Maintenance of Plasma Volume and Serum Sodium Concentration Despite Body Weight Loss in Ironman Triathletes

To investigate the impact of fluid composition on rehydration effectiveness, 30 subjects (15 men and 15 women) were studied during 2 h of rehydration after a 2.5% body weight loss. In a randomized crossover design, subjects rehydrated with water (H2O), chicken broth (CB: 109.5 mmol/l Na, 25.3 mmol/l K), a carbohydrate-electrolyte drink (CE: 16.0 mmol/l Na, 3.3 mmol/l K), and chicken noodle soup (Soup: 333.8 mmol/l Na, 13.7 mmol/l K). Subjects ingested 175 ml at the start of rehydration and 20 min later; H2O was given every 20 min thereafter for a total volume equal to body weight loss during dehydration. At the end of the rehydration period, plasma volume was not significantly different from predehydration values in the CB (−1.6 ± 1.1%) and Soup (−1.4 ± 0.9%) trials. In contrast, plasma volume remained significantly ( P < 0.01) below predehydration values in the H2O (−5.6 ± 1.1%) and CE (−4.2 ± 1.0%) trials after the rehydration period. Urine volume was greater in the CE (310 ± 30 ml) than in the CB (188 ± 20 ml) trial. Urine osmolality was higher in the CB and Soup trials than in the CE trial. Urinary sodium concentration was higher in the Soup and CB trials than in the CE and H2O trials. These results provide evidence that the inclusion of sodium in rehydration beverages, as well as consumption of a sodium-containing liquid meal, increases fluid retention and improves plasma volume restoration.

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Influence of Hemofiltration on Intradialytic Plasma Volume Decrease

Kidney & Blood Pressure Research ◽

10.1159/000498839 ◽

2019 ◽

Vol 44 (1) ◽

pp. 88-93

Author(s):

Masayuki Tanemoto ◽

Takeshi Tomita ◽

Yosuke Motoharu ◽

Masahiro Urata ◽

Yukio Okazaki

Keyword(s):

Weight Loss ◽

Body Weight ◽

Plasma Volume ◽

Body Weight Loss ◽

Intradialytic Hypotension ◽

Preventive Effect ◽

Online Mode ◽

Maintenance Dialysis ◽

Volume Decrease

Background/Aims: Compared with hemodialysis (HD), hemodiafiltration (HDF) reduces the frequency of episodes of intradialytic hypotension. Intradialytic plasma volume decrease (IPVD) induced by ultrafiltration is a leading cause of the episodes, and hemofiltration might have a preventive effect on IPVD. This study examined whether online HDF (ol-HDF) prevented IPVD compared with HD. Methods: Online HDF of pre-dilution mode (pre-ol-HDF) and post-dilution mode (post-ol-HDF) and HD were performed in 22 patients on maintenance dialysis. In each session, IPVD was calculated by using an intradialytic change in hematocrit, and IPVD in pre-ol-HDF and post-ol-HDF was compared with that in HD in a crossover manner. Results: While the ratios of intradialytic body weight loss to post-dialysis BW (IBWL/BW) in ol-HDF were generally smaller than those in HD, the levels of IPVD and IPVD/IBWL/BW were generally larger than those in HD; the IPVD levels were 0.108 ± 0.058, 0.113 ± 0.053, and 0.101 ± 0.057 (P = 0.67), and those of IPVD/IWL/BW were 2.21 ± 0.97, 2.32 ± 0.91, and 1.98 ± 1.14 (P = 0.21) in pre-ol-HDF, post-ol-HDF, and HD, respectively. Conclusion: Online mode hemofiltration, in either pre-dilution mode or post-dilution mode, performed in combination with hemodialysis has no preventive effect on IPVD.

