Hydroelectrolytic and infectious complications in one year of parenteral nutrition in critical care | Revista Española de Anestesiología y Reanimación (English Edition)

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The values in the column on the right correspond to blood glucose." ] ] ] "textoCompleto" => "IntroductionMalnutrition is a prevalent condition in severely ill patients admitted to the ICU. It is found in up to 47% of cases,<a class="elsevierStyleCrossRefs" href="#bib0085">1,2</a> and is associated with an increase in morbidity and mortality,<a class="elsevierStyleCrossRef" href="#bib0095">3</a> mainly due to an increase in the average stay and a higher incidence of nosocomial infections. The benefits of nutritional support to prevent or at least alleviate nutritional deficiencies have been amply demonstrated, although this therapy is not without its complications.<a class="elsevierStyleCrossRef" href="#bib0100">4</a> Parenteral nutrition (PN) consists of the intravenous administration of macronutrients, micronutrients and electrolytes. Total parenteral nutrition is only superior to conventional fluid therapy in terms of infectious morbidity and mortality in seriously ill and undernourished patients.<a class="elsevierStyleCrossRef" href="#bib0100">4</a>The main complications of PN can be summarized in 4 main groups: noninfectious central venous catheter complications, metabolic complications, hepatic dysfunction, and septic complications.<a class="elsevierStyleCrossRef" href="#bib0100">4</a> Metabolic complications include blood glucose alterations, osmolarity, heart failure, dyselectrolytaemia, hipertrigliceridaemia, and uraemia. One of the most important complications is refeeding syndrome, defined as the metabolic abnormalities that can occur after the reintroduction of carbohydrates in chronically malnourished or acutely hypermetabolic patients as a result of a rapid shift to glucose utilization as an energy source.<a class="elsevierStyleCrossRefs" href="#bib0105">5–8</a>There are few descriptions in the literature<a class="elsevierStyleCrossRefs" href="#bib0105">5–8</a> of the electrolyte alterations that can occur during total PN. The few references available are limited to recommendations for the administration of ions, vitamins and trace elements to avoid micronutrient-related disorders.For this reason, we set out to determine the most frequent electrolyte alterations and their time of onset relative to the start of PN and during the first 10 days of therapy. This would enable us to predict onset of these changes with respect to the start of PN and to take appropriate measures for other types of complications. We also measured changes in creatinine and urea over time in order to evaluate the evolution of renal function.We also collected data on central venous catheter complications, since this is the direct route of administration of the PN. For this purpose, we followed the definition of catheter-related infection established in the Bacteriemia Zero project.<a class="elsevierStyleCrossRef" href="#bib0125">9</a>The aim of this study has been to determine the central-line infectious complications associated with PN, evaluate the most frequent electrolyte complications associated with PN, and establish minimum monitoring points for the early detection of electrolyte alterations.Material and methodThis was a retrospective study in patients admitted to the surgical critical care unit (SCCU) of the University Hospital Complex of Ourense. The research protocol, number 2016/370, was submitted and approved by the Pontevedra-Vigo-Ourense Research Ethics Committee, and the study was conducted in the University Hospital.All surgical and trauma patients admitted to the SCCU in 2015 and receiving PN were included. Patients under 18 years of age were excluded.In our hospital, the PN solution is prepared by the Pharmacy Service, and according to data collected from the service's PN management software Medical One Parenteral 2011©, version 2.0.1251, 51 patients received this therapy over the study period. Given the study population of 51, we calculated that 50 patients would be needed to determine the percentage presenting electrolyte alterations, with a statistical power of 99% and a margin of error of 1%. If we had used the loss-adjusted sample size, with a 5% margin for loss of end-point parameters or early interruption of the study therapy, we would have needed 53 patients, which is greater than the sample size available. Therefore, our sample size was 51 cases.After obtaining the list of patients receiving PN from the SCCU, we collected the remaining data from the patient's clinical history: type of PN (full, liver disease, kidney failure, stress), glucose, sodium, potassium, phosphorus, magnesium, calcium, lactate, urea, creatinine, albumin, bilirubin, GOT, GPT, GGT, LDH, haemoglobin, platelets, leukocytes, age, reason for admission to the SCCU (trauma/non-trauma), APACHE II, presence of central line (days), catheter-induced bacteraemia with and without removal of the line, probable catheter-induced bacteraemia, catheter-induced infection, cause of withdrawal of PN, survivor/non-survivor, date of death. If several determinations were made on a particular day, the value (glucose, sodium, potassium, phosphorus, magnesium, calcium, albumin, bilirubin, GOT, GPT, GGT, LDH) furthest from average reference value given in the lab report was taken as the valid measurement. Analytical data were collected during the first 10 days from the start of PN, or until the end of the therapy, whichever occurred first.Microbiological data to determine the presence of infectious complications were collected throughout the period of parenteral nutrition. The presence of bacteraemia<a class="elsevierStyleCrossRef" href="#bib0125">9</a> was defined as fever, chills, or hypotension, and a positive blood culture. If common skin bacteria were identified, 2 blood cultures or a positive antigen blood test were required. Catheter-related microbiological findings were classified according to the Bacteraemia Zero project<a class="elsevierStyleCrossRef" href="#bib0125">9</a>: catheter-induced bacteraemia with and without removal of the line, probable catheter-induced bacteraemia, bacteraemia related to infusion fluids, and catheter-related infection.After collecting the data, we performed a preliminary analysis to identify the presence of errors that could distort the statistical analysis. This is because samples taken from the venous line puncture site can be altered due to haemodilution. We identified such unreliable samples by comparing them with the alterations caused by the sera administered via such lines, such as decreased levels of haemoglobin, platelets, leukocytes, together with electrolyte changes (hypernatraemia, hypokalaemia), which are typical of the use of saline-based solutions. This enabled us to remove incorrect data.If errors were identified in the pre-analytical stage or samples were recorded in the laboratory report as inadequate, coagulated, insufficient, etc., the data from that report were eliminated from the analysis.After all the study parameters had been collected, the variables were tested for normality and the Kruskal–Wallis test was performed to detect statistically significant differences between the days on which the measurements were taken with respect to the start of parenteral nutrition. As this test does not show probability in each group, we also performed an ANOVA analysis to identify the groups with the greatest statistical difference. Infectious complications were analysed on the basis of the number of complications recorded, according to the classification system used in the study, and the days of PN. For the statistical analysis, we used LibreOffice©5.1 for Linux and SOFA Statistics©1.4.6 for Linux.ResultsData were collected from 51 patients, aged 70.58±12.91 years with an APACHE II score of 20.21±7.16. The sample included 3 patients admitted for trauma, a male: female ratio of 35:16, and a total mortality rate of 18 patients. <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> show the results of the analytical tests performed.