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PubMed1996

[Similarity and synergy of trauma and sepsis: role of tumor necrosis factor-alpha and interleukin-6].

Both trauma and infection cause a rise in body temperature, white blood cell count, acute phase proteins, fluid and sodium retention and negative nitrogen balance. This phenomenon is often described as "acute phase response" or "systemic inflammatory response syndrome" to denote a coordinated systemic response to significant tissue injury and/or microbial invasion. It is generally agreed that the acute phase response is mediated through the interaction of cytokine and neuroendocrine pathways. Tumor Necrosis Factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are two of the major key cytokines involved in the generation of acute phase response. Interleukin-6 are consistently found in septic, trauma and post-operative patients and correlated well with the severity of sepsis or injury. IL-6 is responsible for the fever and metabolic changes in the acute phase. In addition to IL-6, TNF-alpha was proved to be the mediator that orchestrates the hemodynamic and tissue injury in septic shock. TNF-alpha destroys endothelial cells and induces disseminated intravascular coagulation, fluid shift, shock, multiple organ system failure and death. On many clinical occasions, both infection and trauma may happen simultaneously on the same patient. Our study demonstrated that operation on the infected patients would cause a synergistic effect on both TNF-alpha and IL-6 levels. The pulse increase in TNF-alpha and the persistent elevation of IL-6 were responsible for the post-operative unstable clinical condition in the infected patients. Should we block the cytokine signal and inflammatory response that appear to be harmful? Animal studies have shown that the septic shock to endotoxin challenge can be prevented by pretreatment with monoclonal antibody against TNF-alpha. The transcription of TNF-alpha can be blocked with corticosteroid in vivo. The post-operative increase in IL-6 and its related inflammation can be attenuated with corticosteroid, epidural anesthesia and narcotics. However, although blocking the inflammatory response has a beneficial effect of stress free it also eliminates our ability to fight with bacterial infection by lowering our immune response. How to manipulate these cytokines is a question of art more than science.

Acute-Phase Reaction↗
PubMed1993

[The significance of body weight measurement of esophageal cancer patients in intra- and postoperative fluid administration].

We tried to clarify the intra- and postoperative pathological state in resected thoracic esophageal cancer patients and analyze the particularity of fluid administration by measuring body weight at certain time serially. We studied 26 resected thoracic esophageal cancer patients between September, 1989 and January, 1991 who underwent an operation through right thoracotomy prior to laparotomy at the same time, and all cases were under general anesthesia combined with epidural anesthesia. We measured body weight preoperatively, just after operation, on the first, second and third postoperative days by means of LIFTER (Ted Hoyer & Co. Inc), and also calculated water balance and measured pressures and cardiac output by Swan-Ganz catheter in 19 cases. As a result, change in body weight was remarkable in resected thoracic esophageal cancer patients intra- and postoperatively. The peak of weight gain was noticed and they gained about 3 kilograms in weight on the 1st postoperative day, while in circulation hypovolemia was found on the data by means of Swan-Ganz catheter. There was a high correlation between rate of change in weight (kg/hr) and water balance (ml/kg/hr) (r = 0.91). We calculated insensible loss by the difference between water balance and body weight. It was about 1.73 intraoperatively, 0 postoperatively, 0.35-0.5 ml/kg/hr on from the 1st through the 3rd postoperative day. It is concluded that body weight measurement is a very easy, precise and useful bedside technique in the intra- and postoperative fluid administration of esophageal cancer patients, because it is very important not only to understand the circulation volume but also to know the interstitial fluid change.

Body Weight↗
PubMed1986

Treatment of acute renal failure in newborns by continuous arterio-venous hemofiltration.

