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At least 19 recordsLinked to original sources
PubMed1990

Aging and disturbances of thirst and fluid balance.

Fluid and electrolyte homeostasis depend on a balance between the intake and output of water. Aging is characterized by reduced homeostatic capacity. Changes in the control of both water intake and excretion accompany aging and may predispose the elderly to disturbances in sodium and water balance. Reduced thirst and water intake in response to water deprivation and thermal dehydration have been observed in healthy elderly persons. This reduction, combined with reduced renal water-conservation capacity, may predispose the elderly to dangerous dehydration when illness increases water losses or physical incapacity prevents access to water. The reasons for the thirst deficit are not clear. The elderly have a reduced capacity to excrete a water load, which means they are predisposed to water overload and hyponatremia. Furthermore, various neuroendocrine changes in the elderly affect fluid and electrolyte homeostasis. More studies are needed to understand the etiology of the disturbances of fluid intake and output so that they can be better prevented and treated.

Aging↗
PubMed1991

Pharmacist interventions improve fluid balance in fluid-restricted patients requiring parenteral nutrition.

Many intensive care unit (ICU) patients require parenteral nutrition (PN) and fluid restriction, making delivery of adequate nutrition difficult. We studied the effects of pharmacist interventions on fluid balance in fluid-restricted ICU patients requiring PN. Twenty patients were randomized to the treatment group (dextrose 70% injection [D70W] plus 15% amino acids for PN, 25-mL piggybacks, selected drugs added to the PN solution) or the control group (D70W plus 10% amino acids, 50- or 100-mL piggybacks). Each group contained 10 patients and they were not significantly different for age, gender, weight, hospital days, and serum albumin concentration. The duration (9.3 +/- 1.2 vs. 9.7 +/- 2.4 d) and doses of PN (29 +/- 6.8 vs. 28.7 +/- 6.9 kcal/kg/d; 1.1 +/- 0.3 vs. 1.1 +/- 0.4 g/kg/d protein) were similar between treatment and control groups. Mean fluid intake (3112 +/- 1146 vs. 3498 +/- 1111 mL/d), fluid balance (146 +/- 1581 vs. 708 +/- 1402 mL/d), and cumulative fluid balance (1358 vs. 6867 mL) were all significantly lower in the treatment group. Mean fluid output was similar between the two groups. Pharmacist interventions can significantly decrease intake and result in a better fluid balance in fluid-restricted ICU patients who require PN.

Adult↗
PubMed1991

Fluid balance during pulmonary edema. Is fluid gain a marker or a cause of poor outcome?

STUDY OBJECTIVE: To evaluate the importance of fluid balance and changes in extravascular lung water (EVLW) on survival in the ICU and short-term outcome in patients with pulmonary edema. DESIGN: Retrospective analysis of data (sorting by survival and "treatment received") from a recent randomized controlled trial of fluid restriction in this population. SETTING: Medical ICU of a university-affiliated, tertiary-care medical center. PATIENTS: Eighty-nine patients (from the previously mentioned study) requiring pulmonary artery catheterization with abnormally high EVLW (greater than 7 ml/kg). MEASUREMENTS AND RESULTS: When analyzed by survival, the survivors had no significant fluid gain or change in EVLW but decreased wedge pressure and body weight, compared to nonsurvivors. When analyzed by fluid balance, patients who gained less than 1 L of fluid by 36 hours into the study had a better rate of survival (74 percent) than the rest (50 percent; p less than 0.05). Also, the median duration of days on the ventilator, ICU days, and days of hospitalization was approximately half as long for each variable in the group with less than 1 L of fluid gain. Even accounting for baseline differences in the severity of illness, fluid balance was an independent predictor of survival (p less than 0.05). When analyzed by whether or not EVLW decreased by more than 15 percent between the first and last measurement, only patients with ARDS or sepsis had decreased days on the ventilator and ICU days. CONCLUSIONS: These data support the concept that positive fluid balance per se is at least partially responsible for poor outcome in patients with pulmonary edema and defend the strategy of attempting to achieve a negative fluid balance if tolerated hemodynamically.

