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Factors affecting bioelectrical impedance measurements in humans.

In several groups of young healthy subjects the effect of the ingestion of a meal, of drinking normal tea or beef tea, of exercise and of the menstrual cycle on body impedance was assessed. The day-to-day reproducibility of the method was also investigated under standardized conditions. Two to four hours after ingestion of a meal, body impedance had decreased by about 13-17 Ohms in comparison with body impedance in the fasting state. Drinking 200 ml of normal tea did not result in a change of body impedance, but drinking 200 ml beef tea lowered the body impedance significantly by 4 +/- 4 Ohms. Moderate exercise on a bicycle ergometer (90 min, 100 W) did not influence body impedance, but strenuous exercise (90 min, 175 W) resulted in a decrease of 9 +/- 11 Ohms in body impedance. In general, changes in body impedance during the menstrual cycle were small, and only the difference between measurements of body impedance 1 week before the onset of the menstruation and again 1 week after menstruation (8 +/- 9 Ohms) was statistically significant. Under standardized conditions (in the morning, in the fasting state after emptying the bladder) the within-person between-day variation was found to be 2.8 per cent (13 Ohms).

Adipose Tissue↗

Effects of guanabenz on sodium and water homeostasis.

Sodium retention may partially offset the therapeutic action of some antihypertensive agents. To assess the effects of guanabenz on sodium balance, six men with mild to moderate hypertension were placed on diets with constant sodium intake (120 mEq/day) for approximately 4 weeks. After achieving sodium balance, the subjects received guanabenz (16-24 mg daily) for approximately 2 weeks. Mean supine blood pressure decreased from 144/93 to 133/86 mmHg during guanabenz treatment (p less than 0.001). Guanabenz therapy was associated with a decrease in body weight (mean +/- SE) from 85.4 +/- 7.0 to 84.4 +/- 6.8 kg (p less than 0.01). Sodium balance, glomerular filtration rate, plasma renin activity, mean maximal urine osmolality, fluid intake, urine volume, and serum sodium concentration were unchanged during guanabenz therapy. Three additional balance studies were performed during a period of greater sodium intake (180 mEq/day). Although higher doses of guanabenz were required to achieve blood pressure control, sodium balance still was not affected by the drug. Thus, an effective therapeutic dose of guanabenz administered for 2 weeks had no clinically significant effects on sodium or water homeostasis in patients with mild to moderate hypertension.

Adult↗

Screening of an enterovirus specific RT-PCR ELISA method for the quantification of enterovirus genomes in human body fluids by means of a three-level experimental design.

In order to obtain a detection limit as low as possible for a quantitative enterovirus specific RT-PCR ELISA assay, optimal reaction conditions, which give rise to the highest response, need to be determined. This was done by investigating the influence of 13 factors, selected from RT and PCR, in a multivariate approach by means of a well-balanced three-level screening design, derived from a three-level Plackett--Burman design. Optimal reaction conditions could be determined by calculation and evaluation of the effects of the different factors on the response, i.e. the measured absorbance of the ELISA detection. The method will be used to study a possible longitudinal relationship between enteroviruses and the development of multiple sclerosis and juvenile diabetes.

Body Fluids↗

Intercompartmental fluid volume shifts during cardiopulmonary bypass measured by A-mode ultrasonography.

To investigate the time course of fluid extravasation during cardiopulmonary bypass (CPB), we measured the peripheral tissue thickness (TT) by A-mode ultrasound in 34 patients undergoing elective cardiac surgery. TT of the forehead was determined by a handheld A-mode ultrasound device and 10 MHz Transducer at nine defined intervals, from the night before surgery until the first postoperative day. Mean calculated loss of 1700 +/- 40 mL (SEM) water during the fasting period resulted in a significant reduction of TT by 0.28 +/- 0.03 mm. From induction to start of CPB, rehydration with 1000 mL of fluid was performed and TT increased to baseline. After 60 min of extracorporal circulation, forehead TT increased significantly by 0.75 +/- 0.08 mm and remained unchanged until the end of surgery when the measured fluid gain was 1580 +/- 138 mL. At discharge from ICU, negative fluid regimen resulted in a balance of -127 +/- 146 mL whereas TT declined significantly to +0.16 +/- 0.09 mm compared to baseline. Dehydration due to fasting and the marked interstitial fluid extravasation during CPB could be detected by the changes of the peripheral TT. We conclude that parts of the fluid load during CPB are shifted from the intravascular compartment to the interstitial space in a time-dependent manner.

