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PubMed1997

Human fluid balance modelling and its treatment simulation with HIDION.

HIDION is a tanden system composed of an expert system for diagnosis of the water and electrolytic balance disturbance and a modelling program for simulation and suggestion of the needed correction. The expert system attempts to make a diagnosis mainly based on clinical symptoms and on patient history, as they are generally available for most physicians. The treatment module assists the user to establish a right strategy for re-equilibration of the fluid balance. The first aim of the system is to achieve a correct diagnosis of the disturbances of the fluid balance and a choice of therapy tactics. The second aim of the system is an educational one for both physicians and nurses. The entire system, including the expert module as well as the modelling module is developed in Turbo Prolog.

Computer Simulation↗
PubMed1998

Comparison of respiratory function and fluid balance in very low birthweight infants given artificial or natural surfactant or no surfactant treatment.

Exogenous surfactant administration improves respiratory function. The speed of improvement appears greater if a natural rather than an artificial surfactant is used, our aim was to determine if that effect was explained by differences in fluid balance, evidenced by the timing of the diuresis onset (i.e. output greater than input). Thirty infants (median gestational age 29 weeks), 10 given an artificial surfactant (Exosurf), 10 a natural surfactant (Survanta) and 10 no surfactant (controls) were studied. During the first three days, compliance and functional residual capacity were measured daily, arginine vasopressin (AVP) levels estimated on days 1, 3 and 5 and, in 8-hourly intervals, the median arterial/alveolar ratio was calculated for each individual and urine output and fluid input recorded. Throughout the three-day period, the median arterial/alveolar ratio was always significantly higher in the control compared to the two surfactant groups (p < 0.05). On day 3 the Exosurf-treated babies had lower compliance and functional residual capacity (p < 0.05) than the other two groups. Neither the timing of diuresis onset, timing of the maximum diuresis nor the AVP levels, however, differed significantly between the groups. Only surfactant treatment and type of surfactant, but not the timing of the onset nor of the maximum diuresis, related significantly to changes in lung function. These results do not support the hypothesis that differences in fluid balance explain differences in the lung function improvement rate following natural and artificial surfactant.

Biological Products↗
PubMed1994

Sodium transport and fluid balance in lungs from normal and dystrophic hamsters.

Gravimetric and sodium transport characteristics of lungs from BIO 14.6 (dystrophic) hamsters were compared with those of lungs from golden Syrian (normal) hamsters at 30 and 150 days of age. Isolated perfused lungs were used to determine lung permeability and fluid balance differences between normal and dystrophic animals at both ages. Apparent permeability-surface area products for air space-to-vascular space sodium, sucrose, and fluorescein isothiocyanate-labeled dextran fluxes were compared in the four groups of hamsters. Morphometric analysis of fixed lungs of representative hamsters from each group was also performed. Dystrophic hamsters exhibited higher lung wet-to-dry weight ratios than normal hamsters at both ages. Lungs from dystrophic hamsters were less sensitive to inhibition of sodium transport by amiloride than lungs from age-matched normal hamsters. Dystrophic hamster lungs had higher absolute permeabilities of the passively transported solutes, lower permeability values for sodium, and only one-half of the amiloride-sensitive sodium transport of lungs from age-matched normal hamsters. Differences in lung fluid balance between dystrophic and normal hamsters may be related to differences in sodium clearance.

Amiloride↗
PubMed2002

Effects of dexamethasone on intravascular and extravascular fluid balance in patients undergoing coronary bypass surgery with cardiopulmonary bypass.