Extravascular Lung Water↗
PubMed1995

Thoracic electrical impedance and fluid balance during aortic surgery.

Indices of fluid balance were evaluated during and after aortic surgery in 16 consecutive patients. Thoracic electrical impedance (TI), heart rate (HR), central venous (CVP), pulmonary artery mean (PAMP), pulmonary wedge (PWP) and mean arterial (MAP) pressure as well as fourteen arterial and venous blood gas variables were followed. Consistent with a reduction of T1 by 4.2 (-5.2 to 9.2) Ohm (median and range) during the operation, fluid balance was in excess of 1.8 (-0.1 to 3.3) 1 when evaporation was not taken into account, and it remained elevated by 1.3 (0.0 to 5.4) 1 on the first postoperative morning. The HR, MAP and PWP remained stable, while CVP and PAMP decreased by 6 (-2 to 13) and 6 (-1 to 22) mmHg, respectively. Of the determined variables only TI revealed a meaningful correlation to fluid balance (rho = -0.41; P < 0.01). Haemoglobin concentrations increased in proportion to the administered packed erythrocytes, while arterial oxygen saturation, pH and base excess decreased in proportion to the excess fluid. The results indicate that while central venous and pulmonary artery mean pressures gave the impression of a volume deficit, the positive fluid balance was mirrored by thoracic electrical impedance, and that even a minor increase of fluid balance may affect pulmonary function in patients subjected to aortic surgery.

Aged↗
PubMed1991

An experimental model for the study of transcapillary fluid balance in hypothermia.

Disturbed fluid balance is a significant clinical problem in hypothermia and rewarming. We have therefore investigated whether the transcapillary fluid balance in rats exposed to hypothermia and rewarming could be studied with the use of a wick method. Double nylon wicks were sewn into the abdominal skin and left there for one hour, then removed to double-bottomed conic vials and centrifuged. Wick fluid was collected and colloid osmotic pressure measured. Blood samples were taken simultaneously for measurement of hematocrit, hemoglobin, red cell count and plasma colloid osmotic pressure. This was done at 37 degrees C (prehypothermic), 13 degrees C (hypothermic) and at 30 degrees C (during rewarming). Blood pressure was also recorded. The model provides a good method to investigate the colloid osmotic changes of both plasma and interstitium during hypothermic situations.

Animals↗
PubMed1990

Endocrine and fluid-balance responses to amniotic and allantoic fluid loss in sheep.

Our aim was to determine fetal and maternal endocrine and fluid-balance responses to prolonged loss of amniotic and allantoic fluids in sheep. In seven sheep, amniotic and allantoic fluids were drained [379.1 +/- 20.1 (SE) ml/day] from 107 to 135.3 +/- 0.6 days of gestation (term: 145 days). The results from these sheep were compared with those from seven control sheep. Maternal water intake, urine production, and urine osmolality were not altered by fluid drainage, nor were fetal and maternal arterial blood gases, pH, or plasma osmolalities. Fluid drainage increased amniotic, but not allantoic, fluid osmolality. Maternal plasma cortisol concentration increased with fluid drainage, but maternal plasma concentrations of prolactin and arginine vasopressin were unchanged. Fluid drainage increased prolactin concentrations in fetal plasma and amniotic fluid, but fetal plasma concentrations of cortisol (hydrocortisone), arginine vasopressin, norepinephrine, and epinephrine were unchanged. Our results show that the fetus is capable of maintaining its plasma osmolality despite prolonged loss of fluid from its amniotic and allantoic sacs and that this is associated with alterations in the production rate and the composition of amniotic fluid.

Allantoin↗
PubMed1969

Transvascular fluid balance in the lung.

