Body Fluid Distribution Research Articles

Evaluating Volume Status in Hemodialysis Patients

Accurate determination of the volume and distribution of body fluids in end stage renal disease patients will permit improved assessment of dry weight and strategies for optimal fluid removal. Certain biochemical markers and anatomical measures have been proposed as markers of dry weight, but these markers primarily reflect the volume of the intravascular compartment and may not reflect total body volume status. Noninvasive determination of total body water and extracellular fluid volumes using bioimpedance analyses has also been proposed for assessment of dry weight, but such determinations do not yet have sufficient accuracy for routine use. Several devices have been recently developed for continuously monitoring changes in blood volume on-line during routine hemodialysis. Such blood volume monitors cannot be used to determine dry weight directly; however, continuous monitoring of blood volume can be used to detect fluid overload because intradialytic changes in blood volume are small in hemodialysis patients who are overhydrated. Furthermore, continuous monitoring of blood volume can be used to predict symptoms resulting from intradialytic hypovolemia. The combined use of blood volume monitoring and time-dependent ultrafiltration and dialysate sodium profiles will be used increasingly in the future to assist in the prevention of hypotension and symptoms that result from intradialytic hypovolemia, especially when automated systems for controlling intradialytic blood volume are individualized and shown to be safe and effective.

Shifts in blood volume alter the perception of posture

Recent experiments have shown that somatic graviceptors exist in humans. Traditionally, extravestibular gravity information has been thought to originate from mechanoreceptors in the joints, muscles and skin. Experiments with normal, paraplegic and nephrectomized subjects revealed that the kidneys and the cardiovascular system are involved in providing truncal gravity information. The present study intends to determine the influence of shifts in body fluid, especially of the distribution of blood along the subjects' spinal (Z-) axis, on the perception of posture. To this end, the distribution of body fluids was altered by means of the technique of lower body negative and positive pressure (LBNP and LBPP). LBNP leads to venous pooling of blood in the legs, whereas LBPP prevents venous blood from pooling, increasing central volume. Changes in blood distribution were measured by segmental impedance cardiography for four body segments: the upper torso (thoracic cavity), lower torso (abdominal and pelvic region), thigh and calf. Seventeen healthy subjects (mean age: 27.3 years) participated in the experiment. They were positioned on the side (right-ear-down head position) on a tilt table which the subjects and the experimenter could tilt via remote control around an axis parallel to the subjects' visual (X-) axis. The experimenter set the initial tilt in total darkness to arbitrary angles, while strictly alternating between head-up and head-down tilts. Subjects were then asked to rotate the board until they felt they were in a horizontal posture. Means and variances of eight pairs of settings were taken as a measure of the subjective horizontal posture (SHP). During LBNP (−30 mmHg), subjects perceived being tilted head-up, whereas LBPP (+30 mmHg) led them to feel tilted head-down. The results corroborate the hypothesis of an effect of the blood's mass on graviception and also indicate supplementary contributions of other visceral afferences. © 1997 Elsevier Science B.V.

Impact of profile haemodialysis on intra-/extracellular fluid shifts and the release of vasoactive hormones in elderly patients on regular dialysis treatment.

In 15 patients with end-stage renal failure and proven coronary heart disease, profile haemodialysis with decreasing ultrafiltration rate and hyperionic, decreasing dialysate solute concentration was compared with conventional, extracorporeal bicarbonate haemodialysis (Na+D = 138 mmol/l). Body fluid distribution and the release of vasoactive hormones (plasma renin activity, aldosterone, norepinephrine, epinephrine, and atrial natriuretic peptide) were investigated. Haemodialysis with constant ultrafiltration rate and constant dialysate composition (A) was followed by two dialysis profiles: decreasing ultrafiltration rate (B) and additional hyperionic, decreasing dialysate sodium concentration (C). In all 15 patients, the dialysis procedures (A) - (C) were used for 2 weeks each with six sessions, the last being taken for investigation. Body fluid distribution was calculated. In patients with serum sodium above 136 mmol/l, the conventional dialysis (A) as well as the Uf profile (B) showed a net fluid shift from extracellular volume (ECV) to intracellular volume (ICV). Using the profile with hyperionic, decreasing Na+D (C), the reverse fluid shift with decreasing ICV was achieved not only in those with serum Na+ <136 mmol/l, but also in those with serum Na+ > or = 136 mmol/l. The release of vasoactive hormones decreased already at profile haemodialysis (B) compared with (A) and was further reduced in (C). These results would suggest, profile dialyses B and C to have less impact on the cardiovascular system in elderly patients assuming higher patient comfort compared with the standard dialysis procedure. A higher benefit was obtained in C compared with B, presumably due to the additional prevention of the ICV shift and plasma volume depletion in patients with initial serum sodium > or = 136 mmol/l using transiently hyperionic Na+D. These results show that in elderly patients, hyperionic profile haemodialysis (Na+D > Na+S) had less impact on cardiovascular regulation than conventional bicarbonate dialysis.

