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array:20 [ "pii" => "S2173572724002248" "issn" => "21735727" "doi" => "10.1016/j.medine.2024.09.003" "estado" => "S200" "fechaPublicacion" => "2024-10-14" "aid" => "2082" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:17 [ "pii" => "S2173572724000274" "issn" => "21735727" "doi" => "10.1016/j.medine.2024.02.003" "estado" => "S200" "fechaPublicacion" => "2024-02-25" "aid" => "1976" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Fractional excretion of sodium and potassium and urinary strong ion difference in the evaluation of persistent AKI in sepsis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Excreción fraccional de sodio y potasio, y brecha aniónica urinaria en la evaluación de la IRA persistente en sepsis" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1448 "Ancho" => 1675 "Tamanyo" => 110835 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0135" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">ROC curve showing the area under de curve of FENa, FEK and uSID.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">FENa: fractional excretion of sodium; FEK: fractional excretion of potassium; uSID: urinary strong ion difference.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nicolás Contrera Rolón, Joaquín Cantos, Iván Huespe, Eduardo Prado, Griselda I. Bratti, Carlos Schreck, Sergio Giannasi, Guillermo Rosa Diez, Carlos F. Varela" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Contrera Rolón" ] 1 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Cantos" ] 2 => array:2 [ "nombre" => "Iván" "apellidos" => "Huespe" ] 3 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Prado" ] 4 => array:2 [ "nombre" => "Griselda I." "apellidos" => "Bratti" ] 5 => array:2 [ "nombre" => "Carlos" "apellidos" => "Schreck" ] 6 => array:2 [ "nombre" => "Sergio" "apellidos" => "Giannasi" ] 7 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Rosa Diez" ] 8 => array:2 [ "nombre" => "Carlos F." "apellidos" => "Varela" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724000274?idApp=WMIE" "url" => "/21735727/unassign/S2173572724000274/v1_202402251056/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "When fat-free parenteral nutrition is required: The strategy that becomes a double-edge sword" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marta de Antonio-Cuscó, Agustí Albalat-Torres, Lucía Picazo Moreno, Javier Mateu-de Antonio" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Marta" "apellidos" => "de Antonio-Cuscó" "email" => array:1 [ 0 => "61323@psmar.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Agustí" "apellidos" => "Albalat-Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Lucía Picazo" "apellidos" => "Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Javier" "apellidos" => "Mateu-de Antonio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Pharmacy Department, Hospital del Mar, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Critical Care Department, Hospital del Mar, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuando se requiere una nutrición parenteral libre de lípidos: la estrategia que se convierte en una espada de doble filo" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Recently, several cases requiring the restriction or suppression of intravenous lipid emulsion (ILE) in parenteral nutrition (PN) have been presented in the ICU of our hospital.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Fat-restrictive strategies in PN should be applied in episodes of severe hypertriglyceridemia, commonly related to critical illness, or allergy to components of ILE. In this context, the solution applied to this clinical problem exposes the patient to a new potential risk of developing an essential fatty acid deficiency (EFAD), difficult to manage.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Linoleic acid (LA) (18:2ω-6) and α-linolenic acid (ALA) (18:3ω-3) are the essential fatty acids (EFAs) for humans and must be obtained from dietary intake.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> EFAD can lead to various physiological consequences, such as the disturbances in biomembrane structures, cell signaling mechanisms, transduction/transcription procedures, susceptibility to oxidative stress, proinflammatory (n-6-derived eicosanoids), and anti-inflammatory (n-3-derived eicosanoids) processes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its clinical signs are diverse and mainly include skin and hair alterations, diminished immune system status, hematological alterations, and/or hepatic steatosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">EFAD is rarely described in the presence of a balanced diet because only 2–4% and 0.25% of total energy should come from LA and ALA, respectively.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, this clinical entity was reported in 30%, 66%, 83%, and 100% of patients with fat-free PN after 1, 2, 3, and 4 weeks, respectively.