The treatment of acute renal failure (ARF) in the newborn with hemo- or peritoneal dialysis is technically difficult and may even be contraindicated. As in the adult, continuous arterio-venous hemofiltration (CAVH) may be an alternative therapy. We used CAVH in the treatment of four newborns with ARF of different etiology. Two brachial, one femoral and one umbilical arteries were cannulated as arterial access, while three jugular and one umbilical veins were used as venous return. An Amicon 0.005 m2 Polysulphon Hollow Fiber hemofilter was connected to the patient with shortened pediatric hemodialysis lines. Total blood volume of the extracorporeal circuit was 15 to 22 ml. Before starting the procedure, an initial bolus of heparin was administered to the patient (100 i.u./kg body wt) and a successive continuous heparin administration was provided during the treatment at the rate of 5 to 7 i.u./kg/hr. Hyperalimentation and/or buffer solutions were used as replacement fluids and were administered according to the patient's fluid balance. mean data in the four patients are summarized as follows. The age of the patients ranged from two to 12 days, while the average body weight was about 3 kg. The ultrafiltration rate during the treatment averaged 0.9 ml/min with a plasma flow ranging from 9.8 to 19.6 ml/min. The treatment duration varied from 30 to 86 hrs. The treatment was well tolerated (patients 1 and 2 recovered, and patients 3 and 4 died due to complications unrelated to the treatment). Arterial pressure remained stable during the procedure. Metabolic acidosis, when present, was corrected by increasing the amount of buffer administered. BUN was maintained below 60 mg/dl in three patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1985

Humidification of incubators.

The effect of increasing the humidity in incubators was examined in 62 infants of less than 30 weeks' gestation. Thirty three infants nursed in high humidity for two weeks were compared retrospectively with 29 infants from an earlier study who were nursed under plastic bubble blankets or with topical paraffin but without raised humidity. Humidification reduced skin water loss and improved maintenance of body temperature from birth, but did not delay the normal postnatal maturation of the skin. Infants nursed without humidity frequently became hypothermic in spite of a high incubator air temperature. These advantages must be weighed against the finding that overheating was more common and Pseudomonas was more commonly isolated from the infants. It is recommended that incubator humidity is raised for babies under 30 weeks' gestation in the first days of life but meticulous attention should be paid to fluid balance, avoiding overheating, and cleansing of the humidifier reservoir.

Body Temperature↗
PubMed2000

High dietary sodium chloride consumption may not induce body fluid retention in humans.

A commonly accepted hypothesis is that a chronically high-sodium diet expands extracellular volume and finally reaches a steady state where sodium intake and output are balanced whereas extracellular volume is expanded. However, in a recent study where the main purpose was to investigate the role of natriuretic peptides under day-to-day sodium intake conditions (Heer M, Drummer C, Baisch F, and Gerzer R. Pflügers Arch 425: 390-394, 1993), our laboratory observed increases in plasma volume without any rise in extracellular volume. To scrutinize these results that were observed as a side effect, we performed a controlled, randomized study including 32 healthy male test subjects in a metabolic ward. The NaCl intake ranged from a low level of 50 meq NaCl/day to 200, 400, and 550 meq/day, respectively. Plasma volume dose dependently increased (P < 0.01), being elevated by 315 +/- 37 ml in the 550-meq-NaCl-intake group. However, in contrast to the increased plasma volume, comparable to study I, total body water did not increase. In parallel, body mass also did not increase. Mean corpuscular volume of erythrocytes, as an index for intracellular volume, was also unchanged. We conclude from the results of these two independently conducted studies that under the chosen study conditions, in contrast to present opinions, high sodium intake does not induce total body water storage but induces a relative fluid shift from the interstitial into the intravascular space.

Adult↗
PubMedDate not supplied

[The pathogenesis of hydrocele].

Hydropic fluid in hydrocele was studied for physicokinetic properties on whose basis an attempt was made to explain the pathogenetic mechanism responsible for dynamic fluid collection in the disease. A total of 45 patients with idiopathic hydrocele whose duration was an average of 4 years were examined. In the majority of cases, the disease was secondary to scrotal injuries. The authors determined hydropic fluid viscosity, hydrostatic pressure in the hydrocyst, total protein levels in the serous fluid, and intensity of hydrocyst absorption of methylene blue after its prior administration into the hydrocyst. The hydrostatic pressure in the hydrocyst, the total protein content, and the viscosity of the serous fluid were found to be directly proportional to each other. The intensity of serum methylene blue absorption was higher, its concentration being lower in most cases than in health. Thus, the pathogenesis of hydrocele seems to be as follows. In imbalance of serous fluid exudation and absorption flows as a consequence of lymphostasis and venous congestion, its collection starts in the vagina, which is accompanied by an increase in the hydrocyst's volume and an elevation of its hydrostatic pressure. With this, microcirculatory abnormalities deteriorate as a result of impaired vascular wall permeability, which causes a change in the composition of the serous fluid and an increase in its viscosity. The elevated hydrostatic pressure results in higher viscosity of the serous fluid, vice versa. Finally, this thermodynamic self-developing system will convert to a new equilibrium state with the established viscosity, pressure, temperature that ensure a balance of flows.

