Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications, such as tissue infiltration and thrombo-phlebitis. This systematic review aims to provide practical recommendations about diluent, pH, osmolarity, dosage, infusion rate, vesicant properties, and phlebitis rate of the most commonly used antimicrobial drugs evaluated in randomized controlled studies (RCT) till 31 March 2023. The authors searched for available IV antimicrobial drugs in RCT in PUBMED EMBASE®, EBSCO® CINAHL®, and the Cochrane Controlled Clinical trials. Drugs\' chemical features were searched online, in drug data sheets, and in scientific papers, establishing that the drugs with a pH of <5 or >9, osmolarity >600 mOsm/L, high incidence of phlebitis reported in the literature, and vesicant drugs need the adoption of utmost caution during administration. We evaluated 931 papers; 232 studies were included. A total of 82 antimicrobials were identified. Regarding antibiotics, 37 reach the \"caution\" criterion, as well as seven antivirals, 10 antifungals, and three antiprotozoals. In this subgroup of antimicrobials, the correct vascular access device (VAD) selection is essential to avoid complications due to the administration through a peripheral vein. Knowing the physicochemical characteristics of antimicrobials is crucial to improve the patient\'s safety significantly, thus avoiding administration errors and local side effects.

Low-intake dehydration is a common and often chronic condition in older adults. Adverse health outcomes associated with low-intake dehydration in older adults include poorer cognitive performance, reduced quality of life, worsened course of illness and recovery, and a high number of unplanned hospital admissions and increased mortality. The subjective methods to assess (risk of) dehydration are not reliable, and the evidence about preventive measures are also limited. So is the knowledge about the optimal intake of beverages per day. This narrative review presents the state of the science on the role of low intake hydration in older adults. Despite its simple cause-the inadequate intake of beverages-low-intake dehydration appears to be a very complex problem to address and much more research is needed in the area. Based on the existing evidence, it seems necessary to take setting specific differences and individual problems and needs into account to tackle dehydration in older adults. Further, it is necessary to increase awareness of the prevalence and severity of low-intake dehydration among older adults and in nursing staff in care homes and hospitals as well as among caregivers of older adults living at home.

