Successful rescue of severe hypernatraemia (196 mmol/L) by treatment with hypotonic fluid

2007 ◽  
Vol 44 (5) ◽  
pp. 491-494 ◽  
Author(s):  
Jinny Jeffery ◽  
Ruth M Ayling ◽  
Richard J S McGonigle
Keyword(s):  
Oral Fluid ◽  
Fluid Intake ◽  
Case Reports ◽  
Pure Water ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Urinary Sodium Excretion ◽  
Sodium Concentration ◽  
Chronic Renal Impairment ◽  
Hypotonic Fluid

Hypernatraemia over 160 mmol/L is considered to be severe. This case reports a patient who developed extreme hypernatraemia with a serum sodium concentration of 196 mmol/L. The patient was known to have chronic renal impairment and was admitted with acute deterioration of renal function secondary to dehydration. This was considered to be secondary to poor oral fluid intake (related to depression) and lithium-induced nephrogenic diabetes insipidus with salt-losing nephropathy. The patient had a high urinary sodium excretion but was also in a pure water losing state as evidenced by an inappropriately low urine osmolality for the plasma osmolality and was successfully treated with hypotonic intravenous fluid and desmopressin.

Age and regulation of fluid and electrolyte balance during repeated exercise sessions

1996 ◽  
Vol 270 (1) ◽  
pp. R71-R79 ◽  
Author(s):  
D. H. Zappe ◽  
G. W. Bell ◽  
H. Swartzentruber ◽  
R. F. Wideman ◽  
W. L. Kenney
Keyword(s):  
Fluid Intake ◽  
Maximal Oxygen Consumption ◽  
Urine Osmolality ◽  
Urinary Sodium Excretion ◽  
Electrolyte Balance ◽  
Similar Response ◽  
Older Individuals ◽  
Warm Environment ◽  
Repeated Exercise ◽  
Exercise Period

A common response after only 3-4 days of repeated exercise in younger individuals is an expansion of plasma volume (PV); however, it is not known if older individuals have a similar response. In this study, six older (O) (67 +/- 1 yr) and six younger (Y) men (24 +/- 2 yr) cycled for 4 successive days at 50% maximal oxygen consumption (Vo2max) for 90 min in a warm environment [30 degrees C temperature dry bulb (Tdb), 24 degrees C temperature wet bulb (Twb)]. On day 4, PV was increased (P < 0.05) in Y (10.0 +/- 1%) but not (P > 0.05) in O (1.7 +/- 2%). The increased PV was associated with a greater (P < 0.05) daily fluid intake during the exercise period in Y (45 +/- 3 ml. day-1.kg body wt-1) compared with O (32 +/- 2 ml.day-1.kg body wt-1) and an increase (P < 0.05) in the total circulating protein (TCP) content in Y (0.23 +/- 0.1 g/kg body wt) but not in O (0.10 +/- 0.1 g/kg body wt). Throughout the 4-day exercise period there were similar reductions in 24-h urine flow rate (UV) and urinary sodium excretion (UNaV) in Y and O. Additionally, acute renal clearance measures made during exercise on days 1 and 4 showed similar (P > 0.05) reductions in UNaV between Y (-55 +/- 10%) and O (-44 +/- 6%). However, during exercise in O there were no changes (P > 0.05) in UV (2 +/- 12%) and urine osmolality (UOsm) (-12 +/- 6%) from resting values compared with Y, where UV was decreased (P < 0.05) by 41 +/- 9% and UOsm was increased (P < 0.05) by 39 +/- 8%. Therefore, the inability of the older subjects to increase PV after repeated days of exercise is not related to an impaired renal fluid and Na+ conservation ability, despite a reduced urine concentrating ability during exercise, but to other factors (e.g., fluid intake and TCP) that appear necessary for the hypervolemic response.

scholarly journals The effects of fasting in Ramadan

1978 ◽  
Vol 40 (3) ◽  
pp. 583-589 ◽  
Author(s):  
K. Y. Mustafa ◽  
N. A. Mahmoud ◽  
K. A. Gumaa ◽  
A. M. A. Gader
Keyword(s):  
Young Adults ◽  
Fluid Balance ◽  
Water Loss ◽  
Fluid Intake ◽  
Urine Volume ◽  
Plasma Osmolality ◽  
Good Control ◽  
Urine Osmolality ◽  
Urine Concentration ◽  
Evaporative Water

