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Relationship between cerebral blood flow changes and cortical extracellular fluid pH during cerebral metabolic depression induced by althesin.

Baboons anaesthetized with halothane and nitrous oxide in oxygen were given Althesin 0.05 ml kg-1 i.v. Cerebral blood flow (c.b.f.) was measured by an electromagnetic flowmeter and by xenon clearance whilst extracellular fluid (e.c.f.) pH of the parietal cortex was measured with a micro pH electrode. Carotid blood flow (carBF) began to decrease and carotid vascular resistance (carVR) to increase 2.0 s (SEM 0.3) after the slowing of the e.e.g. produced by Althesin, while e.c.f. pH began to change to alkaline 10.5 s (SEM 1.0) after the e.e.g. change. The first statistically significant increase in mean e.c.f. pH occurred 25 s after the Althesin-induced change in the e.e.g. The duration of the changes in carVR and e.c.f. pH were 7 and 5 min respectively. It is concluded that the change in e.c.f. pH cannot have initiated the increase in carVR which followed the cerebral matabolic depression produced by Althesin. The later alkaline shift in e.c.f. pH may, however, have maintained the increased carVR during the duration of cerebral metabolic depression produced by Althesin.

Alfaxalone Alfadolone Mixture↗

Ventral medullary extracellular fluid pH and blood flow during hypoxia.

Vascular responses of the ventral medulla and total brain to 30-60 min of isocapnic hypoxia (PaO2 = 32 +/- 2 Torr) were examined using radioactive microspheres in anesthetized, paralyzed, and artificially ventilated cats. Ventral medullary extracellular fluid (ECF) pH was measured using pH microelectrodes with tip diameters of 1-2 micrometers. Total brain blood flow (Q) increased significantly from a control value of 53 +/- 8 (mean +/- SE) to 160 +/- 42 ml.100 g-1.min-1 following 30-60 min of hypoxia. Ventral medullary Q increased from 28 +/- 5 to 97 +/- 20 ml.100 g-1.min-1 and ECF pH decreased by 0.15 +/- 0.06 pH U. Q responses are attributable to decreased vascular resistance as arterial pressure remained constant. The sensitivity of the ventral medullary vasculature to isocapnic hypoxia did not differ from that of the brain as a whole. The results show that under the conditions of our experiment, the ventral medullary vascular response to hypoxia is not sufficient to stabilize local ECF pH. The observation of simultaneously reduced pH and increased Q is consistent with a role for ECF H+ in mediating the cerebrovascular response to hypoxia.

Animals↗

Fast bicarbonate-chloride exchange between brain cells and brain extracellular fluid in respiratory acidosis.

The extracellular pH, PCO2, and [Cl-] at the surface of the brain cortex, expiratory PCO2 and arterial blood pressure were continuously recorded in anaesthetized and artificially ventilated cats. The observations from such a preparation were: 1. In response to a nearly step increase in end-tidal PCO2, the brain ECF pH, PCO2, [Cl-] and calculated [HCO-3] changed in the form of a nearly mono-exponential time function after a delay of 5-7 s. 2. The time constants of the changes in the extracellular pH, PCO2, [Cl-] and [HCO-3] were in the range of 30-40 s. 3. The extracellular [HCO-3] increased markedly at an initial rate of 4.22 mmol.1(-1) . min-1 after 36 s. 4. This increase occurred almost simultaneously with a decrease in the extracellular [Cl-]. An [HCO-3]-[Cl-] exchange ratio was determined which very closely approached one. It is concluded that the brain extracellular bicarbonate concentration in respiratory acidosis increases because the H+ formed from the hydrated CO2 reacts with the intracellular buffers of brain cells, mainly glial cells, and HCO-3 inside the cell is formed and exchanged for Cl- outside the cell similar to the HCO-3/Cl- exchange which occurs between red cells and blood plasma during CO2 loading. The described time constants of the anion exchange represent the wash in or wash out time of CO2 in a tissue containing intracellular buffer.