Whole-body hyperhydration in endurance-trained males determined using radionuclide dilution.

Despite evidence of hypervolemia following endurance training, there is little information regarding corresponding extravascular fluid volumes. Quantification of such volumes relies upon radionuclide dilution methods, previously hampered by the loss of plasma albumin. It was our purpose to measure human body-fluid distribution in eight endurance-trained males, using a simultaneous radionuclide dilution technique, incorporating radioiodinated serum fibronogen (RISF). Fluid distribution was measured on three occasions, using 2 microCi of RISF, 8 microCi of 51 Cr-labeled erythrocytes, and 20 microCi of Na82Br and 450 microCi of 3H2O; to measure PV, erythrocyte (RCV), extracellular (ECFV), and total-body water (TBW) volumes, respectively. Respective volume means, standard deviations, and coefficients of variation were: 46.6 (+/- 4.9; 8.44%), 33.3 (+/- 2.9; 3.89%), 258.1 (+/- 12.1; 4.93%), and 654.2 (+/- 13.4; 3.24%) ml.kg-1. The incorporation of RISF provided a reliable modification to previous methods, and revealed a body-fluid expansion in endurance-trained males. It was concluded that such subjects were hyperhydrated, possessing proportionately expanded fluid volumes throughout both intravascular and extravascular spaces. This was attributed to training history and accompanying reductions in adiposity.

Chronic hypobaric hypoxia decreases intracellular and total body water in microswine

The effects of hypobaric hypoxia on body fluid distribution were studied in five unanesthetized immature microswine (body weight 17.1 ± 1.5 kg, mean ± SEM) at sea level and after 23 days of simulated altitude exposure (427 Torr, 4600 m, 24°C, 50% RH). Total body water (TBW), extracellular fluid volume (ECF), and plasma volume (PV) were determined with D 2O, NaBr, and indocyanine green, respectively. Intracellular fluid volume (ICF = TBW − ECF) and interstitial fluid volume (ISF = ECF − PV) were calculated. Hypoxia resulted in characteristic decreases ( P < 0.05) in arterial PO 2 and PCO 2, and an increase in hemoglobin concentration. Chronic exposure to hypobaric hypoxia elicited significant ( P < 0.05) decrements in body weight gain (− 14%), TBW (− 11%, 12.5 vs 11.3 L), ICF volume (− 13%, 8.9 vs 7.8 L) and PV (− 28%, 0.82 vs 0.57 L). Although the ECF was unaffected (3.66 vs 3.57 L), the ISF was significantly increased (+ 6%, 2.83 vs 3.22 L) ( P < 0.05). Decreased TBW accounted for 51% of the expected reduction in body mass. These results suggest that the suppression in body weight gain is partially accounted for by decreases in TBW, ICF and PV. In addition the apparent elevation of ISF occurring concurrently with decreases in ICF and PV may be related to the development of edema, which can accompany exposure to high altitude.

Gravity, blood circulation, and the adaptation of form and function in lower vertebrates

Gravitational force influences musculoskeletal systems, fluid distribution, and hydrodynamics of the circulation, especially in larger terrestrial vertebrates. The disturbance to hydrodynamics and distribution of body fluids relates largely to the effects of hydrostatic pressure gradients acting in vertical blood columns. These, in turn, are linked to the evolution of adaptive countermeasures involving modifications of structure and function. Comparative studies of snakes suggest there are four generalizations concerning adaptive countermeasures to gravity stress that seem relevant to lower vertebrates generally. First, increasing levels of regulated arterial blood pressure are expected to evolve with some relation to gravitational stresses incurred by the effects of height and posture on vertical blood columns above the heart. Second, aspects of gross anatomical organization are expected to evolve in relation to gravitational influence incurred by habitat and behavior. Third, natural selection coupled to gravitational stresses has favored morphological features that reduce the compliance of perivascular tissues and provide an anatomical "antigravity suit." Fourth, natural selection has produced gradients or regional differences of vascular characteristics in tall or elongated vertebrates that are active in high gravity stress environments. Consideration or awareness of these principles should be incorporated into interpretations of structure and function in lower vertebrates.