BACKGROUND: Cardiac surgery with cardiopulmonary bypass is often associated with postoperative hemodynamic instability. In this regard beneficial effects of corticosteroids are known. The purpose of this study was to investigate whether these effects are due mainly to a modification of the intravascular and extravascular volume status or whether a more direct improvement of cardiovascular performance by corticosteroids is the underlying mechanism. METHODS: Twenty patients undergoing elective coronary bypass grafting were included in this randomized double-blind study. Patients of the treatment group received 1 mg/kg-1 dexamethasone after induction of anesthesia. In addition to the use of standard monitors and detailed fluid balance assessments, the transpulmonary double-indicator technique was used to measure extravascular lung water, total blood volume, and intrathoracic blood volume. Measurements were done after induction of anesthesia and 1 h, 6 h, and 20 h after the end of surgery. RESULTS: After cardiopulmonary bypass, no relevant increase in extravascular lung water was observed, despite highly positive fluid balances in all patients. A significantly smaller increase in extravascular fluid content was observed in the dexamethasone group. Total blood volume and intrathoracic blood volume did not differ in the two groups. Patients pretreated with dexamethasone had a decreased requirement for vasoactive substances and, in contrast with the control group, no increase in pulmonary artery pressure. CONCLUSIONS: Extravascular fluid but not extravascular lung water is increased in patients after surgery with cardiopulmonary bypass. Pretreatment of adult patients with 1 mg/kg-1 dexamethasone before coronary bypass grafting decreases extravascular fluid gain and seems to improve postoperative cardiovascular performance. This effect is not caused by a better intravascular volume status.

Adult↗
PubMed1978

Sodium and fluid balance during hypotensive response to alpha-methyldopa.

1. Detailed observations on sodium and fluid balance during treatment with alpha-methyldopa were made in five hypertensive patients. The initial fall in blood pressure concurred with a decline in fluid and sodium excretion. Sodium balance increased 100-300 mEq. In one patient with serve hypertension the sodium balance was incompletely restored, the relationship with blood pressure indicating a negative feedback loop. In the other patients sodium balance reverted to baseline, while the hypotensive response was maintained. This is probably due to a decrease in renal arteriolar tone. 2. Parallel systemic and renal vasodilatation may account for the discrepancy between a significant increase in blood volume and insignificant long-term changes in the fluid and sodium status.

Adult↗
PubMed1992

Fluid balance, electrolyte profiles and plasma parathyroid hormone concentrations in ewes treated with epidermal growth factor.

The infusion of low doses of epidermal growth factor (EGF) into lactating ewes stimulates water intake and urine volume. The plasma concentrations and daily output of various electrolytes in milk and urine are also affected. We have investigated this further by recording the effects of EGF infusion on fluid balance, electrolyte profiles and plasma concentrations of glucose and parathyroid hormone (PTH) in non-pregnant, non-lactating ewes. Twenty-four animals (n = 8 per group) received infusions of 100 ml saline/day into the jugular vein for 10 days (days 1-10) followed by EGF at a dose rate of either 1 (low dose), 5 (medium dose) or 10 (high dose) micrograms/kg liveweight per day in 100 ml saline for 5 days (days 11-15). All ewes then received an infusion of 100 ml saline/day for 10 days (days 16-25). Most plasma and urine samples had undetectable concentrations of EGF-immunoreactive material during the periods of saline infusion. During EGF infusion, the highest amounts of EGF infusate excreted in urine were 1.6, 5.9 and 5.6% for ewes in low, medium and high dose groups respectively. Water intake increased by 17% (0.5 kg), 88% (2.5 kg) and 89% (2.3 kg) and urine volume increased by 29% (0.5 kg), 108% (2.2 kg) and 134% (2.1 kg) for the three groups respectively. Fluid balance and feed intake were not affected by EGF infusion, but the output of faecal dry matter was reduced in ewes receiving the two higher doses of EGF. All levels of EGF resulted in hypocalcaemia, increased plasma PTH concentrations and hypermagnesaemia. There was no effect of EGF on plasma concentrations of K+ and glucose or on daily urinary excretion of K+ and Mg2+. The only response to the low dose was a reduced plasma concentration of Na+ and an increased daily urinary urate excretion. The two higher doses increased the daily urinary excretion of Na+, PO4(3-) and urate, but had no effect on the respective concentrations in plasma. Urinary Ca2+ excretion was reduced only during infusion of the medium dose of EGF. The responses of most variables were similar during infusion of the medium and high doses of EGF. All three doses of EGF induced polydipsic and diuretic responses in ewes, and infusions of 5-10 micrograms EGF/kg liveweight per day affected renal excretion of Ca2+, Na+ and PO4(3-). We interpret the responses of the kidney and plasma PTH concentrations as a means of maintaining the homeostasis of plasma profiles of electrolytes.

