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Natriuretic factors and lithium clearance in patients with the syndrome of inappropriate antidiuretic hormone (SIADH)

Because the syndrome of inappropriate antidiuretic hormone (SIADH) is a state of disturbed body fluid volume regulation and altered sodium balance we sought to determine if recently described volume regulatory factors were stimulated in SIADH. We measured atrial natriuretic peptide (ANP), endogenous digitalis-like natriuretic factor (EDNF) and urinary free dopamine in SIADH (n = 27). We also determined fractional clearance of lithium (FCLi). The data obtained in SIADH were compared with similar measurements performed in sodium retaining hyponatremias, such as those of heart failure (n = 26), liver cirrhosis (n = 19) and volume contraction (n = 28). We observed: ANP was 19.5 +/- 2.7 fM/ml in SIADH; it was significantly lower than ANP in cardiac failure, but no different from ANP in volume contraction. Urinary free dopamine was 2.2 +/- 0.8 microM/24 h in SIADH; this was significantly higher than in volume contraction and liver cirrhosis. EDNF (259 +/- 42 nM/24 h) and FCLi (21.4 +/- 2%) were both numerically higher in SIADH than in other hyponatremic disorders; however, the differences did not achieve significance. In conclusion, our observations did not establish a specific role of ANP in chronic stable SIADH. As to the importance of EDNF, dopamine and proximal tubular fluid reabsorption (FCLi) additional work using acute volume changes may demonstrate their participation in the renal sodium handling of SIADH more clearly than our study did.

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New roles for an old enzyme: Na,K-ATPase emerges as an interesting drug target.

Na,K-ATPase (NKA) is well known for its role as a maintainer of electrolyte and fluid balance in cells, organs and whole body. Exciting new findings have revealed additional fundamental roles for NKA as a signal transducer and modulator of growth, apoptosis, cell adhesion and motility. The signal transduction function can be triggered by the binding of ouabain, the mammalian analogue of digitalis to NKA. The catalytic subunit of NKA exists in different forms and mutations in two of the forms that are expressed in brain can give rise to migraine, epilepsy and Parkinsonism-like symptoms. This review will present these new aspects of NKA and their clinical implications.

Animals↗

A review of the literature on how important water is to the world's elderly population.

AIM: This article reviews the literature on how important water is to the world's elderly population. BACKGROUND: Water is a finite resource, so we must preserve the water that we have. Physiological aspects and what water requirements our bodies maintain sum up this essential nutrient for life. Dehydration is a concern in the elderly. CONCLUSIONS: Five strategies related to water intake can promote health: (1) assess for symptoms which may indicate dehydration, (2) encourage ingestion of fluids and foods to maintain an optimal fluid level, (3) be alert to physical and clinical conditions affecting hydration in the elderly, (4) consider environmental factors which may affect body fluids, electrolytes and acid-base balance, and (5) encourage methods to increase fluid consumption.

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[Hyperosmolar coma in diabetes (author's transl)].

Diabetic hyperosmolar coma is characterized by the appearance of a diabetic metabolic state in middle age, lack of ketosis, osmolarity of the plasma greater than 350 milliosmoles, psychic and neurological disturbances, increased occurrence of secondary diseases, arterial thromboses, azotemia. The mortality is 30-60%. The pathogenesis is still uncertain in many respects, consequently the suggestions for therapy are varied. The authors have found the following procedure useful: rapid compensation of sodium deficit, restoration of water balance, normalization of the composition of body fluids by reference to continuous laboratory investigation.

Diabetic Coma↗

[Water-salt metabolism in white rats following a flight on the Cosmos-690 biosatellite].

As a result of a combined effect of prolonged weightlessness and ionizing radiation at a dose of 800 rad aboard the biosatellite Cosmos-690, the recovery time of certain parameters of fluid-electrolyte metabolism (hydration of the body, balance of sodium, potassium, calcium) was longer than that for the animals which flew abroad the biosatellite Cosmos-605.

Animals↗

Genetic polymorphisms detectable in human urine: their application to forensic individualization.

This review describes several types of genetic polymorphism, which have recently been identified in human urine in our laboratory, and have also been found in other human body fluids such as blood, saliva and semen. These include uropepsinogen, ribonuclease, deoxyribonuclease I (DNase I), deoxyribonuclease II (DNase II), 43-kDa glycoprotein, alpha-L-fucosidase, glutamate pyruvate transaminase, alpha-2-HS-glycoprotein, transferrin and vitamin D-binding protein. Several substances can be detected more easily in urine than in plasma. The concentrations of uropepsinogen, DNase I and DNase II in blood plasma are too low for analysis, whereas those in urine are high enough for easy typing. In practice, DNase I-polymorphism is one of the most useful genetic markers for practical purposes, because of its higher content in various body fluids including urine, a well-balanced gene frequency, and its easy and accurate detectability. Furthermore, several genetic markers previously identified in blood and/or other forensic samples can be phenotyped reproducibly and easily from the corresponding urine samples. Thus, urine, in addition to the convenience and non-invasive nature of its collection, is by no means inferior to blood as a sample source for typing in the field of forensic science. Biochemical and serological typing of genetic polymorphisms present in human urine could offer useful information to practising forensic biologists for forensic individualization of urine samples.

Deoxyribonuclease I↗

Regulation of renal and lower gastrointestinal function: role in fluid and electrolyte balance.

