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PubMed2004

Effect of sodium balance and the combination of ultrafiltration profile during sodium profiling hemodialysis on the maintenance of the quality of dialysis and sodium and fluid balances.

Excessive sodium gain is a major hindrance of sodium profiling hemodialysis (HD) that offsets the benefit in reducing intradialytic hypotension-related discomforts (IHD). Patients who showed frequent IHD (>30% of the sessions; n = 11) were enrolled in a prospective study that consisted of two phases. In the phase 1 study, eight treatment modalities were evaluated: Conventional HD (control), sodium balance-positive step-down sodium profiling HD (PS), sodium balance-neutral step-down sodium profiling HD (NS), sodium balance-neutral alternating sodium profiling HD (NA) without ultrafiltration (UF) profile, and all those with UF profile (UF only, PS+U, NS+U, and NA+U). The incidences of "dialysis failure," defined as the occurrence of one or more of (1) session failure (discontinuation of session <75% of planned time), (2) UF failure (%UF achieved <70%), and (3) delivery failure (Kt/V <1.1), were 48.5, 21.2, 42.4, 39.4, 45.5, 18.2, 21.2, and 18.2% in control, PS, NS, NA, UF only, PS+U, NS+U, and NA+U, respectively. Four treatments, PS, PS+U, NS+U, and NA+U, reduced the incidence of dialysis failure significantly as compared with control (P < 0.05) and were evaluated in the phase 2 study, a randomized controlled 6-wk crossover study. Parameters were measured in the steady state after a 6-wk maintenance of each treatment. Diffusive sodium gain (DeltaNa) was significantly increased with sodium balance-positive profiles with or without UF profile, PS and PS+U (PS 1.9 +/- 1.1, PS+U 1.7 +/- 1.0 mEq/L; both P < 0.05 to control -0.1 +/- 0.2, NS+U 0.5 +/- 0.4, NA+U 0.4 +/- 0.2 mEq/L). They also increased the interdialytic weight gain (PS 3.8 +/- 0.6, PS+U 4.0 +/- 0.6 kg; both P < 0.05 to control 2.7 +/- 0.6, NS+U 3.3 +/- 0.6 kg; both P = NS to NA+U 3.5 +/- 0.6 kg). Predialysis weight and the required amount of UF also increased significantly with these sodium balance-positive profiles. Although the absolute amount of UF was larger with PS and PS+U, %UF achieved targeting dry weight was higher with sodium balance-neutral profiles with UF profiles, NS+U and NA+U (NS+U 92.7 +/- 3.8, NA+U 93.7 +/- 6.8%; both P < 0.05 to control 72.6 +/- 14.0, PS 88.3 +/- 6.6, PS+U 88.2 +/- 8.2%). Postdialysis weight was closest to dry weight with these treatments showing Delta (postdialysis weight - dry weight) of 0.3 +/- 0.1 and 0.3 +/- 0.2 kg in NS+U and NA+U (both P < 0.05 to control 1.0 +/- 0.6 kg; both P = NS to PS 0.5 +/- 0.3, PS+U 0.5 +/- 0.4 kg). Incidence of excessive weight gain and subjective discomforts during the interdialytic period increased significantly with PS. In conclusion, continuous use of sodium balance-positive sodium profiles resulted in an undesirable steady state with sodium and fluid expansion offsetting their hemodynamic benefit. Sodium balance-neutral sodium profiles in combination with UF profile were associated with less sodium and weight gains, better UF performance with postdialysis weight closest to dry weight, and fewer interdialytic problems with the equivalent hemodynamic benefit. Therefore, it is proposed that sodium balance-neutral sodium profiling HD with UF profile is a better choice, ensuring the dialysis of quality without sodium gain-related complications.

Body Weight↗
PubMed1997

Surfactant regulates pulmonary fluid balance in reptiles.

Reptilian lungs are potentially susceptible to fluid disturbances because they have very high pulmonary fluid filtration rates. In mammals, pulmonary surfactant protects the lung from developing alveolar edema. Reptiles also have an order of magnitude more surfactant per square centimeter of respiratory surface area compared with mammals. We investigated the role of reptilian surfactant 1) in the entry of vascularly derived fluid into the alveolar space of the isolated perfused lizard (Pogona vitticeps) lung and 2) in the removal of accumulated fluid from the alveolar space of the isolated perfused turtle (Trachemys scripta) lung by both the pulmonary venous and lymphatic circulations. The flux of fluorescent (fluorescein isothiocyanate) inulin from the vasculature into the alveolar compartment increased 60% after the removal of surfactant, but capillary fluid filtration over a 10-min period was not affected. Surfactant removal decreased alveolar inulin clearance by both the pulmonary venous circulation and the pulmonary lymphatic system approximately 1.5- and 3-fold, respectively. In reptiles, fluid flux from capillary to air space must occur indirectly via the interstitium. In the absence of surfactant, this may result in interstitial drying, which affects both pulmonary venous and pulmonary lymphatic clearance of alveolar fluid.

