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PubMed1983

The effect of parenteral nutritional repletion on muscle water and electrolytes. Implications for body composition.

Nutritional depletion and repletion are associated with changes in the size of the extracellular and intracellular fluid compartments. Although the effect of nutrition on whole body composition is well established, the distribution of changes among the various body tissues is not. This study correlates changes in skeletal muscle composition with whole body electrolyte and nitrogen balance in an attempt to establish the contribution made by skeletal muscle to the changes in whole body fluid and electrolyte composition. Total parenteral nutrition was administered to ten patients for 16 to 25 days. Oxygen consumption, CO2 production, and balances of N, Na, and K were measured daily. Muscle biopsies were taken prior to administration of TPN, in the middle, and at the end of the nutritional regimen. Prior to administration of parenteral nutrition, muscle concentrations of water, sodium, and chloride were significantly higher than normal. With institution of the nutritional support regimen, all three concentrations decreased. The calculated loss in muscle water could account, at most, for only one-sixth of the loss in total body water. Muscle Na loss could account for approximately one-half of the whole body change. Potassium concentrations in the depleted patients were not significantly decreased from normal values and showed a negligible increase with TPN. Since the ratio of K to dry fat-free solids in muscle was constant, most of the whole body changes could be accounted for by assuming that nearly all N is deposited in muscle. Nutritional support results in restoration of cell mass with a contraction of the extracellular fluid (ECF) compartment. The changes in the ECF must occur in tissues other than muscle, while the restoration of cell mass occurs primarily in muscle.

Adult↗
PubMed1998

Volume repletion after exercise-induced volume depletion in humans: replacement of water and sodium losses.

Sodium and water loss during, and replacement after, exercise-induced volume depletion was investigated in six volunteers volume depleted by 1.89 +/- 0.17% (SD) of body mass by intermittent exercise in a warm, humid environment. Subjects exercised in a large, open plastic bag, allowing collection of all sweat secreted during exercise. For over 60 min beginning 40 min after the end of exercise, subjects ingested drinks containing 0, 25, 50, or 100 mmol/l sodium (trials 0, 25, 50, and 100) in a volume (ml) equivalent to 150% of the mass lost (g) by volume depletion. Body mass loss and sweat electrolyte (Na+, K+, and Cl-) loss were the same on each trial. The measured sweat sodium concentration was 49.2 +/- 18.5 mmol/l, and the total loss (63.9 +/- 38.7 mmol) was greater than that ingested on trials 0 and 25. Urine production over the 6-h recovery period was inversely related to the amount of sodium ingested. Subjects were in whole body negative sodium balance on trials 0 (-104 +/- 48 mmol) and 25 (-65 +/- 30 mmol) and essentially in balance on trial 50 (-13 +/- 29 mmol) but were in positive sodium balance on trial 100 (75 +/- 40 mmol). Only on trial 100 were subjects in positive fluid balance at the end of the study. There was a large urinary loss of potassium over the recovery period on trial 100, despite a negligible intake during volume repletion. These results confirm the importance of replacement of sodium as well as water for volume repletion after sweat loss. The sodium intake on trial 100 was appropriate for acute fluid balance restoration, but its consequences for potassium levels must be considered to be undesirable in terms of whole body electrolyte homeostasis for anything other than the short term.

Adult↗
PubMed2000

Core cooling by central venous infusion of ice-cold (4 degrees C and 20 degrees C) fluid: isolation of core and peripheral thermal compartments.

BACKGROUND: Central venous infusion of cold fluid may be a useful method of inducing therapeutic hypothermia. The aim of this study was to quantify systemic heat balance and regional distribution of body heat during and after central infusion of cold fluid. METHODS: The authors studied nine volunteers, each on two separate days. Anesthesia was maintained with use of isoflurane, and on each day 40 ml/kg saline was infused centrally over 30 min. On one day, the fluid was 20 degrees C and on the other it was 4 degrees C. By use of a tympanic membrane probe core (trunk and head) temperature and heat content were evaluated. Peripheral compartment (arm and leg) temperature and heat content were estimated with use of fourth-order regressions and integration over volume from 18 intramuscular thermocouples, nine skin temperatures, and "deep" hand and foot temperature. Oxygen consumption and cutaneous heat flux estimated systemic heat balance. RESULTS: After 30-min infusion of 4 degrees C or 20 degrees C fluid, core temperature decreased 2.5 +/- 0.4 degrees C and 1.4 +/- 0.2 degrees C, respectively. This reduction in core temperature was 0.8 degrees C and 0.4 degrees C more than would be expected if the change in body heat content were distributed in proportion to body mass. Reduced core temperature resulted from three factors: (1) 10-20% because cutaneous heat loss exceeded metabolic heat production; (2) 50-55% from the systemic effects of the cold fluid per se; and (3) approximately 30% because the reduction in core heat content remained partially constrained to core tissues. The postinfusion period was associated with a rapid and spontaneous recovery of core temperature. This increase in core temperature was not associated with a peripheral-to-core redistribution of body heat because core temperature remained warmer than peripheral tissues even at the end of the infusion. Instead, it resulted from constraint of metabolic heat to the core thermal compartment. CONCLUSIONS: Central venous infusion of cold fluid decreases core temperature more than would be expected were the reduction in body heat content proportionately distributed. It thus appears to be an effective method of rapidly inducing therapeutic hypothermia. When the infusion is complete, there is a spontaneous partial recovery in core temperature that facilitates rewarming to normothermia.

