Cumulative Urine Output Research Articles

Impaired Water Excretion and Elevated Plasma Vasopressin in Patients with Alcohol-withdrawal Symptoms

Reports describing the fluid balance status of alcoholics in withdrawal are varied, and conflicting. We examined this question by recording values for a variety of parameters in response to a standard water load test. Compared with age and sex matched healthy volunteers (n = 14), alcoholics in withdrawal (n = 17) exhibited lower cumulative urine output (p = 0.0001), higher minimum urine osmolality (p = 0.0001), lower serum sodium (p = 0.0024 before loading) and elevated plasma arginine vasopressin levels (p = 0.0045 before loading). We believe that these findings are best explained by a resetting of osmoreceptors, a supposition in keeping with contemporary views on the pathogenesis of alcohol dependence and withdrawal. This additional evidence of an antidiuretic state in alcohol withdrawal leads us to question the practice of fluid supplementation in its management and we suggest that this policy be revised.

Hydroxyethyl Starch versus Albumin for Colloid Infusion Following Cardiopulmonary Bypass in Patients Undergoing Myocardial Revascularization

Hydroxyethyl starch or hetastarch (HES), a synthetic colloid for intravascular volume expansion, was compared with albumin after coronary artery operations in 30 patients (15 in each study group). Cardiac index, atrial pressures, heart rate, and systolic blood pressure were similar in both groups. There were no differences in cumulative urine output at 24 hours or in weight change during the first 7 postoperative days. Values for colloid osmotic pressure, as well as for this variable minus left atrial pressure, were lowest soon after bypass but returned to baseline within 4 hours, with no difference between groups in the first 24 hours or 7 days after operation. Coagulation variables were similar, but prothrombin and partial thromboplastin times were higher 12 hours postoperatively and fibrinogen level was lower 7 days postoperatively in the patients receiving HES. There was no clinical evidence of excessive bleeding, although cumulative chest drainage at 12 and 24 hours was slightly higher in the HES group ( p = 0.09 and 0.08, respectively). We conclude that hetastarch is a safe and effective colloid to use following coronary operations.

Evidence that nalorphine, butorphanol and oxilorphan are partial agonists at a κ-opioid receptor

Nalorphine, butorphanol and oxilorphan were compared in their ability to increase urinary output in the normally hydrated rat and to antagonize the increased urinary output produced by the full κ-agonist, bremazocine. Nalorphine, butorphanol and oxilorphan increased 5-h cumulative urine output compared to controls, but the maximal effect was less than half the amount excreted after injection with 0.08 mg/kg of bremazocine. The effects of bremazocine were antagonized by nalorphine, butorphanol and oxilorphan. These effects of nalorphine, butorphanol and oxilorphan satisfy the criteria for classifying these agents as partial agonists at the κ-opioid receptor responsible for mediating the effect of increased urinary output.