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P1080INCREASE OF POST DIALYSIS HEMOGLOBIN CONCENTRATION IS MORE APPROPRIATELY EXPLAINED BY PLASMA VOLUME CHANGE THAN INTRADIALYTIC WEIGH LOST

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1080 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Elena Babalj Banskolieva ◽

Risto Grozdanovski ◽

Katerina Spaseska Gjurovska ◽

Marko Ilievski ◽

Biljana Filipovska ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Plasma Volume ◽

Volume Change ◽

Body Weight Loss ◽

Volume Changes ◽

Clinical Instability ◽

Plasma Volume Change ◽

The Mean ◽

Group B

Abstract Background and Aims It is well known that haemoglobin significantly increases after haemodialysis and it is associated with the rate of weight loss during dialysis. However, it has been shown that the increase in haemoglobin is not always proportional to the rate of body weight loss during haemodialysis (ultrafiltration). The purpose of the study was to investigate the correlation between haemoglobin changes, body weight loss and plasma volume changes during haemodialysis Method A prospective study was performed on 92 patients in mid-week treatments. Pre-dialysis and post-dialysis haemoglobin and weight were measured. 27 patients were excluded because clinical instability, no change or a decrease in Hb and low pre-dialysis haemoglobin (< 9 g/dL). The correlation was statistically significant between %ΔPV and ΔHb in both groups (R2=0.59), whereas the correlation between %ΔBW and ΔHb was lower (R2=0.19). So, analysis show that only 19% of the variability in haemoglobin is explained by %ΔBW, and that 59% of the variability in haemoglobin is explained by %ΔPV. Results The mean age was 61.16 ± 13.11 year. The men were 52 (56%). The mean pre-dialysis Hb was 11.31 ± 1.16 g/dL, the mean post-dialysis Hb level was 12.53 ± 1.47 g/dL. The mean absolute change of haemoglobin (ΔHb g/dL) and percent of change of haemoglobin (%ΔHb) were 1.22 ± 0.76 and 9.44 ± 5.31, respectively. Average percent of weight change (%ΔBW) was - 2.44 ± 1.01. Percent of plasma volume change was - 9.22 ± 5.46. The patients were divided in two groups according post-dialysis haemoglobin level: Group A with haemoglobin Hb < 13 g/dL (64 patients) and group B with Hb ≥13 g/dL (28 patients). The mean time average haemoglobin concentration (TAC Hb) in all patients was 11.68 ± 1.11 g/dL.(Predicted Hb TAC was calculated according Krisper′s formula) In both groups there was an increase in %ΔHb, but in the group with post dialysis Hb ≥ 13 g/dL, %ΔHb was greater than in group B with post dialysis Hb < 13 g/dL (13.08 ± 5.11 versus 7.87± 4.61, P = 0.000) despite the relatively small difference of %ΔBW between the two groups (- 2.85 ± 0.95 versus - 2.23 ± 1.02; P = 0.010). However, the difference in %ΔPV between the two groups was significant (- 12.90 ± 5.63 versus - 7.61 ± 4.57; P < 0.000). Conclusion The intradialytic changes in haemoglobin levels are predominantly determined by changes in plasma volume. Changes in body weight are of little predictive value in evaluation of variation of haemoglobin levels. TAC Hb determination should be performed in patients with large variations in plasma volume, because the plasma volume has very little effect on TAC Hb.

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Treatment of severe chronic hypotonic hyponatremia: a new treatment model

Italian Journal of Medicine ◽

10.4081/itjm.2013.26 ◽

2013 ◽

pp. 26-31

Author(s):

Antonio Burgio ◽

Rossana Dovico ◽

Luca Burgio

Keyword(s):

