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PubMed1983

Effects of amphotericin B on ion and fluid movement across dog tracheal epithelium.

Ion fluxes or fluid flow were measured across sheets of dog tracheal epithelium mounted in Ussing chambers or a special apparatus, respectively. Under short-circuit conditions, luminal amphotericin B (3 X 10(-5) M) caused an inhibition of net Cl secretion and an increase in net Na absorption across paired tissues. In paired tissues under resting open-circuit conditions, there was no significant net transepithelial flux of either Cl or Na. Amphotericin B induced significant net fluxes of both Cl and Na toward the serosal side. In separate tissues from the same animals, there was no significant transepithelial fluid movement under resting conditions. Amphotericin B caused a net absorption of fluid. The absorption of salt and fluid in amphotericin B-treated tissues was abolished by ouabain. We conclude that stimulation of active Na transport by amphotericin B leads to fluid absorption. In vivo, the movement of fluid across the dog tracheal epithelium may be dependent on a balance between active Cl secretion and active Na absorption.

Amphotericin B↗
PubMed1990

A question of balance--dehydration in the elderly.

The maintenance of optimal water balance is a priority for homeostasis; unfortunately, the aging process adversely affects the mechanisms of water balance, making it more difficult for the body to adequately defend itself against water loss. Four major age-related changes predispose the elderly to dehydration and hypernatremia: a decrease in total body water, an altered sense of thirst, a decrease in the renal urine concentrating ability, and a decrease in the effectiveness of ADH. In the case of fluid balance, careful assessment cannot be overemphasized due to the fact that there are few symptoms unique to dehydration that readily allow a nurse to know that fluid imbalances are involved.

Aged↗
PubMedDate not supplied

[Principles of pharmacotherapy in geriatrics].

This article examines the pharmacokinetics and pharmacodynamics of drugs under the aspects of senile changes in organs and systems in the neurohumoral regulation and in metabolism. It gives reasons for the inadequacy of polypharmacy in the treatment of elderly and old people and for the need of a strict individualization. The retarded reactivity of the organism of old people, their increased susceptibility and reduced tolerance of the effects of drugs necessitate smaller dosages of drugs in geriatrics in comparison with the generally usual dosages, especially at the beginning of treatment. The multitude of exogenous and endogenous changes in the organism, that go hand in hand with the process of aging, leads in old people to an increased susceptibility to more frequent and pronounced secondary effects caused by drugs. Of special importance in the prevention of a possible intoxication by drugs are, in the case of elderly people, the proper composition of food, the water balance and the electrolyte metabolism.

Aged↗
PubMed1984

The physiologic basis for clinical edema.

Edema is a common clinical sign indicating expansion of the interstitial fluid volume. Factors that regulate the size of this compartment are capillary fluid dynamics, interstitial fluid pressure, lymph flow, and interstitial compartment compliance, all of which are delicately balanced. An appreciation of the manner in which common disease processes upset this delicate balance can lead to a better understanding of clinical edema.

Absorption↗
PubMed1998

Fluid balance assessment. The total perspective.

Fluid balance assessment is a fundamental aspect of caring for critically ill patients who often have volume disturbances. Since the introduction of hemodynamic monitoring in the critical care setting decades ago, we have become more dependent on technology to assist us in evaluating a patient's fluid status and less skilled in basic physical examination and interpretation of common blood and urine values. Information obtained from these basic clinical skills is equally as, if not more, important as numbers derived by invasive means.

Adult↗
PubMed1986

Effects of the rate and composition of fluid replacement on the pharmacokinetics and pharmacodynamics of intravenous furosemide.

Effects of differences in the rate and composition of intravenous fluid replacement for urine loss on the pharmacokinetics and pharmacodynamics of furosemide were evaluated using the dog as a model animal. Each of six dogs received 8-hr constant intravenous infusion of 20 mg (15 mg used in one dog) of furosemide with 0% replacement (treatment I), 50% replacement (treatment II), and 100% replacement (treatment III) with lactated Ringer's solution, as well as with 100% replacement with 5% dextrose in water (treatment IV). Most pharmacokinetic parameters, such as plasma clearance, steady-state volume of distribution, mean residence time, and terminal half-life, were essentially the same in all four treatments. Renal clearances and urinary excretion rates of the drug in treatments II-IV were essentially the same, but about 20% higher than those in treatment I. In spite of the similarities in kinetic properties, diuretic and/or natriuretic effects from furosemide were markedly different among the four treatments. For example, mean 10-hr urine outputs were 646, 1046, 3156, and 1976 ml and mean 10-hr sodium excretions were 87.0, 142, 383, and 97.2 mmole for treatments I-IV, respectively. Except for treatment III, diuresis and/or natriuresis were found to be time-dependent, generally decreasing with time until reaching a low plateau during later hours of infusion. The present findings also showed that no fluid replacement and 100% replacement with 5% dextrose solution both produced the same degree of severe acute tolerance in natriuresis, indicating the insignificance of water compensation in tolerance development; in treatment II, where neutral sodium balance was achieved, the development of acute tolerance in diuresis and natriuresis can mainly be attributed to negative water balance under this special condition; at steady state the hourly diuresis and natriuresis could differ up to about ten times between treatments. Some implications for the kinetic/dynamic relationship or modeling, in the clinical use, and in the bioequivalence evaluation of dosage forms are discussed.

