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PubMed2003

Spontaneous diuresis and negative fluid balance predicting recovery and survival in patients with trauma-hemorragic shock.

Most patients with trauma-hemorragic shock, prior to ICU admission, have been resuscitated and stabilized in the emergency room (ER) and/or operation room (OR). Many of them suffer from systemic edema. This extra-vascular fluid is caused by massive infusion of fluid and blood for the maintenance of blood pressure. During the recovery stage, the patients exhibit spontaneous diuresis followed by negative fluid balance. Urine volumes of some patients are more than 10000 ml/d. Do we need to maintain a balance between daily input and output of water at this situation? There are many references in the medical literature and textbooks about fluid resuscitation and the principles in maintaining the balance between input and output of water, but rarely about when and how to restrict it, that is, when and how to permit a negative balance. In this retrospective review, we examined the resuscitation records of 205 patients with systemic edema after trauma-hemorragic shock.

Adolescent↗
PubMed1989

Effects of arginine vasopressin on hemodynamics and lung fluid balance in lambs.

The purpose of this project was to study the effects of increased plasma concentrations of arginine vasopressin (AVP) on hemodynamics and lung fluid balance in lambs. We studied 16 unanesthetized newborn lambs during a base-line period and while infusing AVP into a hindlimb vein at 1.65 +/- 0.12 and 2.98 +/- 0.15 mU.kg-1.min-1. We measured aortic, pulmonary arterial, and left atrial pressures and heart rate continuously and cardiac output at frequent intervals. In five additional experiments, we collected samples of pure lung lymph during a base-line period and while infusing AVP at 2.02 +/- 0.15 mU.kg-1.min-1. AVP infusion increased plasma concentrations of AVP to 11.3 +/- 5.2 and 19.9 +/- 5.2 microU/ml at the low and high rates of infusion, respectively. Both aortic and left atrial pressures increased at the low rate of infusion (11 and 3 Torr, respectively) but remained unchanged at the higher rate. Systemic vascular resistance increased, and heart rate and cardiac output decreased at each rate of infusion. In fact, at the higher rate of infusion cardiac output decreased 38% when compared with base line. Neither pulmonary artery pressure nor pulmonary vascular resistance was affected by infusion of AVP. Despite the increase in left atrial pressure, the rate of lung lymph flow was not affected by the infusion of AVP, whereas the lymph-to-plasma protein ratio decreased slightly but significantly from 0.64 +/- 0.02 to 0.60 +/- 0.02.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Fluid balance during haemodialysis and haemofiltration: the effect of dialysate sodium and a variable ultrafiltration rate.

One of the main causes of hypotension during extracorporeal renal replacement therapy is an insufficient substitution of the ultrafiltrated plasma water by tissue water. To investigate the fluid balance and its effects on hypotension in dialysed patients, the following variables were studied: intracellular fluid volume (IFV) and extracellular fluid volume (EFV), blood volume (BV) and blood pressure. IFV and EFV were measured by means of non-invasive electrical conductivity measurements using four electrodes round the leg. Fifteen haemofiltration (HF) and 15 haemodialysis (HD) patients were studied. The latter group was dialysed in three ways: (1) conventionally, i.e. with dialysate sodium of 138 mmol/l (HD) (2) with a variable dialysate sodium (first half: 138 mmol/l; second half: 146 mmol/l) (HDS), and (3) with the same variable dialysate sodium and an ultrafiltration profile (two-thirds was withdrawn during the first half of treatment, the remainder during the second half) (HDSU). Hypotension frequency was less during HDS, HDSU, and HF compared to HD. This was caused by a more stable blood volume due to a better refill. During HD a fluid shift occurred from the EC to the IC compartment. The use of a high sodium dialysate concentration led to a transcellular fluid shift in the opposite direction. This fluid shift increased the refill, thereby stabilising blood volume. HF gave a better refill than HDS and HDSU, probably due to a reduced urea clearance.

Aged↗
PubMed2006

The effects of ad libitum fluid ingestion on fluid balance during alpine skiing in recreational skiers.

