scholarly journals Body Sodium, Potassium and Water in Peritoneal Dialysis-Associated Hyponatremia

2014 ◽  
Vol 34 (3) ◽  
pp. 253-259 ◽  
Author(s):  
Yijuan Sun ◽  
David Mills ◽  
Todd S. Ing ◽  
Joseph I. Shapiro ◽  
Antonios H. Tzamaloukas
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Evaluation ◽  
Serum Sodium ◽  
Total Body Water ◽  
Sodium Concentration ◽  
Body Water ◽  
Serum Sodium Concentration ◽  
Monovalent Cations ◽  
Body Sodium ◽  
Total Body

Objective This report presents a method quantitatively analyzing abnormalities of body water and monovalent cations (sodium plus potassium) in patients on peritoneal dialysis (PD) with true hyponatremia. Methods It is well known that in the face of euglycemia serum sodium concentration is determined by the ratio between the sum of total body sodium plus total body potassium on the one hand and total body water on the other. We developed balance equations that enabled us to calculate excesses or deficits, relative to the state of eunatremia and dry weight, in terms of volumes of water and volumes of isotonic solutions of sodium plus potassium when patients presented with hyponatremia. We applied this method retrospectively to 5 episodes of PD-associated hyponatremia (serum sodium concentration 121–130 mEq/L) and compared the findings of the method with those of the clinical evaluation of these episodes. Results Estimates of the new method and findings of the clinical evaluation were in agreement in 4 of the 5 episodes, representing euvolemic hyponatremia (normal total body sodium plus potassium along with water excess) in 1 patient, hypovolemic hyponatremia (deficit of total body sodium plus potassium along with deficit of total body water) in 2 patients, and hypervolemic hyponatremia (excess of total body sodium along with larger excess of total body water) in 1 patient. In the 5th patient, in whom the new method suggested the presence of water excess and a relatively small deficit of monovalent cations, the clinical evaluation had failed to detect the cation deficit. Conclusions Evaluation of imbalances in body water and monovalent cations in PD-associated hyponatremia by the method presented in this report agrees with the clinical evaluation in most instances and could be used as a guide to the treatment of hyponatremia. Prospective studies are needed to test the potential clinical applications of this method.

scholarly journals Edelman Revisited: Concepts, Achievements, and Challenges

2022 ◽  
Vol 8 ◽  
Author(s):  
Mark Rohrscheib ◽  
Ramin Sam ◽  
Dominic S. Raj ◽  
Christos P. Argyropoulos ◽  
Mark L. Unruh ◽  
...  
Keyword(s):  
Serum Sodium ◽  
Quantitative Methods ◽  
Sodium Concentration ◽  
Body Fluids ◽  
Body Water ◽  
Serum Sodium Concentration ◽  
Sodium Potassium ◽  
Body Sodium ◽  
Total Body

The key message from the 1958 Edelman study states that combinations of external gains or losses of sodium, potassium and water leading to an increase of the fraction (total body sodium plus total body potassium) over total body water will raise the serum sodium concentration ([Na]S), while external gains or losses leading to a decrease in this fraction will lower [Na]S. A variety of studies have supported this concept and current quantitative methods for correcting dysnatremias, including formulas calculating the volume of saline needed for a change in [Na]S are based on it. Not accounting for external losses of sodium, potassium and water during treatment and faulty values for body water inserted in the formulas predicting the change in [Na]S affect the accuracy of these formulas. Newly described factors potentially affecting the change in [Na]S during treatment of dysnatremias include the following: (a) exchanges during development or correction of dysnatremias between osmotically inactive sodium stored in tissues and osmotically active sodium in solution in body fluids; (b) chemical binding of part of body water to macromolecules which would decrease the amount of body water available for osmotic exchanges; and (c) genetic influences on the determination of sodium concentration in body fluids. The effects of these newer developments on the methods of treatment of dysnatremias are not well-established and will need extensive studying. Currently, monitoring of serum sodium concentration remains a critical step during treatment of dysnatremias.

scholarly journals The Available Clinical Approaches to the Management of Patients with Acute and Chronic Hypernatremia

2020 ◽  
Vol 8 (F) ◽  
pp. 1-10
Author(s):  
Asaad Moradi ◽  
Foroogh Sabzghabaei ◽  
Mohammadshahab Kalantar
Keyword(s):  
Cerebral Edema ◽  
Serum Sodium ◽  
Total Body Water ◽  
Sodium Concentration ◽  
Clinical Treatment ◽  
The Other ◽  
Present Review ◽  
Serum Sodium Concentration ◽  
A Value ◽  
Total Body

