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The extracellular fluid-to-intracellular fluid volume ratio is associated with large-artery structure and function in hemodialysis patients.

BACKGROUND: Large-artery derangement is a major risk factor for cardiovascular and all-cause mortality in patients with end-stage renal disease (ESRD). It is not clear how body fluid distribution affects large-artery structure and function in patients with ESRD. METHODS: One hundred fifty-seven hemodialysis (HD) patients (mean age, 55.9 +/- 15.1 years; 76 men, 81 women) were enrolled. Influence of the extracellular fluid (ECF)-to-intracellular fluid (ICF) ratio derived from bioimpedance spectroscopy on the structure and function of the common carotid artery (CCA) and aorta was analyzed. One hundred forty-four healthy subjects were examined to obtain normal reference values for body fluid compartments. Based on ECF-ICF ratio, 2 groups were identified: ECF-ICF ratio in the 95th percentile or less and ECF-ICF ratio greater than the 95th percentile of age- and sex-stratified normal reference values. RESULTS: ECF-ICF ratio was significantly related to CCA diameter (r2 = 0.26; P < 0.001), CCA incremental modulus (E(inc); r2 = 0.15; P < 0.001), carotid augmentation index (AGI; r2 = 0.10; P < 0.001), and aortic pulse wave velocity (aPWV; r2 = 0.21; P < 0.001). ECF-ICF ratio remained a significant independent determinant for CCA diameter (model r2 = 0.47; P < 0.001), E(inc) (r2 = 0.29; P < 0.001), aPWV (r2 = 0.51; P < 0.001), and AGI (r2 = 0.40; P < 0.001) when age, sex, mean blood pressure, anthropometrical parameters, HD duration, and status of diabetes mellitus were accounted for. HD patients with an ECF-ICF ratio greater than the 95th percentile had a greater CCA diameter, E(inc), aPWV, and AGI than their counterparts. CONCLUSION: ECF-ICF ratio is associated with large-artery structure and function in HD patients. Patients with ESRD with a high ECF-ICF ratio are characterized by significant large-artery derangement.

Adult↗

Use of multifrequency bioelectrical impedance analysis for estimation of total body water and extracellular and intracellular fluid volumes in horses.

OBJECTIVE: To evaluate the use of multifrequency bioelectrical impedance analysis (MF-BIA) for estimating total body water (TBW), extracellular fluid volume (ECFV), and intracellular fluid volume (ICFV) in horses. ANIMALS: 9 healthy mares. PROCEDURE: TBW and ECFV were measured by use of deuterium oxide and sodium bromide dilution techniques, respectively. Intracellular fluid volume was calculated as the difference between TBW and ECFV. Concurrently, MF-BIA recordings were obtained by use of 4 anatomic electrode positions and 3 measurements of length. Models for MF-BIA data were created for all combinations of length and anatomic electrode position. Models were evaluated to determine the position-length configuration that provided the most consistent estimates of TBW, ECFV, and ICFV, compared with values determined by use of the dilution techniques. RESULTS: Positioning electrodes over the ipsilateral carpus and tarsus and use of height at the tuber sacrale for length provided the closest estimate between values for TBW, ECFV, and ICFV predicted by use of MF-BIA and measured values obtained by dilutional techniques. This model had the narrowest 95% limits of agreement. CONCLUSIONS AND CLINICAL RELEVANCE: MF-BIA techniques have been used to predict changes in TBW, ECFV, and ICFV in healthy and diseased humans. Results reported in this study provide an equine-specific model to serve as the basis for further evaluation of MF-BIA in horses with altered fluid states. The MF-BIA techniques have a number of potential applications for use in horses, including evaluation of exercise physiology, pharmacologic studies, and critical-care management.

Animals↗

Potassium, sodium, and the intracellular fluid space of cells from bone.