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Statistically significant differences were found in blood glucose (p<0.001), magnesium (p=0.021), potassium (p<0.001) and creatinine (p<0.001). A borderline statistical trend was observed in albumin (p=0.061) and phosphate (p=0.054). In the interest of clarity, mean changes in some of the parameters obtained relative to the start of parenteral nutrition are shown in graph form in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Only daily changes with a p value of <0.01 were considered. Thus, statistically significant differences were observed in urea (days 3–5), lactate (day 0–4), phosphorus (day 2–3), blood glucose (day 1) and magnesium (days 7–8).We calculated the percentage of patients presenting analytical alterations (defined as values outside the reference range given in the laboratory report) as well as the number of patients in whom each parameter was tested. The results are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. For example, out of the 50 patients who underwent glycaemia testing, 98% presented hyperglycaemia, and 16% presented hypoglycaemia.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>We also analysed the number of study days in which each patient presented out-of-range analytical parameters. The total number of days with analytical alterations was calculated and divided by the total number of days on which the test was requested. The results are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>To determine infectious complications, we analysed a total of 538 days of parenteral nutrition, in which 6 cases of catheter-related bacteraemia, 2 cases of probable catheter-related bacteraemia, and 2 of catheter-related infection were identified. In total, 10 infectious complications were identified, of which 8 involved bacteraemia. There were 14.86 cases of bacteraemia for every 1000 days of central venous catheter.DiscussionOur results show the different parameters that should be monitored in patients receiving PN: glucose, potassium, magnesium and phosphorus. It is interesting to observe that the most significant alternations in these parameters occurred between the second and third day of PN. Decreases in potassium levels observed in the first few days were striking, insofar as although these were not significant, they preceded alterations in glucose, phosphorus and magnesium parameters. Blood glucose remains elevated throughout PN, peaking between the second and third day. Although blood glucose is not within reference ranges, hyperglycaemia in critical patients is usually defined as >180mg/dl.<a class="elsevierStyleCrossRef" href="#bib0130">10</a> Phosphate was also observed to decrease between the second and third day, a finding echoed by other authors.<a class="elsevierStyleCrossRef" href="#bib0105">5</a> No such differences, however, were observed in magnesium, and the differences found on day 7 and 8 could be attributed to the sample, since the mean and standard deviation observed on those days remain the same. All these changes are compatible with the start of refeeding. This is particularly true of solutions based on carbohydrates. These stimulate insulin release, which favours anabolic activity and a decrease in plasma levels of certain elements (mainly phosphorus, potassium and magnesium) due to cellular uptake.<a class="elsevierStyleCrossRef" href="#bib0115">7</a>Albumin levels, meanwhile, are almost always below reference values. All the patients presented hypoalbuminaemia at some point during the study, partly due to periods of fasting and the stress typical of critically ill patients. In addition, albumin can be elevated artificially by exogenous delivery. For all these reasons, it is not a good marker of nutritional status.Although creatinine levels decreased, this cannot be attributed to PN, but rather to factors such as overall improvement of the critically ill patient (evidenced by decreasing lactate levels), withdrawal of nutrition, or even by mortality in the most seriously ill patients. The PN solution used in the SCCU was usually a standard preparation, unlike other similar units in which it is tailored to the patient's needs.<a class="elsevierStyleCrossRef" href="#bib0135">11</a> The use of standardised PN formulas is controversial, but in order to evaluate protein catabolism and its impact on kidney function according to KDIGO guidelines,<a class="elsevierStyleCrossRef" href="#bib0140">12</a> we would have had to measure urea nitrogen in urine.<a class="elsevierStyleCrossRef" href="#bib0145">13</a>Differences in urea levels are difficult to explain, and tend to be slightly higher between day 3 and 5. In order to determine the cause of this, we would have had to perform a multifactorial analysis: kidney function, dehydration, hypovolaemic shock, gastrointestinal bleeding, hyperproteic diet, steroids, fever, etc.Other alterations observed, such as elevated LDH or GGT, could lead us to suspect liver alterations associated with the use of PN, as described in the literature.<a class="elsevierStyleCrossRef" href="#bib0150">14</a> In fact, Pallarés et al. found moderate alterations the lab test results of 78% of patients receiving PN with no history of liver dysfunction. In this case, alterations in GGT were the earliest and most commonly observed.<a class="elsevierStyleCrossRef" href="#bib0155">15</a> Self-limiting elevation of bilirubin could be explained by the overall improvement in the critically ill patient, or by the withdrawal of nutrition during the study period. However, we cannot draw valid conclusions from these findings because relatively few determinations were recorded, testing was not protocolised, there was no baseline reference value, and some days very few samples were taken. Prospective studies are needed to clarify these observations. Cyclic parenteral nutrition could help control these alterations.<a class="elsevierStyleCrossRef" href="#bib0160">16</a>Sodium levels remained in range during the study period, while other ions, such as calcium, were consistently low. These findings are also shown in <a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a> as percentage of patients and percentage of days with such alterations.Some isolated differences between days are observed, some of which are difficult to interpret. For example, the differences in albumin levels on day 7 cannot be explained in isolation, except perhaps as a chance occurrence, due to a smaller sample and differences in the distribution of the data, since the mean of the day does not differ of the rest of the data.According to the Bacteremia Zero programme,<a class="elsevierStyleCrossRef" href="#bib0125">9</a> between 5 and 7.9 cases of central-line related bacteraemia occur per 1000 days of central venous catheter use, although the same programme also cites bacteraemia rates of 14.4×1000 days of central venous catheter use.