Spontaneous Diuresis Research Articles

Renal dysfunction in patients with chronic toxic hepatitis and ways of its correction

The aim of the study was to study the effectiveness of the long-acting angiotensin-converting enzyme (ACE) inhibitor Lisinopril in the correction of renal dysfunction in patients with chronic hepatitis (CH).It was found that in patients with СH under conditions of spontaneous diuresis, the glomerular filtration rate (GFR) decreases by 1.33 times against the background of a decrease in water reabsorption (p<0.05) and a tendency to a decrease in sodium excretion. During a 2-hour water load, a 3-fold decrease in GFR (p<0.05) was revealed with a slight decrease in water reabsorption and a decrease in sodium and potassium excretion in the urine (p<0.05). The occurrence of such disturbances in response to exercise indicates functional changes that may be due to intrarenal vasospasm as a result of activation of the interstitial renin-angiotensin system. The іnclusion of Lisinopril at a dose of 2.5 mg in the treatment regimen had a positive effect both on the clinical symptoms of hepatitis - a decrease in the activity of ALT, AST, urea (p<0.05), and on the functional state of the kidneys, mainly due to the effect on filtration processes. This is especially clearly demonstrated by the implementation of the water load: an increase in diuresis by 2 times (p<0.05) against the background of an increase in the glomerular filtration rate by 3 times (p<0.05), excretion of sodium and potassium (p<0.05). This indicates an increase in the adaptive function of the kidneys when included in the treatment ACE inhibitor.

P243 EXTRACORPOREAL CONTINUOUS VENO–VENOUS ULTRAFILTRATION IN PATIENTS WITH ACUTE HEART FAILURE REFRACTORY TO DIURETIC THERAPY: A SINGLE–CENTER PILOT EXPERIENCE

Abstract Introduction Congestive Acute Heart Failure (C–AHF) is characterized by extracellular fluid overload. Extensive use of loop diuretics may induce worsening renal function, electrolyte imbalance, symptomatic hypotension and diuretic resistance. Extracorporeal veno–venous ultrafiltration (UF) may represent a useful adjunctive therapy. Despite a few randomized clinical trials have been carried out, the results are controversial; aim of this study is to describe our pilot experience using UF. Methods We enrolled consecutive patients with C–AHF refractory to diuretic therapy treated with UF from January to December 2022; patients affected by concomitant acute coronary syndrome were excluded. UF was delivered using a modern device specifically designed for fluid removal in C–AHF patients through slow continuous UF (Fig.1). According to our protocol, the initial UF rate was based on baseline systolic arterial pressure (250cc/h if>120mmHg, 100–120cc/h if 100–120mmHg and <100cc/h if<100mmHg; contra–indicated if<90mmHg). Laboratories values, urinary output and fluid balance were monitored at baseline, after 6 hours (T6) and when UF was stopped (T0). Variables are expressed as medians with 25p–75p. Results Seven patients were enrolled in the study (5M;2F); in each a femoral central venous catheter (20cm/14G) was placed to perform UF. A standard anticoagulation regimen based on UFH bolus + infusion was adopted aiming to an ACT of 180–220. Median age and LVEF were respectively 40[20–50] and 79[73–85]; 3 patients were diabetics, 2 smokers and 4 hypertensive. Median rate of hospitalization in the previous 12 months was 1 [0–2]; domiciliary dosage of furosemide was 75mg [50–125]. Baseline, T6h and T0 creatinine values were respectively 1.2 [1.1–2], 1.3 [1.1–1.8] and 1.4 [1.1–1.9]. Heart rate and blood pressure were stable during the treatment. UF parameters in the patients of the study are summarized in Tab.1; congestion was resolved or improved in 6/7 patients, no severe complication (bleeding, AKI, death) occurred while 1 premature filter clot is reported. Conclusions Our initial experience with UF is promising. Modern heart failure specific devices appear safe, easy to use and require only minimal training. Compared to extensive i.v. diuretic use, predictable fluid removal through UF may be beneficial as it is characterized by higher excretion of sodium, limited neuro–hormonal activation, enhanced spontaneous diuresis and restoration of diuretic response.

