Fluid and electrolyte physiology in anaesthetic practice

2017 ◽  
Author(s):  
Robert G. Hahn
Keyword(s):  
Blood Volume ◽  
Body Fluid ◽  
Extracellular Fluid ◽  
Haemorrhagic Shock ◽  
The Body ◽  
Intracellular Space ◽  
Fluid Compartment ◽  
Life Saving ◽  
Total Body ◽  
Infusion Fluid

The maintenance of body fluid homeostasis is an essential task in perioperative care. Body fluid volumes are tightly controlled by the nervous system, by hormones, and by the kidneys. All these systems are affected by anaesthesia and surgery in ways that must be appreciated by the anaesthetist. Administration of infusion fluids is the key tool to prevent major derangements of the body fluid volumes during before, during, and after surgery. By varying its composition, an infusion fluid can be made to selectively expand or shrink a body fluid compartment. The total osmolality determines whether the infused volume distributes over the total body water or over the extracellular fluid volume, or even attracts fluid from intracellular space. Infusion fluid is the first-line tool in the management of the vasodilation that is induced by both general and regional anaesthesia. Fluids are also an essential component in the treatment of haemorrhage, in which a reduction in arterial pressure implies that 20% of the blood volume has been lost. Capillary refill restores the blood volume, but too slowly to prevent haemorrhagic shock. In this situation, prompt intravenous fluid therapy is life-saving. Electrolyte derangements may be induced by disease and/or medication. The most essential ones to consider during anaesthesia are sodium, potassium, calcium, and bicarbonate.

scholarly journals Characteristics of Intracellular and Extracellular Fluid Ratio for the Varying Body Impedances in Fixed Total Body Fluid

2017 ◽  
Author(s):  
JungHun Choi
Keyword(s):  
Human Body ◽  
High Frequency ◽  
Body Fluid ◽  
Extracellular Fluid ◽  
Bioelectrical Impedance ◽  
The Body ◽  
Horizontal Axis ◽  
Fluid Status ◽  
Total Body ◽  
Frequency Current

A bioelectrical impedance analysis is a proven method to measure body composition in clinical situations. It uses the relation between the body fluid and the impedances in a variety of frequencies. A body model can be simplified as a parallel combination of a capacitor and two resistors which represent a cell membrane, Intracellular Fluid (ICF), and Extracellular Fluid (ECF). Low frequency current passes through ECF and high frequency current also passes through ICF in a body. A Cole-Cole plot is a graphical interpretation of the path of impedances and each axis represents resistance and reactance with variable frequencies. A high value of resistance in a horizontal axis is a resistance value of ECF and a low value of resistance at a high frequency presents ICF. Interpolation technique is needed to find out the exact cross-point between impedance values and the horizontal axis. The two estimated impedance values are used to derive Total Body Water (TBW), ICF, ECF, Fat Free Mass (FFM), and Fat Mass (FM) from various published equations [1]. Minimizing the possible error of fluid volume assessment and accurate prediction of fluid status in a human body is essential for appropriate therapy. Different techniques of fluid status assessment in a human body can be applicable, such as physical examination, orthostatic vital signs, blood volume measurement, acoustic cardiograph, chest radiography, and thoracic ultrasonography [2]. In this study, a bioelectrical impedance spectroscopy device and simple body models were used to collect data such as TBW, ICF, ECF, FM, and FFM. The ratio between ICF and ECF was investigated for the same values of TBW, FM, and FFM by varying impedance values.

Blood Volume, Intracellular and Extracellular Fluid Spaces in Normal Dogs and in Dogs With Ascites Secondary to Severe Tricuspid Insufficiency

1956 ◽  
Vol 184 (2) ◽  
pp. 282-286 ◽  
Author(s):  
Basdeo Balkissoon ◽  
Mitchell W. Spellman ◽  
Edward W. Hawthorne
Keyword(s):  
Blood Volume ◽  
Rose Bengal ◽  
Extracellular Fluid ◽  
Hepatic Function ◽  
Intracellular Space ◽  
Tricuspid Insufficiency ◽  
Rose Bengal Dye ◽  
Total Body ◽  
Surgically Induced ◽  
The Rose

