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At least 19 recordsLinked to original sources
PubMed1990

Aging and disturbances of thirst and fluid balance.

Fluid and electrolyte homeostasis depend on a balance between the intake and output of water. Aging is characterized by reduced homeostatic capacity. Changes in the control of both water intake and excretion accompany aging and may predispose the elderly to disturbances in sodium and water balance. Reduced thirst and water intake in response to water deprivation and thermal dehydration have been observed in healthy elderly persons. This reduction, combined with reduced renal water-conservation capacity, may predispose the elderly to dangerous dehydration when illness increases water losses or physical incapacity prevents access to water. The reasons for the thirst deficit are not clear. The elderly have a reduced capacity to excrete a water load, which means they are predisposed to water overload and hyponatremia. Furthermore, various neuroendocrine changes in the elderly affect fluid and electrolyte homeostasis. More studies are needed to understand the etiology of the disturbances of fluid intake and output so that they can be better prevented and treated.

Aging↗
PubMed1991

Pharmacist interventions improve fluid balance in fluid-restricted patients requiring parenteral nutrition.

Many intensive care unit (ICU) patients require parenteral nutrition (PN) and fluid restriction, making delivery of adequate nutrition difficult. We studied the effects of pharmacist interventions on fluid balance in fluid-restricted ICU patients requiring PN. Twenty patients were randomized to the treatment group (dextrose 70% injection [D70W] plus 15% amino acids for PN, 25-mL piggybacks, selected drugs added to the PN solution) or the control group (D70W plus 10% amino acids, 50- or 100-mL piggybacks). Each group contained 10 patients and they were not significantly different for age, gender, weight, hospital days, and serum albumin concentration. The duration (9.3 +/- 1.2 vs. 9.7 +/- 2.4 d) and doses of PN (29 +/- 6.8 vs. 28.7 +/- 6.9 kcal/kg/d; 1.1 +/- 0.3 vs. 1.1 +/- 0.4 g/kg/d protein) were similar between treatment and control groups. Mean fluid intake (3112 +/- 1146 vs. 3498 +/- 1111 mL/d), fluid balance (146 +/- 1581 vs. 708 +/- 1402 mL/d), and cumulative fluid balance (1358 vs. 6867 mL) were all significantly lower in the treatment group. Mean fluid output was similar between the two groups. Pharmacist interventions can significantly decrease intake and result in a better fluid balance in fluid-restricted ICU patients who require PN.

Adult↗
PubMed1991

Fluid balance during pulmonary edema. Is fluid gain a marker or a cause of poor outcome?

STUDY OBJECTIVE: To evaluate the importance of fluid balance and changes in extravascular lung water (EVLW) on survival in the ICU and short-term outcome in patients with pulmonary edema. DESIGN: Retrospective analysis of data (sorting by survival and "treatment received") from a recent randomized controlled trial of fluid restriction in this population. SETTING: Medical ICU of a university-affiliated, tertiary-care medical center. PATIENTS: Eighty-nine patients (from the previously mentioned study) requiring pulmonary artery catheterization with abnormally high EVLW (greater than 7 ml/kg). MEASUREMENTS AND RESULTS: When analyzed by survival, the survivors had no significant fluid gain or change in EVLW but decreased wedge pressure and body weight, compared to nonsurvivors. When analyzed by fluid balance, patients who gained less than 1 L of fluid by 36 hours into the study had a better rate of survival (74 percent) than the rest (50 percent; p less than 0.05). Also, the median duration of days on the ventilator, ICU days, and days of hospitalization was approximately half as long for each variable in the group with less than 1 L of fluid gain. Even accounting for baseline differences in the severity of illness, fluid balance was an independent predictor of survival (p less than 0.05). When analyzed by whether or not EVLW decreased by more than 15 percent between the first and last measurement, only patients with ARDS or sepsis had decreased days on the ventilator and ICU days. CONCLUSIONS: These data support the concept that positive fluid balance per se is at least partially responsible for poor outcome in patients with pulmonary edema and defend the strategy of attempting to achieve a negative fluid balance if tolerated hemodynamically.

Extravascular Lung Water↗
PubMed1991

An experimental model for the study of transcapillary fluid balance in hypothermia.

