Magnesium citrate

Three trials were undertaken to provide an answer to different questions: 1) Are suckling pigs able to maintain physiological serum Zn levels throughout lactation and do these levels vary between high and low body weight (BW) pigs?, 2) Are serum Zn levels in pigs soon after weaning a predisposing factor for diarrhea?, and 3) Is it possible to increase serum Zn levels at weaning by supplementing Zn during lactation. In trial 1, blood samples were taken from pigs during lactation. Eight pigs (one piglet per litter) had blood drawn on days 0 (farrowing), 7, 14, 21, and 28 (weaning), and 60 pigs (selected from the whole farrowing batch with 35 sows), categorized as either heavy (8.63 kg) or light (5.50 kg) had blood drawn on day 28. Serum Zn levels at birth were 1.2 mg/L and decreased (P < 0.01) to 0.67 mg/L on day 28. Heavier pigs showed greater (P < 0.01) serum Zn levels (0.98 mg/L) than light BW pigs (0.79 mg/L). In trial 2, blood samples were obtained from 240 pigs at weaning (26.2 ± 2.5 d) with an average initial BW of 6.94 ± 1.87 kg and were distributed into 24 pens (10 pigs/pen) by BW. Diarrhea incidence was recorded daily from days 0 to 35 post-weaning. From the 240 pigs, a group of 110 pigs with uniform BW (6.5 ± 1.9 kg) was selected and separated into two groups based on serum Zn levels at weaning with 55 pigs with low serum Zn (LZn: <0.71 mg/L) and 55 pigs with high serum Zn (HZn: >0.9 mg/L). Pigs with LZn were 2.49 times as likely to have diarrhea as pigs with HZn (P < 0.02). In trial 3, a total of 96 suckling pigs were allotted four treatments that consisted of the daily administration of 0, 6, 18, or 30 mg of Zn as Zn citrate in capsule form during the last 7 d of lactation. Pigs were individually weighed, and blood samples were obtained on days 14, 21 (weaning), and 7 after weaning. Serum Zn levels linearly increased by day as Zn citrate supplementation increased (interaction, P < 0.001). However, only light pigs supplemented with 18 and 30 mg/L of Zn experienced an increase in serum Zn levels during lactation. In conclusion, a decrease in serum Zn levels occurs during lactation and is more severe in low BW pigs. Low Zn status (< 0.7 mg/L) at weaning may be a predisposing factor for diarrhea. However, Zn supplementation during lactation can mitigate this decrease in light pigs.

Despite deranged coagulation, children with liver disease undergoing continuous renal replacement therapy (CRRT) are prone to circuit clotting. Commonly used anticoagulants (i.e., heparin and citrate) can have side effects. The aim of this study was to describe our experience of using epoprostenol (a synthetic prostacyclin analog) as a sole anticoagulant during CRRT in children with liver disease.

Single-center, retrospective study, 2010–2019.

Sixteen-bedded PICU within a United Kingdom supra-regional center for pediatric hepatology.

Children with liver disease admitted to PICU who underwent CRRT anticoagulation with epoprostenol.

None.

Regarding CRRT, we assessed filter life duration, effective 60-hour filter survival, and effective solute clearance. We also assessed the frequency of major or minor bleeding episodes per 1,000 hours of CRRT, the use of platelet and RBC transfusions, and the frequency of hypotensive episodes per 1,000 hours of CRRT. In the 10 years 2010–2019, we used epoprostenol anticoagulation during 353 filter episodes of CRRT, lasting 18,508 hours, in 96 patients (over 108 admissions). Median (interquartile range [IQR]) filter life was 48 (IQR 32–72) hours, and 22.9% of filters clotted. Effective 60-hour filter survival was 60.5%.We identified that 5.9% of filters were complicated by major bleeding (1.13 episodes per 1,000 hr of CRRT), 5.1% (0.97 per 1,000 hr) by minor bleeding, and 11.6% (2.22 per 1,000 hr) by hypotension. There were no differences in filter life or clotting between patients with acute liver failure and other liver diseases; there were no differences in rates of bleeding, hypotension, or transfusion when comparing patients with initial platelets of ≤ 50 × 109 per liter to those with a higher initial count.

Epoprostenol, or prostacyclin, as the sole anticoagulant for children with liver disease receiving CRRT in PICU, results in a good circuit life, and complications such as bleeding and hypotension are similar to reports using other anticoagulants, despite concerns about coagulopathy in this cohort.