ABDOMINAL AORTIC ANEURYSM RUPTURE – CASE REPORT

An Abdominal Aortic Aneurysm (AAA) is a localized dilatation and weakening of the abdominal aorta, as it`s infrarenal part is most commonly affected by the disease. Risk of rupture: Size of the AAA is one of the strongest predictors of rupture, as aortic aneurysms above 5,5cm in diameter have a higher risk. Clinical manifestation: Most of the AAAs have no symptoms and are accidently found. Classis symptoms of ruptured AAA (rAAA) are suddenly occurring severe abdominal and/or back pain, arterial hypotension and pulsatile abdominal mass. Preoperative management: When rAAA is suspected, the patient should be consulted with a vascular surgeon as soon as possible. Aggressive fluid resuscitation should be avoided. Surgical treatment: Open surgery is usually performed via a transperitoneal approach with a midline laparotomy. Depending on the anatomy of the AAA and iliac arteries involvement an aorto-arotal or aorto-bifemoral bypass is constructed. Complications after repair of rAAA: Local - Lower limb(s) ischemia, Ischemia of the colon; Systemic - Cardiac, Pulmonary, Renal, Liver or Multiorgan failure, with 30-day mortality reaching up to 89%.CASE REPORT: Male patient, 81 years of age, with multiple concomitant diseases. He was diagnosed with AAA 4 months prior to the rupture. The maximal diameter of the AAA was 15,6cm, iliac arteries were not affected. The patient refused the suggested surgical or endovascular treatments. He presented at ER 4 months later with acute pain in the abdomen and back. Clinical status: severe pain in the abdomen, BP 96/57mmHg, Hgb 102 g/l with HCT -0.331 l/l. On the CT-angiography rupture of AAA was verified with massive retroperitoneal haematoma, occluded right renal artery and aneurysm of the left renal artery. Median laparotomy was conducted under common anaesthesia. Aneurysmal neck was clamped above renal arteries, with clamping time – 30 minutes. After reclamping aorto-bifemoral bypass was constructed. Postoperatively the patient was transferred to intensive care unit (ICU). In the course of ICU treatment, the patient was inadequate and lacked spontaneous diuresis. A temporary catheter for haemodialysis was placed and such was initiated. He was transferred in the Clinic of vascular surgery after stabilizing blood oxygen saturation. The patient was inadequate at the time of transfer, with jaundice present. The patient restored bowel passage, hepatoprotectors were administered and physiotherapy was initiated. On the 20th postoperative day, the patient had a rapid decline in the physical status, demonstrated by hypotonia, bradycardia and regardless of the reanimation, died.DISCUSSION: Ruptured aneurysm of abdominal aorta has high mortality. Despite the immediate surgical treatment and adequate substitution, the patient had lethal outcome. CONCLUSION: Ruptured abdominal aortic aneurysm has high 30-day mortality, ranging between 22,9%-65,9%. In cases of acute renal and/or liver failure following the surgical treatment and when haemodialysis is needed, mortality rate can reach up to 89%.

Phytoadaptogen reverses the adverse effects of Naftussya bioactive water on dynamic muscle performance in healthy rats

Background.. Muscular performance is considered one of the attributes of health and non-specific resistance. Phytoadaptogens occupy an important place in the arsenal of means of increasing non-specific resistance and stress resistance. Many years of research of the Truskavetsian Scientific School of Balneology have demonstrated the adaptogenic properties of the main therapeutic factor of the resort, Naftussya bioactive water, as well as ozokerite and mineral baths. However, in contrast to the beneficial effect of the latter on stress resistance and the neuro-endocrine-immune complex, the effect on the physical performance is ambiguous. The purpose of this study is to test the ability of phytocomposition to prevent the adverse actotropic effect of Naftussya bioactive water at rats. Material and methods. The experimentt have been carried out at 42 female rats. Rats of the control group for 7 days loaded through a tube with tap daily water (2 mL once), while the animals of the other groups received according to a similar scheme daily water with the addition of 0,1 mL of Balm; bioactive Naftussya water per se or with the addition of 0,1 mL of Balm. The day after completion the course of water loads in the animal determined the urinary excretion of 17-ketosteroids, assessed the mineralocorticoid activity (MCA) by the urine K/Na ratio as well as the state of neutrophil phagocytosis by the number of absorbed latex particles. Results. It was found that the weekly use of Naftyssya bioactive water reduces the duration of swimming of rats to exhaustion by 30% compared to the daily water control. Addition of phytoadaptogen to Naftyssya softens its negative actotropic effect by up to -9%, and adding Balsam to daily water prolongs the maximum duration of swimming compared to the control by 11%. A positive correlation of the swimming test with 17-KS excretion and water diuresis was revealed, but a negative correlation with MCA, spontaneous diuresis and neutrophils phagocytosis. Conclusion. Phytoadaptogen reverses the adverse effects of Naftussya bioactive water on dynamic muscle performance in healthy rats by mitigating the decrease in the excretion of 17-ketosteroids and increased mineralocorticoid activity.