Disturbed fluid balance is a significant clinical problem in hypothermia and rewarming. We have therefore investigated whether the transcapillary fluid balance in rats exposed to hypothermia and rewarming could be studied with the use of a wick method. Double nylon wicks were sewn into the abdominal skin and left there for one hour, then removed to double-bottomed conic vials and centrifuged. Wick fluid was collected and colloid osmotic pressure measured. Blood samples were taken simultaneously for measurement of hematocrit, hemoglobin, red cell count and plasma colloid osmotic pressure. This was done at 37 degrees C (prehypothermic), 13 degrees C (hypothermic) and at 30 degrees C (during rewarming). Blood pressure was also recorded. The model provides a good method to investigate the colloid osmotic changes of both plasma and interstitium during hypothermic situations.

Animals↗
PubMed1990

Endocrine and fluid-balance responses to amniotic and allantoic fluid loss in sheep.

Our aim was to determine fetal and maternal endocrine and fluid-balance responses to prolonged loss of amniotic and allantoic fluids in sheep. In seven sheep, amniotic and allantoic fluids were drained [379.1 +/- 20.1 (SE) ml/day] from 107 to 135.3 +/- 0.6 days of gestation (term: 145 days). The results from these sheep were compared with those from seven control sheep. Maternal water intake, urine production, and urine osmolality were not altered by fluid drainage, nor were fetal and maternal arterial blood gases, pH, or plasma osmolalities. Fluid drainage increased amniotic, but not allantoic, fluid osmolality. Maternal plasma cortisol concentration increased with fluid drainage, but maternal plasma concentrations of prolactin and arginine vasopressin were unchanged. Fluid drainage increased prolactin concentrations in fetal plasma and amniotic fluid, but fetal plasma concentrations of cortisol (hydrocortisone), arginine vasopressin, norepinephrine, and epinephrine were unchanged. Our results show that the fetus is capable of maintaining its plasma osmolality despite prolonged loss of fluid from its amniotic and allantoic sacs and that this is associated with alterations in the production rate and the composition of amniotic fluid.

Allantoin↗
PubMed2026

Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock.

BACKGROUND: Whether treatment with balanced crystalloid fluid leads to better outcomes than 0.9% saline in children treated for septic shock is debated. METHODS: In this pragmatic clinical trial conducted at 47 emergency departments in five countries, patients (2 months to <18 years of age) with suspected septic shock and abnormal perfusion were randomly assigned to receive fluid resuscitation with either balanced fluid or 0.9% saline for up to 48 hours. The primary outcome was a major adverse kidney event (a composite of death, new renal-replacement therapy, or persistent kidney dysfunction) at 30 days after enrollment or hospital discharge, whichever occurred first. RESULTS: Of 9041 enrolled patients, 277 (6.1%) in the balanced-fluid group and 282 (6.2%) in the 0.9%-saline group withdrew from the trial, leaving 4235 and 4247 patients, respectively, for analysis. A primary-outcome event occurred in 137 patients (3.4%) in the balanced-fluid group and in 124 (3.0%) in the 0.9%-saline group (difference, 0.4 percentage points; 95% confidence interval [CI], -0.5 to 1.3; risk ratio, 1.10; 95% CI, 0.88 to 1.40; P&#x2009;=&#x2009;0.85). The median number of hospital-free days during 28 days after enrollment was 23 (interquartile range, 19 to 25) in both groups. Hyperchloremia occurred in 868 patients (31.4%) in the balanced-fluid group and in 1383 (49.0%) in the 0.9%-saline group; hypernatremia in 52 (1.8%) and 89 (3.1%), respectively; and hyperlactatemia in 260 (19.8%) and 228 (16.7%). No differences in other safety outcomes or adverse events were seen. CONCLUSIONS: Among children treated for septic shock, no significant difference was seen in the incidence of death, new renal-replacement therapy, or persistent kidney dysfunction when fluid resuscitation was administered with balanced fluid as compared with 0.9% saline. (Funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; PRoMPT BOLUS ClinicalTrials.gov number, NCT04102371.).

Adolescent↗
PubMed1991

Thoracic impedance as an index of body fluid balance during cardiac surgery.

