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ByWILLIAMH.BIRCHARDANDMAURICEB.STRAUSS

urineflow(1),hasrecentlybeenshownby

Blomhert(2)tobefollowedbybriskwater

demonstratedthatsimilardiuresismayresult day.ThusLadd(3)foundthatdiuresisfollow- foretheinfusionwasgiven.Apreviousstudy curredinrecumbentsubjectsbutnotinthose quietlyseatedinachair.Blomhert(2)didnot sameconditionsduringtheday.

SinceBlomhert"sstudiesweremadeonlyon

recumbentsubjectsandnomentionofpostureis tobefoundinotherreportsconcerningthe whiletoascertainwhetherdiuresismightbe induced,andifso,underwhatcircumstances,

METHODS

RESULTS

A.Observationsontheresponsetosalinein-

gestionintrainedsubjectswithandwithout priorhydration

Thesubjectswerethreephysiciansaccustomed

tion. 807

WILLIAMH.BIRCHARDANDMAURICEB.STRAUSS

2724212220

8004080

NORMALHYDRATION

FIG.1.THEEFFECTOFTHEINGESTIONOFONELITER

HYDRATION

gravityareshown.

Whenthesalinewasingestedunderidentical

strictedto250ml.thereoccurredonlyaslight augmentationinurineflow(Figure1).The othersubjectsreactedsimilarly.

Attheendofonehour,whenitwasapparent

thatadiureticresponsewasnotforthcoming,a fortwohours.Diuresisdidnotoccur.En- deavorstoadministerlargervolumesofsaline andfrankdiarrhea. gestedsalineleadstosucharesponse.

B.Observationsonnormallyhydratedsubjects

wtithandwithoutpriorsaltloading

Withoutpreviouspreparationeachoffoursub-

ml.Followingthecollectionoftimedcontrol andthesubjectdrankoneliterof0.9percent salinesolutionwithin10to20minutes.Urine thereafterforthenextthreehours.Duringthe remainderoftheafternoon,butbefore6P.M., aloadof6.2mEq.perKg.2Thesubjectsate whateveradditionalliquidstheywished.The salineingestionwereconcernedwasrepeated.

Ineachinstancewhensalinewasingestedwith-

instanceagainofweight(average0.9Kg.)as- cribabletoanincreaseinthevolumeofextra- urineflowwasdistinctlygreaterthanonthe whichobtained24hoursearlier. mencedpromptly,reachingpeakflowsof5.0to

8.9ml.permin.withinanhourandaccompanied

increatinineU/Pratioandinurinaryspecific sistentchanges.Inonesubjectinwhomurea concentrationwasdetermined,thesumofthe concentrationofureaplus2(Na+K),anesti-

152mMperL.,atthetimeofmaximumdiuresis,

cellularfluid.

Intheotherthreeexperimentshypotonicityof

theurinetotheplasmaatthetimeofmaximum diuresismaybeinferredinviewofthefactthat (2Na+K)wasbetween102and175mMperL.

2InthecaseofsubjectWHBthesaltloadingwas

Sptc.Grov.1711080,60708

i3.- ZE2 c00*o;.._ 300-
yg=*+200-z-rE100-IsL

TIME040minutesPRE-HYDRATED

808

TABLEI

809
Urine mEq./L.mEq./L.mEq./L.

2.4152408.904777.006932.7142142.214202

382651180

151014922261237

242166$66t5512119225223

0.72290961411.01893921521.019114105190

1.7151373.508675.006471.6152012.114182

33156227216474421548210

2.4111431.3202146.603512.314184

3.511131

24147342118503219330146

U/Pratio

276267249129

micro-Eq./ml./min.min.

1387518712017497129155

7518058419166680221546555715358868150440

34710449174122145190114155180126184

70t19$165151

147$398t147t532$137438148545153600

1801266012212295115115118

7913422839136233241192337812532960126383

270

108311971183214312992125125121

ml./mis.

WHBControl

Afterpre-.Ioading

CTControl

Afterpre-loading

ACControl

After pre-loading

RD§Control

After pre-loading

Mixutks

Pret+60+123+189

Pre+33+68+100+138

Pre+60+120+180

Pre+31+67+102+135

Pre+60+120

Pre+30+60+90+120

Pre+60+123+163

Pre+30+60+90+120

WILLIAMH.BIRCHARDANDMAURICEB.STRAUSS

DISCUSSION

Stateofhydration

SlighthydropeniaNormalSlightlyincreased

SlighthydropeniaNormal

PrevioussaltloadingNoneNoneNone

YesYes

Diureticresponse

Theabsenceofwaterdiuresisfollowingthe

subjectswereonthedescendinglimbofaprevi- volved,maybeconsideredtohavebeenfreeof significantemotionalantidiureticstimuli.

Sincethereisnoreasontobelievethatwater

itisunlikelythatalterationsintheeffectiveosmoticpressureoftheplasmaandextracellularfluidexplainthediuresisobserved.Thesug-gestionhasbeenmadeonthebasisofthestudiescitedabove(3,4)as wellasothers(7,8)thatcriticalchangesinthevolumeordistributionoftheextracellularfluidoralternativelyinplasmavolumeordistribution,maymediatetruewaterdiuresis(9).Theinabilityofnormalmanrapidlytodisposeofalargeisotonicsalineloadaffordsasimplemeansoffurtherexaminingthishypothesisthroughtheadministrationofsuchaloadonthedayprecedingthetestdoseofsaline.Althoughsuchaload,withtheexcessofchloride,mightconceivablyelevateserumchloridelevels,nochangesofsignificancewerenoted(TableII).Thedeclineinserumtotalproteins,hemoglobinandhematocritallsuggestanexpansionofplasmavolume.Theaveragegainof900Gm.inweightabovethatoftheprecedingmorningisreadilyascribabletoanexpansionofextracellularfluidvolumeinbothinterstitialandplasmacompart-ments.Incontrasttosittingsubjectsreceivingisotonicsalineintravenouslywhofrequentlyex-hibitslightpittingedemaofthelegs,thesesub-jectswhoreceivedsalineontheprecedingday,awokeonthenextmorningwithperceptiblepuffi-nessabouttheeyesandnoedemaofthelegs.Theimpressionisthusgainedthatthedistribu-tion ofthepresumed900ml.increaseinextra-cellularvolumewasdifferentfromthatobtainingwhenasimilarorevenlargerexpansionwasac-complishedinthesittingpositionwithoutanin-terveningperiodofrecumbency.Whateverthedifferencemaybe,however,itisclearthatthepre-loadedsubjects,beingseatedin

810

TABLEII

PV2/PV1X100*

CONCLUSIONS

penic. tionofextracellularfluidisinferred.

ACKNOWLEDGMENT

811

WILLIAMH.BIRCHARDANDMAURICEB.STRAUSS

REFERENCES

812
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