For the majority of vertebrates, the kidneys are not the sole organs that function to maintain homeostasis of body fluid and electrolytes. Mammals are unusual in this respect, as the kidneys are the organs that fill this role. For non-mammalian vertebrates, other organs such as gills, skin, salt glands, urinary bladders and the gastrointestinal (GI) system function in concert with the kidneys in the control of fluid and ion balance. Birds are of particular interest and unique as they do not possess a urinary bladder and the renal output enters the lower GI tract. The physiology of the interaction of avian kidneys and lower GI tract is an excellent example of integrative physiology and several aspects of it have been examined, for example, the role of the avian antidiuretic hormone (arginine vasotocin, AVT) in controlling renal output. AVT produces both a tubular and glomerular antidiuresis. The glomerular antidiuresis is important, as the fluid from the kidneys that enters the GI should not be highly concentrated. Another hormone, aldosterone, has been shown to play an important role in regulating the transport of sodium by the GI epithelium. In addition, the lower GI tract plays a significant role in recycling a portion of the nitrogen that leaves the kidneys as uric acid. Furthermore, the output of avian kidneys contains large amount of protein that is conserved by the lower GI tract.

Animals↗

Nutrition and lung water.

Lung water homeostasis and the subsequent prevention of pulmonary edema involve a balance of many forces and safety factors. Malnutrition and its effects on fluid distribution within body compartments and on oncotic pressure gradients can play a crucial role in this balance of forces. These forces are discussed, with emphasis on the complications of superimposed malnutrition.

Body Fluids↗

[An experimental study of the water balance and acid-base state of the blood during infusions of the plasma substitute oksiamal].

The influence of the plasma substitute oxyamal on shifts in the water and acid-base balance of the blood was studied in experiments on dogs with simulated severe hemorrhagic shock. Oxyamal therapy of the severe hemorrhagic shock led to a stable reduction of the volume of circulating plasma and blood, and to a rapid normalization of blood circulation. No disorders were observed in the fluid distribution in the body, acid-base balance rapidly recovered that has evidenced a full-value transcapillary water-ion exchange.

Acid-Base Equilibrium↗

A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass.

The ideal priming fluid for cardiopulmonary bypass is not known. We designed a study to determine whether there are important differences in the clinical effects of hydroxyethyl starch versus albumin when used in priming fluid, and in the clinical effects of colloid versus crystalloid priming fluid. We prospectively randomized 83 adult patients undergoing coronary artery bypass or valve replacement. All patients were managed by standardized protocol, and they received one of three priming fluids for bypass: hydroxyethyl starch (HES), 26 patients; albumin (ALB), 28 patients, and lactated Ringer's solution (LRS), 29 patients. The groups were stratified by body weight and type of operation. We measured 41 variables relating to operative time factors, fluid balance, bleeding, and organ function (renal, cardiac, and pulmonary) at several time intervals. The LRS group had a significantly lower colloid osmotic pressure than the other two groups, and the HES group had a substantially higher blood viscosity. Although the prothrombin time was significantly lower in the LRS group (p less than 0.05), the differences were very small and not clinically important. The platelet count in the HES group was significantly lower than in the other two groups immediately after bypass, but it was not different by the time the patients left the operating room. There were no differences among the groups in chest tube drainage, blood bank usage, or fluid balance. Postoperatively, the pulmonary shunt fraction was significantly greater in the LRS group. Body weight increased more in the LRS than in the HES and ALB groups (p = 0.01). No adverse reaction to the prime solutions was noted. The differences between the HES and ALB groups--prothrombin time, platelet count, and blood viscosity--had no apparent clinical effects; thus, the two may be considered clinically equivalent. The greater somatic and pulmonary fluid accumulation in the LRS group suggests that colloid is preferable to crystalloid in priming fluid.

Albumins↗

Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome.

UNLABELLED: Hemodilution and increase in capillary permeability occurring with cardiopulmonary bypass (CPB) impose a risk for tissue edema and blood transfusion that may result in an increased complication rate after coronary artery bypass grafting (CABG). Of the 1280 consecutive patients undergoing isolated on-pump CABG, total fluid balance at the end of the operation was less than or equal to 500 mL in 1155 (Group 1) and more than 500 mL in 125 (Group 2). During CPB, blood was added to the reservoir only when the hematocrit fell to 17% or less and crystalloid solution only when the pump flow index fell below 2.0 L/min/m2. Anesthetic, surgical, and postoperative management and diagnoses were the same in all patients, and a single surgical and anesthesia team performed all operations. No patient was excluded from the study. RESULTS: Hypertension, diabetes, chronic obstructive pulmonary disease, New York Heart Association (NYHA) Class III-IV, use of angiotensin converting enzyme (ACE) inhibitors, chronic renal failure, and female gender were the significant preoperative risk factors for increased volume replacement during CPB. The groups were similar in body mass index, preoperative hematocrit values, total fluid balance in the intensive care unit (ICU), and total chest tube output. However, red blood cells' transfusion rate, readmission rate to the ICU and length of hospital stay were significantly higher in Group 2 patients. Multiple logistic regression revealed that age > 70 years (p < 0.001, Odds Ratio (OR): 2, 95% CI: 1.4-2.8), and total fluid balance > 500 mL at the end of the operation (p < 0.01, OR: 2.2, 95% CI: 1.5-3.2) were the predictors of increased length of stay. For transfusion of red blood cells, age > 70 years (p < 0.0001, OR: 2.3, 95% CI: 1.6-3.3), and total fluid balance > 500 mL at the end of the operation (p < 0.001, OR: 2, 95% CI: 1.3-2.9) were the only significant risk factors. This study suggests that intraoperative volume overload increases blood transfusion and length of hospital stay in patients undergoing CABG.

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