1. Fluid intake, urine output and evaporative water loss were measured and fluid balance calculated in sixteen subjects for 1 d before Ramadan, during weeks 1–5 of fasting and on the 10th day after the end of Ramadan.2. Plasma osmolality at 06.00 hours, the beginning of the fast, at 18.00 hours, before breaking the fast and at 19.00 hours, 1 h after breaking the fast, and urine osmolality during the day and night were measured before, during and after Ramadan.3. All subjects developed an initial negative fluid balance which was maximum at the beginning of week 3 of fasting and that deficit was compensated for during the later weeks.4. Compensation was brought about by an increase in urine concentration, a decrease in urine volume by day, and salt retention.5. No significant changes were observed in plasma osmolality during the days of fasting and the ‘setting’ of plasma osmolality during Ramadan also was not changed.6. It was concluded that healthy young adults maintain good control of fluid and electroytes during Ramadan.

scholarly journals Characterization of the effects of the vasopressin V2 receptor on sweating, fluid balance, and performance during exercise

2014 ◽  
Vol 307 (4) ◽  
pp. R366-R375 ◽  
Author(s):  
Tamara Hew-Butler ◽  
Jed Hummel ◽  
Brian C. Rider ◽  
Joseph G. Verbalis
Keyword(s):  
Body Weight ◽  
Water Conservation ◽  
Collecting Duct ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Sodium Concentration ◽  
Aquaporin 5 ◽  
Water Losses ◽  
Double Blind ◽  
Weight Losses

A regulatory effect of arginine vasopressin (AVP) on sweat water conservation has been hypothesized but not definitively evaluated. AVP-mediated insertion of sweat and salivary gland aquaporin-5 (AQP5) water channels through activation of the vasopressin type 2 receptor (V2R) remains an attractive, yet unexplored, mechanism that could result in a more concentrated sweat with resultant decreased water loss. Ten runners participated in a double-blind randomized control treadmill trial under three separate pharmacological conditions: a placebo, V2R agonist (0.2 mg desmopressin), or V2R antagonist (30 mg tolvaptan). After a familiarization trial, runners ran for 60 min at 60% of peak speed followed by a performance trial to volitional exhaustion. Outcome variables were collected at three exercise time points: baseline, after the steady-state run, and after the performance run. Body weight losses were <2% across all three trials. Significant pharmacological condition effects were noted for urine osmolality [ F = 84.98; P < 0.0001] and urine sodium concentration ([Na+]) [ F = 38.9; P < 0.0001], which verified both pharmacological activation and inhibition of the V2R at the kidney collecting duct. Plasma osmolality and [Na+] demonstrated significant exercise ( F = 26.0 and F = 11.1; P < 0.0001) and condition ( F = 5.1 and F = 3.8; P < 0.05) effects (osmolality and [Na+], respectively). No significant exercise or condition effects were noted for either sweat or salivary [Na+]. Significant exercise effects were noted for plasma [AVP] ( F = 22.3; P < 0.0001), peak core temperature ( F = 103.3; P < 0.0001), percent body weight change ( F = 6.3; P = 0.02), plasma volume change ( F = 21.8; P < 0.0001), and thirst rating ( F = 78.2; P < 0.0001). Performance time was not altered between conditions ( P = 0.80). In summary, AVP acting at V2R does not appear to regulate water losses from body fluids other than renal excretion during exercise.