Body Weight ◽

Sodium Chloride ◽

Serum Sodium ◽

Sodium Concentration ◽

The Body ◽

Serum Sodium Concentration ◽

Close Monitoring ◽

Treatment Needs ◽

Correction Rate ◽

Wide Range

Recommended treatment of severe hypotonic hyponatremia is based on the infusion of 3% sodium chloride solution, with a daily correction rate below 10 mEq/L of sodium concentration, according to the Adrogué and Madias formula that includes the current desired change in sodium concentrations. However, such treatment needs close monitoring of the rate of infusion and does not take into account the body weight or age of the patient. This may result in hypercorrection and neurological damage. We made an inverse calculation using the same algorithms of the Adrogué and Madias formula to estimate the number of vials of sodium chloride needed to reach a correction rate of the serum sodium concentration below 0.4 mEq/h, taking into account the body weight and age of the patient. Three tables have been produced, each containing the number of vials to be infused, according to the patient’s age and body weight, the serum sodium concentration, and the rate of correction over 24 h to avoid the risk of brain damage. We propose a new practical model to calculate the need of sodium chloride infusate to safely correct the hyponatremia. The tables make treatment easier to manage in daily clinical practice in a wide range of patient ages and body weights.

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28 Association of serum sodium concentration, fluid balance and weight loss with bronchopulmonary dysplasia in very preterm infants

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.027 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e10-e11

Author(s):

Safiya Soullane ◽

Sharina Patel ◽

Guilherme Sant’Anna ◽

Martine Claveau ◽

Laila Wazneh ◽

...

Keyword(s):

Weight Loss ◽

Fluid Balance ◽

Serum Sodium ◽

Sodium Concentration ◽

Serum Sodium Concentration ◽

Very Preterm Infants ◽

Maximum Percentage ◽

Median Serum ◽

Percentage Weight ◽

Cumulative Fluid Balance

Abstract Background Bronchopulmonary dysplasia (BPD) affects 20% of very preterm infants born <33 weeks gestational age (GA). In this subgroup of neonates, postnatal fluid adaptation may be inefficient due to kidney immaturity, resulting in increased pulmonary interstitial fluid content, lung damage and impaired air-gas exchange. Early postnatal fluid status might contribute to the risk of developing BPD and requires further investigation. Objectives To investigate the association of three indicators of early postnatal fluid status (median serum sodium concentration, cumulative fluid balance and maximum percentage weight loss) measured over the first 10 days after delivery with death and/or BPD in infants born <33 weeks. Design/Methods This retrospective cohort study included infants born 23-32 weeks GA, admitted to the Montreal Children’s Hospital’s NICU from 2015-2018. Neonates moribund on admission, with any major congenital malformation and/or admitted to the NICU >1 day after birth were excluded. Data was collected from the Canadian Neonatal Network database and individual chart review. BPD was defined as oxygen therapy or respiratory support at 36 weeks’ corrected GA. Unadjusted comparisons were made using the Wilcoxon test. Associations between exposures (median serum sodium concentration, cumulative fluid balance and maximum percentage weight loss in the first 10 days after delivery) and outcomes (death and/or BPD) were assessed using multivariable logistic regression analyses adjusting for sex, steroid use, GA, small-for-gestational-age status, Apgar at 5 min<7, surfactant use and mode of delivery. Results Among 439 eligible infants, 125 died and/or developed BPD (29%). Median serum sodium concentration was 139 mmol/L (IQR 136-141) among BPD-free survivors and 136 mmol/L (IQR 134-139) among infants with death and/or BPD (p<0.001). Cumulative fluid balance was 4.09 dL/kg (IQR 2.98-4.78) among BPD-free survivors and 4.88 dL/kg (IQR 3.96-5.95) among infants with death and/or BPD (p<0.001). Maximum percentage weight loss was 8.5% (IQR 5.4-11.6) among BPD-free survivors and 9.2% (IQR 4.9-12.9) among infants with death and/or BPD (p=0.41). Adjusted odds ratios (95% confidence interval) are presented in Table 1. Conclusion Among very preterm infants, higher cumulative fluid balance in the first 10 days after delivery is associated with higher odds of death and/or BPD. Thus, targeting lower cumulative fluid balance may improve BPD-free survival.

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