Animals↗
PubMed2005

High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury.

STUDY OBJECTIVES: Recent data have suggested that ventilatory strategy could influence outcomes from acute lung injury (ALI) and ARDS. We tested the hypothesis that infection/sepsis and use of higher tidal volumes than those applied in the ARDS Network (ARDSnet) study (> 7.4 mL/kg of predicted body weight) would worsen outcome in patients with ALI/ARDS. DESIGN: International cohort, observational study. SETTING: One hundred ninety-eight European ICUs participating in the Sepsis Occurrence in Acutely Ill Patients study. PATIENTS OR PARTICIPANTS: All 3,147 adult patients admitted to one of the participating ICUs between May 1, 2002, and May 15, 2002. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Patients were followed up until death, hospital discharge, or for 60 days. Of the 3,147 patients, 393 patients (12.5%) had ALI/ARDS. ICU and hospital mortality was higher in patients with ALI/ARDS than those without ALI/ARDS (38.9% vs 15.6% and 45.5% vs 21.0%, respectively; p < 0.001). A multivariable logistic regression analysis with ICU outcome as the dependent factor showed that the independent risks for mortality were as follows: presence of cancer, use of tidal volumes higher than those used by the ARDSnet study, degree of multiorgan dysfunction, and higher mean fluid balance. Sepsis, septic shock, and oxygenation at the onset of ALI/ARDS were not independently associated with higher mortality rates. CONCLUSIONS: In addition to comorbidities and organ dysfunction, high tidal volumes and positive fluid balance are associated with a worse outcome from ALI/ARDS.

Aged↗
PubMed1994

Salt consumption and body fluid balance during cold exposure in rats.

We investigated the effect of exposure to cold on salt consumption and the role of salt consumption on the maintenance of body fluid balance in male Wistar rats. The rats were provided with both tap water and NaCl solution ad lib during 16-h exposure to cold (10 degrees C) and normal (25 degrees C) air temperature conditions. The concentration of the NaCl solution was 0.9% for one group (0.9% NaCl group; n = 7) and 1.8% for the other (1.8% NaCl group; n = 6). At 10 degrees C, weight loss was greater than that at 25 degrees C, and fluid and Na balance were negative in the 0.9% NaCl group. However, the calculated Na concentration of the fluid consumed in the 0.9% NaCl group was about 135 mEq/l Na (0.8% NaCl) at both 10 degrees C and 25 degrees C. In the 1.8% NaCl group, the values indicating fluid and Na balance under both temperature conditions were similar, while the calculated concentration of Na in fluid consumed at 10 degrees C (187 mEq/l Na: 1.1% NaCl) was higher than that at 25 degrees C (153 mEq/l Na: 0.9% NaCl). These results suggest that the consumption of hypertonic NaCl solution indicating increased salt appetite during exposure to cold counteracts the loss of body fluid and Na via urine.

Acclimatization↗
PubMed2003

Thermal responses and body fluid balance of competitive male swimmers during a training session.