Renal effects of overhydration during vasopressin infusion in conscious dogs

1984 ◽  
Vol 247 (1) ◽  
pp. F103-F109 ◽  
Author(s):  
P. Bie ◽  
M. Munksdorf ◽  
J. Warberg
Keyword(s):  
Plasma Protein ◽  
Renal Excretion ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Sodium Concentration ◽  
Conscious Dogs ◽  
Electrolyte Excretion ◽  
Water Load ◽  
Plasma Vasopressin ◽  
Small Doses

The antidiuretic and possibly natriuretic effects of small doses of vasopressin (AVP) were investigated in conscious dogs. Plasma composition and renal excretion of water, Na+, and K+ were measured after overhydration by 20 ml/kg performed during infusion of AVP at rates of 50, 100, 150, 200, or 400 pg X min-1 X kg body wt-1 or of 1-desamino-8-D-arginine vasopressin (DDAVP) 50 pg X min-1 X kg body wt-1. Hydration lowered plasma osmolality and sodium concentration by 4.2 +/- 0.3 and 3.8 +/- 0.2%, respectively; plasma protein showed a larger decrease, 8.5 +/- 0.4% (P less than 0.01). Urine osmolality during hydration was 52 +/- 3 mosmol/kg H2O. AVP infusion at 100 pg X min-1 X kg-1 elevated plasma vasopressin by 1.7 +/- 0.3 pg/ml and urine osmolality by 1,049 +/- 152 mosmol/kg H2O and elicited marked natriuresis and kaliuresis but no change in osmolar clearance. During DDAVP infusion urine osmolality was 1,365 +/- 134 mosmol/kg H2O, but electrolyte excretion was indistinguishable from control. It is concluded that 1) AVP is associated with marked natriuresis and kaliuresis even in doses required to prevent water diuresis, 2) DDAVP--although strongly antidiuretic--does not affect electrolyte excretion, and 3) the water load causes disproportionate dilution of plasma protein and osmolality, probably due to protein redistribution.

scholarly journals Why do team-sport athletes drink fluid in excess when exercising in cool conditions?

2017 ◽  
Vol 42 (3) ◽  
pp. 271-277 ◽  
Author(s):  
Melissa J. Bargh ◽  
Roderick F.G.J. King ◽  
Michael P. Gray ◽  
Ben Jones
Keyword(s):  
Fluid Intake ◽  
Intermittent Exercise ◽  
Thermal Sensation ◽  
Plasma Osmolality ◽  
Sodium Concentration ◽  
Team Sport ◽  
Mouth Dryness ◽  
Rest Periods ◽  
Rugby Players ◽  
Cool Conditions

This study assessed the potential physiological and perceptual drivers of fluid intake and thirst sensation during intermittent exercise. Ten male rugby players (17 ± 1 years, stature: 179.1 ± 4.2 cm, body mass (BM): 81.9 ± 8.1 kg) participated in six 6-min small-sided games, interspersed with 2 min rest, where fluid intake was ad libitum during rest periods. Pre- and postmeasurements of BM, subjective ratings (thirst, thermal comfort, thermal sensation, mouth dryness), plasma osmolality (POsm), serum sodium concentration (S[Na+]), haematocrit and haemoglobin (to calculate plasma volume change; PV) were taken. Fluid intake was measured during rest periods. BM change was –0.17 ± 0.59% and fluid intake was 0.88 ± 0.38 L. Pre- to post-POsm decreased (–3.1 ± 2.3 mOsm·kg−1; p = 0.002) and S[Na+] remained similar (–0.3 ± 0.7 mmol·L−1, p = 0.193). ΔPV was 5.84 ± 3.65%. Fluid intake displayed a relationship with pre-POsm (r = –0.640, p = 0.046), prethermal comfort (r = 0.651; p = –0.041), ΔS[Na+] (r = 0.816, p = 0.004), and ΔPV (r = 0.740; p = 0.014). ΔThirst sensation displayed a relationship with premouth dryness (r = 0.861, p = 0.006) and Δmouth dryness (r = 0.878, p = 0.004). Yet a weak positive relationship between Δthirst sensation and fluid intake was observed (r = 0.085, p = 0.841). These data observed in an ambient temperature of 13.6 ± 0.9 °C, suggest team-sport athletes drink in excess of fluid homeostasis requirements and thirst sensation in cool conditions; however, this was not influenced by thermal discomfort.