Aged↗

The effect of salt water on alveolar epithelial barrier function.

The effect of hyperosmolar fluid aspiration (seawater) on lung fluid balance has not been well studied. Therefore, the effect of this clinically relevant form of acute lung injury on the alveolar epithelial and lung endothelial barriers was examined in ventilated, anesthetized rabbits. Seawater (4 ml/kg body weight, 881 +/- 29 mOsm/kg) with 3 microCi of 125I-albumin was instilled into the lower trachea of ventilated, anesthetized rabbits. Osmotic equilibration with plasma was completed within the first 5 min after seawater instillation. In parallel with the osmotic equilibration of the seawater in the air spaces, there was a 3-fold dilution of the alveolar protein tracer 125I-albumin, indicating an initial large (300%) increase in alveolar fluid volume. There was a marked decline in arterial oxygenation at the same time that the alveolar fluid volume markedly increased. The initial dilution of the alveolar protein tracer was followed by a progressive increase in the alveolar protein tracer concentration that continued until 6 h after seawater instillation. As the alveolar protein tracer concentrated, arterial oxygenation improved, indicting net alveolar liquid clearance. There was only a mild increase in the epithelial and endothelial permeability to protein within the first 2 h after seawater instillation. Thus, a large osmotically induced increase in alveolar fluid volume with severe pulmonary edema did not cause sustained injury to the endothelial or epithelial barriers of the lung. In fact, normal alveolar liquid clearance occurred, indicating the resistance of the epithelial barrier to hyperosmolar injury as well as its capacity to rapidly reabsorb excess alveolar fluid.

Analysis of Variance↗

Prevention of acute pulmonary edema after bone marrow transplantation.

In a retrospective review of 21 bone marrow transplantation procedures (BMT), we identified ten episodes of acute pulmonary edema coinciding with significant weight gain in the second week after BMT. When we prospectively observed nine consecutive BMT recipients, six patients developed acute pulmonary edema associated with significant (p less than 0.05) weight gain and an increase in echocardiographically determined left ventricular end diastolic diameter. These findings led to a prospective prophylactic intervention study of 30 consecutive BMT patients. Prophylactic intervention consisting of reduced fluid volume of parenteral alimentation, and diuretic therapy was instituted at any clinical sign of fluid overload. No episode of pulmonary edema occurred. The dramatic difference--acute pulmonary edema occurred in 16/30 untreated vs 0/30 treated cases--suggests that this post-BMT complication is critically related to fluid balance and can be prevented by careful clinical examination, close monitoring of weight change, avoidance of fluid overload and the appropriate use of diuretic therapy.

Adult↗

Disorders of water and sodium balance.

The serum sodium concentration reflects a patient's relative water balance and thus determines if the patient needs more or less water than normal maintenance needs would dictate. The serum sodium concentration has no bearing on whether a patient requires sodium restriction or saline administration. Rather, the sodium/saline balance is determined by clinical assessment of the patient's extracellular fluid volume. Physicians must clearly understand the principles involved when assessing a patient's water and sodium needs. After maintenance water needs and any foreseeable ongoing losses have been factored in, an intelligent plan of fluid management can be initiated. Frequent reassessments, with serial weight measurements, clinical evaluations of extracellular fluid volume status, and determinations of serum sodium concentration, are essential to determine if the desired therapeutic goals are being reached.

Body Fluids↗