1. The transvascular fluid balance has been studied in isolated blood-perfused lungs of rabbit and cat. During periods of left atrial pressure (LAp) elevation, changes in preparation weight were measured. In some experiments simultaneous recordings of changes in blood volume, as judged by changes in emitted radioactivity from (51)Cr labelled red blood cells, were performed.2. In nine out of eleven experiments, elevation of LAp by 5 mm Hg within a test period of 8 min resulted in new weight stability and thus apparently in the establishment of a new transvascular fluid equilibrium. In five of these eleven experiments weight stability was also obtained on elevation of LAp by 10 mm Hg. When LAp was elevated further, transvascular fluid equilibrium was not obtained, and a continuous and eventually progressive outward flux of fluid occurred.3. In a preparation with the vasculature paralysed by papaverine in order to avoid vasomotor reactions, changes in plasma protein content caused immediate alterations in the weight slopes of the preparations. These alterations were interpreted as being due to changes in transvascular fluid transfer. Again new stable weights were obtained on moderate changes in plasma protein content.4. New weight and transvascular fluid equilibria seemed to be reached as a result of very small transvascular fluxes of fluid. The transvascular fluid balance in the lung may thus be dynamically maintained as a result of such small fluxes of fluid. The Starling hypothesis could account for this balance, provided that a small shift of fluid can cause sufficiently marked alterations in the osmotic and/or hydrostatic pressure gradient across the wall of the exchange vessels.5. The possible role of a small extravascular compartment with a high fluid colloid osmotic pressure is discussed in relation to transvascular fluid balance in the lung.

Animals↗
PubMed1983

Effects of sequential periods of intracranial hypertension on lung fluid balance.

Pulmonary hemodynamics and fluid and protein exchange were examined in dogs subjected to three successive periods of intracranial hypertension. Results indicate that the alteration in lung fluid balance is due to increased microvascular surface area following capillary recruitment. The relationship to the mechanism of neurogenic pulmonary edema is discussed.

Animals↗
PubMed1995

A method of measuring fluid balance during transurethral resection of the prostate.

OBJECTIVE: To design a practical system for non-invasively monitoring fluid balance during transurethral resection of the prostate (TURP) and other endoscopic procedures. MATERIALS AND METHODS: Load cell transducers are incorporated into a platform placed under the operating table. Output is passed to a digital weighmeter and then to a portable computer. The raw data is filtered using software written by the authors (CAL) and the output displayed both numerically and graphically on the computer screen. The device was tested under laboratory conditions and then assessed in the clinical setting. RESULTS: The device proved stable in both the laboratory and clinical settings. Examples of the common patterns generated during TURP are presented. The prototype has been used routinely in our practice to warn the surgeon and anaesthetist of fluid overload and has been used to monitor fluid balance in several studies. CONCLUSIONS: This instrument provides a practical method of monitoring total fluid balance during TURP. It can be used with either general or regional anaesthesia and provides information not otherwise available. It provides an early warning of significant changes in total fluid balance, particularly irrigant fluid absorption. Use of this device serves to prevent development of the TUR syndrome, a potentially fatal complication of endoscopic surgery. Our ultimate aim is to produce a refined version that is simple, compact and cheap enough to be used routinely in all urological theatres. The cost of a single episode of intensive care for a patient developing iatrogenic complications from irrigant absorption would offset the cost of such a device.

Absorption↗
PubMed2026

Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock.