<a class="elsevierStyleCrossRef" href="#bib0125">9</a> Eight cases of bacteraemia were identified among our patients, as blood cultures were negative in the remaining cases of infection. This gives a rate of infection among patients receiving PN of 14.86 cases per 1000 days of central venous catheter use. This, we believe, is an acceptable figure, since our subgroup of patients with central venous catheter presented risk factors for infectious complications, and were not only at risk during their stay in the SCCU, but also on the ward.In summary, we found statistically significant alterations in glucose, potassium and magnesium, and a statistically significant decrease in creatinine. Hypoalbuminaemia and hypocalcaemia were very common among our patients. Major alterations occurred between the second and third day, particularly the early changes in potassium and peak blood glucose levels. The rate of central venous catheter-related infection in patients receiving PN parenteral nutrition is high, but within the limits described by the literature.Conflicts of interestThe authors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1065082" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1013099" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1065083" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1013100" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "xack360396" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-14" "fechaAceptado" => "2018-03-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1013099" "palabras" => array:5 [ 0 => "Parenteral Nutrition" 1 => "Ions" 2 => "Metabolism" 3 => "Complications" 4 => "Bacteremia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1013100" "palabras" => array:5 [ 0 => "Nutrición parenteral" 1 => "Iones" 2 => "Metabolismo" 3 => "Complicaciones" 4 => "Bacteriemia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveParenteral nutrition consists of the intravenous administration of macronutrients, micronutrients and electrolytes. Our objectives were to evaluate the biochemical alterations during the first ten days of initiation and to quantify the bacteremia related to the central venous catheter during the administration of parenteral nutrition. Material and methodsRetrospective study of incidence and prevalence. We included 51 patients who started intravenous nutritional support therapy at Critical Care. We intend to know the infectious complications of the central line associated with parenteral nutrition, to evaluate the most frequent hydroelectrolytic complications of parenteral nutrition, and to identify minimum control points in the detection of hydroelectrolytic alterations. ResultsStatistically significant daily variations were found for glucose, magnesium, potassium and creatinine, and bordering on the statistical significance for albumin and phosphate, the alterations occurring between the second and third days fundamentally. Hypoalbuminemia and hypocalcemia were very frequent. GGT was the liver enzyme that increased more frequently. The infection rate was 14.86 per 1000 days of central venous catheter. ConclusionsWe found daily variations in glucose, potassium and magnesium, as well as a decrease in creatinine. We emphasize the frequency of hypoalbuminemia, hypocalcemia and elevation of GGT. The most important variations occurred between the second and third day, highlighting the precocity of potassium alteration and the peak of glycemia. The rate of infection related to the central venous catheter in patients with parenteral nutrition was high." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoLa nutrición parenteral consiste en la administración intravenosa de macronutrientes, micronutrientes y electrolitos. Nuestros objetivos fueron evaluar las alteraciones bioquímicas durante los diez primeros días de inicio y cuantificar las bacteriemias relacionadas con el catéter venoso central durante la administración de la nutrición parenteral. Material y métodosEstudio retrospectivo de incidencia y de prevalencia. Se incluyeron 51 pacientes que iniciaron terapia de soporte nutricional intravenosa en la Unidad de Reanimación. Pretendemos conocer las complicaciones infecciosas de la vía central asociadas a nutrición parenteral, evaluar las complicaciones hidroelectrolíticas más frecuentes de la nutrición parenteral, e identificar puntos mínimos de control en la detección de las alteraciones hidroelectrolíticas. ResultadosSe encontraron variaciones diarias estadísticamente significativas para la glucosa, magnesio, potasio y creatinina, y rozando la significación estadística para la albúmina y el fosfato, ocurriendo las alteraciones entre el segundo y tercer día fundamentalmente. La hipoalbuminemia y la hipocalcemia fueron muy frecuentes. La GGT fue la enzima hepática que se elevó con más frecuencia. La tasa de infección fue de 14,86 por cada 1.000 días de catéter venoso central. ConclusionesEncontramos variaciones diarias en la glucosa, potasio y magnesio, así como también un descenso de creatinina. Destacamos la frecuencia de hipoalbuminemia, hipocalcemia y de elevación de GGT. Las variaciones más importantes ocurrieron entre el segundo y tercer día, destacando la precocidad de alteración del potasio y el pico de glucemia. La tasa de infección relacionada con el catéter venoso central en los pacientes con nutrición parenteral fue alta." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: López A, Varela JJ, Cid MM, Couñago M, Gago N. Complicaciones hidroelectrolíticas e infecciosas en un año de nutrición parenteral en cuidados críticos. Rev Esp Anestesiol Reanim. 2018;65:373–379." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1461 "Ancho" => 2895 "Tamanyo" => 225944 ] ] "descripcion" => array:1 [ "en" => "Graph showing changes in parameters over time. The values in the column on the right correspond to blood glucose." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Number of samples analysed shown in brackets." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Day \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Alb. (3.5–5.2) g/dl \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Bil. (0.1–1.2) g/dl \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GGT (8–60) U/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GGT (5–38) U/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GPT (5–41) U/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LDH (240–480) U/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Urea (19–47) mg/dl \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Creat.<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (0.5–1.5) g/dl \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.25±0.49 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.88±2.22 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">125.23±149.4 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">114.54±153.46 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">186.33±458.55 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">782.64±530.72 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.12±47.15 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.31±0.91 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.35±0.46 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.81±1.88 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">122.86±96.45 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98.29±116.13 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131.31±239.93 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">876.67±401.59 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.48±44.25 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.14±0.72 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.26±0.57 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.01±2.34 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107.45±79.92 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.45±45.97 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98.1±176.45 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">741.17±507.68 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.26±42.84 (47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.99±0.64 (47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3±0.51 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.78±2.08 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">174.25±195.74 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.83±80.47 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.7±103.57 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">447.40±184.40 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.17±46.7 (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94±0.68 (41) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.15±0.45 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9±2.23 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">256.33±227.62 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.56±35.63 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.56±75.79 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">432±0 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.18±46.03 (39<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86±0.58 (39) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.17±0.49 