Thoracic impedance at 2.5 (TI2.5) and 100 kHz (TI100), central venous pressure (CVP), and body fluid balance were recorded together with rectal temperature and arterial haematocrit in 15 consecutive patients subjected to coronary artery bypass grafting. I.v. fluid and blood were administered in an excess of 3.18 (1.38-9.35) 1 during the operation. TI2.5 decreased from 51.7 (39.2-66.4) to 34.9 (21.1-45.7) ohm (P = 0.001), while TI100 decreased from 41.9 (31.4-55.0) to 30.3 (18.3-40.8) ohm (P = 0.002). CVP, 6 (3-11) mmHg [0.8 (0.4-1.5) kPa], was the same before and after surgery. Temperature decreased during cardiopulmonary bypass from 35.4 (34.1-36.6) to 26.7 (22.9-31.0) degrees C and haematocrit from 39 (34-46)% to a lowest value of 27 (23-32)% (P = 0.0001). A close linear correlation between TI and body fluid balance was observed (TI2.5: r = -0.96, TI100: r = -0.95, P = 0.0001). Corrections of TI for temperature and/or haematocrit improved the correlation between TI and fluid balance to 0.99 (TI2.5) and 0.98 (TI100). The data indicate that changes in thoracic impedance can be used to monitor body fluid balance during cardiac surgery.

Aged↗
PubMed1977

Hana kai ii: a 17-day dry saturation dive at 18.6 ATA. III. Body fluid balance.

Comprehensive studies on body fluid balance on 5 divers were conducted during the Hana Kai II dive (17 days at 18.6 ATA and 7 days of decompression). Daily urine flow increased from about 2000 ml at 1 ATA to 2600 ml at 18.6 ATA, at 31 degrees C. This diuresis was accompanied by a reduction in urine osmolality (from 650 to 500 mOsm) and a slight increase in osmolal clearance. Endogenous creatinine clearance remained at about 173 ml/min throughout the dive. Despite such a sustained diuresis, neither daily water intake nor total body water volume changed significantly. The plasma renin activity changed little, while both plasma aldosterone concentration and urinary aldosterone excretion increased significantly during the first week at 18.6 ATA. The plasma prolactin concentration showed a significant decrease during the first 3 days at 18.6 ATA. The daily excretion of antidiuretic hormone (ADH) decreased significantly (by 40%) 4 days after compression and remained low throughout the rest of the dive. Insensible waterloss at 18.6 ATA was 35% lower than that at 1 ATA. It is suggested that the observed hyperbaric diuresis is due primarily to suppression of ADH as a result of suppression of insensible water loss.

Aldosterone↗
PubMed1978

Clinical experience with continuously monitored fluid balance in automatic hemofiltration.

Automatic fluid balancing, as obtained with the hemofiltration machines from Sartorius (Göttingen, West Germany) and Dialysetechnik (Karlsruhe, West Germany), is accurate enough to replace bed scales, which have been necessary in conventional hemodialysis for patients who are confined to beds. Side effects such as hypotension, nausea and muscle cramps during treatment may be reduced with these new machines, compared to conventional methods, provided that the rate of effective fluid withdrawal does not exceed 0.5 L/hr. In particular, the constant weight loss associated with automatic hemofiltration seems to be well tolerated by the patients with fewer side effects.

Body Weight↗
PubMed1991

The relationship between ARDS, pulmonary infiltration, fluid balance, and hemodynamics in critically ill surgical patients.

Hypervolemia from fluid overload with resultant pulmonary edema is thought to be a frequent cause of Adult Respiratory Distress Syndrome (ARDS). However, ARDS may also occur as a result of the hypovolemic shock of surgery or trauma. To develop an appropriate rationale for fluid therapy in high-risk surgical patients, the relationship between fluid balance, hemodynamics, the onset of ARDS by physiologic criteria (shunt greater than or equal to 20%, and/or PaO2/FiO2 ratio less than 250) and the onset of pulmonary infiltration (PI) associated with ARDS were examined. Fifty patients were prospectively followed from admission throughout their hospitalizations; 38 (76%) had trauma and 12 (24%) were postoperative. Cardiac index, central venous pressure (CVP), wedge pressure (WP), and shunt (Qsp) were measured. All chest x rays were read by one staff radiologist who was blinded to the patients' identities. PI was graded from "0" to "4" (0 = no PI, 4 = maximum PI). The first x ray reading of "2" or greater was used as the time of onset of PI. ARDS by physiologic criteria occurred in 29 of 50 (58%) patients; 27 of these 29 (94%) also developed +2 or greater PI. The mean onset times of ARDS and of +2 PI were 40 +/- 41 hours and 40 +/- 38 hours, respectively. The ARDS patients had a significantly smaller net positive fluid balance than the non-ARDS patients over the first 40 hours after admission (+6,831 ml +/- 4,909 ml vs 12,440 ml +/- 7,817 ml, (P less than 0.01)).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Investigation of the effects of paralysis by pancuronium on heart rate variability, blood pressure and fluid balance.