Phytoadaptogen reverses the adverse effects of Naftussya bioactive water on dynamic muscle performance in healthy rats

Background.. Muscular performance is considered one of the attributes of health and non-specific resistance. Phytoadaptogens occupy an important place in the arsenal of means of increasing non-specific resistance and stress resistance. Many years of research of the Truskavetsian Scientific School of Balneology have demonstrated the adaptogenic properties of the main therapeutic factor of the resort, Naftussya bioactive water, as well as ozokerite and mineral baths. However, in contrast to the beneficial effect of the latter on stress resistance and the neuro-endocrine-immune complex, the effect on the physical performance is ambiguous. The purpose of this study is to test the ability of phytocomposition to prevent the adverse actotropic effect of Naftussya bioactive water at rats. Material and methods. The experimentt have been carried out at 42 female rats. Rats of the control group for 7 days loaded through a tube with tap daily water (2 mL once), while the animals of the other groups received according to a similar scheme daily water with the addition of 0,1 mL of Balm; bioactive Naftussya water per se or with the addition of 0,1 mL of Balm. The day after completion the course of water loads in the animal determined the urinary excretion of 17-ketosteroids, assessed the mineralocorticoid activity (MCA) by the urine K/Na ratio as well as the state of neutrophil phagocytosis by the number of absorbed latex particles. Results. It was found that the weekly use of Naftyssya bioactive water reduces the duration of swimming of rats to exhaustion by 30% compared to the daily water control. Addition of phytoadaptogen to Naftyssya softens its negative actotropic effect by up to -9%, and adding Balsam to daily water prolongs the maximum duration of swimming compared to the control by 11%. A positive correlation of the swimming test with 17-KS excretion and water diuresis was revealed, but a negative correlation with MCA, spontaneous diuresis and neutrophils phagocytosis. Conclusion. Phytoadaptogen reverses the adverse effects of Naftussya bioactive water on dynamic muscle performance in healthy rats by mitigating the decrease in the excretion of 17-ketosteroids and increased mineralocorticoid activity.

Extracorporeal veno-venous ultrafiltration in patients with acute heart failure.

Hospitalization for congestive heart failure represents a growing burden for health care systems. Heart failure is characterized by extracellular fluid overload and loop diuretics have been for decades the cornerstone of therapy in these patients. However, extensive use of intra-venous diuretics is characterised by several limitations: risk of worsening renal function and electrolyte imbalance, symptomatic hypotension and development of diuretic resistance. Extracorporealveno-venous ultrafiltration (UF) represents an interesting adjunctive therapy to target congestion in patients with heart failure and fluid overload. UF consists of the mechanical removal of iso-tonic plasma water from the blood through a semipermeable membrane using a pressure gradient generated by a pump. Fluid removal through UF presents several advantages such as removal of higher amount of sodium, predictable effect, limited neuro-hormonal activation, and enhanced spontaneous diuresis and diuretic response. After twenty years of "early" studies, since 2000 some pilot studies and randomized clinical trials with modern devices have been carried out with somehow conflicting results, as discussed in this review. In addition, some practical aspects of UF are addressed.

Діуретична активність похідного метилксантину фуроксану за одноразового та тривалого застосування на функцію видільної системи щурів на тлі спонтанного діурезу