BACKGROUND: Whether treatment with balanced crystalloid fluid leads to better outcomes than 0.9% saline in children treated for septic shock is debated. METHODS: In this pragmatic clinical trial conducted at 47 emergency departments in five countries, patients (2 months to <18 years of age) with suspected septic shock and abnormal perfusion were randomly assigned to receive fluid resuscitation with either balanced fluid or 0.9% saline for up to 48 hours. The primary outcome was a major adverse kidney event (a composite of death, new renal-replacement therapy, or persistent kidney dysfunction) at 30 days after enrollment or hospital discharge, whichever occurred first. RESULTS: Of 9041 enrolled patients, 277 (6.1%) in the balanced-fluid group and 282 (6.2%) in the 0.9%-saline group withdrew from the trial, leaving 4235 and 4247 patients, respectively, for analysis. A primary-outcome event occurred in 137 patients (3.4%) in the balanced-fluid group and in 124 (3.0%) in the 0.9%-saline group (difference, 0.4 percentage points; 95% confidence interval [CI], -0.5 to 1.3; risk ratio, 1.10; 95% CI, 0.88 to 1.40; P&#x2009;=&#x2009;0.85). The median number of hospital-free days during 28 days after enrollment was 23 (interquartile range, 19 to 25) in both groups. Hyperchloremia occurred in 868 patients (31.4%) in the balanced-fluid group and in 1383 (49.0%) in the 0.9%-saline group; hypernatremia in 52 (1.8%) and 89 (3.1%), respectively; and hyperlactatemia in 260 (19.8%) and 228 (16.7%). No differences in other safety outcomes or adverse events were seen. CONCLUSIONS: Among children treated for septic shock, no significant difference was seen in the incidence of death, new renal-replacement therapy, or persistent kidney dysfunction when fluid resuscitation was administered with balanced fluid as compared with 0.9% saline. (Funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; PRoMPT BOLUS ClinicalTrials.gov number, NCT04102371.).

Adolescent↗
PubMed1991

Thoracic impedance as an index of body fluid balance during cardiac surgery.

Thoracic impedance at 2.5 (TI2.5) and 100 kHz (TI100), central venous pressure (CVP), and body fluid balance were recorded together with rectal temperature and arterial haematocrit in 15 consecutive patients subjected to coronary artery bypass grafting. I.v. fluid and blood were administered in an excess of 3.18 (1.38-9.35) 1 during the operation. TI2.5 decreased from 51.7 (39.2-66.4) to 34.9 (21.1-45.7) ohm (P = 0.001), while TI100 decreased from 41.9 (31.4-55.0) to 30.3 (18.3-40.8) ohm (P = 0.002). CVP, 6 (3-11) mmHg [0.8 (0.4-1.5) kPa], was the same before and after surgery. Temperature decreased during cardiopulmonary bypass from 35.4 (34.1-36.6) to 26.7 (22.9-31.0) degrees C and haematocrit from 39 (34-46)% to a lowest value of 27 (23-32)% (P = 0.0001). A close linear correlation between TI and body fluid balance was observed (TI2.5: r = -0.96, TI100: r = -0.95, P = 0.0001). Corrections of TI for temperature and/or haematocrit improved the correlation between TI and fluid balance to 0.99 (TI2.5) and 0.98 (TI100). The data indicate that changes in thoracic impedance can be used to monitor body fluid balance during cardiac surgery.

Aged↗
PubMed1986

The morphological basis of fluid balance in the interstitium of the juxtaglomerular apparatus.

The morphological basis of fluid balance in the interstitium of the juxtaglomerular apparatus (JGA) was reevaluated in rats, mice and Tupaia. Three ultrastructural features in the region of the vascular pole of the renal corpuscle are described that may be important for the fluid balance in this region: (1) podocyte foot processes in the parietal layer of Bowman's capsule, (2) endothelial fenestrations in the wall of the incoming afferent arteriole, both facing Goormaghtigh and epithelioid cells, and (3) the mesangial-type lining of the glomerular stalk. With respect to the relevant pressure gradients, this morphology may provide the basis of bulk-fluid flow directed to the interstitium of the JGA including the Goormaghtigh cell field. Thus, the fluid balance in the lacis area and, consequently, the tubulo-glomerular feedback mechanism, probably does not solely depend upon the reabsorptive transport of the macula densa. Similar considerations may be valid for the humoral control of renin secretion from juxtaglomerular epithelioid cells.

Animals↗
PubMed1977

Hana kai ii: a 17-day dry saturation dive at 18.6 ATA. III. Body fluid balance.