The effects of pancuronium bromide on the cardiovascular system and fluid balance in preterm ventilated neonates was investigated. Infants were selectively paralysed if actively expiring. Their results were compared to a control group of similar gestational age, ventilated during the same study period, but who received no paralysing agent. There was no significant difference in the blood pressure of the two groups. Treatment with pancuronium was not associated with differences in blood pressure variability. All paralysed infants showed a significant reduction in heart rate variability which persisted during treatment. This was not present in the control infants. Paralysed infants, despite fluid restriction, had evidence of fluid retention, being significantly heavier than the control babies from day 3 onwards and above their birthweight by day 7. No paralysed or control infant developed a pneumothorax or renal failure. We conclude that selective treatment with pancuronium is without adverse effects on blood pressure but strict attention to fluid balance is essential.

Blood Pressure↗
PubMed1978

Perioperative care: intraoperative fluid balance.

Rational intraoperative fluid therapy is based on an understanding of the pathophysiology of severe trauma and surgery. Fluids of suitable compositions are administered in sufficient quantities to form part of the daily maintenance requirement and also to replace blood and ECF lost during surgery.

Acute Kidney Injury↗
PubMed1975

Perturbations in fluid balance induced by medially placed forebrain lesions.

Acute and chronic effects on the fluid balance of radio-frequency forebrain lesions were studied in the goat. Medial lesions which involved practically the entire anterior wall of the third cerebral ventricle cause persistent loss of thirst and lack of significant antidiuretic hormone (ADH) release in response to hypernatraemia and plasma hyperosmolality. As acute response to such lesions an uncompensated, temporary water diuresis was seen, which rapidly caused pronounced hypernatraemia and hypovolaemia. Lesions extending laterally to encroach upon the supraoptic nuclei resulted in persistent signs of weak, inappropriate ADH secretion (=impaired water diuresis, renal salt wasting, and pronounced hyponatraemia during hydration). Forebrain damage, mainly restricted to the septal region, caused hyperdipsia. In some goats, obvious post-lesioning increase in salt appetite was observed which could not be coreelated to the extent of their forebrain damage. The results are discussed in relation to hypothalamic syndromes in man and previous studies on central control of fluid balance in the goat.

Animals↗
PubMed1989

The influence of thoracic epidural analgesia on transcapillary fluid balance in subcutaneous tissue. A study in patients undergoing aortocoronary bypass surgery.

Clinical observation and calculation of fluid balance have shown that patients undergoing aortocoronary bypass surgery with thoracic epidural analgesia (TEA) in addition to general anesthesia retain less fluid than patients having general anesthesia only. The present study was designed to investigate whether this effect could be explained by thoracic epidural analgesia influencing the transcapillary fluid balance, i.e. the transcapillary forces (COPpl, COPif, Pif). Interstitial fluid colloid osmotic pressure (COPif) and interstitial fluid pressure (Pif) were measured subcutaneously at heart level by the blister suction technique and the wick-in-needle technique, respectively. Simultaneously plasma colloid osmotic pressure (COPpl) was recorded. Sixteen male patients were allocated to two groups, one having general anesthesia only (controls, n = 8). The other group (TEA, n = 8) received, at the induction of anesthesia, bupivacaine 50 mg via an epidural catheter as an adjunct to general anesthesia. TEA was maintained by continuous infusion for 24 h postoperatively. Preoperatively no intergroup differences were observed in "the Starling forces" (COPpl, COPif, Pif). At the start of extracorporeal circulation COPpl was significantly lower in the TEA-group than in controls. During extracorporeal circulation the transcapillary COP-gradient (COPpl-COPif) was reversed in both groups. At the end of extracorporeal circulation Pif increased to a minor degree in the TEA-group and remained significantly lower than in controls from 3 to 24 h postoperatively. The subcutaneous interstitial tissue could be less expanded postoperatively in the TEA-group, also reflected by a lower increase in Pif.