The study of the effect of furoxane on renal activity under conditions of spontaneous diuresis was performed by the method of Berkhin. Hydrochlorothiazide was chosen as a reference drug. Furoxane and hydrochlorothiazide were administered intragastrically at a dose of 25 mg/kg for 7 days. The content of Na+ and K+in the urine was determined by flame photometry. The concentration of creatinine in the urine was studied by the method of Folin in the modification of Berkhin. The obtained results were calculated using the methods of variation statistics. The analysis of the results shows that under one-time action of furoxane in rats the daily urination increased by 210.4 % (p <0.001), the concentration of Na+ in the urine of rats increased by 51.9 % (p <0.05), and the concentration of K+ in the urine tended to increase by 5.6 %. Natriuresis increased 1.7 times (p <0.05), potassium - 1.23 times (p <0.05). Excretion of endogenous creatinine increased 1.49 times (p <0.05), indicating an improvement in glomerular ultrafiltration. After administration of hydrochlorothiazide there was an increase in diuresis by 92.2 % (p <0.05), urinary Na+ concentration increased by 49% (p <0.05) and increased Na+excretion from urine by 23.3 % (p <0.05). K+ concentration in urine increased by 12.6 %, and K+excretion - by 27.5 % (p <0.05). Thus, a single administration of furoxane at a dose of 25 mg/kg led to an increase in daily diuresis, Na+ and K+ diuresis, which indicates the potential diuretic and saluretic properties of the drug. Long-term (7 days) furoxane administration contributed to the increase of urination in animals. After 3 days diuresis increased by 226,1 % (p <0.001), on 7th day – by 236,3 % (p <0.001). Salures was increased: the excretion of Na+ after 3 days increased by 2.27 times (p <0,05), after 7 days - by 2,38 times (p <0,05), K+ - 1.83 times (p <0.05). The gradual increase in creatinine excretion in the dynamics of the use of furoxane, indicated a possible prolongation of the effect of furoxane. Thus, furoxane, which by its chemical structure belongs to methylxanthine derivatives is a promising pharmacologically active substance for further study of its specific activity and safety in order to create a highly effective diuretic and implementation in clinical practice.

Preclinical investigation of the cardiovascular actions induced by aqueous extract of Pimpinella anisum L. seeds in rats

Ethnopharmacology relevancePimpinella anisum is used in traditional medicine because of its pharmacological properties which include cardiovascular action. However, no scientific information supports this use. Aim of the studyThis study investigated the effects of Pimpinella on arterial blood pressure (BP) and its pharmacological mechanism of action. Material and methodsPimpinella seeds were extracted with water, concentrated and freeze-dried yielding the aqueous extract (AE). A non-invasive BP assessment method was used (via the caudal artery) on Wistar, Wistar Kyoto, SHRs and rats that were submitted to high intake of dietary salt. Direct BP and heart rate were evaluated in Wistar rats in the absence or presence of atropine, L-NAME and angiotensin II. Spontaneous diuresis and the effect of AE on depolarized portal vein of Wistar rats was also examined. ResultsThe data revealed that AE reduced BP in all groups evaluated and its effects were not due to diuretic, sympatholytic or parasympathomimetic actions. Additionally, it was shown that AE does not act as an angiotensin receptor blocker and does not induce hypotension by reducing vascular resistance induced by oxide nitric. In the depolarized portal vein, AE inhibited calcium influx, which indicates that AE acts as calcium channel blocker. ConclusionThis study validates the cardiovascular actions of Pimpinella and characterizes the hypotensive effects of Pimpinella that are related to the blockade of calcium channels.

The study of the peculiarities of the diuretic action of 2-oxoindoline acylated derivative – N-[(2-oxoindoliniliden-3)-2-oxyacetyl]-valine propyl ester-[(2-oxoindoliniliden-3)-2-oxyacetyl]-valine propyl este

An important issue of modern medicine is the pharmacological correction of regulatory mechanisms of the excretory renal function aimed to normalize the changed water-electrolytic balance in a diseased body. In order to establish the functional balance and correct renal disorders diuretics are used.Aim. To study the effects of N-[(2-oxoindoliniliden-3)-2-oxyacetyl]-valine propyl ester (the conventional name is “Indolinoren”) on the excretory renal function when the repeated doses are administered in spontaneous diuresis and water load, and to determine a possible mechanism of the diuretic action.Materials and methods. The tests were conducted on white non-pedigree rats. The conditionally effective dose of indolinoren (29.5 mg/kg) was intragastrically administered to rats with spontaneous diuresis and water load for 7 days. The values of the excretory renal function were studied.Results. Both under conditions of spontaneous diuresis and under conditions of water load the repeated administration of indolinoren promotes a significant increase of diuresis, which is associated with an increased excretory renal function – natriuresis and, to a lesser extent, kaliuresis. A significant increase in uric acid excretion was observed (by 1.7 and 2 times on day 5 and 7, respectively). It may indicate the uricosuric effect of indolinoren.Conclusions. It has been determined that the possible mechanism of the diuretic action of indolinoren is associated with inhibition of tubular reabsorption, which is indirectly indicated by the increase of natriuresis and kaliuresis on the background of the simultaneous urination increase. The uricosuric properties of indolinoren have been found, it is indicated by an increase of uric acid excretion; these findings require further confirmation.