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.77±2.29 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">264.6±350.1 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35±13.96 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.2±22.69 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">639.00±73.54 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.78±40.37 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.77±0.46 (27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.11±0.49 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.46±3.05 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107.5±27.58 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.5±55.86 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36±0 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">730±0 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.23±41.72 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.74±0.52 (26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.06±0.8 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9±0.94 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">178.33±129.66 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24±8.04 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13±6.78 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">533±0 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.65±45.26 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.71±0.5 (23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.93±0.43 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.78±0.57 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">209±166.04 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25±8.54 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25±25.71 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">486.50±119.50 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.1±46.72 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.76±0.56 (21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.21±0.25 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.78±0.49 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">348±123.56 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.5±0.71 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.5±0.71 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">431±0 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.82±33 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.82±0.56 (17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.52±0.46 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.47±0.23 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">371.25±147.62 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20±9 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.5±6.61 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">318±0 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.8±30.97 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.73±0.51 (15) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1816140.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Statistically significant differences." ] ] ] "descripcion" => array:1 [ "en" => "Non-ionic alterations." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Number of samples analysed shown in brackets." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Day \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lactate (0.5–1.8) mmol/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Free Ca (4.7–5.4) mg/dl \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P (2.6-4.6) mg/dl \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Blood glucose<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> (83–110) mg/dl \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mg<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> (1.6–2.4) mg/dl \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">K<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> (3.5–5.1) mmol/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Na (136–147) mmol/l \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.16±1.63 (47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.34±0.46 (47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.38±1.2 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">137.86±49.64<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.94±0.4 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.94±0.77 (49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">141.94±4.67 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.07±1.99 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.41±0.42 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2±1.19 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">136.28±39.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.92±0.31 (43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.76±0.61 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142.22±4.49 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.26±2.41 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.36±0.43 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.84±1.26 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">163.96±44.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.04±0.29 (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.78±0.71 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">143.21±4.62 (47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.78±1.23 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.54±0.44 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.79±1.12 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168.9±48.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.04±0.28 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8±0.69 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">143.17±5.65 (41) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.96 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.48±0.31 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.99±1.24 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">162.18±45.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1±0.27 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.94±0.71 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142.41±5.04 (39) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.53±0.58 (24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.53±0.34 (24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.95±0.99 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">163.44±44.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.11±0.29 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.26±0.67 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">141.78±4.89 (27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.63 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.47±0.31 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.99±0.63 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">161.85±34.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.11±0.3 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.21±0.68 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140.88±5.16 (26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.38±0.49 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.47±0.27 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.29±0.81 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">162.78±40.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.02±0.4 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.29±0.6 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140.74±5.43 (23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.55±0.61 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.49±0.29 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.34±0.83 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">161.67±38.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.19±0.33 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.28±0.68 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140.71±5.54 (21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.64±0.64 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.41±0.26 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.97±0.75 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160±31.