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PubMed2001

Comparison of initial distribution volume of glucose and plasma volume in thoracic fluid-accumulated patients.

OBJECTIVE: We have reported that initial distribution volume of glucose indicates the central extracellular fluid volume in the presence of fluid gain or loss. The purpose of this study was to describe changes in initial distribution volume of glucose, plasma volume determined by the indocyanine green dilution method (PV-ICG), and thoracic fluid content by thoracic electrical bioimpedance in patients with or without apparent thoracic fluid accumulation in the absence of pleural effusion. We also sought to test whether initial distribution volume of glucose rather than PV-ICG mirrors thoracic fluid content. DESIGN: Prospective, clinical study. SETTING: General intensive care unit. PATIENTS: Eleven consecutive patients with apparent thoracic fluid accumulation as judged by thoracic fluid content >0.05/ohm and underlying pathology and 20 consecutive acute myocardial infarction patients within 24 hrs after its onset were selected for study. None of the acute myocardial infarction patients had thoracic fluid content >0.05/ohm. INTERVENTIONS: Five grams of glucose and 25 mg of indocyanine green were administered simultaneously to calculate initial distribution volume of glucose and PV-ICG daily for the fluid-accumulated patients, and the same dosages were administered to the acute myocardial infarction patients immediately after their admission to the intensive care unit after percutaneous coronary angioplasty. Only the data on the day of the maximal and minimal thoracic fluid content in the fluid-accumulated patients were used for the study. The relationship between these two fluid volumes and thoracic fluid content was evaluated in the two patient groups. MEASUREMENTS AND MAIN RESULTS: Initial distribution volume of glucose and thoracic fluid content rather than PV-ICG and thoracic fluid content moved together in the same direction in each fluid-accumulated patient. Neither pulmonary artery occlusion pressure, central venous pressure, nor PV-ICG produced a better correlation with cardiac index when compared with initial distribution volume of glucose in patients with or without thoracic fluid accumulation. CONCLUSIONS: We suggest that initial distribution volume of glucose rather than PV-ICG is a better indicator of the intrathoracic blood volume status, even although intravenously administered glucose cannot stay in the intravascular compartment.

APACHE↗
PubMed1996

Gas chromatographic determination of midazolam in low-volume plasma samples.

A gas chromatographic method for the sensitive determination of midazolam in plasma volumes as low as 40 microliters was developed, utilizing clinazolam as the internal standard. After liquid-liquid extraction at basic pH into 1-chlorobutane-dichloromethane (96:4) a 2- to 4-microliters portion of the reconstituted extract was injected under electronic pressure control onto a 12 m x 0.2 mm I.D. methyl silicone capillary column, and was exposed to a three-step temperature program from 120 to 310 degrees C, to separate the analytes from the plasma constituents. The compound of interest was identified and quantified by means of a mass-selective detector. The assay was linear from 10 to 500 ng/ml using 40 microliters of plasma (limit of quantification: 10 ng/ml) and was linear from 0.25 to 100 ng/ml using 500 microliters of plasma (limit of quantification: 0.25 ng/ml). The intra-day precision for the 40-microliters aliquots varied from 2.2 to 6.6%, the corresponding accuracy from -7.4 to -4.4%; the inter-day precision ranged from 5 to 7.2% and the corresponding accuracy from -7.2 to -5.1%.

Adjuvants, Anesthesia↗
PubMed1995

Prepartum nutrition and solar radiation in beef cattle: I. Relationships of body fluid compartments, packed cell volume, plasma urea nitrogen, and estrogens to prenatal development.