Twenty-two normal and 12 dogs with ascites secondary to surgically induced isolated, total tricuspid insufficiency or a combination of tricuspid insufficiency with bilateral arteriovenous fistulae in the hind extremities were studied. In the ascitic animals: a) the blood volume, as determined by the use of rose bengal dye, increased secondary to an elevation in the plasma volume. b) The total body water, as measured by use of antipyrine, remained unchanged but the thiocyanate space increased and the calculated intracellular space was comparably diminished. c) The excretory hepatic function as evaluated by the rose bengal dye method was significantly depressed whereas the capacity of the liver to excrete bromsulfalein was not impaired. This investigation provides a basis for evaluating the influences of adrenalectomy among a similar group of ascitic dogs with tricuspid insufficiency.

Hormonal and electrolyte response to exposure to 17,500 ft

1975 ◽  
Vol 38 (4) ◽  
pp. 636-642 ◽  
Author(s):  
R. Frayser ◽  
I. D. Rennie ◽  
G. W. Gray ◽  
C. S. Houston
Keyword(s):  
Plasma Volume ◽  
Body Fluid ◽  
Plasma Renin ◽  
The Body ◽  
Potassium Excretion ◽  
The Third ◽  
Fluid Compartment ◽  
Response To Stress ◽  
Total Body ◽  
Sodium And Potassium

Hormone, electrolyte, and body fluid compartment changes were studied in subjects who either spent time at 10,000 ft before flying to 17,500 ft or were premedicated with acetazolamide and flown directly to 17,500 ft. In the former group, at 10,000 ft, renin and aldosterone were not different from control. Cortisol increased significantly from 9.8 to 19.5 mug/100 ml on the third day. At 17,500 ft, renin, aldosterone and cortisol were significantly elevated on day 3 but had returned to control levels by day 5. Sodium and potassium excretion was significantly reduced at both altitudes. Total body water, extracellular and plasma volume were reduced (P less than 0.05) at 17,500 ft. Subjects pretreated with acetazolamide and flown directly to 17,500 ft had significant increases (P less than 0.001) in plasma renin, aldosterone, and cortisol levels during the first 4 days at altitude. On day 1 there was a decrease of 45% in sodium and 38% in potassium excretion. On day 4 there was a decrease of 63% and 51%, respectively. These changes are not associated with the premedication. The initial changes may reflect the immediate response to stress and alkalosis followed by a return to control levels as the body adapts to altitude.

Use of Continuous Blood Volume Monitoring to Detect Inadequately High Dry Weight

1996 ◽  
Vol 19 (7) ◽  
pp. 411-414 ◽  
Author(s):  
F. Lopot ◽  
P. Kotyk ◽  
J. Bláha ◽  
J. Forejt
Keyword(s):  
Blood Volume ◽  
Vena Cava ◽  
Extracellular Fluid ◽  
Dry Weight ◽  
Whole Body ◽  
The Status ◽  
Varying Length ◽  
Group 3 ◽  
Group 2 ◽  
Total Body

A continuous blood volume monitoring (CBVM) device (Inline Diagnostics, Riverdale, USA) was used to study response to prescribed ultrafiltration during haemodialysis (HD) in 66 stabilised HD patients. Fifty percent of patients showed the expected linear decrease in BV right from the beginning of HD (group 1), 32% exhibited no decrease at all (group 2), while eighteen percent formed the transient group 3 which showed a plateau of varying length after which a decrease occurred. The correct setting of dry weight was verified through evaluation of the ratio of extracellular fluid volume to total body water (VEC/TBW) in 26 patients by means of whole body multifrequency impedometry MFI (Xitron Tech., San Diego, USA) and through measurement of the Vena Cava Inferior diameter (VCID) pre and post HD (in 6 and 5 patients from groups 1 and 3 and from group 2, respectively). The mean VEC/TBW in groups 1 and 3 was 0.56 pre and 0.51 post HD as compared to 0.583 and 0.551 in group 2. VCID decreased on average by 14.1% in groups 1 and 3 but remained stable in group 2. Both findings thus confirmed inadequately high estimation of dry weight. Since CBVM is extremely easy to perform it can be used as a method of choice in detecting inadequately high prescribed dry weight. The status of the cardiovascular system must always be considered before final judgement is made.

