considered to have little or no immediate effect on urine hypotonic to extracellular fluid OF 0 9 PER CENT SODIUM CHLORIDE SOLUTION ON URINARY
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Effect of isotonic versus hypotonic maintenance fluid therapy on
16 mai 2017 · Even at maintenance rate, isotonic solutions caused lower urine output, characterized by decreased aldoster- one concentrations indicating (
Effect of isotonic vs hypotonic maintenance fluid therapy on urine
28 avr 2017 · of a hypotonic solution 13 In the recently published SPLIT trial, over 2000 adults in the intensive care unit received isotonic fluids, and there
PRODUCTION OF INCREASED RENAL SODIUM EXCRETION - JCI
THE HYPOTONIC EXPANSION OF EXTRACELLULAR FLUID VOLUME IN ally diminished urinary excretion of sodium (4), man albumin in 25 per cent solution, thereby in- creasing subjects is without significant effect on the renal
FACTORS INFLUENCING THE DIURETIC RESPONSE OF - JCI
considered to have little or no immediate effect on urine hypotonic to extracellular fluid OF 0 9 PER CENT SODIUM CHLORIDE SOLUTION ON URINARY
[PDF] Antidiuresis immediately caused by drinking a small volume of
water but also to other solutions In this study we report the effects of oropharyngeal and laryngeal stimulation with isotonic or hypertonic saline on urine
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Comparison 1 Isotonic versus hypotonic, Outcome 9 Urine osmolarity at T24 This fluid can cause rare but serious side effects due to the salt level in the body
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ByWILLIAMH.BIRCHARDANDMAURICEB.STRAUSS
urineflow(1),hasrecentlybeenshownbyBlomhert(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 priorhydrationThesubjectswerethreephysiciansaccustomed
tion. 807WILLIAMH.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
wtithandwithoutpriorsaltloadingWithoutpreviouspreparationeachoffoursub-
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,reachingpeakflowsof5.0to8.9ml.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
808TABLEI
809Urine 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
270108311971183214312992125125121
ml./mis.WHBControl
Afterpre-.Ioading
CTControl
Afterpre-loading
ACControl
After pre-loadingRD§Control
After pre-loadingMixutks
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
810TABLEII
PV2/PV1X100*
CONCLUSIONS
penic. tionofextracellularfluidisinferred.ACKNOWLEDGMENT
811WILLIAMH.BIRCHARDANDMAURICEB.STRAUSS
REFERENCES
812quotesdbs_dbs7.pdfusesText_5