Adaptations in body fluid pools during pregnancy were monitored in cows (n = 19) assigned to either low (LO, 70% NRC total feed intake) or high (HI, 110% NRC total feed intake) nutritional level (sudangrass hay) and to either shade (S) or no shade (NS) treatments in a 2 x 2 factorial experiment. Body water distribution (empty body water [EBW] by urea dilution; extracellular water [ECW] by thiosulfate dilution; intracellular water [ICW] by difference; plasma volume by Evans Blue dilution; interstitial water [ISW] by difference) was measured at 4-wk intervals beginning at 3 mo of pregnancy until birth and then immediately after birth. Both EBW and ICW in LO cows showed a steady decline (P < or = .05), whereas HI cows tended to maintain these body pools throughout gestation. Shading did not affect the pattern of change in EBW; however, it did produce a greater (P < or = .05) ICW in the S than in the NS cows throughout gestation. Generally, other body fluid pools (ECW, ISW, and plasma) were either not affected, or were just slightly affected, by shading or nutrition. Most of the body fluid pools (EBW, ECW, ICW, and ISW) inversely followed the seasonal changes in solar radiation. Calf birth weights were not affected by treatments but were moderately correlated to EBW (r = .49; P < or = .05) and ICW (r = .50; P < or = .05). Plasma urea nitrogen change, although not affected by nutrition, was affected (P < or = .05) by shading.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1995

Pronounced and rapid plasma volume reduction upon quiet standing as revealed by a novel approach to the determination of the intravascular volume change.

Plasma volume (PV) changes to 15 min quiet standing were analysed (Hb/Hct-alterations) in two studies (nine and 11 healthy males). Data confirmed and extended our findings that blood, arterial or venous, sampled on standing fails to reveal the induced overall haemoconcentration (PV loss). First, standing led to markedly incomplete mixing of blood between circulatory compartments. Secondly, with sampling of antecubital venous blood, haemoconcentration was strongly affected by regional plasma loss and, apparently equally important, by regional blood flow. These difficulties were circumvented, however, by the finding that the PV restitution (haemoconcentration) in the recumbent subject after standing fitted invariably a monoexponential function with striking precision. It allowed, by extrapolation, a seemingly superior definition of the PV reduction at the very end of standing as supported by the fact that PV changes from Hb/Hct and from IgM protein concentration changes were similar, refuting that Fcell-changes contributed to the pronounced Hb/Hct changes. The described novel approach revealed a nicely reproducible PV loss of no less than 692 +/- 46 mL (18.1 +/- 0.6%, Study I; 18.4 +/- 0.5%, Study II), or approximately 11% reduction of blood volume, showing that quiet standing leads to a much more rapid and haemodynamically important decrease in PV than reported previously. Yet, PV was virtually restored within 20 min of recumbency after standing, with 50% recovery within 6 min and regain of as much as 70 mL in the very first min. The latter data indicate that the body possesses a surprising capacity for rapid fluid transfer from the extra- to the intravascular space.

Adult↗
PubMed1986

Does dihydroergotamine reduce plasma volume?

Indications on a plasma volume reduction by dihydroergotamine (DHE) has been found in earlier studies. This study was made in order to further evaluate such a change. In animal experiments (sheep, n = 10) measurements were performed of red blood cell volume and plasma volume using radioactive labelling techniques. Red blood cell volume was unchanged but a plasma volume decrease of 10% was found after two hours and it persisted for 24 hours. In postoperative patients (n = 9), who had been given an infusion of ringer-glucose (5.5%) at a rate of 100 ml/hour, DHE caused an increase in diuresis but neither ADH (n = 9) nor aldosterone (n = 3) levels were changed. The data from the present study further support the earlier findings of a reduced plasma volume after DHE administration. The main effect of dihydroergotamine is on the vascular bed and especially on capacitance vessels (increased tonus). The reduced plasma volume by DHE seems to be one additional effect of DHE.

Aldosterone↗
PubMed1988

Exercise stroke volume relative to plasma-volume expansion.

The effects of plasma-volume (PV) expansion on stroke volume (SV) (CO2 rebreathing) during submaximal exercise were determined. Intravenous infusion of 403 +/- 21 ml of a 6% dextran solution before exercise in the upright position increased SV 11% (i.e., 130 +/- 6 to 144 +/- 5 ml; P less than 0.05) in untrained males (n = 7). Further PV expansion (i.e., 706 +/- 43 ml) did not result in a further increase in SV (i.e., 145 +/- 4 ml). SV was somewhat higher during supine compared with upright exercise when blood volume (BV) was normal (i.e., 138 +/- 8 vs. 130 +/- 6 ml; P = 0.08). PV expansion also increased SV during exercise in the supine position (i.e., 138 +/- 8 to 150 +/- 8 ml; P less than 0.05). In contrast to these observations in untrained men, PV expansion of endurance-trained men (n = 10), who were naturally PV expanded, did not increase SV during exercise in the upright or supine positions. When BV in the untrained men was increased to match that of the endurance-trained subjects, SV was observed to be 15% higher (165 +/- 7 vs. 144 +/- 5 ml; P less than 0.05), whereas mean blood pressure and total peripheral resistance were significantly lower (P less than 0.05) in the trained compared with untrained subjects during upright exercise at a similar heart rate. The present findings indicate that exercise SV in untrained men is preload dependent and that increases in exercise SV occur in response to the first 400 ml of PV expansion. It appears that approximately one-half of the difference in SV normally observed between untrained and highly endurance-trained men during upright exercise is due to a suboptimal BV in the untrained men.