Thermoregulatory and body fluid balance (BFB) responses of competitive swimmers were studied during a typical interval training session under natural field conditions. Subjects were 9 males (18.0 +/- 1.7 years; VO(2)max = 3.8 +/- 0.9 L x min(-1)) who covered 9,000 m in 180 minutes in an outdoor pool (mean water temperature = 26.8 +/- 0.3 degrees C; mean wet bulb globe temperature = 29.8 +/- 2.8 degrees C). Mean body weight (BWt) decreased by 1.8 +/- 0.5 kg (P < 0.05), and rectal temperature increased by 1.0 +/- 1.0 degrees C (P < 0.05). Volitional water intake (WI) (0.1 +/- 0.2 kg) did not maintain BFB (-0.5 kg per hour) and plasma volume decreased 10.7 +/- 5.4%. During a typical training session, swimmers experienced significant body fluid losses, and WI was not enough to prevent involuntary dehydration. The magnitude of the fluid losses (2.5% of BWt) was sufficient to compromise convective thermoregulation because of the decreased plasma volume. Hence, to prevent involuntary dehydration, swimmers should be encouraged to consume an amount of fluids that equals losses throughout the training sessions.

Acclimatization↗
PubMed1992

Aerosolized Pseudomonas elastase and lung fluid balance in anesthetized sheep.

The role of the lung epithelium in lung fluid balance was studied by ventilating anesthetized sheep with an aerosol of 20 mg of elastase from Pseudomonas aeruginosa (Ps. elastase) to increase lung epithelial permeability without affecting lung endothelial permeability or lung vascular pressures. Ps. elastase had no effect on the lung vascular pressures, the alveolar-arterial PO2 gradient (A-aPO2), the flow or protein concentration of the lung lymph, or the postmortem water volume of the lungs. The morphological alveolar flooding score in these sheep was 2.5 times the control level, but this was only marginally significant. Elevation of the left atrial pressure by 20 cmH2O alone increased the postmortem lung water volume but had no effect on A-aPO2, the alveolar flooding score, or the lung epithelial permeability assessed by the clearance of 99mTc-labeled human serum albumin. Addition of aerosolized Ps. elastase to these sheep had no effect on the total lung water volume, but it caused a redistribution of water into the air spaces, as evidenced by significant increases in the alveolar flooding score and A-aPO2 (P less than 0.01). Elevation of the left atrial pressure by 40 cmH2O without elastase caused the same response as elevation of the left atrial pressure by 20 cmH2O with elastase, except the higher pressure caused a greater increase in the total lung water volume. We conclude that alteration of the integrity of the lung epithelium with aerosolized Ps. elastase causes a redistribution of lung water into the alveoli without affecting the total lung water volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Aerosols↗
PubMed1988

Pituitary and plasma vasopressin concentrations and fluid balance throughout the oestrous cycle of the rat.

Observations were made of fluid balance and vasopressin concentrations throughout the oestrous cycle of normally cyclic female rats housed under a 12 h light: 12 h darkness regime. Plasma vasopressin concentrations were found to increase progressively during the light period, falling again during the night on all days of the cycle except pro-oestrus. On this day, peak vasopressin concentrations of 3.32 +/- 0.8 pmol/l were seen between 10.00 and 12.00 h, with lower concentrations of 1.74 +/- 0.22 pmol/l being seen between 18.00 and 19.00 h. Urine flow appeared to reflect the changes in plasma vasopressin concentrations, being significantly lower during the light phase, with a small increase being seen over this period on pro-oestrus. Pituitary vasopressin concentrations were highest between 09.00 and 10.00 h and fell progressively over each of the 4 days of the oestrous cycle. The changes in pituitary content were greater than could be accounted for in terms of the alterations in the plasma concentrations of vasopressin.

Animals↗
PubMed1991

The technique of slow continuous ultrafiltration. Steps to maintain fluid balance without hemodynamic instability.

Slow continuous ultrafiltration (SCUF) is ideally suited for fluid overloaded patients with renal insufficiency, and for patients who need intravenous fluids in amounts that exceed renal excretory capacity. Like other methods of continuous ultrafiltration, including CAVH and CAVHD, SCUF can be performed in the intensive care unit with a minimum of equipment. During SCUF, arterial blood (usually from the femoral artery) is passed through a hollow-fiber hemofilter; an ultrafiltrate of serum collects at a rate that is determined by the patient's blood pressure. Replacement of intravenous fluids is generally not required with SCUF. The amount of ultrafiltrate that is removed can be titrated to achieve the desired fluid balance.