Gravity, blood circulation, and the adaptation of form and function in lower vertebrates

Gravitational force influences musculoskeletal systems, fluid distribution, and hydrodynamics of the circulation, especially in larger terrestrial vertebrates. The disturbance to hydrodynamics and distribution of body fluids relates largely to the effects of hydrostatic pressure gradients acting in vertical blood columns. These, in turn, are linked to the evolution of adaptive countermeasures involving modifications of structure and function. Comparative studies of snakes suggest there are four generalizations concerning adaptive countermeasures to gravity stress that seem relevant to lower vertebrates generally. First, increasing levels of regulated arterial blood pressure are expected to evolve with some relation to gravitational stresses incurred by the effects of height and posture on vertical blood columns above the heart. Second, aspects of gross anatomical organization are expected to evolve in relation to gravitational influence incurred by habitat and behavior. Third, natural selection coupled to gravitational stresses has favored morphological features that reduce the compliance of perivascular tissues and provide an anatomical “antigravity suit.” Fourth, natural selection has produced gradients or regional differences of vascular characteristics in tall or elongated vertebrates that are active in high gravity stress environments. Consideration or awareness of these principles should be incorporated into interpretations of structure and function in lower vertebrates. © 1996 Wiley-Liss, Inc.

Redistribution of body fluids during postural manipulations

Inter-compartmental body-fluid distribution is contingent upon posture, exercise state and environmental temperature. This investigation aimed at quantifying the distribution of intra- and extravascular fluid volumes during postural manipulations. Fluid shifts were measured in eight males utilizing a simultaneous, radionuclide dilution technique, in which radioiodinated serum fibrinogen, radiochromated erythrocytes, radiobromine and tritiated water were used to measure plasma, red cell, extracellular and total body water volumes. Subjects were exposed to three postural changes [seated (control), supine and standing] for 30 min at an air temperature of 22.0 degrees C, with each posture separated by 30 min seated rest. Total body water content remained stable throughout postural changes (P = 0.842). Relative to seated volumes, BV increased by 89 mL when supine, and decreased by 406 mL while standing (P = 0.003), with such shifts being primarily a result of plasma movement (P = 0.011). Red cell volume changes were not significant. Vascular fluid lost during standing was filtered into the interstitial compartment (P = 0.014), with the extracellular and intracellular volumes remaining unaffected. (P = 0.271 and P = 0.800, respectively). These observations confirmed the influence of posture on inter-compartmental body-fluid distribution. The intravascular fluid loss when standing was caused by the filtration of plasma into the interstitium, while, during supine rest, intravascular volume increased, reflecting fluid flux from the interstitium to the circulation.

Body fluid distribution and its disarrangement following thermal injury

Body fluid distribution and its disarrangement following thermal injury

Lipid peroxide-related hemodilution during repetitive hyperbaric oxygenation.

Tissue oxygen tension can be elevated under controlled conditions by simultaneously increasing the O2 concentration of inspired air and the ambient pressure (Jamieson and Van Den Brank,1963). Increasing tissue oxygen tension by hyperbaric oxygenation (HBO) reduces organ blood flow (Muhvich et al.,1992; Bergo and Tyssebotn,1992) as well as some forms of edema (Nylander et al.,1985; Yamaguchi et al.,1990; Gehrs et al.,1991). An acutely reversible decrease of blood hemoglobin concentration by HBO (Bergo and Tyssebotn, 1992) further suggests hyperoxia affecting body fluid distribution.

Identifying Body Fluid Distribution by Measuring Electrical Impedence

Identifying Body Fluid Distribution by Measuring Electrical Impedence

Identifying Body Fluid Distribution by Measuring Electrical Impedence

Identifying Body Fluid Distribution by Measuring Electrical Impedence

Body fluid distribution in man in space and effect of lower body negative pressure treatment.

The lack of hydrostatic forces in space eventually produces a fluid deficit within the circulatory system. This deficit may alter the circulatory regulation patterns. The aim of the present study was to determine how much of this fluid deficit is attributable to interstitial fluid losses and to determine the effects of lower body negative pressure (LBNP) treatment on fluid distribution. The body fluid distribution of one subject was assessed before, during, and after weightlessness using two electrical impedance methods: (a) standard quadripole impedance for the segments of upper torso, lower torso, thigh, and calf and (b) an electrical impedance tomography technique (applied potential tomography) for a thigh cross-section. To assess the content of interstitial free fluid a thigh cuff overlying the electrodes for applied potential tomography was inflated to suprasystolic values to ascertain how much fluid can be squeezed out of blood vessels and tissue of skin and muscle. After the first thigh cuff maneuver (CUFF I) the subject performed a cardiovascular stress test with LBNP to mimic the gravity-induced blood shift to the lower part of the body. Then the compression maneuver was repeated (CUFF II). (a) This experimental sequence demonstrated a reduction in interstitial fluid in weightlessness of roughly 40% at the thigh. (b) The CUFF I and LBNP experiment demonstrated a reduced ability to cope with blood pooling in microgravity. (c) The CUFF II experiment suggests that LBNP in microgravity can refill the interstitial spaces and counteract the associated cardiovascular deterioration. The impedance measurements provided estimates of the contribution of different body sections to the observed body weight loss of more than 6 kg. The chest contributed nothing of significance, the lower torso more than 0.5 l, and both calves roughly 1.5 l. The thigh segments of both legs contributed between 1.5 l and 2.0 l with an interstitial free fluid reduction in muscle and skin by 40%.

