Objective-To assess the benefit of nebulised amiloride added to the standard inpatient treatment of a respiratory exacerbation in cystic fibrosis. Design-Prospective, randomised, double blind, placebo controlled trial. Subjects-27 cystic fibrosis patients (mean age 12'8 years). Setting-Two hospitals in Leeds, UK. Results-Both forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) showed improvements over the course of treatment, although there was no difference in respiratory function between the two groups at any of three time periods during the study. The time to reach peak FVC was significantly reduced in the amiloride group (4-2 v 7-6 days; 95% CI 04 to 6-4 days), but not in the time to reach peak FEV1 (5.7 v 7 9 days; 950/* CI -1*2 to 5 6 days). Conclusions-Amiloride did not result in a greater overall improvement in respiratory function. There was a suggestion that it may have an effect on the rate of improvement, and thus may possibly influence the duration of treatment. This hypothesis deserves fiurther evaluation. (Arch Dis Child 1995; 73: 427-430)
Objective We compared the relationship of protein intake (as measured by protein nitrogen appearance) and dialysis delivery in insulin-dependent diabetic (IDDM) and nondiabetic patients. Design One to two 24-hour dialysate and urine collections were obtained in 20 diabetic patients and 42 nondiabetic patients. The protein equivalent of nitrogen appearance (PNA) was calculated by the Randerson formula. KTN was determined using V obtained by the Watson formula. PNA was normalized using three different methods to determine body weight: first, by normal or ideal body weight according to the Metropolitan Table (nPNA); second, by standard body weight according to the NHANES Table (sPNA); and third, by V/0.58 (vPNA). Results The mean PNA was not different in diabetics and nondiabetics (53±21 g/day vs 60±14 g/day), nor was weekly KTN (2.1 ±0.6 vs 2.1 ±0.6). Mean normalized PNA was not different in IDDM versus non-DM regardless of the method. KTN correlated with nPNA in IDDM (r = 0.54, p = 0.002 and non-DM, r = 0.31, p = 0.03), and with vPNA in IDDM (r = 0.73, p < 0.00001, and non-DM, r = 0.45, p = 0.0009). KTN also correlated with sPNA in IDDM (r = 0.57, p = 0.001), but not in non-DM (r = 0.25, p = 0.08). The slope for normalized PNA versus KTN was steeper for IDDM than for non-DM. Conclusion KTN and PNA are more closely correlated in IDDM patients than in non-DM patients. Thus it is extremely important that IDDM patients receive an adequate level of dialysis.
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