Study of PEG-Filstim sub-acute toxicity

Febrile neutropenia caused by cytostatic therapy in the treatment of oncological diseases is a frequent complication, which results in enforced reduction in chemotherapy doses and lower effectiveness of the treatment. Introduction of the recombinant forms of the natural protein granulocyte colony-stimulating factor into clinical practice has allowed to minimize the negative consequences of myelosuppressive therapies. The main task of repeated dose toxicity studies of drugs is evaluation of damaging effects of the pharmacological substance, revealing the most sensitive organs and systems in the body.
 Therefore, our work was aimed at studying sub-acute toxicity of PEG-Filstim.
 Toxicity study of PEG-Filstim was performed in 50 white wild-type rats of both sexes with body weight 170 to 230 g on daily (28 days) subcutaneous administration in the doses of 0.5, 1.0 and 2.0 mg/kg. During the whole observational period, survival, water and food consumption, body weight and symptoms of intoxication were registered. After completion of the experiment, spontaneous diurnal diuresis was evaluated and clinical blood and urine examination performed in all groups of animals.
 The results have shown that PEG-Filstim on daily subcutaneous administration in the doses of 0.5, 1.0 and 2.0 mg/kg during 28 days does not cause death in the animals, nor general toxic effects on health, behaviour, food and water consumption, body weight growth in laboratory rats. Upon repeated administration in the studied doses, PEG-Filstim does not affect protein, lipid, carbohydrate metabolism, does not impair functions of urinary and hepatobiliary systems, but increases blood serum alkaline phosphatase activity. PEG-Filstim causes development of pronounced neutrophil leucocytosis and increase in monocyte, lymphocyte and eosinophil count. In the maximum dose of 2.0 mg/kg the studied drug decreases blood red cell count and haemoglobin level.

ВИВЧЕННЯ ВПЛИВУ НОВОГО ПОХІДНОГО МЕТИЛТЕОФІЛІНУ НА ФУНКЦІОНАЛЬНИЙ СТАН НИРОК У ЩУРІВ НА ТЛІ СПОНТАННОГО ДІУРЕЗУ

The results concerning the impact of the new methyltheophylline derivative -7-benzoylmethyl-8-(furyl-2)-methylaminotheophylline on the activity of the kidneys in rats under conditions of spontaneous diuresis and figuring out some of the mechanisms of diuretic action for compounds. Research conducted on the white breed less rats of both sexes. Study of diuretic activity of 7-benzoylmethyl-8-(furyl-2)-methylaminotheophylline was carried out by E. B. Berchin. The content of electrolytes was determined using flame photometry, and an amount of creatinine formed by Folin’s method. The obtained data was calculated by techniques of nonparametric statistics using Student’s criterion (Lapach, Chubenko, & Babich, 2000). Based on the study of single and multiple (within seven days) introduction of 7-benzoylmethyl-8-(furyl-2)-methylaminotheophylline on the functional condition of kidneys in conditions of free access to the water and spontaneous diuresis, it was found, that single introduction of a dose of 30 mg/kg and under conditions of free access to water, 7-benzoylmethyl-8-(furyl-2)-methylaminotheophylline reduces drinking excitability to 2.4% (p<0.05), increases diuresis in 2.77 times (p<0.05), the concentration and excretion of sodium ions in 1.23 times (p < 0.05) and 3.05 times (p < 0.05), respectively; causes the growth of concentration and urinary excretion of potassium ions in 1.07 times (p < 0.05) and 2.68 (p < 0.05); increases the excretion of creatinine in 2.38 times (p<0.05) and slightly reduces the concentration of creatinine (7, 5%; p < 0.05). Observation of rats after applying of the 7-benzoylmethyl-8-(furyl-2)-methylaminotheophylline demonstrated, that on the 2nd day the indices almost returned to control values. Under conditions of multiple introduction of the studied compound the statistically reliable increase of urine output was observed. Average daily diuresis per seven-day period of 7-benzoylmethyl-8-(furyl-2)-methylaminotheophylline exceeded control period data in 2.77 times (p<0.05). After the cancelation of 7-benzoylmethyl-8-(furyl-2)-methylaminotheophylline the decrese in diuresis was noted. Reference drug hydrochlorothiazide in a dose of 25 mg/kg have spontaneous diuresis on only 70% (p<0.05), and the excretion of creatinine increased to 7.4% in comparison with control. Efficiency comparison of 7-benzoylmethyl-8-(furyl-2)-methylaminotheophylline with hydrochlorothiazide indicates a greater capacity of the last to excrete potassium (20.7%) and decrease urine sodium ions excretion (11.3%). It was determined, that in the conditions of spontaneous diuresis urination effected by 7-benzoylmethyl-8-(furyl-2)-methylaminotheophylline more definitely increases after reintroduction of it; prolonged application in the conditions of spontaneous diuresis, tested compound promotes the excretion of sodium ions and to a lesser extent — potassium ions.