Adult↗
PubMed1986

Mechanism for negative water balance during weightlessness: an hypothesis.

The mechanism for the apparent decrease in body fluid volume in astronauts during spaceflight remains obscure. The widespread postulate that the hypohydration is the result of the Henry-Gauer reflex, a diuresis caused by inhibition of vasopressin secretion resulting from increased left and perhaps right atrial (central) venous pressure, has not been established with direct measurements on astronauts. An hypothesis is proposed to account for fluid-electrolyte shifts during weightlessness. A moderate but transient increase in central venous pressure occurs when orbit is entered that is insufficient to activate the Henry-Gauer reflex but sufficient to stimulate the release of atrial natriuretic peptides. Increased sodium excretion would facilitate some increased urinary water loss. The resulting relatively dilute plasma and interstitial fluids would cause fluid to shift into the cellular space, resulting in edema in the head and trunk and inhibition of thirst and drinking. Thus the negative water balance in astronauts would be caused by a gradual natriuresis and diuresis coupled with reduced fluid intake.

Biomechanical Phenomena↗
PubMed1979

Tumor-host responses to various nutritional feeding procedures in rats.

Parenteral and enteral nutrition are being used as adjuncts to cancer therapy. A liquid diet formulation containing a 27% solution of glucose and 3.9% crystalline amino acids with electrolytes and vitamins was given continuously for a week via parenteral (iv), and via intragastric (ig) routes and also was given ad libitum via the oral or per os (po) route to groups of Buffalo rats with and without a Morris No. 7777 transplantable hepatoma to find out how these feeding procedures affect tumor-host interactions. Other groups of rats with and without the hepatoma were given solid food ad libitum. The following parameters were examined: mortality, carcass and organ weights, body and tumor growth, nitrogen balance, energy intake, fluid balance, urinalysis, hematology values, and serum protein levels. The results are considered with respect to the influence of the tumor on the host and the influence of the feeding procedure on the animal with and without a tumor. The presence of the hepatoma was associated with: higher mortality, a decrease in carcass mass, leucocytosis, anemia, a decrease in serum IgG, transferrin and albumin, and an increase in serum alpha fetoprotein. The iv and ig feeding procedures alone resulted in some mortality which was exacerbated by the presence of the tumor. Mortality was especially high in the tumorous rats on the ig feeding procedure. The degree of positive nitrogen balance and carcass mass was similar in non-tumorous rats fed the same liquid diet formula when given iv, ig, or po. Tumorous rats fed the liquid diet ad libitum showed anorexia and a significantly lower nitrogen balance. The iv and ig feeding of tumorous rats at a level which was well above those of the tumorous rats given solid or liquid diet ad libitum maintained the same degree of positive nitrogen balance as non-tumorous rats. Even though the iv feeding of tumorous rats maintained about the same degree of positive nitrogen balance as non-tumorous rats, these tumorous rats still suffered loss of carcass mass. It appears that the large rapidly growing hepatoma has priority for available nutrition over the host. It is further suggested that the rapidly growing hepatoma places an ever increasing demand on the available nutrients. Thus, a point is eventually reached where even supplemental nutritional support can no longer meet the needs of the growing hepatoma and the host.

Animals↗
PubMed2000

Bioelectrical impedance analysis in the clinical management of a pregnant woman undergoing dialysis.

We report a case of successful pregnancy in a woman who was initially diagnosed with renal failure in mid-pregnancy. She was started on hemodialysis, and her fluid balance was serially monitored with bioelectrical impedance analysis. Her body weight decreased and bioelectrical impedance values increased, along with resolution of pulmonary edema in the process of the removal of excessive fluid retention with hemodialysis. The bioelectrical impedance values decreased immediately after the usual dose of oral ritodrine was administered, partly because producing sodium and water retention by ritodrine were enhanced in the setting of fluid imbalances. This decrease preceded the onset of pulmonary edema, while no changes were noted in maternal body weight before hemodialysis. These results suggest that the serial measurement of bioelectrical impedance values enables more reliable and earlier detection of abnormal water retention in pregnant women undergoing dialysis than the effect of body weight changes.

Adult↗
PubMed1995

Fluid-electrolyte balance associated with tennis match play in a hot environment.