Acidosis, Respiratory↗

Does adjustment of GFR to extracellular fluid volume improve the clinical utility of cystatin C?

BACKGROUND: Cystatin C measurement has been proposed as a replacement for creatinine as a serum measure of glomerular filtration rate (GFR). It has also been suggested that GFR itself should be adjusted to the extracellular fluid volume (ECV) of a child rather than the body surface area (BSA). AIMS: To assess the potential of cystatin C compared to serum creatinine in assessing GFR and to establish whether adjustment of GFR to ECV rather than BSA affects the potential usefulness of cystatin C. METHODS: Cystatin C and plasma creatinine were measured in 64 paediatric patients undergoing 77 (51)Cr-EDTA GFR measurements over a six month period. RESULTS: 1/cystatin C concentrations were more closely related to GFR (median 98 ml/min/1.73 m(2), range 8-172) after adjustment for patient BSA (r = 0.81 versus r = 0.44). 1/Creatinine concentrations appeared to be an inferior estimate of BSA adjusted GFR (r = 0.41), even following the use of the Schwartz formula (r = 0.37). Bland Altman statistics showed cystatin C could still only predict 95% of GFR values to within +/-41 ml/min/1.73 m(2) of the (51)Cr-EDTA method. The relation between GFR and 1/cystatin C was not improved by adjusting (51)Cr-EDTA GFR to ECV rather than BSA (r = 0.76 versus r = 0.81). CONCLUSIONS: Cystatin C appears superior to serum creatinine in paediatric subjects although its performance is unlikely to supplant (51)Cr-EDTA GFR measurement. This performance is not being underestimated because of adjusting GFR to BSA rather than ECV.

Adolescent↗

Glomerular filtration rate in relation to extracellular fluid volume: similarity between 99mTc-DTPA and inulin.

The rate constant (alpha2) of the terminal exponential of the technetium-99m diethylene triamine penta-acetic acid (DTPA) plasma clearance curve is close to the ratio of glomerular filtration rate (GFR) to extracellular fluid volume (ECV) and is therefore a convenient, already normalised, measure of filtration function. Since alpha2 depends on the distribution volume of the tracer, our aim was to compare alpha2 from inulin and 99mTc-DTPA and also to compare the equilibration kinetics of the two filtration markers. Fifty millilitres of 99mTc-DTPA (250MBq) and inulin (10%), mixed in the same syringe, were given by intravenous injection in 15 patients undergoing routine 99mTc-DTPA renography for a variety of clinical indications. Frequent antecubital venous blood samples were taken up to about 4h after injection to construct plasma clearance curves from which GFR, ECV and GFR/ECV (i.e. the reciprocal of mean transit time through the distribution volume) were calculated. 99mTc-DTPA/inulin concentration ratio curves were also constructed after normalisation to the ratio in the syringe. GFR given by the two markers correlated closely (DTPA=0.98.inulin-0.4ml/min; r=0.98). 99mTc-DTPA had the same distribution volume as inulin, had a similar transit time through it and gave the same value of alpha2 (r=0.98). GFR/ECV from 99mTc-DTPA accordingly correlated closely with GFR/ECV from inulin (DTPA=0.75.inulin+0.99 ml/min; r=0.95). Even though the distribution volumes and the times to equilibration (i.e. to reach the terminal exponential) were similar, the distribution volume of 99mTc-DTPA at about 10min after injection was, after subtraction of the plasma volume, about twice that of inulin. We confirm the validity of 99mTc-DTPA for measuring GFR. alpha2 is a convenient measure of GFR, can be based on the terminal exponential of inulin of 99mTc-DTPA curves and can be converted to GFR/ECV with an appropriate scaling factor. The kinetics or the two clearance curves with respect to anatomical correlates of the exponentials and the rates of diffusion throughout the respective distribution volumes requires further study.

Extracellular Space↗

Filtration by rat glomeruli after expansion of extracellular fluid volume.