Abstract 221: Lost Adiponectin-induced Renal Sodium Excretion in Hypertension

Obesity related hypertensive patients are often with impaired sodium excretion. However,the mechanisms are not clear. Adipocytes secrete numerous hormones, among which adiponectin is an important one. Adiponectin KO mice developed hypertension when maintained on a high-salt diet. In hypertensive patients, the plasma adiponectin levels are lower; there is relationship between lower serum adiponectin and new-onset hypertension.We hypothesize that adiponectin induces natriuresis and diuresis, the impaired adiponectin-induced sodium excretion might be involved in hypertension. Our present study found the expressions of both adiponectin (AdipoR1 and AdipoR2) receptor in kidney from Wistar-Kyoto rats. Infusion of adiponectin via supra-renal artery induces natriuresis and diuresis in Wistar-Kyoto rats. Treatment with adiponectin inhibited Na + -K + -ATPase activity in renal proximal tubule cells of Wistar-Kyoto rats. The inhibitory effect was mainly via AdipoR2 receptor, because the siRNA of AdipoR2, not AdipoR1,completely blocked the effect of adiponectin. In the presence of inhibitor for AMPK (compound C) or eNOS (L-NAME), the inhibitory effect of adiponectin on Na+-K+-ATPase activity was blocked, indicating AMPK-NO pathway is involved in the signaling pathway. In spontaneous hypertension rats, adiponectin-induced natriuresis and diuresis were lost;similarly, the inhibitory effect on Na+-K+-ATPase activity was also lost in renal proximal tubule cells of spontaneously hypertension rats. The impaired adiponectin effect might be ascribed to lower AdipoR2 expression in renal proximal tubule cells od spontaneously hypertension rats, because transfected with AdipoR2 reversed the inhibitory effect on Na+-K+-ATPase activity. These datas suggested that adiponection, via AdipoR2,induces natriuresis and diuresis; the impaired adiponectin function might be involved in the pathogenesis of hypertension.

Effects of tap water, electrolyte solution, and spontaneous and furosemide-stimulated urinary excretion on thirst

To contrast the effects of various modifications of body fluid volumes on thirst as reported by healthy volunteers. Ten male volunteers aged between 19 and 37 years (mean 22 years) underwent four experiments each, which comprised infusion of 400-800 mL of acetated Ringer's solution and intake of 600 mL of tap water. Half of the experiments were preceded by volume depletion (median 1.7 L) with furosemide. A visual analogue scale (0-100 mm) was used to assess perceived thirst during each experiment. Volume depletion (P < 0.001) and tap water (P < 0.03) both affected thirst by 13 mm per L of fluid, whereas spontaneous diuresis and infusion of Ringer's acetate did not significantly change the thirst rating (multiple regressions). More detailed analyses showed that the volume depletion increased the median (25th-75th percentiles) thirst rating from 28 mm (21-43) to 59 mm (46-72, P < 0.001) while no change occurred in those who were only slightly thirsty (< 30 mm) before the volume depletion began. Ringer's solution alleviated thirst in those who were very thirsty, but tended to increase thirst in the volunteers who were not thirsty before the infusion. Similarly, hydration with tap water decreased thirst (by 24 mm, P < 0.04) in those who were thirsty (> 60 mm) while the others reported no change. The change in thirst rating during volume depletion, administration of Ringer's acetate, and ingestion of tap water were all dependent on the thirst rating obtained when the manipulation of the body fluid volume was initiated.