The benefits which this paper addresses are those of maintaining the intracellular acid-base balance during growth, and of generating osmolarity related to regulation of turgor in environments of low water potential. These benefits may incur costs in terms of the quantity of potentially growth-limiting resources (photons, water, nitrogen) which are needed to produce unit quantity of \'baseline\' plant biomass. The direction (excess H+ or excess OH- ) and magnitude of acid-base perturbation during growth depends on the nature of the N-source (NH4 + , N2 or NO3 - ), so that the costing of pH homoiostasis involves consideration of the costs of overall N-assimilation for comparison with the other costs of growth of a terrestrial C3 plant. Photon costs for the various biochemical and transport processes involved in overall growth, N-assimilation, pH regulation and osmolarity generation are computed using known stoichiometries of coupled reactions. Water costs are deduced from the C-requirements for the various processes (including C lost in associated decarboxylations) by assuming a constant value of water lost in transpiration per unit net C fixed in an illuminated shoot. Nitrogen costs are deduced from the N-content of the plants or compounds under consideration. The computed costs for N-assimilation and the generation of osmolarity are referred to the costs of \'baseline\' plant synthesis using the cheapest mechanisms (NH4 + as source for N-assimilation; inorganic ions as the basis for osmolarity generation) so that the increment of cost related to assimilation of N2 or NO3 - , or of osmolarity generation using an organic compatible solute, can be presented. Photon costs of growth with N2 fixation and the processes associated with regulation of pH are (granted the assumptions made as to stoichiometries and plant composition) 9 % higher than are those of growth with NH4 + as N˜ source. The predicted cost of growth with NO3 - as N source depends on the location of NO3 - reduction and the mechanism of OH- disposal, and ranges from 5 to 12% more than that for growth with NH4 + as N source. H2 O (transpiration) costs follow a similar pattern, with growth on N2 as N source costing 12% more, and growth on NO3 - costing to 1-2 to 167 % more, than growth with NH4 + as N source. The extra costs in photons of using compatible solutes (sorbitol, proline or glycine betaine) to generate an osmolarity of 500 osmol m-3 in all of the non-apoplastic water of the plant add 21·5 to 26·1 % to the total costs of growth, while use of compatible solutes to generate osmolarity in \'N\' phases (i.e. cytosol, plastid stroma, mitochondrial matrix) alone would add 5·2 to 6·2% The costs of growth in terms of transpirational water are increased 7·9 to 98 % by the use of compatible solutes for osmolarity generation in the \'N\' phases only. The increments for the N-containing solutes are higher when NO3 - is the N-source rather than NH4 + . The N-cost of growth with N-containing compatible solutes generating 500 osmol m-3 in \'N\' phases increases the N cost of growth by 33%. These predicted costs are under-estimates of \'real\' costs which take into account the occurrence of alternate oxidase activity under some growth conditions and the production of additional organic acid anions with N2 as opposed to NH4 + as N source. Nevertheless, the predicted minimum costs of attaining the benefits of pH regulation and of turgor generation are of use in suggesting where selectively significant (i.e. low requirement for a scarce resource) alternative mechanisms may occur. Examples include a possible photon saving by using NH4 + rather than N2 or NO3 - where all three are available; a possible water saving by use of photoreduction of NO3 - in leaves in arid environments; and a possible N saving by use of non-N-containing compatible solutes (polyols) in environments of low water potential. Proof of these suggestions involves comparisons of inclusive fitness of genotypes possessing the trait under consideration with that of genotypes lacking the trait. CONTENTS Summary 26 I. Introduction 27 II. pH Regulation and Osmolarity Generation 27 III. Photon Costs of Various Syntheses Related to pH Regulation and Osmolarity Generation 31 IV. Conclusions on Energy Costs of pH Regulation During Nitrogen Assimilation and Growth 56 V. Conclusions on Energy Costs of Osmolarity Generation 60 VI. Water Costs of pH Regulation and Nitrogen Assimilation 61 VII. Water Costs of Osmolarity Generation 67 VIII. Nitrogen Costs of Osmolarity Generation 69 IX. Conclusions 70 Acknowledgements 72 References 73.

It has been shown that patients with end-stage renal disease (ESRD) have an increased risk for changes in intraocular pressure during hemodialysis, or ocular dialysis disequilibrium which can cause pain or discomfort during treatment and lead to decreased vision over time. This is a case of an elderly male with ESRD who was having headaches, nausea, and eye pain during hemodialysis due to increased intraocular pressures. Using a higher sodium prescription resolved his symptoms and normalized his intraocular pressures. This case illustrates that modification in dialysate tonicity can decrease changes in intraocular pressures while patients are on hemodialysis, a vision saving consideration for patients.

This study reviews the addition of compatible solutes to biological systems as a strategy to counteract osmolarity and other environmental stresses. At high osmolarity many microorganisms accumulate organic solutes called \"compatible solutes\" in order to balance osmotic pressure between the cytoplasm and the environment. These organic compounds are called compatible solutes because they can function inside the cell without the need for special adaptation of the intracellular enzymes, and also serve as protein stabilizers in the presence of high ionic strength. Moreover, the compatible solutes strategy is regularly being employed by the cell, not only under osmotic stress at high salinity, but also under other extreme environmental conditions such as low temperature, freezing, heat, starvation, dryness, recalcitrant compounds and solvent stresses. The accumulation of these solutes from the environment has energetically a lower cost than de novo synthesis. Based on this cell mechanism several studies in the field of environmental biotechnology (most of them on biological wastewater treatment) employed this strategy by exogenously adding compatible solutes to the wastewater or medium in order to alleviate environmental stress. This current paper critically reviews and evaluates these studies, and examines the future potential of this approach. In addition to this, a strategy for the successful implementation of compatible solutes in biological systems is proposed.