We studied the filtration characteristics of glomeruli isolated from the superficial and deep renal cortex of Munich-Wistar rats (180 to 300 gm) to determine whether the ultrafiltration coefficient (Kf) or hydraulic conductivity (Lp) of the glomerular capillary is altered during expansion of extracellular fluid volume with isotonic protein-free (SAL) or hyperoncotic (ALB) solutions. SAL rats were given an initial infusion of 1% dextrose in lactated Ringer's solution (0.1 ml/gm body weight) followed by a maintenance infusion for 18 to 20 hours. ALB rats were given hyperoncotic bovine serum albumin (0.01 gm/gm body weight) intravenously 2 hours before sacrifice. At sacrifice, urine flow rate and fractional excretion of sodium were increased and plasma renin activity decreased in both SAL and ALB rats. Expansion of intravascular volume was evidenced by a decrease in the hematocrit of ALB but not of SAL rats; plasma protein concentration was increased in ALB and unchanged in SAL rats. Kf and Lp were estimated during in vitro filtration. Because SAL rats were significantly larger than ALB rats, results were compared with those in separate size-matched controls. Kf of superficial glomeruli of large control and SAL rats did not differ (3.7 +/- 0.4 and 3.5 +/- 0.4 nl/min/mm Hg, respectively). Lp, of the same glomeruli, calculated as the quotient of Kf and estimated filtering area (LpD), were also comparable (1.9 +/- 0.2 and 1.8 +/- 0.2 microliter/min/mm Hg/cm2). Kf of superficial glomeruli of ALB rats was significantly greater than Kf of size-matched control rats (3.7 +/- 0.3 vs. 2.9 +/- 0.1 nl/min/mm Hg, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Response of air sac mesothelium to expansion of extracellular fluid volume in Gallus domesticus.

In this study, scanning electron microscopy was used to examine the effects of hydrothorax on the morphology of the air sac visceral mesothelium of Gallus domesticus. Anaesthetized chickens were subjected to acute hydrodynamic pulmonary oedema induced by expansion of the extracellular fluid volume with an infusion of Ringer's solution equal to 6.5% of body weight. Tissue samples from the visceral surface of the abdominal air sacs near their ostia were obtained and fixed after death induced by anaesthetic overdose. These were compared with similar samples from control "non-volume-loaded" birds. The air sac visceral mesothelium of the volume-loaded animals presented an increased density of bulbous or swollen microvilli. These deformations were similar to changes reported in the visceral pleura of mammals subjected to hydrothorax, suggesting a commonality with regard to the role of these mesothelia in liquid clearance during pulmonary oedema.

Air Sacs↗

Effect of injected human chorionic gonadotrophin on capillary permeability, extracellular fluid volume and the flow of lymph and blood in the testes of rats.

The subcutaneous injection of human chorionic gonadotrophin (HCG) into adult male rats caused appreciable rises in capillary permeability and lymph flow in the testis, accompanied by smaller rises in the volume of extratubular, extracellular fluid. Most of these changes were already apparent 8 h after injection, but became progressively greater during the next 12 h. Testicular blood flow was unchanged at 12 h but increased slightly between 12 and 6 h after injection. The primary effect is probably the increase in capillary permeability. The timing of these changes suggests that HCG does not affect the capillaries directly, but it would seem that the changes are due to some substances secreted by the testis in response to the HCG. It is clear that these changes will have important influences both on the access to the testicular cells of peptide hormones in the blood and also on the passage into the venous blood of hormones secreted by the testis.

Animals↗

Sac1p of Saccharomyces cerevisiae is not involved in ATP release to the extracellular fluid.