Regulation of body fluid compartments during short-term spaceflight

1996 ◽  
Vol 81 (1) ◽  
pp. 105-116 ◽  
Author(s):  
C. S. Leach ◽  
C. P. Alfrey ◽  
W. N. Suki ◽  
J. I. Leonard ◽  
P. C. Rambaut ◽  
...  
Keyword(s):  
Body Fluid ◽  
Extracellular Fluid ◽  
Plasma Renin ◽  
Capillary Membranes ◽  
Urinary Cortisol Excretion ◽  
Hormone Responses ◽  
Body Fluid Compartments ◽  
Cortisol Excretion ◽  
Fluid Compartments ◽  
Total Body

The fluid and electrolyte regulation experiment with seven subjects was designed to describe body fluid, renal, and fluid regulatory hormone responses during the Spacelab Life Sciences-1 (9 days) and -2 (14 days) missions. Total body water did not change significantly. Plasma volume (PV; P < 0.05) and extracellular fluid volume (ECFV; P < 0.10) decreased 21 h after launch, remaining below preflight levels until after landing. Fluid intake decreased during weightlessness, and glomerular filtration rate (GFR) increased in the first 2 days and on day 8 (P < 0.05). Urinary antidiuretic hormone (ADH) excretion increased (P < 0.05) and fluid excretion decreased early in flight (P < 0.10). Plasma renin activity (PRA; P < 0.10) and aldosterone (P < 0.05) decreased in the first few hours after launch; PRA increased 1 wk later (P < 0.05). During flight, plasma atrial natriuretic peptide concentrations were consistently lower than preflight means, and urinary cortisol excretion was usually greater than preflight levels. Acceleration at launch and landing probably caused increases in ADH and cortisol excretion, and a shift of fluid from the extracellular to the intracellular compartment would account for reductions in ECFV. Increased permeability of capillary membranes may be the most important mechanism causing spaceflight-induced PV reduction, which is probably maintained by increased GFR and other mechanisms. If the Gauer-Henry reflex operates during spaceflight, it must be completed within the first 21 h of flight and be succeeded by establishment of a reduced PV set point.

Extracellular and intracellular carbon dioxide concentration as a function of temperature in the toad Bufo marinus.

1994 ◽  
Vol 195 (1) ◽  
pp. 345-360 ◽  
Author(s):  
J N Stinner ◽  
D L Newlon ◽  
N Heisler
Keyword(s):  
Body Temperature ◽  
Extracellular Fluid ◽  
Carbon Dioxide Concentration ◽  
The Body ◽  
Whole Body ◽  
Mean Values ◽  
Temperature Changes ◽  
Fluid Compartment ◽  
Average Change ◽  
Higher Temperature

Previous studies of reptiles and amphibians have shown that changing the body temperature consistently produces transient changes in the respiratory exchange ratio (RE) and, hence, changes in whole-body CO2 stores, and that the extracellular fluid compartment contributes to the temperature-related changes in CO2 stores. The purpose of this study was to determine whether the intracellular fluid compartment contributes to the changes in CO2 stores in undisturbed resting cane toads. Increasing body temperature from 10 to 30 degrees C temporarily elevated RE, and returning body temperature to 10 degrees C temporarily lowered RE. The estimated average change in whole-body CO2 stores associated with the transient changes in RE was 1.0 +/- 0.8 mmol kg-1 (+/- S.D., N = 6). Plasma [CO2] and, thus, extracellular fluid [CO2], were unaffected by the temperature change. Plasma calcium levels were also unaffected, so that bone CO2 stores did not contribute to changes in whole-body CO2 stores. Intracellular [CO2] was determined for the lung, oesophagus, stomach, small intestine, liver, ventricle, red blood cells, skin and 14 skeletal muscles. [CO2] was significantly lower (P &lt; 0.05) at higher temperature in 10 of these, and seven others, although not statistically significant (P &gt; 0.05), had mean values at least 0.5 mmol kg-1 lower at the higher temperature. The average change in intracellular [CO2] for all tissues examined was -0.165 mmol kg-1 degrees C-1. We conclude that, in cane toads, the temperature-related transients in RE result from intracellular CO2 adjustments, that different tissues have unique intracellular CO2/temperature relationships, and that a combination of respiratory and ion-exchange mechanisms is used to adjust pH as temperature changes.