Acute Kidney Injury↗
PubMed1988

The sauna and body fluid balance.

Sauna bathing may affect the fluid, electrolyte and acid-base balance. In addition to sweating and thirst, a sauna bath also has effects on many endogenous regulatory mechanisms maintaining the balance between the fluid compartments and appropriate distribution of the circulating blood. Although the sauna-induced fluid loss is usually not very severe, its adequate replacement as early as possible is important. In practice, the most convenient and effective way is to replace the fluid loss by small liquid doses repeated frequently during the bathing. If a sauna bath is taken after heavy physical activity, the fluid compensation may be necessary already before bathing.

Acid-Base Equilibrium↗
PubMed1990

Lung fluid balance evaluated by the rate of change of extravascular lung water content.

Lung fluid balance was studied in 27 mongrel dogs by measuring changes in extravascular lung water content (EVLW). The expression delta EVLWi, which is the difference in EVLWi per kilo bodyweight per hour between two measurement occasions, was used as an estimate of the rate of change of EVLW. EVLW was measured by a double-indicator dilution technique (EVLWi) using iced glucose and indocyanine green. In addition, EVLW was determined at the end of each experiment with gravimetric technique (EVLWg), which enabled the calculation of a regression equation between EVLWi and EVLWg. Delta EVLWi was calculated repeatedly during an 8-h period of mechanical ventilation (MV) with no application of a positive end-expiratory pressure (n = 5), during an 8-h period with a positive end-expiratory pressure (PEEP) of 10 cmH2O (1.0 kPa) (n = 5), during the development of oleic acid (OA)-induced pulmonary oedema (n = 7), and hydrostatic pulmonary oedema (left atrial balloon inflation) (n = 9). An increase of EVLW was seen during PEEP 8 h (mean 35%) and after induction of OA and hydrostatic oedema (mean 300%), but no change was found during MV without PEEP. The regression equation was EVLWi = 5.5 + 0.97 x EVLWg (P = 0.001, r = 0.90). OA-induced oedema caused a mean maximum delta EVLWi of 5.1 ml/kg/h, indicating capillary leakage which, however, was self-limiting within 2 h after OA injection. In hydrostatic oedema there was a maximum delta EVLWi of 16.0 ml/kg/h. Delta EVLWi was negative after deflation of the left atrial balloon, indicating reabsorption of oedema.

Animals↗
PubMed1987

Fluid balance and the adult respiratory distress syndrome.

This study examined the effect of fluid balance on survival in ARDS. Of the 213 patients entered into a prospective data collection study, we evaluated 113 patients who met strict criteria for ARDS. Multiple variables were analyzed for as long as 14 days after intubation including cardiac output, pulmonary capillary wedge pressure, mean blood pressure, intake minus output (I-O), cumulative intake minus output (cum I-O), and change in weight (delta wt). We found significant differences in cum I-O and delta wt between survivors and nonsurvivors on almost every day. Survivors lost weight and had a significantly lower cum I-O compared with nonsurvivors. Logistic regression was used to determine if delta wt and cum I-O could predict survival. Patients who lost 3 kg or more weight had a much higher survival than did those who gained 3 kg or more weight (67 and 0%, respectively, on Day 14). Similar results were obtained using comparably low and high values for cum I-O. The logistic regression equations demonstrated that weight loss and low cumulative I-O correlated with improved survival. Although cause and effect relationships are difficult to determine from these types of analyses, they can be used to formulate prospective studies and predict survival in patients.