Water and solute balance in rats during 10 h water deprivation and rehydration

1993 ◽  
Vol 71 (5-6) ◽  
pp. 379-386 ◽  
Author(s):  
Guus H. M. Schoorlemmer ◽  
Mark D. Evered
Keyword(s):  
Water Balance ◽  
Water Deprivation ◽  
Extracellular Fluid ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Sodium Concentration ◽  
Sodium Balance ◽  
Electrolyte Excretion ◽  
Fluid Deficit

Rats with bladder and venous cannulas were deprived of water from midnight (00:00) to 10:00. Water deprivation reduced food intake within 2 h, reducing the amount of water sequestered in the gut and the solute load to the tissues. There was little change in either urinary water loss or osmolality, but water-deprived rats excreted more Na+, K+, and Cl− than food-matched controls. The change in solute balance helped preserve osmolality and cell volume at the expense of extracellular fluid volume. When water was returned, rats quickly drank enough to restore the intracellular but not the extracellular fluid deficit. Plasma osmolality and sodium concentration fell below predeprivation values. Urine osmolality and excretion of Na+, K+, and Cl− fell rapidly after drinking. Drinking continued at a slower rate for at least 4 h, but urine flow also increased so water balance stabilized. The changes in intake and electrolyte excretion during water deprivation and rehydration illustrate the important role of changes in solute balance in fluid homeostasis.Key words: water deprivation, thirst, drinking, water balance, sodium balance.

scholarly journals Effects of a 14-Day Hydration Intervention on Individuals with Habitually Low Fluid Intake

2021 ◽  
Author(s):  
Aaron R. Caldwell ◽  
Megan E. Rosa-Caldwell ◽  
Carson Keeter ◽  
Evan C. Johnson ◽  
François Péronnet ◽  
...  
Keyword(s):  
Body Weight ◽  
Total Body Water ◽  
Fluid Intake ◽  
Urine Volume ◽  
Urine Osmolality ◽  
Body Water ◽  
Control Group ◽  
Intervention Phase ◽  
Total Body ◽  
Experimental Group

<b><i>Background:</i></b> Debate continues over whether or not individuals with low total water intake (TWI) are in a chronic fluid deficit (i.e., low total body water) [<xref ref-type="bibr" rid="ref1">1</xref>]. When women with habitually low TWI (1.6 ± 0.5 L/day) increased their fluid intake (3.5 ± 0.1 L/day) for 4 days 24-h urine osmolality decreased, but there was no change in body weight, a proxy for total body water (TBW) [<xref ref-type="bibr" rid="ref2">2</xref>]. In a small (<i>n</i> = 5) study of adult men, there were no observable changes in TBW, as measured by bioelectrical impedance, after increasing TWI for 4 weeks [<xref ref-type="bibr" rid="ref3">3</xref>]. However, body weight increased and salivary osmolality decreased indicating that the study may have been underpowered to detect changes in TBW. Further, no studies to date have measured changes in blood volume (BV) when TWI is increased. <b><i>Objectives:</i></b> Therefore, the purpose of this study was to identify individuals with habitually low fluid intake and determine if increasing TWI, for 14 days, resulted in changes in TBW or BV. <b><i>Methods:</i></b> In order to identify individuals with low TWI, 889 healthy adults were screened. Participants with a self-reported TWI less than 1.8 L/day (men) or 1.2 L/day (women), and a 24-h urine osmolality greater than 800 mOsm were included in the intervention phase of the study. For the intervention phase, 15 participants were assigned to the experimental group and 8 participants were assigned to the control group. The intervention period lasted for 14 days and consisted of 2 visits to our laboratory: one before the intervention (baseline) and 14 days into the intervention (14-day follow-up). At these visits, BV was measured using a CO-rebreathe procedure and deuterium oxide (D<sub>2</sub>O) was administered to measure TBW. Urine samples were collected immediately prior, and 3–8 h after the D<sub>2</sub>O dose to allow for equilibration. Prior to each visit, participants collected 24-h urine to measure 24-h hydration status. After the baseline visit, the experimental group increased their TWI to 3.7 L for males and 2.7 L for females in order to meet the current Institute of Medicine recommendations for TWI. <b><i>Results:</i></b> Twenty-four-hour urine osmolality decreased (−438.7 ± 362.1 mOsm; <i>p</i> &#x3c; 0.001) and urine volume increased (1,526 ± 869 mL; <i>p</i> &#x3c; 0.001) in the experimental group from baseline, while there were no differences in osmolality (−74.7 ± 572 mOsm; <i>p</i> = 0.45), or urine volume (−32 ± 1,376 mL; <i>p</i> = 0.89) in the control group. However, there were no changes in BV (Fig. <xref ref-type="fig" rid="f01">1</xref>a) or changes in TBW (Fig. <xref ref-type="fig" rid="f01">1</xref>b) in either group. <b><i>Conclusions:</i></b> Increasing fluid intake in individuals with habitually low TWI increases 24-h urine volume and decreases urine osmolality but does not result in changes in TBW or BV. These findings are in agreement with previous work indicating that TWI interventions lasting 3 days [<xref ref-type="bibr" rid="ref2">2</xref>] to 4 weeks [<xref ref-type="bibr" rid="ref3">3</xref>] do not result in changes in TBW. Current evidence would suggest that the benefits of increasing TWI are not related changes in TBW.

