Sodium-free Fluid Research Articles

Update on Ghanem’s new scientific discoveries in physics, Physiology, and Medicine

Introduction and objective: To report the new scientific discoveries in physics, physiology and medicine by one author. Material and Methods: Results of my research are summarized. It is based on 2 clinical studies one prospective and the second case series on hyponatraemia (HN) of the transurethral resection of the prostate (TURP) syndrome. A physics study on porous orifice (G) tube proves Starling’s law is wrong. I reported prospective study on nephroptosis revealing its link with the loin pain haematuria syndrome (LPHS) and curative surgery for it. Results: Two physics and two physiological discoveries are reported. Acute HN presents as shock during surgery. It is induced by massive gain of sodium-free fluid recognized as volumetric overload shock (VOS). Features of the multiple organ dysfunction syndrome occur, include ARDS, Acute renal failure (ARF) and Coma. The prospective study demonstrated volumetric overload is the most significant in patho-aetiology. The case series demonstrated mistaking VOS for a known shock and treating it with further volume expansion cause death. Correct diagnoses as VOS and treating it with hypertonic sodium is lifesaving. The physics study on the G tube demonstrated that proximal, akin to arterial, pressure induces suction not filtration producing the hydrodynamic phenomenon that replaces Starling’s law. The link of LPHS with nephroptosis is demonstrated by the IVU 7 sign. The curative surgery for LPHS is renal sympathetic denervation and nephropexy. Conclusion: Dilution HN presents as shock that is mistaken for known shocks and treated with volume expansion causing death or ARDS. Manifestations include shock, ARDS, ARF and Coma. The correct treatment is hypertonic sodium. Starling s law has proved wrong. The correct replacement is the hydrodynamics of G tube. The puzzle of LPHS was also resolved.

Update on Ghanem’s New Scientific Discoveries in physics, Physiology, and Medicine

Introduction and objective: To report the new scientific discoveries in physics, physiology and medicine by one author. Materials and methods: Results of my research are summarized. It is based on 2 clinical studies one prospective and the second case series on Hyponatraemia (HN) of The Transurethral Resection of the Prostate (TURP) syndrome. A physics study on porous orifice (G) tube proves Starling’s law is wrong. I reported prospective study on nephroptosis revealing its link with the Loin Pain Haematuria Syndrome (LPHS) and curative surgery for it. Results: Two physics and two physiological discoveries are reported. Acute HN presents as shock during surgery. It is induced by massive gain of sodium-free fluid recognized as Volumetric Overload Shock (VOS). Features of the multiple organ dysfunction syndrome occur, include ARDS, Acute Renal Failure (ARF) and Coma. The prospective study demonstrated volumetric overload is the most significant in patho-aetiology. The case series demonstrated mistaking VOS for a known shock and treating it with further volume expansion cause death. Correct diagnoses as VOS and treating it with hypertonic sodium are lifesaving. The physics study on the G tube demonstrated that proximal, akin to arterial, pressure induces suction not filtration producing the hydrodynamic phenomenon that replaces Starling’s law. The link of LPHS with nephroptosis is demonstrated by the IVU 7 sign. The curative surgery for LPHS is renal sympathetic denervation and nephropexy. Conclusion: Dilution HN presents as shock that is mistaken for known shocks and treated with volume expansion causing death or ARDS. Manifestations include shock, ARDS, ARF and Coma. The correct treatment is hypertonic sodium. Starling s law has proved wrong. The correct replacement is the hydrodynamics of G tube. The puzzle of LPHS was also resolved.

Update on Ghanem’s New Scientific Discoveries in Physics, Physiology, and Medicine

Introduction and objective: To report the new scientific discoveries in physics, physiology and medicine by one author. Materials and methods: Results of my research are summarized. It is based on 2 clinical studies one prospective and the second case series on Hyponatraemia (HN) of The Transurethral Resection of the Prostate (TURP) syndrome. A physics study on porous orifice (G) tube proves Starling’s law is wrong. I reported prospective study on nephroptosis revealing its link with the Loin Pain Haematuria Syndrome (LPHS) and curative surgery for it. Results: Two physics and two physiological discoveries are reported. Acute HN presents as shock during surgery. It is induced by massive gain of sodium-free fluid recognized as Volumetric Overload Shock (VOS). Features of the multiple organ dysfunction syndrome occur, include ARDS, Acute Renal Failure (ARF) and Coma. The prospective study demonstrated volumetric overload is the most significant in patho-aetiology. The case series demonstrated mistaking VOS for a known shock and treating it with further volume expansion cause death. Correct diagnoses as VOS and treating it with hypertonic sodium are lifesaving. The physics study on the G tube demonstrated that proximal, akin to arterial, pressure induces suction not filtration producing the hydrodynamic phenomenon that replaces Starling’s law. The link of LPHS with nephroptosis is demonstrated by the IVU 7 sign. The curative surgery for LPHS is renal sympathetic denervation and nephropexy. Conclusion: Dilution HN presents as shock that is mistaken for known shocks and treated with volume expansion causing death or ARDS. Manifestations include shock, ARDS, ARF and Coma. The correct treatment is hypertonic sodium. Starling s law has proved wrong. The correct replacement is the hydrodynamics of G tube. The puzzle of LPHS was also resolved.