The aim of this study was to assess the influence of ad libitum water ingestion, using a back-mounted hydration system (BMHS), on fluid balance during alpine skiing. Fourteen skiers skied on two different days. On one day, seven skiers ingested water during skiing via the BMHS and the other seven skiers refrained from fluid ingestion during skiing until the midday break (NW trial). On the second day, the trials were reversed. Results indicated that when skiers used the BMHS they drank significantly more water than during the NW trials (2.0 +/- 0.9 vs. 0.78 +/- 0.4 litres). However, skiers drank significantly more at the midday break during the NW trials than during the BMHS trials (0.78 +/- 0.4 vs. 0.4 +/- 0.2 litres). Percent change in plasma volume was less during the BMHS trials than during the NW trials (-0.1 +/- 5.3 vs. -4.9 +/- 5.2%), urine osmolality was maintained in the BMHS trials but rose from 295 +/- 80 to 818 +/- 168 mOsm . kg(-1) at midday during the NW trials, and body mass loss was minimized during the BMHS trials compared with the NW trials (0.4 +/- 0.4 vs. 1.1 +/- 0.2 kg). Skiers reported that they felt significantly better when they ingested water during the BMHS trials. In conclusion, a back-mounted hydration system allowed the skiers to maintain hydration status.

Adult↗
PubMed1995

[Effects of dehydration on functional parameters of fluid balance as well as effectiveness of rehydration using crystalline or colloidal infusion drips in calves].

Studies were conducted on 57 calves (aged 3-23 d) to elucidate the effects of diarrhoeal and experimentally induced dehydration upon functional parameters of the fluid balance and of renal functionality. Aggravating intensity and length of diarrhoea was found to be accompanied by decline in intravasal and extracellular fluid compartments. Ante mortem dehydration of the animals with diarrhoea was close to 20% relative to body weight. This was paralleled by life-threatening drop of glomerular filtration rates to < 10% of original physiological values. Administration of a diuretic, associated with reduction by 50% of daily liquid uptake, proved helpful in generating dehydration of 5 to 6% relative to body weight. Evidence was provided to the effect that isooncotic colloid-electrolyte solution was superior to pure isotonic electrolyte solution for rehydration of calves dehydrated in the first place in the way described. Colloidal infusion, in particular, produced favourable therapeutic effects in terms of optimization of blood plasma volume and renal ultrafiltration.

Animals↗
PubMed1997

Fetal and maternal fluid balance in sheep during hyperthermia with and without water deprivation.

Our aim was to determine the effect of maternal hyperthermia, both with and without maternal water deprivation, on fetal fluid balance. Seven pregnant ewes (131.8 +/- 1.0 days gestation) were studied during a control period and periods of maternal heating (MH, 42-44 degrees C for 8 h, water freely available), maternal water deprivation (MWD, 30 h) and maternal heating combined with water deprivation (MH + MWD, 30 h deprivation with heating during last 8 h). Relative to control values, MH increased maternal water intake and urine output, and [K+] in fetal plasma and fetal urine. Relative to control values, MH decreased maternal plasma osmolality, [Na+] and [K+]; fetal plasma osmolality and [Na+]; fetal lung liquid [Na+] and [Cl-]; and fetal production rates of lung liquid and urine. In response to MH + MWD, the osmolality, [Na+] and [Cl-] of maternal and fetal plasma, fetal lung liquid and fetal urine (excluding urinary [Cl-]) increased compared with control values. In the fetus, MH + MWD increased plasma and urinary [K+], and decreased production rates of lung liquid and urine compared with control values. During MH + MWD, compared with MH alone, greater alterations were seen in maternal rectal temperature, water input and urine output; osmolality, [Na+] and [Cl-] of maternal and fetal plasma, fetal lung liquid and fetal urine (excluding urinary [Cl-]); and fetal urinary [K+]. During MH + MWD, compared with MWD alone, greater alterations were seen in maternal plasma [Cl-] and [K+]; fetal urinary osmolality and [K+]; and fetal plasma [K+]. Our results show that, when water is available, maternal hyperthermia stimulates ewes to drink substantially more than under normal conditions, thereby decreasing their plasma osmolality; water transfer to the fetus may increase, thereby decreasing fetal plasma osmolality. When drinking water is unavailable, maternal hyperthermia and associated dehydration may decrease water transfer to the fetus. Thus, the fetus becomes not only hyperthermic, but also hyperosmotic and possibly hypovolaemic. Maternal hyperthermia, irrespective of the availability of drinking water, decreases production rates of lung liquid and urine in the fetus.

Animals↗
PubMed1985

Effects of imidazole and indomethacin on fluid balance in isolated sheep lungs.

