A Study on the Distribution of Body Fluids after Rapid Saline Expansion in Normal Subjects and in Patients with Renal Insufficiency: Preferential Intravascular Deposition in Renal Failure

1983 ◽  
Vol 64 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Hendrik A. Koomans ◽  
Anton B. Geers ◽  
Peter Boer ◽  
Jan C. Roos ◽  
Evert J. Dorhout Mees
Keyword(s):  
Renal Failure ◽  
Blood Volume ◽  
Plasma Volume ◽  
Extracellular Fluid ◽  
Normal Subjects ◽  
Distribution Volume ◽  
Fluid Distribution ◽  
Severe Renal Failure ◽  
Control Value ◽  
Stage Renal Disease

1. The effect of rapid intravenous infusion of 25 ml of isotonic sodium chloride solution (saline)/kg body weight on extracellular fluid volume (ECFV, 82Br distribution volume), plasma volume (131I-labelled albumin distribution volume) and blood volume (from plasma volume and packed cell volume) was studied in nine normal subjects and a group of 11 patients with end-stage renal disease (ESRD). 2. Immediately after the infusion, the increases in ECFV were equal in the two groups but the increases in plasma and blood volumes were significantly larger in the patients with ESRD. .3. Ninety minutes after the end of the infusion, the blood volume/ECFV ratio was significantly decreased from the control value in the normal subjects, but slightly increased in the patients with ESRD. 4. It is concluded that in severe renal failure the control of fluid distribution is changed in a way which leads to a preferential distribution of rapidly infused saline into the intravascular compartment.

Oxalate Dynamics and Removal Rates during Haemodialysis and Peritoneal Dialysis in Patients with Primary Hyperoxaluria and Severe Renal Failure

1984 ◽  
Vol 66 (5) ◽  
pp. 591-597 ◽  
Author(s):  
R. W. E. Watts ◽  
N. Veall ◽  
P. Purkiss
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Extracellular Fluid ◽  
Primary Hyperoxaluria ◽  
Distribution Volume ◽  
Pool Size ◽  
Severe Renal Failure ◽  
Oxalate Excretion ◽  
Metabolic Pool

1. We have measured the plasma oxalate concentration (POx), urinary oxalate excretion (UOx), oxalate equilibrium distribution volume (ODV), oxalate metabolic pool size [(ODV) × (POx)], total plasma oxalate clearance (PCOx), renal (or dialyser) oxalate clearance (RCOx), non-renal oxalate clearance (NRCOx) and the tissue oxalate accretion rate (TOA)= [(NRCOx) × (POx)] in three patients with severe renal failure due to primary hyperoxaluria who were being treated by peritoneal dialysis or haemodialysis, or by renal transplantation. The clearance (either GFR or dialyser) of [99mTc]diethylenetriaminepenta-acetate (DTPA) and the extracellular fluid volume (ECF) measured as [99mTc]DTPA distribution volume were also determined. 2. Negligible amounts of 14C were found in faeces or as 14CO2 in expired air and hence (NRCOx) = (PCOx-RCOx). 3. Haemodialysis removed oxalate more efficiently than peritoneal dialysis in the patient where a direct comparison was possible. Neither treatment could keep up with the TOA when performed for clinically acceptable times. 4. The plasma oxalate concentrations calculated from 14C clearance through the dialyser and the chemically determined concentration of the oxalate in the dialysate were in the range 111–146 μmol/l. This is higher than in normals and in hyperoxaluric patients who are not in renal failure. Hence, although the ODV and ECF are similar to those of hyperoxaluric patients without renal failure and normal control subjects, the oxalate metabolic pool (ODV × POx) is grossly enlarged. 5. In the patient treated by renal transplantation, the oxalate pool size diminished concurrently with the resumption of oxalate excretion but expanded again as renal function decreased due to oxalosis. 6. The quantitative data show that dialysis procedures can only be a temporary holding operation and the prognosis with transplantation remains bad unless excessive oxalate production can be controlled.