Water economy and body fluid distribution in the hamadryas baboon ( Papio hamadryas)

1. 1.|Water economy and body fluid distribution in hamadryas baboons were studied in outdoor enclosures during the summer (22–32°C). 2. 2.|Following 2 days of water deprivation the baboons' lost 10% of body mass. 3. 3.|Following water deprivation, sweating, fecal and urinary water losses were greatly reduced. 4. 4.|After water deprivation, blood plasma volume dropped by only 4% of their initial volume. 5. 5.|Maintenance of blood plasma volume is interpreted as an adaptation to life in xerotic habitat.

Determination of body fluid compartments with multiple frequency bioelectric impedance.

Almost all current usage of bioelectric impedance is at a frequency of 50 kHz. However, body composition estimates from total body impedance measures at 50 kHz do not account for differences in the distribution of body fluids among extracellular spaces and in levels of hydration of tissues among individuals. Bioelectric impedance measurements at different current frequencies may provide new and improved body composition estimates.1–3 Bioelectric impedance at separate frequencies can differentiate the proportion of extra-cellular fluid volume (ECF) in the body.4,5 At low frequencies ( 100 kHz), the current completely penetrates all body tissues and reactance is supposedly minimal 6 The ratio of the impedance at low frequency to the impedance at high frequency is supposed to provide estimates of the proportion of total body water (TBW) in extracellular fluids, and could clarify the possible effects of different levels of hydration on estimates of fat-free mass (FFM) among individuals.3,7 The differentiation of extracellular and total fluid compartments by bioelectric impedance at low and high frequencies has considerable potential for exploring variations within and between individuals and samples in levels of hydration.

Relationship between nutrition, weight change, and fluid compartments in preterm infants during the first week of life

This study was conducted to investigate the redistribution of fluid compartments and to examine the factors contributing to the variability of early weight loss in premature infants. Fourteen preterm infants (mean +/- SD: birth weight, 1473 +/- 342 gm; gestational age, 30.7 +/- 2.4 weeks) were studied at 1 and 7 days of age. Total body water was measured by deuterium oxide dilution, extracellular volume by bromide dilution, and intracellular volume by the difference between total body water and extracellular volume. There were significant changes in body fluid distribution per concurrent weight from birth to age 1 week. Extracellular volume decreased by 11%, and intracellular volume increased by 8.5% with no change in total body water. Infants were then grouped according to postnatal weight loss (group 1 (n = 7) > 10% and group 2 (n = 7) < 5% of birth weight). In group 1 there was a significant loss of both weight (mean +/- SD: 15.6% +/- 3.7%) and extracellular volume (15.9% +/- 9% of birth weight), with no change in intracellular volume. In group 2 there was no significant weight loss (1.4% +/- 1.8%), but a significant loss of extracellular volume (13.0% +/- 5.4% of birth weight) and a significant increase in intracellular volume. Other differences between the groups were a lower energy intake in group 1 than in group 2 (mean +/- SD: 177 +/- 46 vs 269 +/- 45 kilojoules/kg per day; p < 0.005) and a higher physiologic stability index in group 1 (p < 0.05). We conclude that significant postnatal weight loss as a result of the contraction of the extracellular compartment occurs only in less stable infants whose energy intake is inadequate. With adequate energy intake, weight loss is minimal because of the expansion of the intracellular compartment, which may be related to the onset of growth.

Monitoring body fluid distribution in microgravity using impedance tomography (APT (applied potential tomography)).