Adult↗
PubMed1986

[Effects of the intravenous injection of an ionic contrast medium on the circulating plasma volume: an assessment with plasma colloid oncotic pressure].

UNLABELLED: We investigated effects of intravenous injection of ionic contrast medium (ICM) on circulating plasma volume (CPV) by measurements of changes in plasma colloid oncotic pressure (COP). METHOD: ICM (60% meglumine iothalamate 30 ml) was injected intravenously as a bolus into 7 healthy male volunteers. The venous blood samples were drawn before, and 1, 2, 3, 5 and 10 minutes after the injection. Relatively massive doses of the ICM (150-180 ml) were infused intravenously into 6 male cardiac patients with normal cardiac and renal function during ECG gated cardiac X-ray computed tomography. The blood samples were drawn before, soon after and an hour after the infusion. The plasma COP values of the blood samples were measured with a needle-type osmometer and the sequences of CPV were estimated from the changes of COP values. RESULTS: The bolus injection of the ICM increased the CPV by 10%, 8-9 ml of the CPV per 1 ml of the ICM, and the increase continued during the study (at least for 10 minutes). The massive infusion of the ICM resulted in about 20% increase of the CVP soon after the infusion, and then induced a diuletic effect. The CVP returned to the basal level in one hour, but some patients became rather dehydrated. CONCLUSION: These findings suggested that an intravenous injection of ICM produced considerable expansion of CPV and subsequent dehydration. Careful considerations would be necessary when patients with impaired cardiac or renal function are treated with intravenous ICM during X-ray computed tomography or digital subtraction angiography.

Adult↗
PubMed2002

The regulation and measurement of plasma volume in heart failure.

Plasma volume, the intravascular portion of the extracellular fluid volume, can be measured using standard dilution techniques with radiolabeled tracer molecules. In healthy persons, plasma volume remains relatively constant as a result of tight regulation by the complex interaction between neurohormonal systems involved in sodium and water homeostasis. Although chronic heart failure (CHF) is characterized by activation of many of these neurohormonal systems, few studies have evaluated plasma volume in this condition under treatment. Untreated edematous decompensated heart failure (HF) is associated with a significant expansion of plasma volume. Patients with stable CHF, receiving conventional therapy, appear to have a contracted plasma volume, a concept that is in contrast to the widely held belief that CHF is associated with long-term hypervolemia. It is likely that significant changes in plasma volume occur during intensification of medical therapy or during transition from the edematous to the stable state. Clinical assessment of plasma volume may be of particular value during treatment in patients with decompensated HF, in whom the plasma volume is contracted despite an increase in total extracellular fluid volume. Under these circumstances, treatment with inotropes or renal vasodilators may be more appropriate than intravenous diuretics alone. Further studies evaluating plasma volume in HF may help to improve our understanding of the pathophysiologic mechanisms occurring in the development and progression of this complex condition.

Cytokines↗
PubMed1975

[Red cell mass and plasma volume in chronic cor pulmonale (author's transl)].