Aged↗
PubMed1976

Interstitial fluid and transcapillary fluid balance in the lung.

Alterations in extravascular lung water content when capillary pressure or plasma colloid osmotic pressure is increased have been evaluated in isolated, continuously weighed, plasma-perfused pairs of rabbit lungs. After modest increases in left atrial pressure, most preparations rapidly reached a new stable weight, and thus a new transcapillary fluid balance, but no significant increase in extravascular lung water content could be detected. In preparations where there was still a steady, slow gain in weight and thus still some transvascular filtration of fluid 15 min after the increase in pressure, a moderate but significant increase in extravascular water could be detected. It is concluded that only very small transvascular shifts of fluid occur in the lungs when capillary pressure changes, as long as this change is kept below the level that causes oedema. This limitation of pressure-induced transvascular shifts of fluid in the lung could be explained by the existence, close to the capillaries, of a small interstitial space containing fluid with a high protein concentration. Alterations in the colloid osmotic pressure exerted by this fluid would then contribute markedly towards continuous readjustment of the transcapillary fluid balance in the lung. Experiments by other workers indicate that alveolar pressure can markedly affect the transcapillary fluid balance of the isolated perfused lung.

Animals↗
PubMed1988

Salt and fluid balance in newborn infants.

About 5 years ago it was widely thought that preterm infants should be supplemented with extra sodium to avoid hyponatremia. It has, however, to be pointed out that VLBW infants during the first postnatal week run a risk of developing hypernatremia which makes it difficult to give general recommendations for sodium supplementation. Since the serum sodium level depends not only upon the balance between sodium intake and sodium excretion but also upon the water balance which may vary depending on the clinical condition of the baby, it seems advisable to monitor the serum sodium level in all preterm infants. Supplementation should be given in case of hyponatremia. In instances of hyponatremia it also has to be considered if the infant due to positive fluid balance has retained fluid in excess of sodium. As a general conclusion the importance of monitoring sodium balance in every preterm infant should be stressed. Disturbances are most likely to occur in VLBW infants and in infants with acute illnesses. The best way of assisting fluid balance is by repeated accurate measurements of the body weight. It should, however, be kept in ming that no reliable methods are available for the measurement of the body weight of a preterm infant who is under intensive care and who cannot be taken out of the incubator. Serum sodium levels may give information of the sodium balance but it has to be stressed that fluid and sodium balances are always interrelated and that it is desirable to have simultaneous estimations of both balances. Excess retention of fluid may be caused primarily by excess retention of sodium or by fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

Fluid balance during heat stress in lactating goats.

Fluid balance and thermoregulation were studied during an acute heat load (maximal daily temperature, 38 +/- 1 degrees C; night temperature 27 +/- 1 degrees C) in six goats during lactation and non-lactation. The goats had free access to water for 1 day, followed by 29.5 h of water deprivation and then water was returned. With water available the goats increased water intake and urinary and milk water losses, while plasma and milk osmolality decreased. Water deprivation caused plasma osmolality and vasopressin concentration to increase most in lactating goats. Milk osmolality rose to values similar to plasma osmolality. Plasma cortisol increased in lactating goats at the end of dehydration. Renal Na+ excretion increased during dehydration in lactating goats. Evaporative heat loss was larger in lactating goats when hydrated, but became less than in non-lactating goats during dehydration. Lactating goats exhibited higher respiratory frequency and rectal temperature than non-lactating goats. In conclusion, our results show that goats increase the water turnover during heat stress if allowed to drink ad libitum, but when they are deprived of water lactating goats reduce water loss in urine, milk and by evaporation, and rectal temperature reaches higher levels than in non-lactating animals. This saving of water could allow milk production to be maintained for a longer time during heat stress.

Animals↗