We determined the effects of extracorporeal perfusion with a constant flow (75 ml . min-1 . kg-1) of autologous blood on hemodynamics and fluid balance in sheep lungs isolated in situ. After 5 min, perfusate leukocyte and platelet counts fell by two-thirds. Pulmonary arterial pressure (Ppa) increased to a maximum of 32.0 +/- 3.4 Torr at 30 min and thereafter fell. Lung lymph flow (QL), measured from the superior thoracic duct, and perfusate thromboxane B2 (TXB2) concentrations followed similar time courses but lagged behind Ppa, reaching maxima of 4.1 +/- 1.2 ml/h and 2.22 +/- 0.02 ng/ml at 60 min. Lung weight gain, measured as the opposite of the weight change of the extracorporeal reservoir, and perfusate 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha) concentration increased rapidly during the first 60 min and then more gradually. After 210 min, weight gain was 224 +/- 40 g and 6-keto-PGF1 alpha concentration, 4.99 +/- 0.01 ng/ml. The ratio of lymph to plasma oncotic pressure (pi L/pi P) at 30 min was 0.61 +/- 0.06 and did not change significantly. Imidazole (5 mM) reduced the changes in TXB2, Ppa, QL, and weight and platelet count but did not alter 6-keto-PGF1 alpha, pi L/pi P, or leukocyte count. Indomethacin (0.056 mM) reduced TXB2, 6-keto-PGF1 alpha, and the early increases in weight, Ppa, and QL but did not alter the time courses of leukocyte or platelet counts. Late in perfusion, however, Ppa and QL were greater than in either untreated or imidazole-treated lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed2000

Influence of hypovolemic and hypertonic treatments on plasma vasopressin levels and fluid balance in the thyroidectomy-induced hypothyroid rats.

OBJECTIVES: This study was undertaken to investigate the effects of hypovolemic and hypertonic treatments on plasma vasopressin (AVP) levels and fluid balance in thyroidectomy-induced hypothyroidism in the rat. The influence of hypothyroidism on AVP responsiveness to hypertonic and hypovolemic stimuli were compared. MATERIALS & METHODS: Adult male rats were divided into two groups. The rats were surgically thyroidectomized (hypothyroid) or sham-operated (euthyroid). Two weeks later these groups were further divided in three subgroups each containing six rats. The first subgroup consisted of unchallenged rats. The second group underwent hypovolemic treatment by using I.P. 700 mg polyethylene glycol. The third subgroup consisted of hypertonic (1.5 M NaCl; 1 ml/100 g) stimulated animals. All rats were decapitated and trunk blood collected in heparinized tubes. Plasma samples were stored at -20 degrees C until assayed. Plasma AVP, T3 and T4 levels were measured by radioimmunoassay. Hematocrit values and plasma Na and K concentrations were also determined. RESULTS: In the hypothyroid rats, hypovolemic treatment significantly reduced the expected increases in plasma AVP levels (p<0.05) compared to the respective intact animals. In the hypertonic group, similar increases occurred in plasma AVP levels of hypothyroid and euthyroid rats. Hematocrit values and plasma Na concentrations were not significantly different in the hypothyroid rats compared to euthyroid rats. CONCLUSION: In conclusion, thyroidectomy-induced hypothyroidism may affect AVP response to hypovolemic stimulus although it has no important effect on basal AVP levels nor AVP response to hypertonic stimulus.

Journal Article↗
PubMed2001

Activation of kidney-directed neurons in the lamina terminalis by alterations in body fluid balance.

This study was undertaken to determine if neurons in the lamina terminalis, previously identified as projecting to the kidney (35), were responsive to alterations in stimuli associated with fluid balance homeostasis. Neurons in the lamina terminalis projecting to the kidney were identified by the retrograde transynaptic transport of Bartha's strain of pseudorabies virus in anesthetized rats. Rats were also exposed to 24-h water deprivation, intravenous hypertonic saline, or intracerebroventricular ANG II. To determine if "kidney-directed" neurons were activated following each stimulus, brain sections that included the lamina terminalis were examined immunohistochemically for viral antigen and Fos protein. With the exception of ANG II in the subfornical organ, all regions of the lamina terminalis contained neurons that were significantly activated by water deprivation, hypertonic saline, and ANG II. These results provide evidence for a neural substrate, which may underpin some of the effects of hypertonic saline and ANG II on renal function thought to be mediated through the lamina terminalis.

