Abstract
Disturbances in tonicity (effective osmolarity) are the major clinical disorders affecting cell volume. Cell shrinking secondary to hypertonicity causes severe clinical manifestations and even death. Quantitative management of hypertonic disorders is based on formulas computing the volume of hypotonic fluids required to correct a given level of hypertonicity. These formulas have limitations. The major limitation of the predictive formulas is that they represent closed system calculations and have been tested in anuric animals. Consequently, the formulas do not account for ongoing fluid losses during development or treatment of the hypertonic disorders. In addition, early comparisons of serum osmolality changes predicted by these formulas and observed in animals infused with hypertonic solutions clearly demonstrated that hypertonicity creates new intracellular solutes causing rises in serum osmolality higher than those predicted by the formulas. The mechanisms and types of intracellular solutes generated by hypertonicity and the effects of the solutes have been studied extensively in recent times. The solutes accumulated intracellularly in hypertonic states have potentially major adverse effects on the outcomes of treatment of these states. When hypertonicity was produced by the infusion of hypertonic sodium chloride solutions, the predicted and observed changes in serum sodium concentration were equal. This finding justifies the use of the predictive formulas in the management of hypernatremic states.
Highlights
BackgroundMaintenance of constant volume is of great importance for proper function and survival of body cells [1]
Early comparisons of serum osmolality changes predicted by these formulas and observed in animals infused with hypertonic solutions clearly demonstrated that hypertonicity creates new intracellular solutes causing rises in serum osmolality higher than those predicted by the formulas
Formulas used to calculate the volume of hypotonic solutions needed to correct the hypertonic states do not take into account ongoing fluid losses during treatment, which should be replaced
Summary
Maintenance of constant volume is of great importance for proper function and survival of body cells [1]. Increases in the body content of endogenous (e.g., urea) or exogenous (e.g., alcohols) solutes distributed in total body water cause rises in body fluid osmolality but do not cause changes in cell volume in the steady state. Where [Na]3 = sodium concentration of the infusate, [Na]1 = initial EC sodium concentration, and [Na]2 = final EC sodium concentration This is a consequence of the osmotic principle). Final osmolality is higher than the value predicted by equation 8 and, VOsm is less than either body water or V Na [8, 26] This finding led to the conclusion that hypertonic expansion produces new solute, the so-called “idiogenic osmoles” [8]. Elevated levels of the tumor suppressor p53, which initiates apoptotic pathways in hypertonicity, is an important apoptotic mechanism activated by hypertonicity but apparently not the only one [50]
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