scholarly journals Urine and Plasma Osmolality in Patients with Autosomal Dominant Polycystic Kidney Disease: Reliable Indicators of Vasopressin Activity and Disease Prognosis?

2015 ◽  
Vol 41 (3) ◽  
pp. 248-256 ◽  
Author(s):  
Niek F. Casteleijn ◽  
Debbie Zittema ◽  
Stephan J.L. Bakker ◽  
Wendy E. Boertien ◽  
Carlo A. Gaillard ◽  
...  
Keyword(s):  
Water Intake ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Kidney Volume ◽  
Polycystic Kidney ◽  
Estimated Gfr ◽  
Total Kidney Volume ◽  
Autosomal Dominant Polycystic Kidney ◽  
Crude Analysis

Background: Vasopressin plays an essential role in osmoregulation, but has deleterious effects in patients with ADPKD. Increased water intake to suppress vasopressin activity has been suggested as a potential renoprotective strategy. This study investigated whether urine and plasma osmolality can be used as reflection of vasopressin activity in ADPKD patients. Methods: We measured urine and plasma osmolality, plasma copeptin concentration, total kidney volume (TKV, by MRI) and GFR (125I-iothalamate). In addition, change in estimated GFR (eGFR) during follow-up was assessed. Results: Ninety-four patients with ADPKD were included (56 males, age 40 ± 10, mGFR 77 ± 32 ml/min/1.73 m2, TKV 1.55 (0.99-2.40) l. Urine osmolality, plasma osmolality and copeptin concentration were 420 ± 195, 289 ± 7 mOsmol/l and 7.3 (3.2-14.6) pmol/l, respectively. Plasma osmolality was associated with copeptin concentration (R = 0.54, p < 0.001), whereas urine osmolality was not (p = 0.4). In addition, urine osmolality was not associated with TKV (p = 0.3), in contrast to plasma osmolality (R = 0.52, p < 0.001) and copeptin concentration (R = 0.61, p < 0.001). Fifty-five patients were followed for 2.8 ± 0.8 years. Baseline plasma and urine osmolality were not associated with change in eGFR (p = 0.6 and p = 0.3, respectively), whereas baseline copeptin concentration did show an association with change in eGFR, in a crude analysis (St. β = -0.41, p = 0.003) and also after adjustment for age, sex and TKV (St. β = -0.23, p = 0.05). Conclusions: These data suggest that neither urine nor plasma osmolality are valid measures to identify ADPKD patients that may benefit from increasing water intake. Copeptin appears a better alternative for this purpose.

scholarly journals Plasma and Electrolyte Changes in Exercising Humans After Ingestion of Multiple Boluses of Pickle Juice

2015 ◽  
Vol 50 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Michael A. McKenney ◽  
Kevin C. Miller ◽  
James E. Deal ◽  
Julie A. Garden-Robinson ◽  
Yeong S. Rhee
Keyword(s):  
Body Weight ◽  
Relative Humidity ◽  
Blood Sample ◽  
Plasma Volume ◽  
Potassium Concentration ◽  
Plasma Osmolality ◽  
Plasma Potassium ◽  
Sodium Concentration ◽  
Plasma Sodium ◽  
Plasma Sodium Concentration