The Clinical Measurement of Skeletal Blood Flow

1976 ◽  
Vol 50 (4) ◽  
pp. 261-268 ◽  
Author(s):  
R. Wootton ◽  
J. Reeve ◽  
N. Veall
Keyword(s):  
Blood Flow ◽  
Blood Volume ◽  
Transfer Rate ◽  
Random Noise ◽  
Extracellular Fluid ◽  
Normal Subjects ◽  
Normal Male ◽  
Physiological Variables ◽  
51Cr Edta ◽  
Absorbed Radiation Dose

1. A new method for measurement of skeletal blood flow is described which depends on the complete extraction of 18F in a single passage through bone. 2. Plasma concentration and urinary excretion are measured over a 2 h period. The technique of impulse analysis is used to determine the initial transfer rate of 18F to bone and extravascular extracellular fluid (ECF). The ECF component is evaluated by using a second tracer (51Cr-EDTA or 82Br) and the bone transfer rate obtained by difference. The 51Cr-EDTA data also provide an estimate of glomerular filtration rate and enable a correction to be applied for urinary bladder retention when necessary. 3. Duplicate measurements of skeletal blood flow in eight normal male volunteers gave mean flows between 4·4 and 5·9% of blood volume/min, or about 4 ml min−1 100 g−1 of bone. The variation between normal subjects was least when the results were expressed as % of blood volume/min rather than ml/min, ml min−1 kg−1 or ml min−1 1·73 m−2 body surface area. The precision of the technique was estimated to be 16·4%. 4. Addition of 1·5% random noise to the input data resulted in an uncertainty of 8·5% in the measurement of skeletal blood flow, suggesting that improved precision depends on closer control of physiological variables. 5. In six patients with severe untreated Paget's disease of bone, skeletal blood flow was 8·4–15·3% of blood volume/min. The increase was significant in all cases. 6. The absorbed radiation dose is low, so that the measurement can be repeated.

scholarly journals DETERMINATION OF THE VOLUME OF THE EXTRACELLULAR FLUID OF THE BODY WITH RADIOACTIVE SODIUM

1941 ◽  
Vol 74 (6) ◽  
pp. 569-590 ◽  
Author(s):  
Nolan L. Kaltreider ◽  
George R. Meneely ◽  
James R. Allen ◽  
William F. Bale
Keyword(s):  
Body Weight ◽  
Intravenous Injection ◽  
Intravenous Administration ◽  
Plasma Volume ◽  
Radioactive Isotope ◽  
Extracellular Fluid ◽  
Normal Subjects ◽  
Volume Of Fluid ◽  
The Body ◽  
Excess Sodium