Convalescent Pulmonary Dysfunction Following Hantavirus Pulmonary Syndrome in Panama and the United States

The objective of this study was to document persistent pulmonary symptoms and pulmonary function abnormalities in adults surviving hantavirus pulmonary syndrome (HPS). Acute infection by most hantaviruses result in mortality rates of 25–35%, while in Panama the mortality rate of 10% is contrasted by an unusually high incidence. In all types of HPS, the viral prodrome, cardiopulmonary phase due to massive pulmonary capillary leak syndrome, and spontaneous diuresis are followed by a convalescent phase with exertional dyspnea for 3–4 weeks, but the frequency of persistent symptoms is not known. In this observational study of a convenience sample, 14 survivors of HPS caused by Choclo virus infection in Panama and 9 survivors of HPS caused by Sin Nombre virus infection in New Mexico completed a questionnaire and pulmonary function tests up to 8 years after infection. In both groups, exertional dyspnea persisted for 1–2 years after acute infection in 43% (Panama) and 77% (New Mexico) of survivors surveyed. Reduction in midexpiratory flows (FEF25–75%), increased residual volume (RV), and reduced diffusion capacity (DLCO/VA) also were common in both populations; but the severity of reduced expiratory flow did not correlate with exertional dyspnea. Symptoms referable to previous hantavirus infection had resolved within 3 years of acute infection in most but not all patients in the Panama group. Temporary exertional dyspnea and reduced expiratory flow are common in early convalescence after HPS but resolves in almost all patients.

Lipid peroxidation, activity of Na+,K+-ATPase and exzymes of antioxidant defence in rats with nephropathy induced by cobalt chloride

Chronic parenteral administration of cobalt chloride (6 mg/kg) to male rats for 2 weeks or 1 month was accompanied by activation of lipid peroxidation (LPO), a decrease of superoxide dismutase activity and an increase of catalase activity. The membrane toxic action also resulted in a decrease of cortical and medullar Na+,K(+)-ATPase activity of kidneys, and the decrease in renal functions (glomerular filtration, renal water reabsorption, spontaneous diuresis, electrolyte excretion).

Recommendations for treatment of hyponatraemia at endurance events.

This review focuses on possible pathophysiology of exercise-associated hyponatraemia and its implication on evaluation and treatment of collapsed athletes during endurance events. Rehydration guidelines and field care have traditionally been based on the belief that endurance events create a state of significant fluid deficit in athletes, which must be corrected by liberal hydration. Beliefs in the necessity of liberal hydration may have contributed to cases of hyponatraemia. Assumptions that fluid loss accounts for the entire weight loss during exercise and that fluid ingestion is the only source of water gain during exercise may lead to an overestimation of the degree of volume depletion and the amount of fluid needed for replacement. Increasing evidence suggests that hyponatraemic athletes are fluid overloaded; ingestion of large amount of hypotonic fluid in combination with inappropriate or inadequate physiological responses leads to excessive retention of free fluid. Risk factors include hot weather, female sex, slower finishing time, and possibly the use of nonsteroidal anti-inflammatory medications. Symptoms of hyponatraemia can be subtle and can mimic those of other exercise-related illnesses, thereby complicating its diagnosis and leading to possible inappropriate treatment. Most athletes who collapse at the finish line experience exercise-associated collapse, a benign and transient form of postural hypotension that can be treated simply by continued ambulation after finishing or elevation of legs while in a supine position for those who cannot walk. Care providers should consider the use of intravenous hydration with normal saline carefully since it is not needed by most collapsed athletes and may worsen the condition of patients with unsuspected hyponatraemia. Historic information and clinical signs of volume depletion should be elicited prior to its use. Most hyponatraemic athletes will recover uneventfully with careful observation while awaiting spontaneous diuresis. Use of hypertonic saline should be reserved for patients with severe symptoms. Moderate consumption of carbohydrate-electrolyte solution during exercise may allow the maintenance of adequate hydration and the prevention of hyponatraemia.

Postpartum seizure prophylaxis: using maternal clinical parameters to guide therapy