One activity ascribed to Sac1p is the transport of ATP into the lumen of the endoplasmic reticulum of Saccharomyces cerevisiae; therefore, the question of whether this protein plays a role in ATP efflux from yeast was addressed. Preliminary results suggested that deletion of the SAC1 gene eliminated nigericin-stimulated ATP efflux. However, further experimentation revealed that this result was caused by a pronounced extracellular ATPase activity for sac1delta cells at alkaline pH, conditions required to measure extracellular ATP in wild type cells. At acid pH, sac1delta cells exhibit glucose-dependent, nigericin-stimulated ATP efflux. sac1delta cells express less acid phosphatase activity in the periplasm than do wild type cells, thus increasing the stability of extracellular ATP. At alkaline pH, however, sac1delta cells tend to lose structural integrity and release lactate dehydrogenase as well as an unidentified ATPase activity to the extracellular fluid. Therefore, Sac1p is not involved in ATP efflux from S. cerevisiae.

Adenosine Triphosphate↗

Serum beta 2 microglobulin and extracellular fluid volume during haemodialysis.

Conflicting results have been published concerning serum beta 2 microglobulin (beta 2-M) kinetics during dialysis with a cuprophane membrane which is not permeable for the protein. We have investigated the hypothesis that the apparent increase of free serum beta 2-M could result from extracellular fluid volume (ECV) contraction. Using inulin, ECV was measured before and 1 h after a dialysis session with a sodium dialysate concentration of 145 mmol/l. Dialysis was performed either with a cuprophane or a high-flux membrane. Transcellular water shift and changes in beta 2-M concentration were calculated from total body water changes (ultrafiltration) and ECV. ECV decreased from a predialysis value of 16.6 +/- 3.51 (mean +/- SD) (24.9% bodyweight) to a postdialysis value of 11.9 +/- 2.11 (19.8% bodyweight). Ultrafiltration was only 3.1 +/- 1.01, indicating concomitant water shift from ECV to intracellular fluid space. A significant decrease in corrected beta 2-M concentration was found for high-flux membranes. However, postdialysis beta 2-M did not change significantly after dialysis with cellulosic membranes. In conclusion, the apparent increase of serum beta 2-M concentration measured during dialysis with cellulosic membranes may be explained by ECV contraction. These results have to be taken into account for any pathogenic mechanism of the beta 2-M-associated amyloidosis occurring in long-term haemodialysed patients.

Amyloidosis↗

Relationship between tumor extracellular fluid exposure to topotecan and tumor response in human neuroblastoma xenograft and cell lines.

PURPOSE: We have reported a 6-fold difference in the topotecan (TPT) lactone systemic exposure achieving a complete response in the human neuroblastoma xenografts NB-1691 and NB-1643. However, the relationship between tumor extracellular fluid (ECF) exposure to TPT and the antitumor activity in xenograft and in vitro models has not been established. METHODS: TPT was given i.v. to mice bearing NB-1691 and NB-1643 tumors. Prior to dosing, microdialysis probes were placed in tumors of mice bearing NB-1691 and NB-1643 tumors. Plasma and tumor ECF concentrations of TPT lactone were assayed by high performance liquid chromatography. The inhibitory concentration (IC50) was determined for NB-1691 and NB-1643 cell lines in vitro. RESULTS: The TPT AUC(ECF) values determined for NB-1691 (n = 10) and NB-1643 (n = 11) were 7.3 +/- 0.84 and 25.6 +/- 0.76 ng h ml(-1), respectively (P < 0.05). TPT tumor ECF penetration in NB-1691 and NB-1643 was 0.04 +/- 0.04 and 0.15 +/- 0.11 (P < 0.05), respectively. The IC50 values recorded after 6 h of TPT exposure daily for 5 consecutive days for NB-1691 and NB-1643 were 2.7 +/- 1.1 and 0.53 +/- 0.19 ng/ml, respectively (P < 0.05). CONCLUSIONS: NB-1643 was more sensitive in vitro than NB-1691, and at similar plasma TPT exposures, NB-1643 had a greater degree of TPT tumor ECF exposure and penetration as compared with NB-1691. Potential factors affecting tumor TPT ECF disposition include tumor vascularity, capillary permeability, and interstitial pressure. The clinical importance of this study is underscored by the need to select anticancer agents with a high capacity for tumor penetration and to optimize drug administration to increase tumor penetration.