Absorption↗
PubMed2005

Early identification of hypovolemia using total body resistance measurements in long-term care facility residents.

BACKGROUND: Clinical management of fluid imbalance continues to be a major challenge in the long-term care industry. A proactive method of recognizing hypovolemia (reduced total body fluid) in its early stages is greatly needed. OBJECTIVES: The goals of this research were 3-fold: (1) to determine the mean total body resistance(TBR) of an unmatched population of long-term care facility (LTCF) residents and correlate increased levels of TBR with evidence of fluid imbalance; (2) to identify patients at risk for hypovolemia by using TBR measurements as an objective guide; and (3) to suggest nursing practices designed to increase hydration in LTCF residents. METHODS: Two pairs of electrocardiograph-type electrodes were placed on the right humeral-carpal junction and at the level of the right lateral malleolus of each patient. A 50-kHz signal was introduced to the outer electrode of each pair; the inner electrode detected variation of the resistance to the signal as a function of ionic conduction through the electrolyte content of body fluids. Resistance, reactance, and phase angle were measured. RESULTS: The medical records of patients in 26 LTCFs (17 urban, 9 rural) in north-central and east Texas were reviewed during 2001. The mean age of the 1225 study patients (754 women, 471 men) was 76 years; mean height was 165.8 cm, and mean body weight was 71.9 kg. The mean TBR (right wrist-right ankle) for men and women was 504.81 ohms. Based on this measurement and a measurement of 629 ohms in residents judged to be hypovolemic on the basis of abnormal clinical laboratory data, patients with a wrist-ankle resistance >550 ohms were considered at risk for hypovolemia and possibly clinically significant dehydration. Subsequent measurements of TBR revealed a reduction consistent with levels in the normal range. CONCLUSIONS: In these studies, TBR measurements correlated inversely with total body water and fluid compartments. Extracellular fluid compartments were found to be larger in females than in males, reflecting larger cellular mass in males. Total body resistivity was found to be higher in females than in males, which may have implications for body composition metrics. TBR provides a reference for comparison with both clinical and laboratory findings. The ability to identify LTCF residents at risk for hypovolemia, using noninvasive bedside measurements, may offer a definitive guideline for management of adequate fluid balance.

Aged↗
PubMed1989

Fluid balance, vasopressin and withdrawal symptoms during detoxification from alcohol.

Nineteen patients were studied during the first 4 days after withdrawal from alcohol. Plasma vasopressin was raised (P less than 0.05) and fluid retention occurred (P less than 0.05), with falls in haematocrit (P less than 0.01) and calculated plasma osmolality (P less than 0.02), which were consistent with expansion of plasma volume. Despite these changes mean total body water was within normal limits although there were substantial inter-individual variations. There was no correlation between any measure of fluid balance and the severity of withdrawal symptoms.

Adult↗
PubMed1991

Transcapillary fluid shifts in tissues of the head and neck during and after simulated microgravity.

