Não há conflitos de interesse. RESUMOA síndrome de realimentação (SR) é uma complicação da terapia nutrológica subdiagnosticada em que múltiplos sistemas podem ser afetados, incluindo: cardiovascular, respiratório, hematológico, musculoesquelético e neurológico. Algumas das principaiscaracterísticas são ahipervolemia, aqueda do nível sérico de eletrólitos, principalmente os de predominância intracelular (fósforo, magnésio e potássio), aalteração do metabolismo da glicose (hiperglicemia) e deficiência de vitaminas e oligoelementos. O objetivo desse estudoé realizar umbreve relato de uma série de casos clínicos correlacionando-os com dados da literatura revisada.Palavras-chave: Síndrome de realimentação, subnutrição, hipofosfatemia. ABSTRACTRefeeding syndrome (RS) is an underdiagnosed complication of nutrologicaltherapy in which multiple systems can be affected, including cardiovascular, respiratory, hematological, musculoskeletal, and neurological. Some key features are fluid overload, decrease in serum electrolyte levels mainly the ones with intracellular predominance (phosphorus, magnesium and potassium), altered glucose metabolism (hyperglycemia) and vitamin and trace element deficiency. The aim of this manuscriptis to conduct a brief report of four cases and review the literature correlating it with the cases described.A síndrome de realimentação (SR) é uma condição descritaem literatura médica há mais de 65 anos, porém ainda pouco reconhecida, caracterizada por um grupo de sinais e sintomas clínicos que ocorrem em pacientes subnutridos e caquéticos submetidos ao jejum prolongado quandosão realimentados. Trata-se de desequilíbrio hidroeletrolítico, muitas vezes grave, desencadeado pelo retorno da alimentação empacientes cronicamente adaptados a produção de energia através do metabolismo lipídico 1 .

No abstract

COSTA, CALDAS, NUNES ET AL. commended 7 . In contrast, the discontinuation of drugs, such as angiotensin-converting enzyme inhibitors (ACE inhibitors) on the day of the surgery based on reports of significant hypotension after induction of anesthesia suggesting a deleterious interaction between ACE inhibitors and anesthetics in general has been questioned or suggested by some authors 8,9 . However, discontinuation of drugs used for a long time, such as antihypertensives, can implicate on a higher risk of intraoperative hypertensive peaks with harmful consequences for the patient 7 . This has generated controversies among anesthesiologists and, occasionally, conflicts with the physician in charge. The objective of this preliminary study was to evaluate the influence of the preoperative use of ACE inhibitors on the incidence of clinically significant hypotension (hypotension requiring intervention by the anesthesiologist) after anesthetic induction. METHODSAfter approval by the Ethics Committee of the hospital, a case-control, retrospective study in which the study group was composed by all patients who presented significant hypotension after anesthetic induction during the study period, i.e., one year, was undertaken. Cases of hypotension that required intervention such a volume expansion and use of vasopressors by the anesthesiologist responsible for the case were considered significant. Patients underwent orthopedic, neurosurgical, reconstructive plastic surgery, urologic, and thoracic procedures. Electronic medical records were reviewed for data on anesthetic induction, the moment the patient developed hypotension, therapeutic measures, and evolution of the case. The control group was composed by four patients, randomly selected, for each study patient, to increase the power of the statistical analysis 10 . Patients in the control group were in the same age range, underwent the same type of surgery and at the same time as the study patients, and did not develop hypotension after anesthetic induction. Patients younger than 18 years and those who received local anesthetics or sedation as the only technique were excluded from the study. Parameters analyzed were as follows: age, gender, size of the surgery, prior diagnosis of hypertension, use of ACE inhibitors, physical status (ASA), intraoperative bleeding, anesthetic technique, and duration of the surgery. Analysis of Variance was used for numerical parameters and Fisher's Exact test for categorical parameters. For categorical parameters with significant association, the degree of increase in risk was determined by odds ratio. Univariate and multiple analyses were also undertaken using logistic regressions. Data were processed by SPSS for Windows, version 13.0.

Introduction: Home parenteral nutrition (HPN) is useful for patients with intestinal failure (IF), defined as gastrointestinal insufficiency to sustain nutrition or hydration without intravenous support. IF can be transitory, subacute or chronic, for this last one HPN is indicated. Objective: Epidemiology profile analysis of patients in a private setting in Brasilia, DF, Brazil, using HPN and its complications (infections, metabolic and hepatic). Methods: Retrospective study, using data base analysis of patients using HPN between October 2012 and May 2019. Results: Analysis of 22 patients, mean age of 52 years old, female gender prevalence (54.5%). IF causes: gastrointestinal tract neoplasm (44%), short intestine syndrome (12%), Crohn’s disease (8%). In total, 2.781 bag of HPN were used. The central lines catheters were PICC® (85.36%) and Hickman® (13.87%). Primary bloodstream infection (CLABSI) was present in 1.43 to 1.000 catheters/day and the pathogens isolated by cultures were: Gram positive coccos (50%); Gram negative bacilli (25%); fungi (25%). Prophylactic lock therapy was used in 50% of the patients, hyperglycemia occurred in 31.81% and 36.36% had hepatic dysfunction. Complex and balanced lipid emulsion (CBLE) containing soya, olive and fish oil was used in 95.4% of the patients. The overall mortality was 63.6%, reducing to 26% when the oncologic patients were excluded. Intestinal recovery was present in 24%. Discussion: HPN has benefits and complications; the last ones can be reduced by the presence of a multidisciplinary team associated to patients and their caregivers training. We found CLABSI prevalence similar to literature and by using lock therapy we might reduce it. Avoiding caloric overload, using CBLE and preferring cyclic infusion can prevent liver disease. Conclusion: The use of HPN has increased in the last decade, especially due to its capability of promote intestinal rehabilitation and improve quality of life. For an optimized, efficient and secure treatment a skilled team is mandatory.

No abstract