Animals↗

Changes in partition of extracellular fluid volumes in anemic dialyzed uremic patients after partial correction of the anemia with recombinant human erythropoietin treatment.

The purpose of this work was to study the effects of correcting anemia on the distribution and partition of body fluids in dialyzed uremic subjects. We studied nine (7 m, 2 f) patients before and three months after the start of i.v. treatment with rHu-EPO, measuring total body water (TBW) with 3H2O, extracellular fluid volume (ECFV) with 35SO4 and plasma volume (PV) with 125I-SA. The intracellular water (ICW) and the interstitial fluid volumes (IFV) were derived by calculation from those measurements. The total blood volume (TBV) was calculated from the PV and the packed cell volume (PCV). Mean TBW, 482 +/- 45 (M +/- SD) ml/kg/bw and ECFV, 168 +/- 27.5 ml were significantly lower in patients than in nine matched normal controls, while the mean ICW (315 +/- 43 ml/kg) was similar. PCV before the start of rHu-EPO was 17.2 +/- 2.9% and had risen significantly to 31.3 +/- 4.8% (p = 0.000) after three months of therapy. Body weight (58 +/- 13 kg), TBW, ECFV and ICW did not change. TBV before rHU-EPO was 68.7 +/- 7.5 ml/kg and remained nearly unchanged, while PV fell significantly from 57 +/- 9 to 48 +/- 8 ml/kg (p < 0.025), with the calculated IFV rising from 111 +/- 25 to 127 +/- 27 (p = 0.000). The PV/IFV ratio decreased from 0.53 +/- 0.12 to 0.38 +/- 0.09 (p = 0.001). The decrease in PV/IFV ratio was paralleled by simultaneous increase in PCV in all but one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Oxidative damage to extracellular fluids by ozone and possible protective effects of thiols.

Environmental levels of ozone (O3) frequently exceed air quality standards in many urban areas, and much research has been devoted to pathophysiological effects of O3 inhalation. Inhaled O3 will interact primarily with respiratory tract lining fluids (RTLF) and with constituents therein. It is believed that interaction of O3 with constituents in RTLF occurs by reactive absorption. We investigated interactions of O3 with human blood plasma, used as a model extracellular fluid representing RTLF, and studied oxidation of plasma antioxidants, proteins, and lipids. Plasma was exposed to various concentrations of O3 in humidified air, supplied at a continuous flow, in a system that mimics exposure of RTLF to inhaled O3 in vivo. Interaction of O3 with plasma appeared to be caused by reactive absorption of O3 by plasma. It was found that O3 reacts primarily with the aqueous antioxidants ascorbate and urate. Reactive absorption of O3 by plasma ascorbate and urate was found to be more efficient at low (2 ppm) O3 levels than at high (16 ppm) levels. We were also able to detect oxidative damage to plasma proteins and lipids after prolonged exposure to O3. Second, we investigated whether GSH or dihydrolipoic acid (DHLA) could prevent oxidative damage to plasma proteins and lipids by O3, under our exposure conditions. In contrast to plasma, RTLF contain relatively high amounts of GSH, which may contribute to antioxidant protection to respiratory tract epithelial cells. DHLA is an endogenous dithiol and has potent antioxidant properties. Addition of either GSH or DHLA to plasma (at concentrations up to 1 mM) prior to O3 exposure did not inhibit oxidation of plasma proteins and lipids during exposure to O3, nor did it attenuate depletion rates of ascorbate or urate. Our results indicate that added thiols cause increased reactive absorption of O3, rather than preventing reaction of O3 with other plasma constituents. Thiol supplementation could afford protection against O3-induced injury in vivo by increasing reactive absorption of O3 in the upper respiratory tract, thereby protecting the epithelia of lower airways and gas-exchanging portions of the lungs from exposure to toxic levels of O3.(ABSTRACT TRUNCATED AT 400 WORDS)

8,11,14-Eicosatrienoic Acid↗

Extracellular fluid volume expansion and third space sequestration at the site of small bowel anastomoses.