Letter to the Editor

Dear Editor:I read with great interest the recent article by Anastasiou CA, Kavouras SA, Arnaoutis G, et al (and supported by the Gatorade Sport Science Institute) entitled “Sodium Replacement and Plasma Sodium Drop During Exercise in the Heat When Fluid Intake Matches Fluid Loss” (J Athl Train. 2009;44(2):117–123). In this letter, I propose further discussion and an alternative interpretation of their findings.A purpose of the study was to examine the ability of several beverages (high [Na+], low [Na+], placebo, and distilled water) to maintain serum sodium concentrations when fluid supplementation matched fluid lost to sweating. The authors concluded that even small amounts of sodium (19 mmol/L) in replenished fluid were able to prevent the decrease in plasma sodium observed when sodium-free fluids were ingested during prolonged exercise. An alternative interpretation of the results is that sodium-containing beverages better attenuated the drop in serum [Na+] during prolonged exercise in a state of overhydration.In citing Greenleaf and Sargent's seminal 1965 work,1 the authors noted that “thirst perception is an insufficient means to match fluid losses during exercise.” This is true, although the goal of exactly matching fluid losses during exercise is unclear. It is well established that exercising humans replace a fraction (20%–70%) of sweat losses when given ad libitum access to fluids.2–4 Recent work has demonstrated maintenance of total body water despite weight loss of 4%–5% during the prolonged exercise of an ultradistance triathlon.5 The correlation with body-weight loss and maintenance of physiologic [Na+] is well established.6 Sharwood et al7 demonstrated that large losses of body weight in an ultradistance triathlon correlated with neither decreased performance nor likelihood of presenting to medical stations. The recommendation to replace all weight loss with fluid volume is not supported by these studies.The authors also noted that the findings of their study, along with those of Vrijens and Rehrer,8 contrast with those of several other investigators9–11 as to the ability of sodium-containing fluids to maintain plasma volume and [Na+]. The difference is to be found in the methods: in the latter 3 studies, ad libitum hydration was offered to participants, whereas in the former 2, participants were overhydrated by replacing sweat losses.The authors concluded that “when sweating is excessive and the goal is to restore fluid losses during exercise, special attention should be paid to the replenishment of sodium.” The data presented indicate that the goal of rehydration during exercise is not to replenish fluid losses but rather to maintain [Na+]. This is best accomplished by drinking to thirst,12–16 does not require sodium supplementation,9,17 and is usually accompanied by mild to moderate weight loss.6 It is my hope that critical review of hydration, as presented in this letter, will influence more runners to avoid the complications associated with overhydration.

Fluid needs for training and competition in athletics

The diverse nature of the athletic events, together with the varied training programmes and individuality of athletes taking part, inevitably means that fluid needs are highly variable – between athletes, perhaps between training and competition, and with differing environmental conditions and degree of training and heat acclimatization. There are limited data from athletics on all aspects of fluid balance, but wherever possible we have focused on this information to draw conclusions. When appropriate, euhydration will best be ensured by consuming 6 – 8 ml · kg body mass−1 of a sodium-containing fluid, or sodium-free fluid together with food, about 2 h before exercise. The individual sweat responses are so variable that athletes should assess their own individual sweat losses to determine if these are likely to be a cause for concern. The volume of drink that is consumed should never be so much that an athlete gains mass over an event, unless perhaps there is evidence that they began in a hypohydrated state. This may be a particular concern in the field events and multi-event disciplines when competition can be spread over a number of hours and when there are significant rest periods between activities.

What can be concluded regarding water versus sports drinks from the Vrijens-Reher experiments?