Animals↗
PubMed1983

Influence of captopril on fluid and electrolyte balances and adrenocortical responses during sodium deprivation in the rat.

An angiotensin I-converting enzyme inhibitor (captopril) was given by gastric lavage at a dose of 30 mg/kg body weight per day to Long-Evans rats for a 13-day period during which they received a sodium-deficient diet. This regime was preceded by a 3-day period during which measurements were made on the animals on a sodium-replete dietary intake. Control sodium-deprived rats showed increased plasma renin activities, increased peripheral aldosterone concentrations and reduced urinary sodium excretion; they maintained positive sodium balance and the zona glomerulosa of the adrenal cortex hypertrophied. Captopril-treated sodium-deprived rats failed to reduce urinary sodium excretion sufficiently and entered a period of marked and sustained negative sodium balance. Peripheral aldosterone concentrations after 12 days of sodium deprivation in the presence of captopril treatment were similar to those of sodium-replete rats. The adrenocortical zona glomerulosa of the captopril-treated rats did not increase in size and regressive changes were noted.

Adrenal Cortex↗
PubMed1989

Post-traumatic changes in, and effect of colloid osmotic pressure on the distribution of body water.

The aim of this study was to define the post-traumatic changes in body fluid compartments and to evaluate the effect of plasma colloid osmotic pressure (COP) on the partitioning of body fluid between these compartments. Forty-two measurements of plasma volume (green dye), extracellular volume (bromine), and total body water (deuterium) were done in ten traumatized patients (mean Injury Severity Score, ISS, = 34) and 23 similar control studies were done in eight healthy volunteers who were in stable fluid balance. Interstitial volume, intracellular volume, and blood volume were calculated from measured fluid spaces and hematocrit; COP was directly measured. Studies in volunteers on consecutive days indicated good reproducibility, with coefficients of variation equal to 3.5% for COP, 6.3% for plasma volume, 4.5% for extracellular volume, and 4.9% for total body water. COP values extended over the entire range seen clinically, from 10 to 30 mmHg. Interstitial volume was increased by 55% in patients, but intracellular volume was decreased by 10%. We conclude (1) that posttraumatic peripheral edema resulting from hemodilution is located in the interstitial compartment, with no intracellular space expansion; and (2) that interstitial volume, but not intracellular volume, is closely related to plasma COP.

Blood Proteins↗
PubMed2005

Human water needs.

Healthy humans regulate daily water balance remarkably well across their lifespan despite changes in biological development and exposure to stressors on hydration status. Acute or chronic body water deficits result when intakes are reduced or losses increase, but day-to-day hydration is generally well maintained so long as food and fluid are readily available. Total water intake includes drinking water, water in beverages, and water in food. Daily water needs determined from fluid balance, water turnover, or consumption studies provide similar values for a given set of conditions. A daily water intake of 3.7 L for adult men and 2.7 L for adult women meets the needs of the vast majority of persons. However, strenuous physical exercise and heat stress can greatly increase daily water needs, and the individual variability between athletes can be substantial.

Body Water↗
PubMed2004

Fluid and electrolytes in the elderly.

PURPOSE OF REVIEW: The intake of water and electrolytes is inseparable from the ingestion of nutrients by normal or artificial means. Recent reports have agreed in criticizing the poor standards of practice and of training in the management of fluid and electrolyte balance, resulting in a large amount of avoidable morbidity, particularly in the elderly who are more vulnerable to fluctuations in body composition. RECENT FINDINGS: Ageing is associated with impaired physiological reserve and a reduced ability to compensate for fluctuations in environmental conditions. These changes include reduced cardiac and renal reserve, making the elderly more vulnerable to changes in water and electrolyte gain or loss with a resulting increase in morbidity and mortality. The ability to cope with errors in prescriptions is correspondingly diminished. Dehydration is a common problem in nursing homes and in the community, due often to failures in detection and appropriate management. In many cases, the cause is iatrogenic due to diuretics or drugs which impair the intake of food and fluid. Salt and water overload, particularly in hospital patients, is also common and results in impaired recovery from surgery and increased perioperative mortality and morbidity. Hyponatraemia is also an important clinical problem in hospital and the community. SUMMARY: Better training in the detection, prevention and management of fluid and electrolyte imbalance is needed to reduce common and serious morbidity associated with this problem to which the elderly are especially prone, owing to their diminished physiological reserves and increased comorbidity.