Hypernatremia has been known as a conventional electrolyte problem and is defined as a serum sodium concentration growth up to a value above 145 mmol/l. This disease is also known as a hyperosmolar condition, which is resulted from a reduction in total body water compared to the electrolyte content. Since two types of hypernatremia, including acute and chronic, exist, in the present study, we will review the available clinical approaches for the management of patients with acute and chronic hypernatremia. To this end, 68 studies having the criteria of the present review and published from 2000 were chosen and their data were extracted. The inclusion criterion was to be mainly focused on hypernatremia clinical treatment and those having side topics were excluded from the study. Acute symptomatic hypernatremia is a disease that occurs in <24 h and needs to be treated immediately. On the other hand, there is a chronic hypernatremia that occurs in a duration of more than 48 h and is required to be treated at a lower speed due to cerebral edema risks during treatment. Finally, for providing beneficial outcomes to patients, both chronic and acute hypernatremia need to be compared thoroughly and also more investigation needs to be done.

Serum Disaccharides and Osmolality in Ccpd Patients Using Icodextrin Or Glucose as Daytime Dwell

1997 ◽  
Vol 17 (6) ◽  
pp. 602-607 ◽  
Author(s):  
Nynke Pasthuma ◽  
Pieter M. Ter Wee ◽  
Ab J.M. Danker ◽  
Po L. Oe ◽  
Wim Van Dorp ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Sodium ◽  
Sodium Concentration ◽  
Average Concentration ◽  
Serum Sodium Concentration ◽  
Dialysis Fluid ◽  
Total Carbohydrate ◽  
Initial Decrease ◽  
Osmolal Gap

Objective To evaluate the safety, efficacy, and biocompatibility of icodextrin and glucose-containing dialysis fluid during continuous cycling peritoneal dialysis (CCPD), patients were treated for 2 years with either icodextrin or glucose-containing dialysis fluid for their daytime dwell (14 -15 hours). Prior to entry into the study, all patients used a standard glucose solution (Dianeal 1.36%,2.27%, or 3.86%, Baxter, Utrecht, The Netherlands). Design Open, randomized, prospective, two-center study. Setting University hospital and teaching hospital. Patients Both established and patients new to CCPD were included. A life expectancy of more than 2 years, a stable clinical condition, and written informed consent were necessary before entry. Patients aged under 18, those with peritonitis in the previous month, and women of childbearing potential, unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients entered the study, and 25 (13 glucose, 12 icodextrin) had a follow-up period of 12 months or longer in December 1996. Main Outcome Measures Serum icodextrin metabolites: one to five glucose units (G1–G5), a high molecular weight fraction (G > 10), and total carbohydrate level, as well as a biochemical profile were determined every 3 months in combination with all other study variables. Results In icodextrin-treated patients, serum disaccharide (maltose) concentrations increased from 0.05 ± 0.01 (mean±SEM) at baseline, to an average concentration in the follow-up visits of 1.14 ± 0.13 mg/mL (p < 0.001). All icodextrin metabolites increased significantly from baseline, as illustrated by the serum total carbohydrate minus glucose levels: from 0.42 ± 0.05 mg/mL to an average concentration in the follow-up visits of 5.04 ± 0.49 mg/mL (p < 0.001). At the same time, serum sodium levels decreased from 138.1 ± 0.7 mmol/L to an average concentration in the follow-up visits of 135.4 ± 0.8 mmol/L (p < 0.05). However, after 12 months the serum sodium concentration increased nonsignificantly (NS) from base line to 136.6 ± 0.9 mmol/L, after an initial decrease. Serum osmolality increased significantly from baseline in icodextrin users at 9 and 12 months, but did not differ significantly from glucose users in any visit. In icodextrintreated patients, the calculated serum osmolal gap increased significantly from 4.1 ± 1.4 mOsm/kg to an average of 11.8 ± 1.7 mOsm/kg (p < 0.01). The sum of the serum icodextrin metabolites in millimoles/liter equaled the increase in osmolal gap. Body weight increased in icodextrin users (71.9 ± 2.7 kg to 77.8 ± 3.0 kg; NS). Clinical adverse effects did not accompany these findings. Residual renal function remained stable during follow-up. Conclusions The serum icodextrin metabolite levels in the present study increased markedly and were the same as those found previously in continuous ambulatory peritoneal dialysis patients treated with icodextrin, despite thelonger dwell time for CCPDpatients (14 -16 hr versus 8 -12 hr). The initial decrease in serum sodium concentration was followed by an increase to a concentration not different from baseline at 12 months. The pathophysiology of this finding is speculated. Calculated osmolal gap in icodextrin patients increased significantly (p < 0.01) at every follow-up visit, and could be explained by the serum icodextrin metabolite increase. We encountered no clinical side effects of the observed levels of icodextrin metabolites.