scholarly journals Blood volume and body fluid compartment changes soon after closed and open intracardiac surgery

1966 ◽  
Vol 52 (5) ◽  
pp. 698-705 ◽  
Author(s):  
John Cleland ◽  
James R. Pluth ◽  
W. Newlon Tauxe ◽  
John W. Kirklin
Keyword(s):  
Blood Volume ◽  
Body Fluid ◽  
Fluid Compartment ◽  
Intracardiac Surgery

Hydration of fat-free body in protein-depleted patients

1985 ◽  
Vol 249 (2) ◽  
pp. E227-E233 ◽  
Author(s):  
A. H. Beddoe ◽  
S. J. Streat ◽  
G. L. Hill
Keyword(s):  
Cell Mass ◽  
Protein A ◽  
Extracellular Fluid ◽  
The Body ◽  
Fat Free Mass ◽  
Body Protein ◽  
Mean Values ◽  
Free Body ◽  
Fluid Compartments ◽  
Total Body

It is widely believed that increased hydration of the fat-free body accompanies most major disease processes as a result of contraction of the body cell mass and expansion of the extracellular fluid. Measurements of total body water (TBW) and total body nitrogen in 68 normal volunteers and 95 surgical ward patients presenting for intravenous nutrition have been used to derive ratios of TBW to fat-free mass (TBW:FFM) and protein indices (PI), where PI is defined as the ratio of measured total body protein to predicted TBP. Mean values of PI were 1.009 +/- 0.116 (SD) and 0.783 +/- 0.152 in the normal and patient groups, respectively, corresponding to mean TBW:FFM ratios of 0.719 +/- 0.016 and 0.741 +/- 0.029. However, 48 patients had normal TBW:FFM despite having lost 15% of body protein. A theoretical model of body composition changes in catabolic illness is presented, which is in accord with the patient data, demonstrating that TBW:FFM does not necessarily increase in catabolic illness and that the ratio masks underlying shifts in body fluid compartments.

Shift in body fluid compartments after dehydration in humans

1988 ◽  
Vol 65 (1) ◽  
pp. 318-324 ◽  
Author(s):  
H. Nose ◽  
G. W. Mack ◽  
X. R. Shi ◽  
E. R. Nadel
Keyword(s):  
Body Fluid ◽  
Extracellular Fluid ◽  
Plasma Osmolality ◽  
Free Water ◽  
Inverse Correlation ◽  
The Body ◽  
Free Water Clearance ◽  
Before And After ◽  
Body Fluid Compartments ◽  
Fluid Compartments

To investigate the influence of [Na+] in sweat on the distribution of body water during dehydration, we studied 10 volunteer subjects who exercised (40% of maximal aerobic power) in the heat [36 degrees C, less than 30% relative humidity (rh)] for 90-110 min to produce a dehydration of 2.3% body wt (delta TW). After dehydration, the subjects rested for 1 h in a thermoneutral environment (28 degrees C, less than 30% rh), after which time the changes in the body fluid compartments were assessed. We measured plasma volume, plasma osmolality, and [Na+], [K+], and [Cl-] in plasma, together with sweat and urine volumes and their ionic concentrations before and after dehydration. The change in the extracellular fluid space (delta ECF) was estimated from chloride distribution and the change in the intracellular fluid space (delta ICF) was calculated by subtracting delta ECF from delta TW. The decrease in the ICF space was correlated with the increase in plasma osmolality (r = -0.74, P less than 0.02). The increase in plasma osmolality was a function of the loss of free water (delta FW), estimated from the equation delta FW = delta TW - (loss of osmotically active substance in sweat and urine)/(control plasma osmolality) (r = -0.79, P less than 0.01). Free water loss, which is analogous to "free water clearance" in renal function, showed a strongly inverse correlation with [Na+] in sweat (r = -0.97, P less than 0.001). Fluid movement out of the ICF space attenuated the decrease in the ECF space.(ABSTRACT TRUNCATED AT 250 WORDS)

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