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.18±0.4 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.14±0.66 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140.12±5.16 (17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.48±0.66 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.44±0.27 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.18±0.7 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">146.33±30.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1±0.35 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.16±0.67 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140.07±5.47 (15) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1816139.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Statistically significant differences." ] ] ] "descripcion" => array:1 [ "en" => "Ionic alterations." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. patients \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Low \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Elevated \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Na (136–147) mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">K (3.5–5.1) mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">P (2.6–4.6) mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mg (1.6–2.4) mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alb. (3.5–5.2) g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Free Ca (4.7–5.4) mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood glucose (83–110) mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bil. (0.1–1.2) g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creat. (0.5–1.5) g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea (19–47) mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lactate (0.5–1.8) mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GOT (5–38) U/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GPT (5–41) U/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GGT (8–60) U/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDH (240–480) U/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1816138.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Percentage of patients with analytical alterations during the study period." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of days analysed \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Low \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Elevated \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Na (136–147) mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">356 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">K (3.5–5.1) mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">350 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">P (2.6–4.6) mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">286 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mg (1.6–2.4) mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">286 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alb. (3.5–5.2) g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">237 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Free Ca (4.7–5.4) mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">310 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood glucose (83–110) mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">356 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bil. (0.1–1.2) g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creat. (0.5–1.5) g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">356 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea (19–47) mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">356 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lactate (0.5–1.8) mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">310 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GOT (5–38) U/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GPT (5–41) U/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GGT (8–60) U/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDH (240–480) U/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1816137.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Total percentage of days (days×no. patients in whom testing was performed) with alterations." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of 3 tools to assess nutrition risk in the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. 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SERGAS-UVIGO: África Morán Álvarez, Ana Gómez Pombo, Andrea Carballude García, Ángel López Pérez, Beatriz García Martín, Cristina Teresa de Llano Sánchez, Cristina Zepeda Blanco, Guillermo Petinal Algás, Jackeline Lucia Carrera Sieiro, Javier Juan Centeno García, Jorge do Olmo Rodríguez, Laura González Dacal, Laura Lamelas Rodríguez, Leticia Gómez Viana, Lucia Tojo Díaz, Luis Martín Muñoz, María Lage Rey, María Elena Paramés Mosquera, Marta Couñago Garrido, Milagros Cid Manzano, Nerea González Salas, Noelia Gago Dieguez, Nuria Adán Valencia, Nuria Carballo Loureiro, Olalla Figueiredo González, Pablo González Montes, Sara Pardo López and Sonia Alvarado de la Torre." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006500000007/v1_201807260406/S2341192918300945/v1_201807260406/en/main.assets" "Apartado" => array:4 [ "identificador" => "34051" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000007/v1_201807260406/S2341192918300945/v1_201807260406/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300945?idApp=UINPBA00004N"]

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Hydroelectrolytic and infectious complications in one year of parenteral nutrition in critical care

Complicaciones hidroelectrolíticas e infecciosas en un año de nutrición parenteral en cuidados críticos

A. Lópeza,b,

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angel.orense@gmail.com

Corresponding author.

, J.J. Varelac, M.M. Cida,b, M. Couñagoa,b, N. Gagoa,b

a Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVigo, Vigo, Spain

b Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), Sergas, Ourense, Spain

c Servicio de Farmacia, Complexo Hospitalario Universitario de Ourense (CHUO), Sergas, Ourense, Spain

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evaluate the most frequent electrolyte complications associated with PN&#44; and establish minimum monitoring points for the early detection of electrolyte alterations&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><p id="par0035" class="elsevierStylePara elsevierViewall">This was a retrospective study in patients admitted to the surgical critical care unit &#40;SCCU&#41; of the University Hospital Complex of Ourense&#46; The research protocol&#44; number 2016&#47;370&#44; was submitted and approved by the Pontevedra-Vigo-Ourense Research Ethics Committee&#44; and the study was conducted in the University Hospital&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All surgical and trauma patients admitted to the SCCU in 2015 and receiving PN were included&#46; Patients under 18 years of age were excluded&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In our hospital&#44; the PN solution is prepared by the Pharmacy Service&#44; and according to data collected from the service&#39;s PN management software Medical One Parenteral 2011<span class="elsevierStyleSup">&#169;</span>&#44; version 2&#46;0&#46;1251&#44; 51 patients received this therapy over the study period&#46; Given the study population of 51&#44; we calculated that 50 patients would be needed to determine the percentage presenting electrolyte alterations&#44; with a statistical power of 99&#37; and a margin of error of 1&#37;&#46; If we had used the loss-adjusted sample size&#44; with a 5&#37; margin for loss of end-point parameters or early interruption of the study therapy&#44; we would have needed 53 patients&#44; which is greater than the sample size available&#46; Therefore&#44; our sample size was 51 cases&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">After obtaining