Body Weight↗
PubMed1999

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

This study was undertaken to investigate the effects of hypovolemic and hypertonic treatments on plasma vasopressin (AVP) levels and fluid balance in propylthiouracil (PTU)-induced hypothyroidism in the rat. The influence of hypothyroidism on AVP responsiveness to hypertonic and hypovolemic stimuli were compared. Adult male rats were divided into two groups. Groups I and II were intraperitoneally (i.p.) injected with saline (1ml/250g) and PTU (10mg/kg/day), respectively, for a period of two weeks. These groups were further divided in three subgroups each containing six rats. The first subgroup consisted of unchallenged rats. I.P. 700 mg polyethylene glycol was used for hypovolemic treatment. The third subgroup consisted of hypertonic (1.5 M NaCl; 1ml/100 g) stimulated animals. All rats were decapitated and trunk blood collected in hep-arinized tubes. Plasma samples were stored at -20 degrees C until assayed. Plasma AVP, T3 and T4 levels were measured by radioimmunassay. Hematocrit values and plasma Na concentrations were also determined. In the PTU-induced hypothyroid rats, hypertonic treatment caused lower increase in plasma AVP levels (p<0.05) compared to the respective control animals. In the hypovolemic group, decreases in AVP responses were not found to be statistically significant. In conclusion, although hypothyroidism does not statistically change basal AVP levels, it may affect AVP response to hypertonic stimulus. It is not clear whether changes in fluid-electrolyte balance cause disturbance in AVP release in hypothyroidism or vice versa. Therefore, these preliminary findings need to be confirmed by further investigations.

Journal Article↗
PubMed1975

Renal control of sodium and fluid balance in newborn infants during intravenous maintenance therapy.

Changes in accumulated fluid and sodium balance during intravenous maintenance fluid therapy has been studied in 38 newborn infants with different clinical disorders and gestational ages 28-42 weeks. The results from the infants born before 36 weeks of gestation (preterm) have been compared with the result from infants born after 36 weeks. Three different saline infusions 10, 20 and 40 mEq Na1/2/1000 ml 5.5% glucose have been given. The infusion rate has in preterm neonates been 3.3 ml/kg and hour and in the more full-term neonates been 3.6 ml/kg and hour. The study lasted for 5-8 hours. Urine was collected by spontaneous voidings in plastic bags. The balances were calculated as the difference between the amount given intravenously, and the amount excreted in the urine. In the more full-term neonates Na1/2 balance became increasingly negative with the 10 mEq solution, just balanced with the 20 mEq solution and increasingly positive with the 40 mEq solution. A different response was found in the preterm neonates. The natriuresis was higher and the sodium balances were increasingly negative with both the 10 and 20 mEq solutions. With the 40 mEq solution the negative balance tended to level off. The fluid balances were fairly well maintained in all infants regardless of the sodium concentration in the infusate.

Blood Proteins↗
PubMed1989

Pulmonary function tests and fluid balance in neonates with chronic lung disease during dexamethasone treatment.

Pulmonary function tests and fluid balance were measured serially during treatment with dexamethasone in seven ventilator-dependent, 14- to 27-day-old infants. The infants showed no improvement in respiratory status during the prior 5 days. Birth weights ranged from 540 to 900 g, with gestational ages of 24 to 26 weeks. The decision to treat the infants with dexamethasone was made by the clinical team. Pulmonary function tests were performed prior to the first dose and then every 12 hours until extubation. Significant differences were first seen after only 12 hours of treatment. Five infants were extubated within 48 hours of starting therapy. Before extubation at 48 hours, changes were found in dynamic compliance (74% increase), total pulmonary resistance by midvolume and regression methods (38% and 35% decreases, respectively), and expiratory time constant (49% increase), with P less than .01 in all cases. An increase in urine output was also observed in the first 12 hours. Improvements in chronic lung disease produced by dexamethasone are rapid and may result from dexamethasone-induced pulmonary fluid shifts.

Bronchopulmonary Dysplasia↗