Red cell mass and plasma volume were simultaneously measured by Cr51 and J125-albumine, respectively, in 36 patients with chronic obstructive lung disease and cor pulmonale. Additionally, pulmonary function tests and arterial blood gas analyses as well as pulmonary circulatory and right ventricular hemodynamic measurements were performed the same day. Patients were divided into 3 clinical subgroups: 1. a predominantely emphysematous A-type (n =12), 2. a predominantly bronchial B-type (n = 12), and 3. an intermediate type (n = 12) with about equal scores for A and B. With regard to the cardiac state, A-patients were clinically characterized by small ptotic hearts on chest x-ray and the absence of overt cardiac failure during the whole course of illness whereas B-patients generally showed radiological evidence of heart dilatation associated with recurrent episodes of manifest right ventricular failure. Patients of the intermediate type mostly had recovered from cardiac failure. The following results were obtained: 1. Red cell volume, plasma volume, and total blood volume were within normal limits in A-patients and in patients of the intermediate type. A marked hypervolemia in B-patients was almost entirely due to an increased red cell volume. 2. Close correlations of the red cell volume and total blood volume, respectively, to the arterial PO2 as well as to the arterial PCO2 could be established. 3. Total blood volume was significantly correlated to certain hemodynamic parameters, including cardiac output, stroke volume, pulmonary artery pressure, and right ventricular enddiastolic pressure. 4. The quotient body hematocrit/venous hematocrit was lowered to a significant degree as compared to normal subjects. As a consequence, indirect determination of red cell volume and total blood volume from plasma volume and venous hematocrit leads to a consistent overestimation of both parameters, amounting to 28% in the mean for the red cell mass and to 12% for the total blood volume in the present series.

Blood Pressure↗
PubMed1991

Acute effects of exercise on plasma lipids, noradrenaline levels and plasma volume.

1. Total plasma cholesterol, high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), noradrenaline, haematocrit, haemoglobin and heart rate were measured in blood sampled from an antecubital vein in nine volunteers after 1 min standing and at intervals up to 1 h following 5 min of vigorous bicycle exercise. 2. Heart rates and plasma noradrenaline levels rose substantially immediately following exercise and gradually returned toward baseline levels 60 min post-exercise. 3. Total plasma cholesterol levels rose by 24% immediately post-exercise and slowly returned to baseline levels 60 min post-exercise. Similar changes were observed for LDL-C (20.2%) and HDL-C (27.7%). As a result, LDL:HDL ratios did not alter. 4. These changes in total plasma cholesterol, HDL-C and LDL-C were explained by changes in plasma volume that occurred as a consequence of vigorous exercise. 5. Changes in plasma volume may be a mechanism by which some environmental factors such as stress are associated with elevated plasma cholesterol levels.

Adult↗
PubMed1975

Volume studies. II. Simultaneous determination of plasma volume, red cell mass, extracellular fluid, and total body water before and after volume expansion in dog and man.

A method for the simultaneous determination of plasma volume, red cell mass, extracellular fluid volume, and total body water is described. Plasma volume and red cell mass were determined by a standard dual gamma-tracer technique using 125radioiodinated labeled human serum albumin (125RISA) and 51radiochromate-tagged red cells (51Cr-RBC). Extracellular fluid volume and total body water were determined by a dual beta-tracer technique which utilized radiosulfate-35 (35SO4) and tritiated water (THO), respectively. Kinetic studies of each radionuclide in normal and fluid expanded states demonstrated equilibration of 125RISA and 51Cr-RBC in 5 minutes, 35SO4 and THO in 30 minutes. The results of the volume studies in dog and man demonstrated less than 10 per cent variation on repetitive study, and better than 70 per cent accuracy in estimating a known fluid change. This technique will enable a more precise and simplified investigation of the physiology of body fluid volume regulation in health and disease.

Animals↗
PubMed2000

The initial distribution volume of glucose rather than indocyanine green derived plasma volume is correlated with cardiac output following major surgery.

OBJECTIVES: To determine whether the initial distribution volume of glucose (IDVG) rather than plasma volume or blood volume is correlated better with cardiac output during the 4 days following major surgery. DESIGN AND SETTING: Prospective clinical investigation in the general intensive care unit of a university hospital. PATIENTS AND METHODS: 31 consecutive patients who underwent radical surgery for esophageal carcinoma were enrolled. Continuous thermodilution cardiac output monitor was placed in the operating room. Indocyanine green (ICG; 25 mg) and glucose (5 g) were administered simultaneously to calculate IDVG and plasma volume determined using the ICG dilution method. Blood volume was also calculated from plasma volume ICG and hematocrit. Those volumes were measured on admission to the ICU and daily on the first 3 postoperative days. The relationships between each volume and cardiac index (CI), and between routine clinical variables and CI were evaluated. RESULTS: IDVG had a linear correlation with CI in the early postoperative days (r = 0.71, n = 124, p < 0.000001). Measurements of neither the plasma volume nor the blood volume yielded a better correlation with CI than did IDVG (r = 0.45, n = 124, p < 0.000001, and r = 0.23, n = 124, p < 0.01, respectively). No correlation was found between pulmonary artery wedge pressure and CI or between central venous pressure and CI. CONCLUSIONS: Our results indicate that IDVG rather than intravascular volume is correlated with cardiac output. We suggest that IDVG has potential as an alternative indicator of cardiac preload following major surgery.