the list of patients receiving PN from the SCCU&#44; we collected the remaining data from the patient&#39;s clinical history&#58; type of PN &#40;full&#44; liver disease&#44; kidney failure&#44; stress&#41;&#44; glucose&#44; sodium&#44; potassium&#44; phosphorus&#44; magnesium&#44; calcium&#44; lactate&#44; urea&#44; creatinine&#44; albumin&#44; bilirubin&#44; GOT&#44; GPT&#44; GGT&#44; LDH&#44; haemoglobin&#44; platelets&#44; leukocytes&#44; age&#44; reason for admission to the SCCU &#40;trauma&#47;non-trauma&#41;&#44; APACHE II&#44; presence of central line &#40;days&#41;&#44; catheter-induced bacteraemia with and without removal of the line&#44; probable catheter-induced bacteraemia&#44; catheter-induced infection&#44; cause of withdrawal of PN&#44; survivor&#47;non-survivor&#44; date of death&#46; If several determinations were made on a particular day&#44; the value &#40;glucose&#44; sodium&#44; potassium&#44; phosphorus&#44; magnesium&#44; calcium&#44; albumin&#44; bilirubin&#44; GOT&#44; GPT&#44; GGT&#44; LDH&#41; furthest from average reference value given in the lab report was taken as the valid measurement&#46; Analytical data were collected during the first 10 days from the start of PN&#44; or until the end of the therapy&#44; whichever occurred first&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Microbiological data to determine the presence of infectious complications were collected throughout the period of parenteral nutrition&#46; The presence of bacteraemia<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> was defined as fever&#44; chills&#44; or hypotension&#44; and a positive blood culture&#46; If common skin bacteria were identified&#44; 2 blood cultures or a positive antigen blood test were required&#46; Catheter-related microbiological findings were classified according to the Bacteraemia Zero project<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a>&#58; catheter-induced bacteraemia with and without removal of the line&#44; probable catheter-induced bacteraemia&#44; bacteraemia related to infusion fluids&#44; and catheter-related infection&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">After collecting the data&#44; we performed a preliminary analysis to identify the presence of errors that could distort the statistical analysis&#46; This is because samples taken from the venous line puncture site can be altered due to haemodilution&#46; We identified such unreliable samples by comparing them with the alterations caused by the sera administered via such lines&#44; such as decreased levels of haemoglobin&#44; platelets&#44; leukocytes&#44; together with electrolyte changes &#40;hypernatraemia&#44; hypokalaemia&#41;&#44; which are typical of the use of saline-based solutions&#46; This enabled us to remove incorrect data&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">If errors were identified in the pre-analytical stage or samples were recorded in the laboratory report as inadequate&#44; coagulated&#44; insufficient&#44; etc&#46;&#44; the data from that report were eliminated from the analysis&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">After all the study parameters had been collected&#44; the variables were tested for normality and the Kruskal&#8211;Wallis test was performed to detect statistically significant differences between the days on which the measurements were taken with respect to the start of parenteral nutrition&#46; As this test does not show probability in each group&#44; we also performed an ANOVA analysis to identify the groups with the greatest statistical difference&#46; Infectious complications were analysed on the basis of the number of complications recorded&#44; according to the classification system used in the study&#44; and the days of PN&#46; For the statistical analysis&#44; we used LibreOffice<span class="elsevierStyleSup">&#169;</span>5&#46;1 for Linux and SOFA Statistics<span class="elsevierStyleSup">&#169;</span>1&#46;4&#46;6 for Linux&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">Data were collected from 51 patients&#44; aged 70&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;91 years with an APACHE II score of 20&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;16&#46; The sample included 3 patients admitted for trauma&#44; a male&#58; female ratio of 35&#58;16&#44; and a total mortality rate of 18 patients&#46; <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> show the results of the analytical tests performed&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Statistically significant differences were found in blood glucose &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; magnesium &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41;&#44; potassium &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and creatinine &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; A borderline statistical trend was observed in albumin &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;061&#41; and phosphate &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;054&#41;&#46; In the interest of clarity&#44; mean changes in some of the parameters obtained relative to the start of parenteral nutrition are shown in graph form in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Only daily changes with a <span class="elsevierStyleItalic">p</span> value of &#60;0&#46;01 were considered&#46; Thus&#44; statistically significant differences were observed in urea &#40;days 3&#8211;5&#41;&#44; lactate &#40;day 0&#8211;4&#41;&#44; phosphorus &#40;day 2&#8211;3&#41;&#44; blood glucose &#40;day 1&#41; and magnesium &#40;days 7&#8211;8&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We calculated the percentage of patients presenting analytical alterations &#40;defined as values outside the reference range given in the laboratory report&#41; as well as the number of patients in whom each parameter was tested&#46; The results are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; For example&#44; out of the 50 patients who underwent glycaemia testing&#44; 98&#37; presented hyperglycaemia&#44; and 16&#37; presented hypoglycaemia&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">We also analysed the number of study days in which each patient presented out-of-range analytical parameters&#46; The total number of days with analytical alterations was calculated and divided by the total number of days on which the test was requested&#46; The results are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">To determine infectious complications&#44; we analysed a total of 538 days of parenteral nutrition&#44; in which 6 cases of catheter-related bacteraemia&#44; 2 cases of probable catheter-related bacteraemia&#44; and 2 of catheter-related infection were identified&#46; In total&#44; 10 infectious complications were identified&#44; of which 8 involved bacteraemia&#46; There were 14&#46;86 cases of bacteraemia for every 1000 days of central venous catheter&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Our results show the different parameters that should be monitored in patients receiving PN&#58; glucose&#44; potassium&#44; magnesium and phosphorus&#46; It is interesting to observe that the most significant alternations in these parameters occurred between the second and third day of PN&#46; Decreases in potassium levels observed in the first few days were striking&#44; insofar as although these were not significant&#44; they preceded alterations in glucose&#44; phosphorus and magnesium parameters&#46; Blood glucose remains elevated throughout PN&#44; peaking between the second and third day&#46; Although blood glucose is not within reference ranges&#44; hyperglycaemia in critical patients is usually defined as &#62;180<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> Phosphate was also observed to decrease between the second and third day&#44; a finding echoed by other authors&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> No such differences&#44; however&#44; were observed in magnesium&#44; and the differences found on day 7 and 8 could be attributed to