Animals↗
PubMed1997

Restoration of fluid balance after exercise-induced dehydration: effects of alcohol consumption.

The effect of alcohol consumption on the restoration of fluid and electrolyte balance after exercise-induced dehydration [2.01 +/- 0.10% (SD) of body mass] was investigated. Drinks containing 0, 1, 2, and 4% alcohol were consumed over 60 min beginning 30 min after the end of exercise; a different beverage was consumed in each of four trials. The volume consumed (2,212 +/- 153 ml) was equivalent to 150% of body mass loss. Peak urine flow rate occurred later (P = 0.024) with the 4% beverage. The total volume of urine produced over the 6 h after rehydration, although not different between trials (P = 0.307), tended to increase as the quantity of alcohol ingested increased. The increase in blood (P = 0.013) and plasma (P = 0.050) volume with rehydration was slower when the 4% beverage was consumed and did not increase to values significantly greater than the dehydrated level (P = 0.013 and P = 0.050 for blood volume and plasma volume, respectively); generally, the increase was an inverse function of the quantity of alcohol consumed. These results suggest that alcohol has a negligible diuretic effect when consumed in dilute solution after a moderate level of hypohydration induced by exercise in the heat. There appears to be no difference in recovery from dehydration whether the rehydration beverage is alcohol free or contains up to 2% alcohol, but drinks containing 4% alcohol tend to delay the recovery process.

Adult↗
PubMed1990

Hydrostatic and oncotic determinants of microvascular fluid balance in normal canine joints.

Water moves between plasma (p) and synovial fluid (SF) in response to gradients in the balance of opposing hydrostatic pressures (HP) and oncotic pressures (OP). At the vascular site where proximal filtration ceases and distal reabsorption begins, all forces are theoretically in balance. At this point, the transitional microvascular pressure (TMP) may be estimated from the equation TMP = HPSF + OPP - OPSF. We measured these forces in the shoulders, wrists, and knees of 10 normal dogs, ages 2-10 years. The mean HPSF in the knee was lower than that in the shoulders and significantly lower than that in the wrist. Conversely, the OPSF in the wrist was significantly lower than that in the shoulder or the knee. These factors combined indicate that the microvascular bed in the normal knee has a remarkably low mean TMP (7.9 mm Hg). We also found a strong positive correlation between the age of each dog and the mean oncotic pressure of its SF.

Animals↗
PubMed1996

Pulmonary vascular filtration of starch-based macromolecules: effects on lung fluid balance.

BACKGROUND: Pulmonary edema is a complication of critical care fluid management that may be restricted by the use of oncotically effective resuscitation fluids. Potentially beneficial oncotic properties of starch-based plasma volume expanders such as hetastarch (Het), pentafraction (Pen), and Dextran-70 (Dex) may be compromised by their broad range of molecular masses, some of which are small enough to filter from the circulation. Leakage of these molecules into the pulmonary interstitium may limit their oncotic effectiveness and enhance fluid filtration. We measured the filtration of these three resuscitation solutions into lung lymph to evaluate their oncotic contribution to pulmonary edema formation. MATERIALS AND METHODS: Unanesthetized euvolemic adult sheep, prepared with chronic lung lymph fistulae, underwent plasma volume expansion with Het (n = 6), Pen (n = 6), or Dex (n = 6 ) (6%, 35 ml/kg/90 min). Oncotic effectiveness was determined by measuring plasma and lymph oncotic pressures and the oncotic pressures contributed by each starch. Pulmonary hydrostatic pressures and lung lymph flows (Q(L)) were also measured. Results are expressed as means +/- SEM. Comparisons were made by two-factor analysis of variance. RESULTS: Dex contributed 9.0 +/- 0.9 mmHg to the plasma oncotic pressure, significantly more than Het and Pen (5.3 +/- 0.6, 6.5 +/- 0.6 mmHg, respectively). However, Dex filtration also contributed 6.1 +/- 0.5 mmHg to the lymph oncotic pressure, compared to 3.1 +/- 0.3 and 4.7 +/- 0.5 mmHg for Het and Pen, respectively (P < or = 0.05). Dex, Het, and Pen raised Q(L) over baseline by 7.7 +/- 1.5, 4.3 +/- 1.0, and 3.2 +/- 0.7 ml/30 min, respectively (P < or = 0.05). Dex increased Q(L) significantly more than Het or Pen. CONCLUSIONS: Pen and Het demonstrated greater oncotic effectiveness because of restricted plasma-to-lymph macromolecular filtration and limited transvascular fluid flux. By comparison, Dex filtered rapidly and increased transvascular fluid filtration. Pen appears to possess filtration properties that optimize critical care fluid management compared to currently available colloid solutions such as Het and Dex.

Animals↗