To understand the mechanism, magnitude, and time course of facial puffiness that occurs in microgravity, seven male subjects were tilted 6 degrees head-down for 8 h, and all four Starling transcapillary pressures were directly measured before, during, and after tilt. Head-down tilt (HDT) caused facial edema and a significant elevation of microvascular pressures measured in the lower lip: capillary pressures increased from 27.7 +/- 1.5 mmHg (mean +/- SE) pre-HDT to 33.9 +/- 1.7 mmHg by the end of tilt. Subcutaneous and intramuscular interstitial fluid pressures in the neck also increased as a result of HDT, whereas interstitial fluid colloid osmotic pressures remained unchanged. Plasma colloid osmotic pressure dropped significantly by 4 h of HDT (21.5 +/- 1.5 mmHg pre-HDT to 18.2 +/- 1.9 mmHg), suggesting a transition from fluid filtration to absorption in capillary beds between the heart and feet during HDT. After 4 h of seated recovery from HDT, microvascular pressures in the lip (capillary and venule pressures) remained significantly elevated by 5-8 mmHg above baseline values. During HDT, urine output was 126.5 ml/h compared with 46.7 ml/h during the control baseline period. These results suggest that facial edema resulting from HDT is caused primarily by elevated capillary pressures and decreased plasma colloid osmotic pressures. The negativity of interstitial fluid pressures above heart level also has implications for maintenance of tissue fluid balance in upright posture.

Adult↗
PubMed1997

Alcohol's impact on kidney function.

Both acute and chronic alcohol consumption can compromise kidney function, particularly in conjunction with established liver disease. Investigators have observed alcohol-related changes in the structure and function of the kidneys and impairment in their ability to regulate the volume and composition of fluid and electrolytes in the body. Chronic alcoholic patients may experience low blood concentrations of key electrolytes as well as potentially severe alterations in the body's acid-base balance. In addition, alcohol can disrupt the hormonal control mechanisms that govern kidney function. By promoting liver disease, chronic drinking has further detrimental effects on the kidneys, including impaired sodium and fluid handling and even acute kidney failure.

Acute Kidney Injury↗
PubMed1987

Effect of short-term administration of vasopressin on arterial pressure and norepinephrine turnover in Long-Evans rats.

Vasopressin (AVP) in acute experiments has been shown to influence cardiovascular reflexes, but the effect of a more prolonged administration of AVP on the sympathetic nervous system has not been investigated. Long-Evans rats were treated for 7 days with AVP (Pitressin tannate in oil, with single daily doses of 100 or 500 mU.100 g-1, s.c.) to determine whether AVP alters norepinephrine (NE) turnover in kidney, intestine, or skeletal muscle. Control rats were given equal doses of peanut oil daily. NE turnover was determined by measuring the decline in tissue levels of NE for 8 h after inhibition of tyrosine hydroxylase with alpha-methyl-p-tyrosine (300 mg.kg-1, i.p. every 4 h). Measurements of water intake, urine output, and urine osmolality showed that chronic administration of the high dose, but not the low dose, of AVP produced maintained increases in urine osmolality and decreases in water intake and urine output. Body weight, plasma osmolality, plasma electrolytes, and hematocrit were not significantly altered by AVP treatment, but mean arterial pressure was elevated significantly (control, 105 +/- 3 mmHg versus AVP, 119 +/- 4 mmHg, p less than 0.05) (1 mmHg = 133.3 Pa) in the high dose group. Plasma renin activity was decreased slightly, but significantly in rats treated with the high dose of AVP. Compared with results in control animals, there were no statistically significant changes in NE turnover after chronic administration of either the low or the high dose of AVP. The results indicate that administration of AVP for 7 days to rats in normal fluid balance does not result in a decrease in NE turnover in peripheral organs.

Animals↗
PubMed1976

Regulatory and secondary water intake in rats with lesions of the zona incerta.

Bilateral electrolytic lesions of the zona incerta (ZI) permanently reduced daily water intake of rats by 20-30%. Lesioned rats did not differ from controls in daily food intake, body weight, hematocrit, or serum osmolality, Na+ or K+ levels. The hypodipsia was not caused by changes in water requirements or excretory function or by a nonspecific depression of behavior. Compensatory reductions in water losses maintained fluid balance. Lesioned rats drank as much water as controls in response to intracellular and extracellular dehydration, but unlike controls, appeared to restrict their daily water intake to these regulatory responses. Lesions of the ZI attenuated the ingestion of extra water observed when rats were maintained on a liquid diet adequate to meet fluid requirements, and daily water intake of lesioned but not control rats closely followed changes in water needs. It was concluded that lesions of the ZI reduce daily water intake towards minimal requirements for fluid balance by attenuating secondary drinking (drinking independent of water needs for fluid homeostasis.

Animals↗