Cells enzymatically dispersed from fetal rat calvaria were analyzed for sodium and potassium content and intracellular fluid space (ICF). Even when obtained in comparatively high yield, the cells are damaged by the isolation procedure as evidenced by high sodium and low potassium content immediately after isolation. During a post-incubation period potassium is accumulated and sodium extruded to steady-state levels. Although electrolyte content of cells after recovery did not vary as a function of cell yield, ICF was increased in cells obtained in lower yield, suggesting cell swelling as a result of membrane damage. The weighted mean values obtained for the best cell preparations were 117 mM K+ and 27 mM Na+. Based on DNA assay of isolated cells and the whole tissue, 20- to 21-day calvaria were found to have an average of 8.1 x 10(6) cells/calvarium. Combining cell data with analysis of total tissue sodium, potassium, and water, it was concluded that the tissue extracellular sodium is in equilibrium with blood but that the potassium concentraiton is approximately 5-fold higher than blood levels.

Animals↗

Continuous monitoring of plasma, interstitial, and intracellular fluid volumes in dialyzed patients by bioimpedance and hematocrit measurements.

Bioimpedance spectroscopy (BIS) permits evaluation of extra- and intracellular fluid volumes in patients. We wished to examine whether this technique, used in combination with hematocrit measurement, can reliably monitor fluid transfers during dialysis. Ankle to wrist BIS measurements were collected during 21 dialysis runs while hematocrit was continuously monitored in the blood line by an optical device. Extracellular (ECW) and intracellular (ICW) water volumes were calculated using Hanai's electrical model of suspensions. Plasma volume variations were calculated from hematocrit, and changes in interstitial volume were calculated as the difference between ECW and plasma volume changes. Because accuracy of ICW was too low, changes in ICW were calculated as the difference between ultrafiltered volume and ECW changes. Total body water (TBW) volumes calculated pre- and postdialysis were, respectively, 3.25+/-3.2 and 1.95+/-2.5 liters lower on average than TBW given by Watson et al.'s correlation. Average decreases in fluid compartments expressed as percentage of ultrafiltered volume were as follows: plasma, 18%; interstitial, 28%, and ICW, 54%. When the ultrafiltered volume was increased in a patient in successive runs, the relative contributions of ICW and interstitial fluid were augmented so as to reduce the relative drop in plasma volume.

Adult↗

Extracellular and intracellular fluid volume monitoring during dialysis by multifrequency impedancemetry.

Impedance techniques can, in principle, permit non-invasive monitoring of extracellular (Ve) and intracellular (Vi) fluid volumes during dialysis. The authors present a method that determines the resistances Re and Ri of extracellular and intracellular compartments, respectively, by extrapolating impedance measurement toward zero, as well as infinite frequencies, according to the Cole-Cole model of biologic issues. These measurements were made using a XITRON 4000 B impedance meter (Xitron Technologies Inc., San Diego, CA) at frequencies ranging from 5 kHz to 1 MHz. The fact that the body is not a cylindric, homogeneous conductor is taken into account by introducing shape factors ke and ki and different resistivities pe and pi for the extracellular and intracellular fluid compartments. Assuming that these four unknown parameters can be regarded as constant during dialysis, the authors obtain: [formula: see text] where subscript o denotes initial values at start of dialysis. Impedances were measured at 30 min intervals on 11 pediatric patients and two adults, whereas total body water volume was determined by measuring urea in collected dialysate. Without ultrafiltration, Ve and Vi do not change significantly in percentage whereas, in the presence of ultrafiltration, Ve decreased by 15% to 25%. In cases when Vi does not change, it is possible to determine Ve and its variation during dialysis.

Adolescent↗

Intracellular fluid of waybread (Plantago major) as a prophylactic for mammary cancer in mice.

The investigations were performed on female mice of the strain C3H Strong. Only the breeders were used in the experiments. A number of mice were given intracellular fluid of way-bread in subcutaneous injections. The controls received no treatment. The age at which mammary cancer appeared was noted and also how often the tumors occurred. The frequency of tumor formation was 93.3% in the controls and 18.2% in the treated mice. The difference is significant.

Animals↗

What is the impact of potassium excretion on the intracellular fluid volume: importance of urine anions.