Aged↗
PubMed1983

Extracellular water, electrolyte and nitrogen balance after postoperative parenteral nutrition and intracellular involvement in muscle.

Brief periods of fasting or moderate trauma were previously shown to give rise to malnutrition characterized by negative nitrogen balance, reduction of lean body mass and relative increase of body water. The present study aimed to assess the possibility that brief low-calorie, low-protein parenteral fluid regimen after relatively moderate surgical trauma can modify the muscle metabolism and alter the water, electrolyte and protein composition. Well-nourished patients undergoing elective cholecystectomy were studied. During the first four postoperative days, seven patients (group I) received parenteral nutrition adequate as regards water, sodium and potassium but deficient in carbohydrates and without amino acids, while six patients (group II) had adequate parenteral supply of calories and nitrogen. The extracellular balance in regard to water, sodium, potassium, calcium, phosphorus, magnesium and urea was assessed in all 13 patients. Needle biopsy of muscle was performed during surgery and at the end of the observation period in six patients from group I and five from group II, in order to assess the total and the intracellular and extracellular water content and also sodium, chloride, potassium, magnesium, phosphorus and alkali-soluble protein nitrogen. In group I, but not in group II, there was weight loss and negative extracellular balance of all parameters, in particular potassium and nitrogen, and reduction of muscle potassium. The analyses of balance and of muscle cell composition showed considerable loss of lean body mass and indicated 'true' electrolyte disturbance, although clinical symptoms were absent and serum parameters remained normal.

Adult↗
PubMed1999

[An assessment of acid-base imbalance in body tissues and fluids].

Ions hydrogene concentration in fluids and tissues is one of the strict regulated physiological organism variables. Most common man and animal diseases are accompanied with compensated acid-base balance shift development. But diagnosis of metabolic acidosis and alkalosis with blood indices (pH, pCO2, HCO3) doesn't reflect true tissue condition that is connected not only with respiratory and excretion system functioning but with hypercompensation of metabolic processes. Excess organic acid formation in case of metabolic alkalosis formation in tissues directed to support pH leads to acidification, what brings an essential mistake in pathogenesis understanding of such diseases as cardiomyopathy, ischemic cardiac disease, myocardial infarction, hepatitis, collagenosis, caries, peptic ulcer, macula dystrophy, atherosclerosis, virus diseases, radiation damages. Ignorance primary tissue damages doesn't allow to conduct necessary preventive measures and to cure disease. It is suggested to assess development of metabolic acidosis and alkalosis by compensated changes of regulation acid-base homeostasis system, which is the basis of all future damages and development of different diseases against this background.

Acid-Base Imbalance↗
PubMed1975

[Evaluation of sectorial fluid movement by measurement of the global impedance of the body. Study during hemodialysis and during treatment with major diuretics].

During courses of haemodialysis or treatment with powerful diuretics, the clinician at the present time bases his actions on blood pressure levels which reflects blood volume and on weight variation which is dependent on water loss. The authors show, in studying variations in total body impedance at 5kHz and 1kHz and their ratio R, that there exists another method of observation which complements the basic notions provided by blood pressure levels and baseline weight. They were thus able to detect the possible formation of cellular oedema due to excessively rapid osmotic depletion. The method makes possible the evaluation of these sectorial fluid transfers when they occur, even though they are not evident clinically. This easy to use method is perhaps less rapid than the usual means of observation but is nevertheless more rational and provides information on electrolyte balance.

Blood Volume↗
PubMed2001

The relevance of gastrointestinal fistulae in clinical practice: a review.