Intestinal surgery is usually associated with the parenteral administration of sodium and water, sometimes in amounts considerably in excess of excretory capacity. We have studied the effect of this situation on the water content of the gut at and 5 cm from a single-layer end-to-end anastomosis in the rabbit. Water content was measured by desiccation. One group of animals (group 1) did not receive intravenous therapy. The second group (group 2) received 5 ml kg-1 h-1 of Hartmann's solution during the operative period and thereafter to a total volume of 200 ml by 48 h. In group 1 there was a 5-10 per cent increase in tissue weight both at the anastomotic site and at 5 cm (P less than 0.01, Mann-Whitney U test) on the first 3 days. Thereafter, water content at the anastomosis persisted, but resolved in normal gut. In group 2 a further 5 per cent increase in weight over group 1 occurred (P less than 0.01), persistent at the anastomotic site over 5 days, though resolving elsewhere after 2 days. Extracellular fluid volume expansion exaggerates an anatomical third space present in the region of an anastomosis. At the suture line, oedema so induced is persistent and could be deleterious.

Animals↗

Simultaneous measurement of extracellular fluid distribution and renal function with a single injection of 99mTc DTPA.

BACKGROUND: The initial rate of renal uptake of 99mTc DTPA is equal to the product of injected dose and the glomerular filtration rate (GFR):plasma volume (PV) ratio, whilst later the plasma clearance rate constant is equal to the GFR:extracellular fluid volume (ECF) ratio. Expressing GFR in terms of body fluid volumes has several attractions, and techniques for measuring it in this form may be useful. METHODS: GFR/PV was determined from a Patlak plot in 82 studies in 47 patients undergoing routine gamma-camera 99mTc DTPA renography and compared with GFR/ECV, determined from the terminal slope of the plasma clearance curve. RESULTS: GFR/PV (y) correlated significantly with GFR/ECV (x): y = 3.2.x + 5.3 ml/min/l (r = 0.82, n = 82, P < 0.001). The ratio, GFR/PV:GFR/ECV is ECV/PV, which (x) correlated significantly with a regional estimate (y) of ECV/PV (rECV/rPV) derived from a Patlak plot applied to a subrenal ROI: y = 0.47x + 1.14 (r = 0.61, n = 52, P < 0.001). The initial rate constant of disappearance of 99mTc DTPA from the blood, determined from a ROI over the left ventricle, reflects tracer clearance from plasma to interstitial fluid plus GFR/PV: Subtraction of GFR/PV yields a rate constant which reflects extrarenal 99mTc DTPA clearance, Z, as a fraction of PV. A regional estimate of 99mTc DTPA clearance from plasma to interstitial fluid, rZ, was derived from the Patlak plot applied to the subrenal ROI and expressed in relation to rPV. Z/PV (y) correlated significantly with rZ/rPV (x): y = 2.2x + 0.02 min-1 (r = 0.56, n = 52, P < 0.001). The distribution of ECF between plasma and interstitial fluid was related to extrarenal 99mTc DTPA clearance. Thus rZ/rPV correlated significantly with ECV/PV (r = 0.55, n = 52, P < 0.001) and Z/PV correlated significantly with rECV/rPV (r = 0.6, n = 52, P < 0.001). There was no correlation between renal function and extrarenal 99mTc DTPA clearance or distribution of ECF. CONCLUSIONS: GFR can be measured in terms of PV and ECF volume from a single injection of 99mTc DTPA. ECV/PV, rECV/rPV, and variables representing the clearance of 99mTc DTPA across the microvasculature can be measured at the same time.

Adolescent↗

Neurotransmission in the brain by diffusion through the extracellular fluid: a review.