This study assessed whether replacing sweat losses with sodium-free fluid can lower the plasma sodium concentration and thereby precipitate the development of hyponatremia. Ten male endurance athletes participated in one 1-h exercise pretrial to estimate fluid needs and two 3-h experimental trials on a cycle ergometer at 55% of maximum O2 consumption at 34°C and 65% relative humidity. In the experimental trials, fluid loss was replaced by distilled water (W) or a sodium-containing (18 mmol/l) sports drink, Gatorade (G). Six subjects did not complete 3 h in trial W, and four did not complete 3 h in trial G. The rate of change in plasma sodium concentration in all subjects, regardless of exercise time completed, was greater with W than with G (−2.48 ± 2.25 vs. −0.86 ± 1.61 mmol·l−1·h−1, P = 0.0198). One subject developed hyponatremia (plasma sodium 128 mmol/l) at exhaustion (2.5 h) in the W trial. A decrease in sodium concentration was correlated with decreased exercise time ( R = 0.674; P = 0.022). A lower rate of urine production correlated with a greater rate of sodium decrease ( R = −0.478; P = 0.0447). Sweat production was not significantly correlated with plasma sodium reduction. The results show that decreased plasma sodium concentration can result from replacement of sweat losses with plain W, when sweat losses are large, and can precipitate the development of hyponatremia, particularly in individuals who have a decreased urine production during exercise. Exercise performance is also reduced with a decrease in plasma sodium concentration. We, therefore, recommend consumption of a sodium-containing beverage to compensate for large sweat losses incurred during exercise.

SODIUM FREE FLUID INGESTION DECREASES PLASMA SODIUM DURING EXERCISE IN THE HEAT

This study assessed whether replacing sweat losses with sodium-free fluid can lower the plasma sodium concentration and thereby precipitate the development of hyponatremia. Ten male endurance athle...

Nutritional Considerations for Ultraendurance Performance

The nutritional considerations of the ultraendurance athlete center around proper caloric and nutrient intake during training as well as adequate energy and fluid replacement during competition to maintain optimal performance. Energy needs of ultraendurance athletes during training vary widely, depending upon duration, intensity, and type of exercise training. These athletes may train several hours daily, thus risking inadequate caloric intake that can lead to chronic fatigue, weight loss, and impaired physical performance. It is not known whether protein needs are increased in ultraendurance athletes as a result of extended exercise training. Additionally, micronutrient needs may be altered for these athletes while dietary intake is generally over the RDA because of high caloric intake. Prior to competition, ultraendurance athletes should consider glycogen supercompensation and a prerace meal eaten 4 hrs before as a means of improving performance. Carbohydrate feedings during prolonged exercise can significantly affect performance. During events lasting over several hours, sodium sweat losses and/or the consumption of sodium-free fluids may precipitate hyponatremia.

Antidiuretic Hormone Following Surgery in Children

We studied 13 children subjected to elective tonsillectomy, 6 of whom (study patients) received supplemental intravenous isotonic saline during and after operation, and 7 of whom (controls) did not. Clinical and biochemical evidence of hypovolaemia was present in the control but not in the study patients. Plasma antidiuretic hormone (ADH) and urine osmolality were higher in controls (p less than 0.005 and p less than 0.05 respectively). Plasma sodium concentration and osmolality were similar in the two groups. We conclude that hypovolaemia is the principal stimulus to ADH release following surgery and that, in addition to replacement of observed losses of blood and other fluids by fluids of appropriate composition, hypovolaemia should be prevented by the administration of maintenance quantities of isotonic fluid, rather than exacerbated by fluid restriction, in patients in whom oral fluid intake is interrupted for more than a brief period. Hypotonic and sodium free fluids should be avoided because of the risk of hyponatraemia.

Paradoxical electromechanical effect of lanthanum ions in cardiac muscle cells

Although lanthanum ions (La+++) block calcium influx in cardiac cells, they may paradoxically accentuate the sodium-free contracture. We have therefore studied the effects of La+++ on the zero sodium response in chick embryonic myocardial cell aggregates. Zero sodium alone causes: (a) A maintained contracture; (b) Asynchronous localized contractions that are selectively inhibited by caffeine or ryanodine, and presumably reflect release of calcium from the sarcoplasmic reticulum; (c) A nonspecific conductance increase that is ascribable to calcium-activated ion channels. Addition of La+++ potentiates the sodium-free contracture, and causes similar potentiation of the localized contractions and the conductance increase. All three phenomena occur 5-10-fold faster in 1 mM La+++ than in sodium-free fluid alone. In contrast, when La+++ is combined with caffeine or ryanodine, the zero sodium response is suppressed. We conclude that the paradoxical effect of La+++ on the contracture is not due to calcium influx, but to enhancement, or disinhibition of intracellular calcium release. Relaxation of normal myocardium may involve control of spontaneous calcium release by lanthanum- and sodium-sensitive calcium transport across the surface membrane.