Gastrointestinal fistulae most frequently occur as complications after abdominal surgery (75-85%) although they can also occur spontaneously--for example, in patients with inflammatory bowel disease (IBD) such as diverticulitis or following radiation therapy. Abdominal trauma can also lead to fistula formation although this is rare. Postoperative gastrointestinal fistulae can occur after any abdominal procedure in which the gastrointestinal tract is manipulated. Regardless of the cause, leakage of intestinal juices initiates a cascade of events: localised infection, abscess formation and, as a result of a septic focus, fistulae formation. The nature of the underlying disease may also be important, with some studies showing that fistula formation is more frequent following surgery for cancer than for benign disease. Fistula formation can result in a number of serious or debilitating complications, ranging from disturbance of fluid and electrolyte balance to sepsis and even death. The patient will almost always suffer from severe discomfort and pain. They may also have psychological problems, including anxiety over the course of their disease, and a poor body image due to the malodorous drainage fluid. Postoperative fistula formation often results in prolonged hospitalisation, patient disability, and enormous cost. Therapy has improved over time with the introduction of parental nutrition, intensive postoperative care, and advanced surgical techniques, which has reduced mortality rates. However, the number of patients suffering from gastrointestinal fistulae has not declined substantially. This can partially be explained by the fact that with improved care, more complex surgery is being performed on patients with more advanced or complicated disease who are generally at higher risk. Therefore, gastrointestinal fistulae remain an important complication following gastrointestinal surgery.

Humans↗
PubMed1986

Salt and water balance in congestive heart failure.

The majority of symptoms related to congestive heart failure (CHF) can be derived from the excessive accumulation of fluid in the body. The retention of fluid is the result of the activation of a complex system of compensatory mechanisms working on the kidneys and altering the hemodynamic situation in the body. The compensatory mechanisms are essentially the same as those activated in acute blood loss. The common denominator for CHF and acute blood loss is a decrease of the effective arterial blood volume (EABV), a parameter defined as blood volume in relation to vascular capacity. In the early stages of CHF there is an increased sympathoadrenergic tone, leading to a peripheral vasoconstriction and a decrease of blood flow to the kidneys. Due to a preferential constriction of the efferent arterioles, the filtration fraction is increased and the glomerular filtration rate remains unchanged. However, there is an increased colloid osmotic pressure and a decreased intravascular hydrostatic pressure in the peritubular capillaries. These alterations result in an increased reabsorption of sodium and water in the kidneys. Furthermore, the blood flow in the kidneys is rerouted from the cortical to the juxtamedullary nephrons, which have larger glomeruli and longer loops of Henle. This will further increase the retention of salt and water. The renin-angiotensin-aldosterone (R-A-A) system is also activated due to the decrease of EABV. Angiotensin II exerts about the same effects as norepinephrine--vasoconstriction, rerouting of blood within the kidney and preferential vasoconstriction of the efferent arterioles--all changes contributing to the retention of salt and water.(ABSTRACT TRUNCATED AT 250 WORDS)

Arginine Vasopressin↗
PubMed1990

Regulation of the amiloride-blockable sodium channel from epithelial tissue.

The first step in net active transepithelial transport of sodium in tight epithelia is mediated by the amiloride-blockable sodium channel in the apical membrane. This sodium channel is the primary site for discretionary control of total body sodium and, therefore, investigating its regulatory mechanisms is important to our understanding of the physiology of fluid and electrolyte balance. Because essentially all of the regulatory sites on the channel are on the intracellular surface, patch clamp methods have proven extremely useful in the electrophysiological characterization of the sodium channel by isolating it from other channel proteins in the epithelial membrane and by allowing access to the intracellular surface of the protein. We have examined three different regulatory mechanisms. (1) Inhibition of channel activity by activation of protein kinase C; (2) activation of the channel by agents which activate G-proteins; and (3) modulation of channel kinetics and channel number by mineralocorticoids. Activation of protein kinase C by phorbol esters or synthetic diacylglycerols reduces the open probability of sodium channels. Protein kinase C can be activated in a physiological context by enhancing apical sodium entry. Actions which reduce sodium entry (low luminal sodium concentrations or the apical application of amiloride) increase channel open probability. The link between sodium entry and activation of protein kinase C appears to be mediated by intracellular calcium activity linked to sodium via a sodium/calcium exchange system. Thus, the intracellular sodium concentration is coupled to sodium entry in a negative feedback loop which promotes constant total entry of sodium. Activation of G-proteins by pertussis toxin greatly increases the open probability of sodium channels. Since channels can also be activated by pertussis toxin or GTP gamma S in excised patches, the G-protein appears to be closely linked in the apical membrane to the sodium channel protein itself. The mechanism for activation of this apical G-protein, when most hormonal and transmitter receptors are physically located on the basolateral membrane, is unclear. Mineralocorticoids such as aldosterone have at least two distinct effects. First, as expected, increasing levels of aldosterone increase the density of functional channels detectable in the apical membrane. Second, contrary to expectations, application of aldosterone increases the open probability of sodium channels. Thus aldosterone promotes the functional appearance of new sodium channels and promotes increased sodium entry through both new and pre-existant channels.

Aldosterone↗