A method for measuring the volume of fluid available for the distribution of sodium (sodium space) by the use of its radioactive isotope (Na24) has been described and the accuracy of the method has been discussed. Simultaneous determinations of the plasma volume by means of the blue dye T-1824 and the volume of the extracellular fluid by employing radiosodium and sodium thiocyanate have been made in normal subjects. Repeated measurements were made at varying periods of time in the same individuals. In order to establish the rate of diffusion equilibrium for the radioactive isotope of sodium and thiocyanate between serum and serous effusions, simultaneous samples of both were obtained at varying intervals after the intravenous injection of these substances. Since evidence in the literature indicates that there is an excess of sodium mainly limited to bone, which cannot be attributed to the extracellular phase, experiments on dogs and man were so devised that the ratio of tissue concentration to plasma concentration for radiosodium and chemically determined chloride could be calculated. The following conclusions may be drawn from the results of this investigation: 1. Radiosodium after intravenous administration spreads rapidly during the first 3 hours from the plasma into a volume of fluid which represents approximately 25 per cent of the body weight of man. Thereafter for 6 hours it diffuses more slowly into certain tissue spaces—the central nervous system and probably the skeleton. The plasma volume and interstitial fluid represent 15 and 85 per cent of the sodium space respectively. 2. Diffusion equilibrium for both radiosodium and thiocyanate is not established between serum and transudates in edematous patients until from 9 to 12 hours after the intravenous injection of these substances. 3. Until more complete information is available, it is concluded that unless the difference between repeated observations on the same individual exceeds ±1.38 liters there is no significant change in the sodium space providing that the activity of the standard and serum samples are in the range of 40 counts per minute per milliliter with the counting apparatus used. As the activity of the samples increases, the error becomes less because there is no correlation between the magnitude of the error and the magnitude of the activity. 4. Climatic conditions produce no significant changes in the volume of the blood or extracellular fluid. 5. In the dog, following the intravenous injection of radiosodium, the concentration of the isotope in bone reaches its maximum rapidly (3 hours). The extra sodium in the skeleton of dog is equal to about ¼ of the total counts in the body, assuming that the chloride space of bone represents its extracellular volume. Similar amounts of excess sodium are found in the skeleton of man 12 hours after the administration of Na24. 6. Correction of the sodium space of man for the excess sodium reduced the average value by 3.7 liters or 18.9 per cent. The average corrected volume for the normal subjects 6 hours after the injection is 15.9 liters or 21.1 per cent of the body weight compared with the thiocyanate space of 17.7 liters, representing 23.5 per cent of the body weight. 7. The most useful method for calculating the sodium space from the data obtained after intravenous administration of radiosodium is as follows: See PDF for Equation This space exceeds the volume of extracellular fluid by the amount of excess sodium in the body that cannot be attributed to the extracellular phase. 8. While neither the thiocyanate method nor the radiosodium method gives precise estimates of the extracellular fluid, the error is of the same order of magnitude in both. For clinical use, the thiocyanate method is superior because of the ready availability of the substance, and the apparatus required.

Pharmacokinetics of Iopentol in Patients with Chronic Renal Failure

1992 ◽  
Vol 33 (5) ◽  
pp. 482-484 ◽  
Author(s):  
M. G. Svaland ◽  
F. Kolmannskog ◽  
P. E. Lillevold ◽  
K. P. Nordal ◽  
L. Ressem ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Half Life ◽  
Extracellular Fluid ◽  
Reference Value ◽  
Apparent Volume ◽  
Volume Of Distribution ◽  
Severe Renal Failure ◽  
Elimination Half ◽  
The Difference

Iopentol 350 mg I/ml was injected in doses of 265 to 533 mg I/kg b.w. (mean 417 mg I/kg b.w.) in 10 patients with advanced nondiabetic chronic renal failure (S-creatinine 672 ± 259 μmol/l (mean ± SD)). Urine (10 patients) and feces (7 patients) were collected at 24 h intervals for 5 days after the injection. The elimination of iopentol was delayed. Five days after injection a mean of 54% (range 35–79%) of the dose was recovered in urine, and 11% (0–20%) in feces. Mean elimination half-life was 28.4 h, about 14 times the half-life found in healthy volunteers. The apparent volume of distribution was 0.27 1/kg b.w., indicating distribution only to extracellular fluid. Using renal iopentol clearance as reference value, GFR was overestimated by 40 to 60% with iopentol total clearance, showing extrarenal elimination of iopentol. The difference was most pronounced in patients with low GFR. In conclusion, this study shows an extrarenal elimination of iopentol and demonstrates a substantial increase in the fecal elimination in patients with severe renal failure.

scholarly journals Methamphetamine (N-methylamphetamine)-induced renal disease: underevaluated cause of end-stage renal disease (ESRD)

2019 ◽  
Vol 12 (9) ◽  
pp. e230288 ◽  
Author(s):  
Krishna M Baradhi ◽  
Samata Pathireddy ◽  
Subhasish Bose ◽  
Narothama Reddy Aeddula
Keyword(s):  
Renal Failure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Healthcare Workers ◽  
Uncontrolled Hypertension ◽  
Severe Renal Failure ◽  
Crystal Meth ◽  
Public Health Professionals ◽  
Stage Renal Disease ◽  
End Stage