THE EFFECTS OF CHANGES OF THE TONICITY OF THE BATHING FLUID UPON THE TENSION GENERATED BY ATRIAL TRABECULAE ISOLATED FROM THE HEART OF THE FROG, RANA PIPIENS

Raising the tonicity of the fluid bathing frog atrial trabeculae has three effects: an initial sustained relaxation, which depends on muscle length and probably originates from structures other than the contractile apparatus; an increase in contractility, which takes the form of a transient contracture if the muscle has previously undergone a high-potassium or a low-sodium contracture, and a further rise in contractility on return to isotonic fluid (off response). The hypertonic contractures, in high-potassium or sodium-free fluids, are antagonized by local anaesthetics and in Na-free media they are unaffected by removal of extracellular coat, whereas the 'off responses' are insensitive to both experimental manoeuvres. Hypotonic fluids applied in Na-free solutions evoke a phasic and a tonic contracture, neither of which are sensitive to local anaesthetics. The tonic response is reduced by lowering the [Ca]o, and occurs at tonicities where the permeability of the cell membrane is likely to have increased. The phasic part of the hypotonic contracture resembles the 'off response' which follows exposure to hypertonic solution. The effects of hypertonic fluids and of caffeine on frog heart are alike, and are also similar to the responses induced by the same experimental manoeuvres in skeletal muscle. The results can be interpreted by assuming that the intracellular relaxing system in frog heart is sensitive to changes in tonicity, and could be functionally divided.

Sodium-free fluid reabsorption in Necturus kidney perfused with sodium-free media

Sodium-free fluid reabsorption in Necturus kidney perfused with sodium-free media. The ability of tubular epithelium to transport sodium-free fluid from lumen to the peritubular side was tested in the isolated Necturus kidney perfused in situ with sodium-free solutions. Each animal was perfused with a single solution. Perfusion rates were 0.11 ml/min (portal vein) and 0.21 ml/min (aorta). The standard Na solutions were a Ringer's bicarbonate and a Ringer's phosphate (Na, 95 mM; total osmolality, 200 mOsm). The substituted solutions were of similar composition to the control Ringer's phosphate in all but the Na content. Sodium was substituted by either lithium, potassium, rubidium, cesium or choline. Large split-drops were introduced into in the proximal tubule with an aliquot of the perfusing solution. In most experiments volume reduction was actually measured until at least one-half of the split-drop was reabsorbed. It was found that fluid transport proceeds in Na-free solutions, without important changes in reabsorptive rate. When ouabain was added to sodium and choline solutions, reabsorption was sharply reduced. The data suggest that transepithelial net movement, metabolically dependent, may occur in Necturus kidney perfused with Na-free media. Reabsorption tubulaire dans le rein de Necturus , perfuse avec des solutions depourvues de sodium. La capacite de l'epithelium tubulaire de reabsorber le fluide intra-tubulaire de la lumiere vers l'interstitium a ete etudiee dans le rein isole de Necturus , perfuse avec diverses solutions depourvues de sodium. Chaque animal a ete perfuse avec une seule solution. Les debits de perfusion etaient de 0.11 ml/min (veine porte) et 0.21 ml/min (aorte). Les solutions standard avec sodium etaient un Ringer bicarbonate et un Ringer phosphate (Na, 95 mM; osmolalite totale, 200 mOsm). Les solutions de substitution avaient la meme composition que le Ringer phosphate, a l'exception du sodium qui a ete remplace par du lithium, du potassium, du rubidium, du cesium ou de la choline. Un aliquot de la solution de perfusion a ete depose entre deux colonnes d'huile dans la lumiere tubulaire proximale. Dans la plupart des cas, la reduction du volume de la gouttelette a ete observee jusqu'a reabsorption de plus de sa moitie. Le transport se poursuit en l'absence de sodium, sans modification majeure de la vitesse de reabsorption. L'addition d'ouabaine dans les solutions de sodium et de choline reduit considerablement la reabsorption. Ces resultats suggerent qu'un transport transepithelial net, consommant de l'energie, peut avoir lieu dans le rein de Necturus perfuse avec des solutions depourvues de sodium.