the sample&#44; since the mean and standard deviation observed on those days remain the same&#46; All these changes are compatible with the start of refeeding&#46; This is particularly true of solutions based on carbohydrates&#46; These stimulate insulin release&#44; which favours anabolic activity and a decrease in plasma levels of certain elements &#40;mainly phosphorus&#44; potassium and magnesium&#41; due to cellular uptake&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Albumin levels&#44; meanwhile&#44; are almost always below reference values&#46; All the patients presented hypoalbuminaemia at some point during the study&#44; partly due to periods of fasting and the stress typical of critically ill patients&#46; In addition&#44; albumin can be elevated artificially by exogenous delivery&#46; For all these reasons&#44; it is not a good marker of nutritional status&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Although creatinine levels decreased&#44; this cannot be attributed to PN&#44; but rather to factors such as overall improvement of the critically ill patient &#40;evidenced by decreasing lactate levels&#41;&#44; withdrawal of nutrition&#44; or even by mortality in the most seriously ill patients&#46; The PN solution used in the SCCU was usually a standard preparation&#44; unlike other similar units in which it is tailored to the patient&#39;s needs&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> The use of standardised PN formulas is controversial&#44; but in order to evaluate protein catabolism and its impact on kidney function according to KDIGO guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> we would have had to measure urea nitrogen in urine&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Differences in urea levels are difficult to explain&#44; and tend to be slightly higher between day 3 and 5&#46; In order to determine the cause of this&#44; we would have had to perform a multifactorial analysis&#58; kidney function&#44; dehydration&#44; hypovolaemic shock&#44; gastrointestinal bleeding&#44; hyperproteic diet&#44; steroids&#44; fever&#44; etc&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Other alterations observed&#44; such as elevated LDH or GGT&#44; could lead us to suspect liver alterations associated with the use of PN&#44; as described in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> In fact&#44; Pallar&#233;s et al&#46; found moderate alterations the lab test results of 78&#37; of patients receiving PN with no history of liver dysfunction&#46; In this case&#44; alterations in GGT were the earliest and most commonly observed&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> Self-limiting elevation of bilirubin could be explained by the overall improvement in the critically ill patient&#44; or by the withdrawal of nutrition during the study period&#46; However&#44; we cannot draw valid conclusions from these findings because relatively few determinations were recorded&#44; testing was not protocolised&#44; there was no baseline reference value&#44; and some days very few samples were taken&#46; Prospective studies are needed to clarify these observations&#46; Cyclic parenteral nutrition could help control these alterations&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Sodium levels remained in range during the study period&#44; while other ions&#44; such as calcium&#44; were consistently low&#46; These findings are also shown in <a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a> as percentage of patients and percentage of days with such alterations&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Some isolated differences between days are observed&#44; some of which are difficult to interpret&#46; For example&#44; the differences in albumin levels on day 7 cannot be explained in isolation&#44; except perhaps as a chance occurrence&#44; due to a smaller sample and differences in the distribution of the data&#44; since the mean of the day does not differ of the rest of the data&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">According to the Bacteremia Zero programme&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> between 5 and 7&#46;9 cases of central-line related bacteraemia occur per 1000 days of central venous catheter use&#44; although the same programme also cites bacteraemia rates of 14&#46;4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1000 days of central venous catheter use&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> Eight cases of bacteraemia were identified among our patients&#44; as blood cultures were negative in the remaining cases of infection&#46; This gives a rate of infection among patients receiving PN of 14&#46;86 cases per 1000 days of central venous catheter use&#46; This&#44; we believe&#44; is an acceptable figure&#44; since our subgroup of patients with central venous catheter presented risk factors for infectious complications&#44; and were not only at risk during their stay in the SCCU&#44; but also on the ward&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In summary&#44; we found statistically significant alterations in glucose&#44; potassium and magnesium&#44; and a statistically significant decrease in creatinine&#46; Hypoalbuminaemia and hypocalcaemia were very common among our patients&#46; Major alterations occurred between the second and third day&#44; particularly the early changes in potassium and peak blood glucose levels&#46; The rate of central venous catheter-related infection in patients receiving PN parenteral nutrition is high&#44; but within the limits described by the literature&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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            0 => "Parenteral Nutrition"
            1 => "Ions"
            2 => "Metabolism"
            3 => "Complications"
            4 => "Bacteremia"
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            0 => "Nutrici&#243;n parenteral"
            1 => "Iones"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Parenteral nutrition consists of the intravenous administration of macronutrients&#44; micronutrients and electrolytes&#46; Our objectives were to evaluate the biochemical alterations during the first ten days of initiation and to quantify the bacteremia related to the central venous catheter during the administration of parenteral nutrition&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of incidence and prevalence&#46; We included 51 patients who started intravenous nutritional support therapy at Critical Care&#46; We intend to know the infectious complications of the central line associated with parenteral nutrition&#44; to evaluate the most frequent hydroelectrolytic complications of parenteral nutrition&#44; and to identify minimum control points in the detection of hydroelectrolytic alterations&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Statistically significant daily variations were found for glucose&#44; magnesium&#44; potassium and creatinine&#44; and bordering on the statistical significance for albumin and phosphate&#44; the alterations occurring between the second and third days fundamentally&#46; Hypoalbuminemia and hypocalcemia were very frequent&#46; GGT was the liver enzyme that increased more frequently&#46; The infection rate was 14&#46;86 per 1000 days of central venous catheter&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We found daily variations in glucose&#44; potassium and magnesium&#44; as well as a decrease in creatinine&#46; We emphasize the frequency of hypoalbuminemia&#44; hypocalcemia and elevation of GGT&#46; The most important variations occurred between the second and third day&#44; highlighting the precocity of potassium alteration and the peak of glycemia&#46; The rate of infection related to the central venous catheter in patients with parenteral nutrition was high&#46;</p></span>"
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            "titulo" => "Objective"