Twenty (12 male and 8 female) tennis players from two Division I university tennis teams performed three days of round-robin tournament play (i.e., two singles tennis matches followed by one doubles match per day) in a hot environment (32.2 +/- 1.5 degrees C and 53.9 +/- 2.4% rh at 1200 hr), so that fluid-electrolyte balance could be evaluated. During singles play, body weight percentage changes were minimal and were similar for males and females (males -1.3 +/- 0.8%, females -0.7 +/- 0.8%). Estimated daily losses (mmol.day-1) of sweat sodium (Na+) and potassium (K+) (males, Na+ 158.7, K+ 31.3; females, Na+ 86.5, K+ 18.9) were met by the players' daily dietary intakes (mmol.day-1) of these electrolytes (males, Na+ 279.1 +/- 109.4, K+ 173.5 +/- 57.7; females, Na+ 178.9 +/- 68.9, K+ 116.1 +/- 37.5). Daily plasma volume and electrolyte (Na+, K+) levels were generally conserved, although, plasma [Na+] was lower (p < .05) on the morning of Day 4. This study indicated that these athletes generally maintained overall fluid-electrolyte balance, in response to playing multiple tennis matches on 3 successive days in a hot environment, without the occurrence of heat illness.

Adolescent↗
PubMed2002

Significance of intraabdominal compartment pressures following TRAM flap breast reconstruction and the correlation of results.

Abdominal wall closure after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction is often performed under considerable tension and may theoretically cause a component of abdominal compartment syndrome. This prospective study examined intraabdominal pressure after TRAM reconstruction and correlated the findings with clinical course and outcome. All patients who underwent pedicled TRAM flap breast reconstruction from November of 1999 to December of 2000 (n = 77) were included and compared with nonoperative controls (n = 24). Intraabdominal pressures were measured indirectly using the urinary catheter in the postanesthesia care unit on postoperative days 1 and 2. Outcome measures included vital signs, urinary output, net 24-degree fluid balance, and complications. The preoperative variables were age, body mass index, parity, and presence of an epidural. For statistical analysis, the TRAM patients were divided into three groups on the basis of type of closure (bipedicle, unipedicle, and mesh), which were compared by analysis of variance. A multivariate logistic regression was performed to identify risk factors for patients with intraabdominal pressures > or =20 mmHg who were thought to have a component of abdominal compartment syndrome. The incidence of complications was compared by chi-square, with statistical significance determined for p < 0.05. Average intraabdominal pressures were significantly higher in the bipedicled TRAM (14.1 mmHg) and unipedicle TRAM (9.9 mmHg) groups when compared with the mesh group (5 mmHg) and controls (3.7 mmHg; p < 0.001). Increased intraabdominal pressure was transient and peaked on postoperative day 1. Elevated pressure was associated with decreased urinary output, decreased net fluid balance, and increased respiratory rate. Patients with intraabdominal pressures > or =20 mmHg (n = 10) had a higher incidence of complications (60 percent) compared with patients who had pressures <20 mmHg (18 percent; p < 0.05). Elevated intraabdominal pressures were strongly associated with donor-site and general complications. Positive predictive factors for elevated pressure included body mass index and type of closure (bipedicled or bilateral). Multiple pregnancies seemed to have a protective effect.A transient component of abdominal compartment syndrome does exist after TRAM flap breast reconstruction. Bipedicle closure, nulliparous women, and increased body mass index were risk factors for elevated intraabdominal pressures. Tension-free mesh closure seemed to have a protective effect. Symptomatic trends and certain complications were associated with, and possibly explained by, an elevated intraabdominal pressure.

Abdomen↗
PubMed2002

Clinical approach to disorders of salt and water balance. Emphasis on integrative physiology.

Our purpose was to illustrate the utility of an approach that begins with simple principles of physiology to patients who have a disturbance in salt and water balance (Table 1). At times, the physiology is restricted to the kidney and body fluid compartments. In these settings, the goals of therapy are defined by calculating a tonicity balance--electrolyte-free water balances simply do not provide the needed information [3]. At other times, performing balances of other solutes such as urea reveal that another critically important problem is present (tissue catabolism). Thus the physiologic analysis becomes more integrative, extending beyond renal issues. Goals for therapy become clearer once the integrative physiology is known. More modern contributions from molecular studies permit a revised interpretation of the physiology. An example presented was the possible role of gentamicin-like drugs as a cause of high output renal failure that is basically a persistent loop diuretic-like effect. In the patient presenting with hyponatremia, the first step is to determine if the time course is less than 48-hours because emergency therapy is different in this setting. With acute hyponatremia, the objective is to diminish brain cell swelling especially if even mild symptoms are present. In contrast, the objective in the patient with chronic hyponatremia is to prevent ODS. An even slower rate of rise of the PNa is required in patients who are malnourished and/or K+ depleted.

Acute Disease↗