For an astronaut, the excitement of going into orbit is accompanied by a shift of 1 to 1.5 l of fluid from the legs into the upper body. Information on the way the redistributed fluid is handled by the body is very useful to space physiologists studying the process of adaptation to zero-gravity. Applied potential tomography (APT) can be used to image changes in fluid distribution. To ensure that the technique was capable of measuring fluid shifts induced by changing gravitational forces on the body, a standard Sheffield APT system was used to study several subjects during the eight ESA parabolic flight campaign. The results clearly demonstrated the feasibility of using APT for monitoring fluid redistribution during space flight. A battery-powered, body-worn APT system has now been developed for use in space. The equipment was tested on the eleventh parabolic flight campaign. The data collected with the miniaturised system was comparable to that obtained in the earlier experiment. Ergonomic tests indicated that the equipment is no more difficult to operate and maintain under weightless conditions than on earth. The system is undergoing space qualification tests in Munich. If no problems arise it will be used by German astronauts on missions to MIR and Skylab.

Glutamine-enriched Intravenous Feedings Attenuate Extracellular Fluid Expansion After a Standard Stress

A double-blind, randomized controlled trial was performed to determine the effect of glutamine (GLN)-enriched intravenous feedings on the volume and distribution of body fluids in catabolic patients. Subjects with hematologic malignancies in remission underwent a standard treatment of high-dose chemotherapy and total body irradiation before bone marrow transplantation. After completion of this regimen, they were randomized to receive either standard parenteral nutrition (STD, n = 10) or an isocaloric, isonitrogenous nutrient solution enriched with crystalline L-glutamine (0.57 g/kg/day, GLN, n = 10). Extracellular water (ECW) and total body water (TBW), determined by bromide and heavy water dilution techniques, were measured before the conditioning treatment and after termination of the intravenous feedings that were administered for 27 +/- 1 days. In addition electrical resistance (R, in ohms, omega) and reactance (Xc, omega) of the body to a weak alternating current were measured at these time points. Both study groups were comparable for age, weight, height, sex, and diagnosis. Initial TBW was highly related to electrical resistance (r = -0.93, p less than 0.001). After conditioning therapy, bone marrow infusion, and intravenous feedings, a 20% expansion in ECW was observed in the STD group (ECW: 18.0 +/- 1.1 L vs. 14.9 +/- 1.0, p = 0.012), and this fluid retention was associated with a marked decrease in electrical resistance (R: 514 +/- 28 omega vs. 558 +/- 26, p less than 0.05). In contrast the extracellular fluid compartment in patients receiving GLN-supplementation did not change (ECW: 15.8 +/- 0.9 L vs. 15.4 +/- 0.8, p = 0.49), and the body's resistance was maintained (R: 552 +/- 27 omega vs. 565 +/- 23, p = 0.42). Expansion of ECW could not be related to differences in fluid or sodium intake, or to the use of diuretics or steroids. Patients receiving the STD solution, however, exhibited a greater number of positive microbial cultures (p less than 0.01) and a higher rate of clinical infection compared with the GLN patients (5/10 vs. 0/10, p less than 0.05); the fluid expansion in infected STD patients was greater compared with uninfected individuals (delta ECW: + 5.0 +/- 1.4 vs. 0.7 +/- 0.5, p = 0.007). In this model of catabolic stress, fluid retention and expansion of the extracellular fluid compartment commonly observed after standard total parenteral nutrition can be attenuated by administering glutamine-supplemented intravenous feedings, possibly by protecting the host from microbial invasion and associated infection.

Relative expansion of extracellular fluid in obese vs. nonobese women

There is a conflict in previous studies with regard to the relation between adipose tissue mass and total body fluid distribution. This study tested the hypothesis that obesity is accompanied by an increase in the extracellular-to-intracellular fluid ratio above that observed in nonobese subjects. Extracellular fluid was evaluated in obese (n = 39) and nonobese (n = 26) healthy women, using two different dilution volumes, 35SO4 [extracellular water (ECW)] and 24NaCl [exchangeable sodium (Nae)]. Intracellular water (ICW = 3H2O dilution volume-ECW) and total body potassium (TBK; 40K whole body counting) were assumed to represent intracellular fluid. Two independent markers of relative fluid distribution were formulated as ECW/ICW and Nae/TBK. Obese and nonobese women were of similar age and height but differed in body weight and TBW by 67.7 kg and 12.9 liters, respectively. The obese women had significantly larger absolute ECW, Nae, ICW, and TBK compared with the nonobese women (all P less than 0.001). The ratios ECW/ICW and Nae/TBK were significantly higher in obese vs. nonobese women and were highly correlated with each other (r = 0.54, P less than 0.001) in the pooled group of subjects. Fluid volumes are thus increased in obese women, and the expansion is relatively greater for the extracellular compartment. These results have implications in the study of human body composition and may also account in part for the fluid-overload states that often accompany severe obesity.

Atrial natriuretic factor: regulates plasma volume by modulating body fluid distribution

Atrial natriuretic factor: regulates plasma volume by modulating body fluid distribution