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These data may be relevant, especially in those allergies directly related to soybean or indirectly (cross allergies), such as peanuts, when lipid administration is precluded in PN due to the lack of availability of soybean-free ILEs. A possible alternative could be the use of an ILE based solely on fish oil, as this emulsion has not shown any evidence of EFAD when used as the sole fat source in home PN.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, it is not commercialized in Spain, so a request for its importation and for each case must be made to the Spanish Medicines Agency and wait for its approval.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Additional solutions are not good alternatives, either. Switching to enteral nutrition when possible is not feasible in cases of soybean or peanut allergy since all enteral diets marketed include soy lecithin. The topical administration of oils as a source of EFAs has no solid evidence in adult patients as it seems only to act at skin level.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">To provide an early diagnosis and as a monitoring tool of EFAD, we propose to rescue the almost forgotten triene/tetraene ratio (T:T-ratio) (eicosatrienoic acid/arachidonic acid), a biochemical marker of both.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Serum mead acid (20:3 n-9) to arachidonic acid (20:4 n-6) ratios greater than 0.2 suggest EFAD,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> indicating increased metabolism of oleic acid to mead acid due to inadequate LA and ALA intake.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Biochemical evidence of EFAD with T:T-ratio usually can be detected two weeks before the clinical signs and symptoms appear.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However, EFAD in obese individuals develops over a longer term due to fat mobilization from adipose tissue.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Given the complex management of EFAD and the current limited therapeutic arsenal available, we recommend closely monitoring this clinical entity in patients requiring lipid-restricted PN and establishing the T:T-ratio in hospital biochemical panels for early detection in high-risk situations.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Essential fatty acid requirements and intravenous lipid emulsions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Gramlich" 1 => "C. Ireton-Jones" 2 => "J.M. Miles" 3 => "M. Morrison" 4 => "A. Pontes-Arruda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jpen.1537" "Revista" => array:6 [ "tituloSerie" => "J Parenter Enter Nutr" "fecha" => "2019" "volumen" => "43" "paginaInicial" => "697" "paginaFinal" => "707" "itemHostRev" => array:3 [ "pii" => "S0165032719330903" "estado" => "S300" "issn" => "01650327" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pharmacokinetics in hepatic impairment: mind the protein binding" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Chtioui" 1 => "T. Buclin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2015.07.042" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2015" "volumen" => "63" "paginaInicial" => "1539" "paginaFinal" => "1540" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26343957" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical application of fish-oil intravenous lipid emulsion in adult home parenteral nutrition patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.S. Mundi" 1 => "S.L. Bonnes" 2 => "B.R. Salonen" 3 => "M.M. McMahon" 4 => "R. Martindale" 5 => "R.T. Hurt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ncp.10581" "Revista" => array:5 [ "tituloSerie" => "Nutr Clin Pract" "fecha" => "2021" "volumen" => "36" "paginaInicial" => "839" "paginaFinal" => "852" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can cutaneous application of vegetable oil prevent an essential fatty acid deficiency?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W. Marcason" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jada.2007.05.028" "Revista" => array:6 [ "tituloSerie" => "J Am Diet Assoc" "fecha" => "2007" "volumen" => "107" "numero" => "7" "paginaInicial" => "1262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17604757" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Essential fatty acid deficiency in a murine model" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "HD Le" 1 => "EM Fallon" 2 => "B.T. Kalish" 3 => "VE De Meijer" 4 => "J.A. Meisel" 5 => "K.M. Gura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.metabol.2012.10.003" "Revista" => array:6 [ "tituloSerie" => "Metabolism" "fecha" => "2013" "volumen" => "62" "paginaInicial" => "499" "paginaFinal" => "508" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23151438" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/unassign/S2173572724002248/v1_202410140409/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735727/unassign/S2173572724002248/v1_202410140409/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724002248?idApp=WMIE" ]
