3/82 patients) and 5.4% (5/92 patients) in the i.v. hydration arm. The persistent PC-AKI rate was 1.8% (1/82 patients) in the oral hydration arm and 3.3% (3/92 patients) in the i.v. hydration arm. No patient required dialysis during the first month after CE-CT or had adverse effects related to the hydration regime. Conclusion In oncological patients with stage IIIb CKD referred for elective CE-CT, the rate of PC-AKI in those receiving oral hydration did not significantly differ from that of patients receiving i.v. hydration.

An Audit on the implementation of administering Ondansetron in children with acute gastroenteritis and its effect on admission rate

Acute gastroenteritis (AGE) is a common presenting complaint in paediatrics. Most often, the reason for admission into hospital is to initiate intravenous rehydration in patients with severe dehydration and inability to tolerate oral intake. We found that Ondansetron acts as a potent antiemetic to support an increased number of children receiving oral hydration, and subsequently leading to decreased rates of admission. This study aims to audit the use of Ondansetron to Oral Rehydration Therapy (ORT) on children with acute gastroenteritis, and its effect on admission rates from the emergency department in University Hospital, Limerick (UHL). Data collected over a 3-month period from June to August 2017 in which Ondansetron was not used was compared to another 3-month period when Ondansetron was used. Several outcomes were measured including admission to hospital. The rate of admission decreased by 15% [26/74 (35%) in 2017 to 16/81 (20%) in 2019 p = 0.22]. 81 patients received Ondansetron, of which 79% were successfully rehydrated orally. The administration of Ondansetron reduced the need for intravenous fluids and hospital admission overall in these children with AGE. This reduction ultimately accounted for lower costs incurred by the Health Services Executive per patient, and also suggested the anti-emetic use as a cost effective measure for managing and treating patients with AGE.

Preoperative Oral Hydration Is Safe in Rapid Recovery Total Hip Arthroplasty

Fluid and food restrictions prior to surgery are thought to reduce the risk for perioperative aspiration pneumonia. However, the recent anesthesia literature suggests that clear fluids up to 2 hours before surgery may be tolerated. Here we investigate the safety and efficacy of a standardized hydration protocol among same-day discharge total hip arthroplasty (SDD-THA) candidates. All patients scheduled to undergo primary SDD THA between January 2017 and October 2018 were included. Surgical recipients between January 2017 and August 2017 were used as historical controls. Surgical recipients between September 2017 and October 2018 participated in the hydration initiative which allowed for the consumption of 32 oz of clear fluid 2 hours prior to surgery. Baseline demographics and quality metrics were prospectively collected and analyzed to define the impact of a hydration protocol in SDD THA. In total, 585 consecutive SDD-THA candidates were included in this study, of which 309 and 276 patients were in the control and hydration cohorts, respectively. Univariable analysis of postoperative outcomes demonstrated that a similar number of THA recipients failed SDD (7.44 vs. 7.97%; p = 0.88); however, a clinically meaningful reduction in hypotensive episodes was observed among the hydration cohort (0.4 vs. 1.9%; p = 0.08). Multivariable regression demonstrated similar outcomes after controlling for all collected patient risk factors (odds ratio 0.95; 95% confidence interval 0.48–1.88; p = 0.89). Our study suggests hydration protocols are safe and may reduce the clinical incidence of postoperative hypotension when compared with standard nil per os restrictions. Future studies are needed to better elucidate the role of perioperative hydration before THA. The level of evidence of the study is level II, prospective observational cohort.