Hyponatremia is a common electrolyte abnormality that causes symptoms as a result of swelling of brain cells. We evaluated the impact of a negative balance for sodium (Na) and potassium (K) salts on the intracellular fluid (ICF) volume, emphasizing the role of anions excreted with K. Rats (N = 10) were deprived of food and water for 24 hours. They received half-isotonic saline to expand their extracellular fluid (ECF) volume by 20%; a long acting antidiuretic hormone (DDAVP) preparation was given to prevent the excretion of electrolyte-free water. The concentration of Na in plasma fell from 139 +/- 1 mM to 120 +/- 2 mM 24 hours after the infusion of hypotonic saline (P < 0.01). Since these rats had a small negative balance for water (4 +/- 1 ml), hyponatremia was due to their negative balances for Na (2.2 +/- 0.3 mmol) and K (2.2 +/- 0.1). There were negative balances for Cl (2.4 +/- 0.2 mmol) and phosphate (0.7 +/- 0.05 mmol). Despite the negative balance for NaCl, the ECF volume as assessed by 3H-inulin space was not contracted. In this model for acute hyponatremia, its basis was electrolyte loss, but the ECF volume was not contracted, suggesting that water shifted from the ICF to the ECF. Hyponatremia is associated with cell swelling only if its cause is positive water balance and/or is loss of Na from the ECF. It is critical to examine the urine anions to determine the compartment of origin of particles excreted with K and thereby whether hyponatremia will result in overall expansion or contraction of the ICF volume.

Animals↗

An in vitro assessment of tissue compression damage during circular stapler approximation tests, measuring expulsion of intracellular fluid and force.

Circular staplers are among the many instruments used during minimally invasive or open surgery that should approximate soft tissue within safe compression limits. Previous in vivo suture-line blood flow measurement has suggested a safe thickness reduction limit of 25 per cent during circular stapling procedures. The present work investigates in vitro assessment of the maximum safe compression of large and small porcine intestines, measuring the required compressive force and the expelled intracellular fluid (measured as a potassium solution). A test-rig mounted on a materials testing machine allowed staplers of three sizes to compress tissue samples to thicknesses ranging from 90 to 45 per cent of original thickness. The expelled fluid was collected in 40 ml of 0.9 per cent NaCl and analysed in a flame photometer. The force measurements indicated that the small intestinal tissue samples underwent a sharp increase in stiffness over a strain range of 0.19-0.34. The large bowel tissue underwent a similar increase in stiffness over a planar compressive strain range of 0.19-0.40. The regularity of the potassium output results was limited, making it difficult to draw firm conclusions, although there was some indication that the potassium output from small intestinal tissue may change from erratic to approximately linear at a strain of approximately 0.19, while that of the large bowel tissue appeared to be approximately linear over the entire strain range tested. From the force measurements, it is concluded that strain-induced structural change may help provide a useful definition of safe tissue approximation. The possible implications for reduced dehiscence (wound disintegration) and stricture incidence in stapled anastomoses are discussed.

Animals↗

Generalizability of extracellular-to-intracellular fluid ratio using bio-impedance spectroscopy.

Generalizability theory was used to investigate the score consistency of observed extracellular fluid/intracellular fluid (ECF/ICF) ratio measurements for both the global and leg-segmental bio-impedance spectroscopy methods. The test instrument used was a Xitron Hydra ECF/ICF Bio-Impedance Analyzer System, model 4200 (Xitron Technologies, San Diego, CA). Fifty able-bodied American men (17 to 72 years) and 50 able-bodied American women (17 to 76 years) volunteered as experimental subjects. Xitron continuous global and leg-segmental ECF/ICF procedures for testing were followed for assessing subjects in both the standing erect and lying supine postures. A two-facet, person-by-trial, completely crossed design was used, and all facets were treated as random. Data were independently analyzed for each method, each body posture and each sex group. The major findings of this study were: (1) the leg-segmental method was superior in producing the higher G-coefficients when compared to the global method regardless of gender or posture; (2) the global method resulted in higher G-coefficients in males compared to females regardless of posture; (3) when the global method was used, the relative and absolute error variances were higher for females while the opposite trend was observed when the segmental method was used and (4) when using the global method, the precision of the ECF/ICF ratio scores in females could be increased by simply using the mean of several trials (e.g., by using the mean of 5, 10 or more test trials).

Adolescent↗