Add fluid to prevent contrast kidney damage

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Renal complications caused by contrast dye can be reduced in at-risk patients by using a sliding scale of fluid volume expansion in individuals undergoing PCI, reports Somjot Brar, MD, MPH, of the University of California, Los Angeles at the 2012 Transcatheter Cardiovascular Therapeutics meeting at Miami, USA.

The sliding-scale for hydration calls for additional hydration for at-risk individuals. They are with a glomerular filtration rate (GFR) < 60, diabetes, age >75, hypertension or a history of congestive heart failure.

The hydration schedule is guided by the left ventricular end diastolic pressure.

1.    Left ventricular end diastolic pressure (LVEDP) < 13: Give 5 mL/kg/hour of 0.9% saline hydration.

2.    LVEDP 13-18: Give 3 mL/kg/hour.

3.    LVEDP > 18: Give 1.5 mL/kg/hour

Hydration at that level is continued for all patients until 4 hours post procedure.

Most sudden cardiac deaths occur on Monday mornings of December and January

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1.    Maximum sudden cardiac deaths peak in the morning.

2.    Primary arrhythmic event is more likely to occur in the morning because increased adrenergic activity at this time may increase electrical instability or induce myocardial ischemia without heart attack.

3.     Mortality reports of the Massachusetts Department of Public Health, of 2203 individuals who in 1983 died an out-of-hospital death from ischemic heart disease one hour or less after the onset of symptoms, showed peak frequency of sudden death between 9 and 11 AM [Circulation 1987;75:131].

4.    Framingham Heart Study: The hourly risk of sudden cardiac death was at least 70 percent greater between 7 and 9 AM than the average risk during the remaining 22 hours of the day [Am J Cardiol 1987;60:801].

5.     Data from the Berlin emergency care system found a peak frequency of ventricular fibrillation between 6 AM and noon; in contrast, asystolic episodes were more evenly distributed throughout the day [Circulation 1993;88:2284].

6.     The morning peak in sudden death is particularly related to the first three hours after awakening and onset of activity [Am J Cardiol 1992;70:65]

7.    Data from the Seattle Fire Department, based upon 6603 cases of out-of-hospital cardiac arrest, of which 3690 were witnessed, also exhibited a diurnal variation, with a low incidence at night and two peaks of approximately the same size [Circulation 1998;98:31]. An evening peak at 4 to 7 PM was attributed primary to patients found in ventricular fibrillation, while arrests that showed other rhythms exhibited mainly a morning peak from 8 to 11 AM.

8.    Cardiac arrests also show a weekly and seasonal variation; the daily incidence peaks on Monday and the seasonal incidence is greatest in the winter [Eur Heart J 2000;21:315, Am Heart J 1999;137:512].

9.    One 12 year analysis of 222,265 cases of death from coronary heart disease found that there were approximately 33 percent more deaths in December and January than in June through September [Circulation 1999;100:1630].

Vitamin D Facts

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1.     Vitamin D is an indispensable assistant to calcium in building bone, calcium has:

2.     Vitamin D helps the body absorb calcium.

3.     Increasing vitamin D can help prevent osteoporosis.

4.      A small amount of sun exposure can help the body manufacture its own vitamin D.

5.     Five to 30 minutes of sunlight between 10 a.m. and 3 p.m. twice a week to your face, arms, legs, or back without sunscreen will enable you to make enough of the vitamin.

6.     People with fair skin that burns easily should protect themselves from skin cancer by limiting sun exposure to 10 minutes or less.

7.      Food and sun exposure should suffice, but if not, get 2,000 IU of vitamin D daily from a supplement.

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