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            "titulo" => "Material and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La nutrici&#243;n parenteral consiste en la administraci&#243;n intravenosa de macronutrientes&#44; micronutrientes y electrolitos&#46; Nuestros objetivos fueron evaluar las alteraciones bioqu&#237;micas durante los diez primeros d&#237;as de inicio y cuantificar las bacteriemias relacionadas con el cat&#233;ter venoso central durante la administraci&#243;n de la nutrici&#243;n parenteral&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de incidencia y de prevalencia&#46; Se incluyeron 51 pacientes que iniciaron terapia de soporte nutricional intravenosa en la Unidad de Reanimaci&#243;n&#46; Pretendemos conocer las complicaciones infecciosas de la v&#237;a central asociadas a nutrici&#243;n parenteral&#44; evaluar las complicaciones hidroelectrol&#237;ticas m&#225;s frecuentes de la nutrici&#243;n parenteral&#44; e identificar puntos m&#237;nimos de control en la detecci&#243;n de las alteraciones hidroelectrol&#237;ticas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se encontraron variaciones diarias estad&#237;sticamente significativas para la glucosa&#44; magnesio&#44; potasio y creatinina&#44; y rozando la significaci&#243;n estad&#237;stica para la alb&#250;mina y el fosfato&#44; ocurriendo las alteraciones entre el segundo y tercer d&#237;a fundamentalmente&#46; La hipoalbuminemia y la hipocalcemia fueron muy frecuentes&#46; La GGT fue la enzima hep&#225;tica que se elev&#243; con m&#225;s frecuencia&#46; La tasa de infecci&#243;n fue de 14&#44;86 por cada 1&#46;000 d&#237;as de cat&#233;ter venoso central&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Encontramos variaciones diarias en la glucosa&#44; potasio y magnesio&#44; as&#237; como tambi&#233;n un descenso de creatinina&#46; Destacamos la frecuencia de hipoalbuminemia&#44; hipocalcemia y de elevaci&#243;n de GGT&#46; Las variaciones m&#225;s importantes ocurrieron entre el segundo y tercer d&#237;a&#44; destacando la precocidad de alteraci&#243;n del potasio y el pico de glucemia&#46; La tasa de infecci&#243;n relacionada con el cat&#233;ter venoso central en los pacientes con nutrici&#243;n parenteral fue alta&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; L&#243;pez A&#44; Varela JJ&#44; Cid MM&#44; Cou&#241;ago M&#44; Gago N&#46; Complicaciones hidroelectrol&#237;ticas e infecciosas en un a&#241;o de nutrici&#243;n parenteral en cuidados cr&#237;ticos&#46; Rev Esp Anestesiol Reanim&#46; 2018&#59;65&#58;373&#8211;379&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GGT &#40;8&#8211;60&#41; U&#47;l&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&#46;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;54 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;75 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Elevated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Na &#40;136&#8211;147&#41; mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">K &#40;3&#46;5&#8211;5&#46;1&#41; mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">P &#40;2&#46;6&#8211;4&#46;6&#41; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mg &#40;1&#46;6&#8211;2&#46;4&#41; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alb&#46; &#40;3&#46;5&#8211;5&#46;2&#41; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Free Ca &#40;4&#46;7&#8211;5&#46;4&#41; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood glucose &#40;83&#8211;110&#41; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bil&#46; &#40;0&#46;1&#8211;1&#46;2&#41; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creat&#46; &#40;0&#46;5&#8211;1&#46;5&#41; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea &#40;19&#8211;47&#41; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lactate &#40;0&#46;5&#8211;1&#46;8&#41; mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GOT &#40;5&#8211;38&#41; U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GPT &#40;5&#8211;41&#41; U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GGT &#40;8&#8211;60&#41; U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDH &#40;240&#8211;480&#41; U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Percentage of patients with analytical alterations during the study period&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of days analysed&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Elevated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Na &#40;136&#8211;147&#41; mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">356&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">K &#40;3&#46;5&#8211;5&#46;1&#41; mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">P &#40;2&#46;6&#8211;4&#46;6&#41; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">286&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mg &#40;1&#46;6&#8211;2&#46;4&#41; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">286&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alb&#46; &#40;3&#46;5&#8211;5&#46;2&#41; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">237&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Free Ca &#40;4&#46;7&#8211;5&#46;4&#41; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">310&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood glucose &#40;83&#8211;110&#41; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">356&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bil&#46; &#40;0&#46;1&#8211;1&#46;2&#41; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creat&#46; &#40;0&#46;5&#8211;1&#46;5&#41; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">356&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea &#40;19&#8211;47&#41; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">356&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lactate &#40;0&#46;5&#8211;1&#46;8&#41; mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">310&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GOT &#40;5&#8211;38&#41; U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GPT &#40;5&#8211;41&#41; U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GGT &#40;8&#8211;60&#41; U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDH &#40;240&#8211;480&#41; U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Total percentage of days &#40;days<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>no&#46; patients in whom testing was performed&#41; with alterations&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:16 [
            0 => array:3 [
              "identificador" => "bib0085"
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              "referencia" => array:1 [
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                  ]
                ]
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            ]
            1 => array:3 [
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            2 => array:3 [
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            ]
            3 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8519852"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "S&#237;ndrome de realimentaci&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "M&#46;T&#46; Fern&#225;ndez L&#243;pez"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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            5 => array:3 [
              "identificador" => "bib0110"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                            0 => "S&#46;E&#46; Parli"
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              "identificador" => "bib0115"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "S&#237;ndrome de realimentaci&#243;n&#46; Revisi&#243;n&#46; Refeeding syndrome&#46; A review"
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                          "etal" => false
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Refeeding syndrome&#58; screening&#44; incidence&#44; and treatment during parenteral nutrition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "R&#46;S&#46; Walmsley"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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