Adult↗
PubMed1995

Effect of an equal volume replacement with 500 mL 6% hydroxyethyl starch on the blood and plasma volume of healthy volunteers.

The effect of an equal volume replacement with 6% low molecular weight (200,000) hydroxyethyl starch (substitution ratio 0.60-0.66) (Elohaes) on the blood volume and plasma volume of eight healthy volunteers was investigated with special attention to volume overshooting. After replacement of 500 mL whole blood, blood volume was measured repeatedly for 8 1/2 h using chromium-51 labelled erythrocytes. Red cell volume and plasma volume were calculated from standard formulae. After replacement, blood and plasma volumes were unchanged from control (4754 +/- 630 mL and 2900 +/- 450 mL, respectively). The haematocrit decreased from 43.7 +/- 2.5% to 39.0 +/- 1.4% (1 h after starch infusion) and 41.1 +/- 1.9% (7.5 h after starch infusion). There were no significant changes in haemodynamic variables (systolic and diastolic blood pressure; heart rate), liver function (bilirubin; transaminases), renal function (serum creatinine; serum sodium) or coagulation (activated partial thromboplastin time). Alpha-amylase was significantly increased, which is a well known effect of starches. The replacement of 500 mL whole blood by hydroxyethyl starch maintains isovolaemia for at least 8 h in normal volunteers without any significant volume overshooting; this is not what was seen in earlier studies. This should increase safety in patients with cardiac disease.

Adult↗
PubMed1983

Use of plasma volume substitutes and plasma in developing countries.

Plasma and plasma substitutes are used in the treatment of various conditions such as haemorrhage and shock. This article examines the role of crystalloids, artificial colloids, human plasma, human albumin, and plasma protein fraction, in the treatment of such patients, with particular reference to peripheral health facilities in developing countries.It is concluded that 0.9% saline, together with 5-6% dextrose, is of particular importance in this situation since it is easy to produce locally, is stable at high temperatures, and has a low cost/benefit ratio. The second priority is to ensure the availability of a limited quantity of one or more colloid plasma substitutes. In the field of plasma, fresh frozen or fresh liquid plasma is most useful for the treatment of various haemostatic derangements and follow-up treatment of severe burns, since it contains the widest spectrum of therapeutically useful components and can be produced locally with an acceptable degree of difficulty.The treatment of severe diarrhoea with special alkaline electrolyte solutions and oral rehydration solutions is also outlined.

Burns↗
PubMed1976

Plasma volume changes after infusion of various plasma expanders.

In the immediate post-operative period after moderate surgical procedures, 1 litre of a colloid solution or saline was given intravenously. The plasma volume expansion after infusion of dextran 70 (Macrodex), hydroxyethylstarch (Volex), polygelatin (Haemaccel), albumin and saline was found to be between 790 and 180 ml. The most efficent plasma expander was dextran, followed by hydroxyethylstarch. Polygelatin and saline did not give full restitution, although twice the calculated loss was infused. Total plasma protein concentration was lowered in all groups in proportion to the dilution, except for the patients given albumin, in whom the concentration of total protein increased. Calculation of the total circulating protein mass showed no decrease during the period immediately after the infusion. This investigation has demonstrated that the most efficient plasma volume expander is dextran but that hydroxyethylstarch offers an almost equal alternative in terms of volume expansion. Dextran, however, exerts an advantageous effect on the microcirculation. As the metabolic pathways of hydroxyethylstarch have not yet been further explored, dextran is preferred when using artificial colloids. Judged by its secondary effects alone, including the influence on plasma protein patterns, albumin seems to be the compound of choice. Polygelatin and saline are not efficient expanders when hypovolaemia is to be corrected rapidly.