Comprehensive studies on body fluid balance on 5 divers were conducted during the Hana Kai II dive (17 days at 18.6 ATA and 7 days of decompression). Daily urine flow increased from about 2000 ml at 1 ATA to 2600 ml at 18.6 ATA, at 31 degrees C. This diuresis was accompanied by a reduction in urine osmolality (from 650 to 500 mOsm) and a slight increase in osmolal clearance. Endogenous creatinine clearance remained at about 173 ml/min throughout the dive. Despite such a sustained diuresis, neither daily water intake nor total body water volume changed significantly. The plasma renin activity changed little, while both plasma aldosterone concentration and urinary aldosterone excretion increased significantly during the first week at 18.6 ATA. The plasma prolactin concentration showed a significant decrease during the first 3 days at 18.6 ATA. The daily excretion of antidiuretic hormone (ADH) decreased significantly (by 40%) 4 days after compression and remained low throughout the rest of the dive. Insensible waterloss at 18.6 ATA was 35% lower than that at 1 ATA. It is suggested that the observed hyperbaric diuresis is due primarily to suppression of ADH as a result of suppression of insensible water loss.

Aldosterone↗
PubMed1978

Clinical experience with continuously monitored fluid balance in automatic hemofiltration.

Automatic fluid balancing, as obtained with the hemofiltration machines from Sartorius (Göttingen, West Germany) and Dialysetechnik (Karlsruhe, West Germany), is accurate enough to replace bed scales, which have been necessary in conventional hemodialysis for patients who are confined to beds. Side effects such as hypotension, nausea and muscle cramps during treatment may be reduced with these new machines, compared to conventional methods, provided that the rate of effective fluid withdrawal does not exceed 0.5 L/hr. In particular, the constant weight loss associated with automatic hemofiltration seems to be well tolerated by the patients with fewer side effects.

Body Weight↗
PubMed1986

The importance of plasma colloid osmotic pressure for interstitial fluid volume and fluid balance after elective abdominal vascular surgery.

The relationships between plasma colloid osmotic pressure (COPp) and interstitial fluid volume (IFV) as well as postoperative fluid balance were investigated in a prospective study involving 53 patients undergoing elective abdominal aortic reconstruction. The patients were divided into four groups according to pre- and postoperative blood replacement and fluid therapy programs whereby a continuum of postoperative COPp-values between 33 and 16 mmHg was obtained. Measurements were done before the operation and on days 1 and 4 after surgery. After surgery, COPp below 20 mmHg led to increased IFV. On day 1, COPp was linearly correlated to the total amount of fluid retained during the day of operation. A positive fluid balance of 3 L on this day ensured unchanged extracellular fluid volume (ECV). Of the 3 L, 1.5 L was insensible water loss and 1.5 L had moved into the cells. On day 4 after surgery, COPp below 22 mmHg was associated with increased plasma volume. The authors suggest that COPp be maintained above 20 mmHg after major surgery, and positive fluid balance should not exceed 5 L during the day of operation.

Aged↗
PubMed1986

Amniotic fluid volume and its relationship to fetal fluid balance: review of experimental data.

The studies described above collectively suggest that, whenever there is a decrease in fluid balance in the fetus, both fetal urine flow and tracheal secretion into the amniotic space are decreased. Conversely, when fetal hydration is increased, both urine and tracheal flows into the amniotic fluid may be increased. These observations suggest the hypothesis that, except under pathological conditions, aberrations in amniotic fluid volume may be the consequence of the existing state of hydration of the fetus. In addition, it appears that under many circumstances, these deviations from normal in fetal fluid balance may be due to maternal influences. Of course, the concept that fetal fluid balance is the primary factor determining amniotic fluid volume needs to be modified to incorporate transmembrane fluxes. However, these fluxes have yet to be documented as they relate to amniotic fluid volume and its regulation.

Amniotic Fluid↗