[Electrolyte imbalance and its physiopathological mechanisms in trauma].
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Biomedical subjects
Publications and source records attributed to V D Slepushkin.
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In dogs, i.v. administration of pituitrin (0.5-0.8;5.0-8.0; 50.0-80.0 med/kg) in conditions of spontaneous and water diuresis increases the renal excretion of Mg, Ca and Na. This is due to the vasopressin fraction of pituitrin as the synthetic vasopressin exerted the same effect. An increase in Mg excretion after i.p.-administration of pituitrin (1 med/100 g) was noted in rats too. In 2 week puppies administration of 1 med pituitrin did not change the urine excretion of Mg or Ca. Vasopressin is supposed to participate in the Mg metabolism regulation.
Experiments on rats have shown that administration of a synthetic analog of leucine enkephalin at a dose of 100 mg/kg did not change the content of the immunoreactive parathyroid hormone in the blood plasma, but eliminated the parathyroidin-stimulating effect on the cAMP concentration in the renal tissue and AP activity in the blood. We conclude that enkephalins do not influence the secretion and metabolism of the parathyroid hormone, but block its peripheral effects and stimulate thyroid C-cell function.
Epiphysectomy in dogs and rats was accompanied by a reduction of urinary excretion of calcium and magnesium, by an increase in the magnesium concentration in the blood plasma of dogs. Administration of epiphysial extracts induced an increase of diuresis in dogs on account of a greater rate of glomerular filtration and a fall of the tubular water reabsorption. Calcium and magnesium urinary excretion increased in dogs and rats as well; this was due both to an increase of their ultrafiltration and a reduction of reabsorption in the renal tubules. Consequently, the epiphysis took part in the regulation of metabolism of bivalent cations.
On the 5th day after epiphysectomy rats displayed a reduction of the kidney excretion of Ca and Mg with a simultaneous increase of these elements in the tissues. By the 10th day after the operation the mentioned indices were restored to the preoperative level, but there occurred an increase in the urinary excretion of Na and a reduction of its tissue content. DOCA administration to the epiphysectomized rats eliminated the changes in the Mg and Ca excretion, but failed to influence the Na excretion. Apparently, the hormones of the epiphysis are necessary for the manifestation of the Na-retention action of the mineralocorticoids.
Mean blood pressure and heart rate have been registered in the experiments on male Wistar rats. Kallikrein-kinin system (KKS) components have been evaluated in blood plasma: plasma kallikreinogen, kallikrein-inhibiting capacity, spontaneous esterase activity. The parameters were determined before and after hemorrhage in the volume accounting for 10, 20 and 30% of the circulating blood volume. The rats were administered enkephalin analogues--DAGO, DADL and naloxone. The administration of mu-agonist DAGO improved hemodynamics. DAGO effect was eliminated by naloxone. The administration of enkephalins did not affect KKS parameters, while naloxone potentiated KKS changes induced by hemorrhage. It has been shown that KKS is not involved into the mechanism of hemodynamic changes in response to enkephalin administration during hemorrhagic shock.
Cardiac output and myocardial contractility have been studied in dogs with experimental myocardial infarction complicated by 5 min clinical death. Control animals (16 dogs) were intravenously injected physiologic saline, while test animals (12 dogs) were administered leu-enkephalin analogue dalargin at a dose of 100 micrograms/kg, 20 min and 6-h after recovery. It has been established that dalargin improved basic hemodynamic parameters due to normalization of cardiac contractility, arrhythmia removal and reduction of the peripheral resistance. The data obtained make it possible to recommend dalargin for combined therapy of postresuscitation hemodynamic disturbances in acute myocardial infarction.
The data of 114 examinations of 38 patients with respiratory failure of different genesis have been presented. The method used was that of averaging the ECG signal with analysis of late ventricular potentials and parameters of spectral mapping, as well as analysis of the R-R intervals. The patients were examined initially, 30-45 min after intravenous injection of 1 mg dalargin and 16-20 hours later. The results have shown that there were differences in the changes of a number of basic characteristics of the QRS complex spectrum. In 18 cases (21%) signs of late potentials have been recorded, 14 of them (78%) in the group with decreased total spectral density. A shift of extremums by the beginning of QRS was observed. Statistical and spectral characteristics of the R-R intervals changed in one direction. It has been shown that dalargin has a complex effect on electrophysiological myocardial properties. The use of the method of ECG signal averaging and its different modifications broadens considerably the quality of evaluation of the drug effect in the heart. The technique of spectral-time mapping simplifies the diagnosis of late potentials and elucidates their inner structure.
Medical records of 320 persons, who were injured in terrorist attacks in 1999-2003, were analyzed. The main errors in rendering the anesthetic-and-resuscitation care were pointed out. An algorithm of actions is elaborated for the anesthesiologist working at the reception, surgical and intensive care departments of a hospital. Owing to the mentioned algorithm, the lethality rate of wounded persons dropped from 18 to 10%.
Content of adenine nucleotides, lactic and pyruvic acids, glucose and fructose-6-phosphate was studied in kidney of rats with hemorrhage constituting 3% of body mass after intravenous administration at a dose of 100 mg/kg of agonists of mu-opiate receptors DAGO and delta-opiate receptors DADL and dalargin. Stimulation of both these types of receptors amplifies the kidney ischemia developed after hemorrhage, which was expressed as increased decomposition of ATP, decrease in energetic charge of the adenine nucleotide system (DAGO) and increase in content of AMP (DADL, dalargin).
The effect of intravenous infusion of agonists of mu-(DAGO) and delta-(DADL, DAAE) opiate receptors on mean arterial pressure and heart rate was studied in experiments on rats with dosed blood loss of up to 30% of calculated blood volume. Stimulation of mu-opiate receptors inhibited the drop of mean arterial pressure in hemorrhagic shock, whereas stimulation of delta-opiate receptors failed to produce such an effect. Preliminary injection of naloxone blocked the effects of mu-receptor stimulation.
Beta-endorphin (BE), met- and leu-enkephalin (ME and LE) contents have been determined in patients with circulating blood volume deficiency to 10, 15-20 and 25-30%. It has been established that with the mounting of circulating blood volume deficiency and a simultaneous decrease in central venous pressure, hematocrit and lactate level elevation there was an increase in BE, ME and LE blood plasma content. In up to 20% circulating blood volume deficiency LE blood plasma content decreases 2-3-fold, with an increase in more than 20% deficiency.
Experiments on dogs demonstrated that intravenous administration of the epiphysis extracts prevented the antidiuretic action of both the endogenous (traumatic stress) and exogenous (pituitrin) antidiuretic hormone (ADH). Injection of the extract into the renal artery gave a unilateral diuretic effect. The diuretic action of the preparation was eliminated by the block of the alpha-adrenergic receptors, whereas beta-adrenoblockers were ineffective. A conclusion was drawn that the mechanism of the diuretic action of the epiphysis extracts consisted in the competitive suppression of the ADH action at the renal tubules level on account of excitation of the alpha-adrenoceptors and inhibition of the adenylcyclase activity.
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