Optimal composition of fluid-replacement beverages

The objective of this article is to provide a review of the fundamental aspects of body fluid balance and the physiological consequences of water imbalances, as well as discuss considerations for the optimal composition of a fluid replacement beverage across a broad range of applications. Early pioneering research involving fluid replacement in persons suffering from diarrheal disease and in military, occupational, and athlete populations incurring exercise- and/or heat-induced sweat losses has provided much of the insight regarding basic principles on beverage palatability, voluntary fluid intake, fluid absorption, and fluid retention. We review this work and also discuss more recent advances in the understanding of fluid replacement as it applies to various populations (military, athletes, occupational, men, women, children, and older adults) and situations (pathophysiological factors, spaceflight, bed rest, long plane flights, heat stress, altitude/cold exposure, and recreational exercise). We discuss how beverage carbohydrate and electrolytes impact fluid replacement. We also discuss nutrients and compounds that are often included in fluid-replacement beverages to augment physiological functions unrelated to hydration, such as the provision of energy. The optimal composition of a fluid-replacement beverage depends upon the source of the fluid loss, whether from sweat, urine, respiration, or diarrhea/vomiting. It is also apparent that the optimal fluid-replacement beverage is one that is customized according to specific physiological needs, environmental conditions, desired benefits, and individual characteristics and taste preferences.

In too deep: understanding, detecting and managing DVT

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious health and social care problem of the developed world, affecting 1 in 1000 adults every year, and with an annual financial overhead of approximately £640 million. The nature of DVT means that often the condition can go unrecognized until the thrombus becomes an embolus. The pathogenesis of DVT continues to be based on Virchow's triad, which attributes VTE to 'hypercoagulability', 'stasis' and 'intimal injury'. The diagnosis of DVT is often the result of a number of tests performed either sequentially or in combination before mechanical and/or chemical treatment is embarked on. Creating public awareness of DVT and PE is the best way to prevent this condition. Nurses are in an ideal position to discuss the importance of lifestyle changes and other related measures to prevent DVT.

A survey of public transport use by immunocompromised children in the United Kingdom

BACKGROUND

The advice given to immunocompromised children and their families on the use of public transport at our oncology unit has been inconsistent, with a lack of written or evidence based guidelines. We therefore carried out two surveys, one national and one local on this issue, to determine what advice is given to families. We also undertook an extensive literature search on this subject.

METHODS

The first survey was completed by the Paediatric Oncology Nurses Forum link member at each of the 22 United Kingdom Childrens' Cancer Study Group (UKCCSG) centres. We asked their current practice for use of public transport for hospital visits, school attendance, regular weekly use and holidays. We looked at recommendations for travel on holiday in the UK and abroad with reference to neutrophil and platelet counts. The second survey was completed by parents of 64 children attending our outpatient clinic over a 2-week period to ascertain whether the families comply with our verbal recommendations.

RESULTS

There was a 100% response from UKCCSG centres. None of the centres had any written or evidence based guidelines. 55% of centres allowed public transport for hospital visits, 82% for school and 90% for holidays. Sixty-eight percent of centres allowed UK travel with a neutrophil count of 0.5-1 x 109/L and 18% if neutrophils <0.5 x 109/L. Eighteen percent of centres allowed foreign travel with a neutrophil count of 0.5-1 x 109/L but only 9% if <0.5 x 109/L. The second survey showed 2% used public transport to attend hospital, 5% for school, 17% for regular use and 50% travelled by plane for holidays. A Pubmed literature search revealed a lack of studies on immunocompromised patients.

CONCLUSION

A certain use of public transport is necessary for patients to engage in as normal a life as possible. There is a need for further studies to produce sensible and consistent advice on this issue.

Air travel and seizure frequency for individuals with epilepsy

This study investigated whether air travel is associated with an increase in seizures for individuals with epilepsy. Thirty-seven participants monitored their seizure frequency for one week prior to flying and for one week after flying. For the sample as a whole, seizures were significantly more common after flying (p=.02). No seizures were reported as occurring during flight. Participants who experienced an increase in seizures after flying compared to those who did not (a) had a higher baseline of seizure frequency (p=.004), (b) were more likely to have previously experienced an increase in seizures after flying (p=.001), (c) were more worried about having a seizure while flying (p=.001) and (d) were more likely to avoid air travel (p=.02). Participants with complete seizure control prior to flying did not experience seizures after flying. Distance traveled, time zones crossed, duration of flight and direction of flight were not significantly different for those with seizure increase than for those without such an increase. This study suggests that air travel promotes an increase in seizures for those with a prior history of flight related seizures and a relatively high baseline seizure frequency.

Travel counseling for the elderly traveler

As the baby boomer's generation retirees, many will have the time and money to travel abroad to see the world's exotic wonders or visit family and friends. When the travelers are elderly, they are particularly vulnerable to the effects of travel. Healthcare professionals are responsible for counseling elders on travel health based on their medical history, destination, method of transportation, and exposure risks. Important areas of travel counseling include preparing for travel, air travel, safety, sun and heat, insect precautions, food and water precautions, and vaccinations.