scholarly journals Regulation of Water and Some Ions in Gammarids (Amphipoda)

1971 ◽  
Vol 55 (2) ◽  
pp. 357-369
Author(s):  
D. W. SUTCLIFFE
Keyword(s):  
Sodium Chloride ◽  
Sea Water ◽  
Chloride Concentration ◽  
Sodium Concentration ◽  
Body Water ◽  
The Body ◽  
Salinity Range ◽  
Sodium Potassium ◽  
Body Sodium ◽  
Total Body

1. A comparison was made of the body water contents and the concentrations of sodium, potassium and chloride in the blood and body water of Gammarus zaddachi, G. locusta and Marinogammarus finmarchicus. 2. G. zaddachi had a slightly higher body water content than G. locusta and M. finmarchicus. 3. In all three species the blood chloride concentration was lower than the external chloride concentration in 80-113 % sea water, but the blood sodium concentration was equal to or slightly above the sodium concentration in the external medium. 4. The total body sodium concentration was always greater than the total body chloride concentration. In M.finmarchicus the ratio of body sodium/chloride increased from 1.2 to 1.3 over the salinity range 100-20% sea water. In G. zaddachi the ratio of body sodium/chloride increased from 1.08 at 100% sea water to 1.87 in 0.25 mM/l NaCl. 5. The total body potassium concentration remained constant. The potassium loss rate and the balance concentration were relatively high in G. zaddachi. 6. The porportion of body water in the blood space was calculated from the assumption that a Donnan equilibrium exists between chloride and potassium ions in the extracellular blood space and the intracellular space. In G. zaddachi the blood space was equivalent to 60% body H2O at 100% sea water, and equivalent to 50% body H2O at 40% sea water down to 0.5 mM/l NaCl. In M.finmarchicus the blood space was equivalent to 38-44% body H2O at salinities of 20-100% sea water. 7. The mean intracellular concentrations of sodium, potassium and chloride were also calculated. It was concluded that for each ion its intracellular concentration is much the same in the four euryhaline gammarids. The intracellular chloride concentration is roughly proportional to the blood chloride concentration. The intracellular sodium concentration is regulated in the face of large changes in the blood sodium concentration.

The Ratio of Extracellular Fluid to Total Body Water and Technique Survival in Peritoneal Dialysis Patients

2004 ◽  
Vol 24 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Colin H. Jones ◽  
Charles G. Newstead
Keyword(s):  
Peritoneal Dialysis ◽  
Total Body Water ◽  
Extracellular Fluid ◽  
Residual Renal Function ◽  
Body Water ◽  
C Reactive Protein ◽  
Dialysis Patients ◽  
Technique Survival ◽  
Reactive Protein ◽  
Total Body

Background Patients receiving peritoneal dialysis experience a high technique failure rate and are often overhydrated. We examined whether an increased extracellular fluid volume (VECF) as a proportion of the total body water (VTBW) predicted technique survival (TS) in a prevalent patient cohort. Methods The VECF and VTBW were estimated by multiple-frequency bioelectric impedance in 59 prevalent peritoneal dialysis patients (median time on dialysis 14 months). Demographic, biochemical (albumin, C-reactive protein, and ferritin), and anthropometric data, forearm muscle strength, nutritional score by three-point Subjective Global Assessment, residual renal function, dialysate-to-plasma (D/P) creatinine ratio, total weekly Kt/V urea, total creatinine clearance, normalized protein equivalent of nitrogen appearance, and midarm muscle circumference were also assessed. Technique survival was determined at 3 years, and significant predictors of TS were sought. Results In patient groups defined by falling above or below the median value for each parameter, only residual renal function ( p = 0.002), 24-hour ultrafiltrate volume ( p = 0.02), and VECF / VTBW ratio ( p = 0.05) were significant predictors of TS. Subjects with a higher than median VECF / VTBW ratio had a 3-year TS of 46%, compared to 78% in subjects with a lower than median value. In multivariate analysis, systolic blood pressure and VECF / VTBW ratio (both p < 0.05) were significant predictors of TS. C-reactive protein approached significance. Conclusion Increased ratio of extracellular fluid volume to total body water is associated with decreased TS in peritoneal dialysis.

scholarly journals Measuring total body water in peritoneal dialysis patients using an ethanol dilution technique

1999 ◽  
Vol 56 (6) ◽  
pp. 2297-2303 ◽  
Author(s):  
Naomi V. Dahl ◽  
Edward F. Foote ◽  
Toros Kapoian ◽  
Caroline A. Steward ◽  
Richard A. Sherman
Keyword(s):  
Peritoneal Dialysis ◽  
Total Body Water ◽  
Body Water ◽  
Dialysis Patients ◽  
Dilution Technique ◽  
Total Body
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