Adult↗
PubMed1999

Mechanism for the posture-specific plasma volume increase after a single intense exercise protocol.

To test the hypothesis that exercise-induced hypervolemia is a posture-dependent process, we measured plasma volume, plasma albumin content, and renal function in seven healthy subjects for 22 h after single upright (Up) or supine (Sup) intense (85% peak oxygen consumption rate) exercise. This posture was maintained for 5 h after exercise. Plasma volume decreased during exercise but returned to control levels by 5 h of recovery in both postures. By 22 h of recovery, plasma volume increased 2.4 +/- 0.8 ml/kg in Up but decreased 2.1 +/- 0.8 ml/kg in Sup. The plasma volume expansion in Up was accompanied by an increase in plasma albumin content (0.11 +/- 0.04 g/kg; P < 0.05). Plasma albumin content was unchanged in Sup. Urine volume and sodium clearance were lower in Up than Sup (P < 0.05) by 5 h of recovery. These data suggest that increased plasma albumin content contributes to the acute phase of exercise-induced hypervolemia. More importantly, the mechanism by which exercise influences the distribution of albumin between extra- and intravascular stores after exercise is altered by posture and is unknown. We speculate that factors associated with postural changes (e.g., central venous pressure) modify the increase in plasma albumin content and the plasma volume expansion after exercise.

Adult↗
PubMed1974

Capillary permeability to protein as a factor in the control of plasma volume.

1. Measurements of plasma volume, blood volume, extracellular fluid volume and capillary permeability to albumin were made in rats before and after plasmapheresis extending over 2 days.2. In spite of a mean reduction of albumin concentration of nearly 40%, plasma volume showed a significant increase of 12%. There was a slight increase in blood volume and a slight decrease in extracellular fluid volume but these changes were not statistically significant.3. The mean capillary permeability to albumin was significantly lower after plasmapheresis than before and changes in permeability showed a strong negative correlation with changes in plasma volume. The possibility of a causal relationship is discussed.

Animals↗
PubMed2000

Measurement of plasma volume using 99Tc(m)-labelled DMP-HSA.

Red cell volume (RCV) and plasma volume (PV) measurements are performed routinely in nuclear medicine departments to diagnose a number of haematological disorders. Currently, 125I-HSA is used as a plasma tracer and 99Tcm-labelled red cells to determine red cell volume. 125I-HSA is not always readily available, leading to inconvenience for patients and medical practitioners. Due to the availability of 99Tcm in nuclear medicine departments, the use of albumin labelled with 99Tcm was investigated. A new 99Tcm-human serum albumin labelling kit (99Tcm-DMP-HSA) was developed by Verbeke and supplied for use in this study. The main aim of the study was to investigate the use of 99Tcm-DMP-HSA for PV determination. Secondly, the feasibility to determine red cell and plasma volume simultaneously using 99Tcm as radionuclide in both instances was investigated. Fourteen healthy volunteers were enrolled in the dual-phase study. During the first study, 99Tcm-DMP-HSA was used as tracer to calculate PV (PV1a) after intravenous administration. Subsequently, 99Tcm-labelled red cells were administered and the PV (PV1b) and RCV (RCV1) were calculated. The second study was repeated within 2 weeks using the conventional method. 125I-HSA and 99Tcm-labelled red cells were administered simultaneously. The PV (PV2) and RCV (RCV2) were calculated. We found that the redistribution of 99Tcm-DMP-HSA is faster than that of 125I-HSA; therefore, the plasma counts obtained at different times were back-extrapolated to time zero for plasma volume calculations. The mean values for the different calculated PVs were 2964+/-470 ml for PV1a, 3006+/-623 ml for PV1b and 3001+/-530 ml for PV2, the reference PV. The confidence intervals indicate no significant differences between plasma volumes PV1a and PV2 and plasma volumes PV1a and PV1b. The mean calculated RCV1 was 2130+/-322 ml; that of RCV2 was 2128+/-353 ml. The difference between RCV1 and RCV2 was not significant. Our results indicate that 99Tcm-DMP-HSA could be used for plasma volume calculation. Red cell and plasma volumes can be calculated simultaneously using 99Tcm as radionuclide in both cases.

Erythrocyte Volume↗