Synaptic or 'hard wired' neurotransmission in the brain, subject to modulation by a class of substances called modulators, has been the dominant model of brain function. However, increasing evidence for alternate non-synaptic neurotransmission mechanisms is forcing consideration of a more inclusive model. Evidence is presented for such neurotransmitter systems that require diffusion through the extracellular fluid. Old and new findings have been interpreted within a conceptual framework that is not centered on the synaptic model, but instead considers a continuum of neurotransmitter actions.

Animals↗

Derivation of extracellular fluid volume fraction and equivalent dielectric constant of the cell membrane from dielectric properties of the human body. Part 1: Incorporation of fat tissue into cell suspension model in the arm.

The non-invasive characterisation of cell pathophysiology is clinically important. A cell suspension model is applied to derive the extracellular fluid (ECF) volume fraction and the equivalent dielectric constant of the cell membrane epsilon m from the dielectric properties of human arms. Frequency-dependent dielectric constants and electrical conductivities of arms are obtained from 35 surgical patients over a frequency range of 5-1000 kHz. The cell suspension model is applied to fit the data using a complex non-linear least-squares method. The arms show typical dielectric dispersions, although the cell suspension model yields a poor fitting in dielectric constants at lower frequencies and electrical conductivities at higher frequencies. In contrast, a new cell suspension model, taking into account the fat tissue component, remarkably improves the overall fitting performance, allowing estimation of the volume fractions of ECF (0.34 +/- 0.05) and fat tissue (0.16 +/- 0.04) and the equivalent epsilon m (23 +/- 9). The resulting estimates of the volume fraction of fat tissue are in good correlation with arm skinfold thickness (fat volume fraction of arm = 2.42 x 10(-3) x arm skinfold thickness (mm) + 0.099, R = 0.756, p < 0.0001). Therefore it is concluded that the newly derived cell suspension model is well suited for the description of the dielectric properties of human tissues and thus the derivation of the ECF volume fraction and equivalent epsilon m.

Adipose Tissue↗

Extracellular fluid volumes in pregnancy-induced hypertension.

OBJECTIVES: Reduction in plasma volume (Pvol) of women with pregnancy-induced hypertension (PIH; preeclampsia) has both physiological and clinical implications. This study was undertaken to determine the following variables in women with PIH: (1) the incidence of reduced Pvol; (2) the distribution of total extracellular fluid volume (ECFV); (3) the relationship between Pvol and birth weight; and (4) whether any readily available clinical or laboratory parameters predict the presence of reduced Pvol. SETTING: Teaching hospital obstetric unit and antenatal clinic. PARTICIPANTS: Forty-nine primigravidae with PIH (28 mild, 21 severe), 54 normotensive primigravidae and 25 non-pregnant controls. DESIGN: Pvol was measured using Evans Blue dye and ECFV as the mannitol space. These measures were compared amongst groups, and also within groups for those with PIH, according to the severity of their disorder and the presence of proteinuria or oedema. Blood pressure, haematocrit, uric acid and serum albumin were also evaluated as predictive indices of reduced Pvol in women with PIH. RESULTS: Pvol, ECFV and the Pvol:ECFV ratio all increased during normal pregnancy. Pvol in women with PIH was reduced compared with normal pregnancy and correlated significantly with birth weight. Total ECFV was unchanged in women with PIH, but their Pvol:ECFV ratio was significantly reduced compared with normal pregnancy. Although there was a significant correlation between Pvol and haematocrit in women with PIH, haematocrit was a poor predictor for reduced Pvol. Diastolic blood pressure greater than 100 mmHg, persistent proteinuria and severe PIH were the only reliable positive predictors of a reduced Pvol. CONCLUSIONS: Pvol is related to birth weight, but is reduced in only approximately half of women with PIH. This reduced Pvol is the result of maldistribution, not loss, of total ECFV, and can be predicted by high diastolic blood pressure, proteinuria or other clinical signs of severity, but not by haematocrit.

Adult↗