A 26-year-old Caucasian man with no medical history, except years of oral and intravenous drug abuse, presented with fatigue, shortness of breath, epistaxis and uncontrolled hypertension. He was pale with skin ecchymosis over his thighs and was anaemic, with severe renal failure and metabolic acidosis. Following initial clinical stabilisation of the patient, a renal biopsy was obtained, which showed vascular and glomerular changes consistent with thrombotic microangiopathic injury and advanced glomerulosclerosis. He was treated with antihypertensives and required haemodialysis. He admitted using ‘crystal meth’ regularly for many years, which is likely responsible for his renal failure. We present the case to illustrate methamphetamine-induced renal disease leading to end-stage renal disease and to bring awareness among practising clinicians, ancillary healthcare workers and public health professionals of this often undervalued cause of renal failure, which can be prevented.

Comparison of Radioisotope Methods for the Measurement of Phosphate Absorption in Normal Subjects and in Patients with Chronic Renal Failure

1981 ◽  
Vol 60 (1) ◽  
pp. 55-63 ◽  
Author(s):  
K. Farrington ◽  
M. N. Mohammed ◽  
S. P. Newman ◽  
Z. Varghese ◽  
J. F. Moorhead
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Extracellular Fluid ◽  
Normal Subjects ◽  
Rapid Phase ◽  
Deconvolution Analysis ◽  
Phosphate Absorption ◽  
Transplant Patients ◽  
Rate Of Absorption ◽  
Intestinal Phosphate Absorption

1. Intestinal phosphate absorption was measured in normal subjects, in patients with chronic renal failure, and in post-transplant patients, by a double isotope technique involving oral administration of 32P and simultaneous intravenous injection of 33P with subsequent deconvolution analysis. 2. By this technique intestinal phosphate absorption has been shown to have two components: an initial rapid phase, which is completed by 3 h, and a slower more prolonged phase, which continues beyond 7 1/2 h. 3. Phosphate malabsorption has been demonstrated in chronic renal failure and transplant patients, which is accounted for by impairment of the initial rapid phase of absorption. 4. Results obtained by deconvolution analysis have been compared with other estimates of phosphate absorption obtained from analysis of 32P radioactivity curves alone. 5. The fractional hourly rate of absorption and the plasma 32P radioactivity at 60 min corrected for extracellular fluid volume provided the best approximations to the result obtained by deconvolution analysis, with respect to both the maximal rate of phosphate absorption and cumulative percentage phosphate absorption.

Preoptic recess lesions, body fluid compartments, and the renin-aldosterone system

1983 ◽  
Vol 245 (6) ◽  
pp. R901-R905 ◽  
Author(s):  
S. L. Bealer ◽  
E. G. Schneider
Keyword(s):  
Plasma Volume ◽  
Sodium Excretion ◽  
Total Body Water ◽  
Body Fluid ◽  
Third Ventricle ◽  
Extracellular Fluid ◽  
Body Water ◽  
Fluid Distribution ◽  
Volume Depletion ◽  
Total Body

The effects of electrolytic ablation of the periventricular tissue surrounding the anteroventral third ventricle (AV3V) of the rat brain on body fluid distribution and the renin-aldosterone system were determined. Rats underwent either ablation of AV3V periventricular tissue or control surgeries. After recovery, animals were implanted with femoral arterial and jugular venous catheters, and sodium space and plasma volume were measured by calculating the dilution of intravenous injections of 22Na- and 125I-labeled serum albumin, respectively. Total body water was determined in separate groups of rats by desiccation. Other animals with AV3V lesions and control rats were used to measure urinary sodium excretion and plasma renin (Prenin) and aldosterone (Paldo) concentrations while volume replete and after volume depletion. Animals with AV3V lesions had expanded extracellular fluid volume and decreased plasma volume, but total body water was comparable with control-operated rats. Volume-replete and volume-depleted rats with AV3V lesions had significantly higher Prenin than control animals in similar volume states. Although Paldo was not different between groups in the volume-replete state, it was significantly greater in rats with AV3V lesions than in control animals after volume depletion. These data demonstrate that AV3V periventricular ablation results in chronic alterations in the normal body fluid distribution but does not diminish the rats' ability to increase Prenin and Paldo or decrease sodium excretion during volume depletion.