Angiotensin II↗
PubMed1986

Effects of inspiratory resistance loading on lung fluid balance in awake sheep.

Because pulmonary edema has been associated clinically with airway obstruction, we sought to determine whether decreased intrathoracic pressure, created by selective inspiratory obstruction, would affect lung fluid balance. We reasoned that if decreased intrathoracic pressure caused an increase in the transvascular hydrostatic pressure gradient, then lung lymph flow would increase and the lymph-to-plasma protein concentration ratio (L/P) would decrease. We performed experiments in six awake sheep with chronic lung lymph cannulas. After a base-line period, we added an inspiratory load (20 cmH2O) and allowed normal expiration at atmospheric pressure. Inspiratory loading was associated with a 12-cmH2O decrease in mean central airway pressure. Mean left atrial pressure fell 11 cmH2O, and mean pulmonary arterial pressure was unchanged; calculated microvascular pressure decreased 8 cmH2O. The changes that occurred in lung lymph were characteristic of those seen after other causes of increased transvascular hydrostatic gradient, such as increased intravascular pressure. Lung lymph flow increased twice base line, and L/P decreased. We conclude that inspiratory loading is associated with an increase in the pulmonary transvascular hydrostatic gradient, possibly by causing a greater fall in interstitial perimicrovascular pressure than in microvascular pressure.

Airway Obstruction↗
PubMedDate not supplied

The management of fluid balance.

This is the sixth part in the series Care is Critical, which looks at the more complex interventions nurses now have to deal with on general wards and in the community. This article looks at the clinical assessment and management of fluid-balance disturbances.

Aged↗
PubMed1996

Fluid balance and renal response following dehydrating exercise in well-trained men and women.

We examined the recovery of plasma volume, plasma osmolality, renal water and sodium handling and fluid-regulating hormones to dehydrating exercise in well-trained women and compared them to men. Ten male and eight female athletes cycled at anaerobic threshold at an ambient temperature of 32 degrees C until dehydration by 3% of their body mass (mb). After exercise, they drank water equal to 1% mb and rested for 240 min. Plasma renin activity (PRA), serum aldosterone [ALDO]s, plasma arginine vasopressin [AVP]pl, norepinephrine concentrations and plasma osmolality (Osmpl) were determined at baseline, end of exercise, 30, 60, 120 and 240 min postexercise. Urine was collected at baseline, end of exercise, 60, 120 and 240 min postexercise. Renal free water and sodium handling were assessed. The recovery of OSMpl and plasma volume occurred within the first 60 min of recovery and at similar rates between the groups. However, women had lower PRA at the end of exercise (P = 0.05), an earlier recovery of [ALDO]s, and a slower [AVP]pl recovery. Overall fluid balance was similar between the men and women, as were the early recovery of renal free water clearance (CH2O). During the last 120 min of recovery CH2O was more negative (greater water reabsorption) and fractional sodium excretion was increased in the women compared to the men. Despite small differences in sodium and water reabsorption following dehydration, it appears from other study that recovery from dehydrating exercise in well-trained men and women is remarkably similar.

Adult↗
PubMed1989

Fluid balance, vasopressin and withdrawal symptoms during detoxification from alcohol.

Nineteen patients were studied during the first 4 days after withdrawal from alcohol. Plasma vasopressin was raised (P less than 0.05) and fluid retention occurred (P less than 0.05), with falls in haematocrit (P less than 0.01) and calculated plasma osmolality (P less than 0.02), which were consistent with expansion of plasma volume. Despite these changes mean total body water was within normal limits although there were substantial inter-individual variations. There was no correlation between any measure of fluid balance and the severity of withdrawal symptoms.

Adult↗
PubMed1989

Effects of a thromboxane A2 analogue and prostacyclin on lung fluid balance in newborn lambs.