Context: Twenty-five percent of athletic trainers administer pickle juice (PJ) to treat cramping. Anecdotally, some clinicians provide multiple boluses of PJ during exercise but warn that repeated ingestion of PJ may cause hyperkalemia. To our knowledge, no researchers have examined the effect of ingesting multiple boluses of PJ on the same day or the effect of ingestion during exercise. Objective: To determine the short-term effects of ingesting a single bolus or multiple boluses of PJ on plasma variables and to characterize changes in plasma variables when individuals ingest PJ and resume exercise. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Nine euhydrated men (age = 23 ± 4 years, height = 180.9 ± 5.8 cm, mass = 80.7 ± 13.8 kg, urine specific gravity = 1.009 ± 0.005). Intervention(s): On 3 days, participants rested for 30 minutes, and then a blood sample was collected. Participants ingested 0 or 1 bolus (1 mL·kg−1 body weight) of PJ, donned sweat suits, biked vigorously for 30 minutes (approximate temperature = 37°C, relative humidity = 18%), and had a blood sample collected. They either rested for 60 seconds (0- and 1-bolus conditions) or ingested a second 1 mL·kg−1 body weight bolus of PJ (2-bolus condition). They resumed exercise for another 35 minutes. A third blood sample was collected, and they exited the environmental chamber and rested for 60 minutes (approximate temperature = 21°C, relative humidity = 18%). Blood samples were collected at 30 and 60 minutes postexercise. Main Outcome Measure(s): Plasma sodium concentration, plasma potassium concentration, plasma osmolality, and changes in plasma volume. Results: The number of PJ boluses ingested did not affect plasma sodium concentration, plasma potassium concentration, plasma osmolality, or changes in plasma volume over time. The plasma sodium concentration, plasma potassium concentration, and plasma osmolality did not exceed 144.6 mEq·L−1 (144.6 mmol·L−1), 4.98 mEq·L−1 (4.98 mmol·L−1), and 289.5 mOsm·kg−1H2O, respectively, in any condition at any time. Conclusions: Ingesting up to 2 boluses of PJ and resuming exercise caused negligible changes in blood variables. Ingesting up to 2 boluses of PJ did not increase plasma sodium concentration or cause hyperkalemia.

scholarly journals Prediction of renal dysfunction in patients with obstructive icterus

2011 ◽  
Vol 64 (9-10) ◽  
pp. 503-506 ◽  
Author(s):  
Suzana Raicevic-Sibinovic ◽  
Aleksandar Nagorni ◽  
Vesna Brzacki ◽  
Mirjana Radisavljevic
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Concentration Index ◽  
Surgical Intervention ◽  
Urine Osmolality ◽  
Sodium Concentration ◽  
Control Group ◽  
Osmotic Concentration ◽  
Creatinine Concentration ◽  
Urinary Osmolality

Introduction. Renal dysfunction is one of complications in patients with obstructive icterus. It is important to recognize it early and take adequate measure to prevent its occurrence. One third of the patients with obstructive icterus have deterioration of renal function before surgical intervention. The aim of the research was to assess the renal dysfunction markers in patients with obstructive icterus. The following factors were examined: diuresis, urinary sodium concentration, sodium excretory fraction, urine osmolality, osmotic concentration index, creatinine concentration index and renal index of lesion. Material and methods. The study included 85 patients with obstructive icterus (50 patients before surgical intervention and 35 after surgical intervention) and 30 patients without icterus as a control group. The patients with normal renal function before the development of the disease were included. Results. Malignant etiology was present in 39 patients and benign in 46 patients of the examined group. The evaluation parameters of renal function were examined in all of the patients. Creatinine concentration index led to the greatest change in the coefficient value of an internal consistency, showing that it was the best renal function marker in the examined group of patients with icterus. The next one was the urinary osmolality, since its exclusion would lead to a decrease in the value of Cronbach ? coefficient to 0.06. Icterus and surgical intervention show statistically significant effects to change in the value of the markers of laboratory differentiation of renal function, observed as an entire set. Discussion and conclusion. The examination showed that the concentration clearances of creatinine and urine osmolality are the parameters which point to the probability of renal dysfunction occurrence in obstructive icterus.

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