Distribution of Red Cells and Plasma in the Dog

1957 ◽  
Vol 191 (1) ◽  
pp. 163-166 ◽  
Author(s):  
R. A. Huggins ◽  
E. L. Smith ◽  
S. Deavers
Keyword(s):  
Blood Volume ◽  
Plasma Volume ◽  
The Body ◽  
Red Cells ◽  
Significant Shift ◽  
Group Iii ◽  
Control Value ◽  
Control Distribution ◽  
Cell Plasma ◽  
Plasma Distribution

Two questions are examined: a) is the venous hematocrit a representative sample of the percentage of red cells to plasma in the circulation, and b) does the distribution of red cells and plasma remain constant with changes in blood volume? The dogs were anesthetized with a morphine-pentobarbital combination. Red cell volume was measured with either radioactive Cr51 or Fe59 and plasma volume with Evans blue or radioactive I131. The distribution of cells was expressed by the ratio BH/VH and of plasma by (100-BH)/(100-VH). The body hematocrit (BH) was significantly less than the venous hematocrit (VH) for 60 control dogs, and the distribution of red cells, expressed by the ratio BH/VH, was 0.90 and for the plasma 1.09. Transfusion of blood (100– 149 cc/kg, group III) was followed by a significant shift from the control value in the distribution of plasma but not of red cells. Neither hemorrhage of 15% of the estimated blood volume, reinfusion of the blood nor successive transfusion into group III was followed by a significant change in the distribution of red cells and plasma from the control distribution. With a large hemorrhage 58% of the measured blood volume and shock there was a significant shift in the distribution of red cells (0.795) from the control value. Since changes in blood volume may accompany a shift in the cell-plasma distribution, the cell or plasma volume, venous hematocrit, and a factor cannot be used for measuring blood volume unless the factor is determined for the circulatory condition being studied. Following this work we reconsidered the effect of these data on previously published work from this laboratory. Some of the absolute values were significantly altered but not the direction or percentage change.

Comparison of the Effects of Water Immersion and Saline Infusion on Central Haemodynamics in Man

1977 ◽  
Vol 52 (4) ◽  
pp. 343-350
Author(s):  
R. Levinson ◽  
M. Epstein ◽  
M. A. Sackner ◽  
R. Begin
Keyword(s):  
Blood Volume ◽  
Volume Expansion ◽  
Water Immersion ◽  
Extracellular Fluid ◽  
Normal Subjects ◽  
Capillary Blood ◽  
Alveolar Volume ◽  
Pulmonary Tissue ◽  
Capillary Blood Volume ◽  
Saline Administration

1. The effects of acute intravenous infusion of 2 litres of saline/120 min on pulmonary capillary blood flow (Q̇c), diffusing capacity per unit of alveolar volume (DL/VA), functional residual capacity (FRC), and pulmonary tissue plus capillary blood volume (VTPC) were compared with the changes induced by water immersion to the neck for 4 h. Serial measurements were made at 30 min intervals in five normal subjects, utilizing a non-invasive rebreathing method with a gas mixture containing 0·5% acetylene, 0·3% C180, 10% He, 21% O2 and 68·2% N2. 2. Infusion of saline produced a rise in Q̇c which was similar to that induced by immersion. This increment in Q̇c persisted for the 3 h of observation after stopping the infusion, in contrast to the prompt decrease in Q̇c to pre-study values after cessation of immersion. 3. DL/VA was unaffected by saline administration in contrast to the marked and prompt increment induced by immersion. 4. Pulmonary tissue plus capillary blood volume was unchanged during both saline administration and immersion, suggesting that neither gradual saline administration nor immersion induces major extravasation of fluid into the pulmonary interstitial space. 5. The present data indicate that the ‘volume stimulus’ of immersion is similar to that of saline-induced extracellular fluid volume expansion in normal seated subjects. Immersion may be a preferred investigative approach for assessing the effects of volume expansion in subjects in whom rapid reversibility of the ‘volume stimulus’ is desirable.

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