We have previously shown that the pulmonary venoconstriction produced by a stable thromboxane A2 analogue (STA2) is attenuated by prostacyclin (PGI2), but PGI2 increases the STA2-induced edema. The present study was designed to determine the effects of STA2 and PGI2 on the fluid balance in isolated blood-perfused newborn lamb lungs. Vascular permeability was evaluated by use of the fluid filtration coefficient (Kf) and the osmotic reflection coefficient for total proteins (sigma, hematocrit-protein double indicator technique), and pulmonary capillary pressure (Pc) was estimated by the double occlusion technique. All lungs had a period of hydrostatic stress induced by elevation of the left atrial pressure from 5 to 20 mm Hg to promote fluid filtration, and the rate of lung weight gain (delta W/delta T) during this period was determined. Studies were made in four groups; before the hydrostatic stress, lungs were given 1) STA2 (50 micrograms, n = 6), 2) PGI2 (0.4 micrograms/kg/min, n = 6), 3) both PGI2 and STA2 (n = 6), or 4) vehicles (control, n = 5). Measurements of Kf were made at the baseline period and after the hydrostatic stress. Kf was significantly increased by 76% with STA2, by 121% with PGI2, and by 157% with both PGI2 and STA2, but remained constant in controls. In comparison with control lungs, a similar delta W/delta T was observed with less of an increase in Pc during the hydrostatic stress in the STA2 group, and greater values of delta W/delta T were obtained with smaller elevations in Pc in the groups receiving PGI2 or both PGI2 and STA2.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

The involvement of vasopressin in the renal actions of atrial natriuretic peptide in conscious fluid-balanced rats.

The renal and endocrine actions of atrial natriuretic peptide (ANP) administered at a rate to induce plasma concentrations within the physiological range have been re-examined in conscious rats in which body fluid volume was maintained by infusion of replacement fluid at a rate to match spontaneous urine losses (servo-controlled replacement) throughout experimentation. The involvement of vasopressin in the actions of ANP was assessed by comparing the responses induced in Brattleboro (DI) and Long-Evans (LE) rats. A rate of ANP administration inducing a less than twofold increment in circulating ANP concentration evoked a small but significant diuresis and natriuresis. In contrast to previous studies during which body fluid balance had not been maintained and the response to ANP was transient, renal responses were rapid in onset and sustained over the period of hormone administration. The change in renal excretion occurred without concomitant changes in mean arterial blood pressure, haematocrit or glomerular filtration rate, and without consistent alterations in the circulating concentrations of angiotensin II, vasopressin, aldosterone or corticosterone. Furthermore, although small differences between the two strains in the character of the response could be demonstrated, the evoked response was of similar magnitude in vasopressin-replete and -deficient animals. In summary, in conscious rats in which body fluid volume was maintained, the profile of the diuretic and natriuretic responses evoked by low-rate ANP administration was different from that previously observed in anaesthetized and/or constantly infused preparations; being rapid in onset and sustained.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Fluid balance documentation: a case study of daily weight and intake/output omissions.

Daily intake and output (I&O) and weight documentation is frequently incomplete or omitted completely, even when a physician's order is in place. This brief case study illustrates the importance of maintaining these records to avoid fluid balance disorders and negative patient outcomes, as well as support patient well-being.

Body Fluids↗
PubMed1995

Effects of manganese superoxide dismutase on lung fluid balance after smoke inhalation.

There is evidence of increased oxygen free radical activity after smoke inhalation with and without concomitant burn injury. We determined the effects of manganese superoxide dismutase (Mn SOD) on lung fluid balance as measured by lung microvascular permeability coefficient (sigma), filtration coefficient (Kf), and lymph flow. Merino breed ewes (n = 6/group) were surgically prepared. The SOD group (SOD) received Mn SOD (9,000 U/kg) as an intravenous bolus and was insufflated with smoke. The control group (CON) received saline and smoke. sigma and Kf were determined 24 h before and 24 h after smoke injury. Lymph flow, arterial O2-to-inspired O2 fraction ratio, systemic hemodynamics, and pulmonary arterial and capillary pressures were measured. The sigma was significantly (P < 0.05) higher after smoke insufflation in SOD compared with CON (0.71 +/- 0.03 vs. 0.53 +/- 0.05). Kf was significantly lower after smoke insufflation in SOD compared with CON (0.038 +/- 0.010 vs. 0.061 +/- 0.010). Lymph flows were significantly lower during the 24 h after smoke insufflation in SOD compared with CON (33 +/- 7 vs. 55 +/- 8 ml/h at 24 h). Arterial O2-to-inspired O2 fraction ratio was significantly improved at 6 and 12 h after smoke insufflation in SOD compared with CON at the same time points. Mn SOD meliorates the lung microvascular permeability changes associated with smoke inhalation injury.

Administration, Inhalation↗