OBJECTIVE: To use individual patient clinical parameters to signal cessation of postpartum magnesium sulfate seizure prophylaxis for the spectrum of pregnancy-related hypertensive disorders. METHODS: This was a prospective study using clinical symptoms (absence of headache, visual changes, epigastric pain) and signs (sustained blood pressure less than 150/100 without need for acute antihypertensive therapy, spontaneous diuresis more than 100 mL per hour for no less than 2 hours) to signal cessation of intravenous magnesium sulfate postpartum in gravidas diagnosed with preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome. Laboratory assessments (including proteinuria) were not used as criteria for drug discontinuation. RESULTS: Five hundred three patients were enrolled and classified according to American College of Obstetricians and Gynecologists criteria (mild preeclampsia, severe preeclampsia, chronic hypertension with superimposed preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome). Maternal age, gestational age, and hours of magnesium therapy before delivery were not statistically different among groups. There was no significant difference in the duration of postpartum magnesium sulfate therapy among groups with the median duration of therapy 4 hours (range 2–77 hours). No eclamptic seizures occurred after magnesium discontinuation. Thirty-eight patients (7.6%) required reinstitution of magnesium therapy for 24 hours because of exacerbation of blood pressure (sustained blood pressure more than 160/110) associated with headache or visual changes. CONCLUSION: Clinical criteria, when compared with arbitrary protocols, can be used successfully to shorten the duration of postpartum magnesium sulfate administration for seizure prophylaxis in patients with pregnancy-related hypertensive disorders.

Postpartum Seizure Prophylaxis: Using Maternal Clinical Parameters to Guide Therapy

OBJECTIVE: To use individual patient clinical parameters to signal cessation of postpartum magnesium sulfate seizure prophylaxis for the spectrum of pregnancy-related hypertensive disorders. METHODS: This was a prospective study using clinical symptoms (absence of headache, visual changes, epigastric pain) and signs (sustained blood pressure less than 150/100 without need for acute antihypertensive therapy, spontaneous diuresis more than 100 mL per hour for no less than 2 hours) to signal cessation of intravenous magnesium sulfate postpartum in gravidas diagnosed with preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome. Laboratory assessments (including proteinuria) were not used as criteria for drug discontinuation. RESULTS: Five hundred three patients were enrolled and classified according to American College of Obstetricians and Gynecologists criteria (mild preeclampsia, severe preeclampsia, chronic hypertension with superimposed preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome). Maternal age, gestational age, and hours of magnesium therapy before delivery were not statistically different among groups. There was no significant difference in the duration of postpartum magnesium sulfate therapy among groups with the median duration of therapy 4 hours (range 2-77 hours). No eclamptic seizures occurred after magnesium discontinuation. Thirty-eight patients (7.6%) required reinstitution of magnesium therapy for 24 hours because of exacerbation of blood pressure (sustained blood pressure more than 160/110) associated with headache or visual changes. CONCLUSION: Clinical criteria, when compared with arbitrary protocols, can be used successfully to shorten the duration of postpartum magnesium sulfate administration for seizure prophylaxis in patients with pregnancy-related hypertensive disorders. (Obstet Gynecol 2003;101:66-9. © 2003 by The American College of Obstetricians and Gynecologists.)

Abdominal Compartment Syndrome with Massive Lower-Extremity Edema Caused by Colonic Obstruction and Distention

Abdominal compartment syndrome is a well-described condition in which increased intraabdominal pressure causes various physiologic derangements with adverse effects on cardiac, pulmonary, and renal function. A patient presented with radiation-induced distal colonic obstruction, abdominal distention, and severe bilateral leg edema. We performed a diverting transverse loop colostomy as treatment for her obstruction. This resulted in massive, spontaneous diuresis with complete resolution of her lower-limb edema. Abdominal compartment syndrome due to colonic obstruction can contribute to the development of lower-extremity edema. Colon decompression with reduction of intra-abdominal pressure can lead to resolution of edema in this situation.

Postpartum magnesium sulfate prophylaxis: a prospective trial utilizing clinical parameters to indicate duration of therapy for hypertensive diseases of pregnancy

Objective: To utilize patient clinical parameters to signal safe cessation of postpartum magnesium sulfate seizure prophylaxis for the spectrum of pregnancy-related hypertensive disorders. Methods: A prospective trial using clinical symptoms (absence of headache, visual changes, epigastric pain) and signs (sustained blood pressure less than 150/100, spontaneous diuresis) was used to signal safe cessation of intravenous magnesium sulfate postpartum in gravidas with preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Laboratory assessments (including proteinuria) were not used as criteria for drug discontinuation. Results: Five hundred three patients were enrolled and classified according to ACOG criteria for hypertensive disease. Maternal age, gestational age, and hours of magnesium therapy before delivery were not statistically significant among groups. There was no significant difference in the duration of postpartum magnesium sulfate therapy among groups, with the average duration of therapy 7.04 ± 8.17 hours. No eclamptic seizures occurred after magnesium discontinuation. Conclusion: Clinical criteria can be used successfully and safely to shorten the duration of postpartum magnesium sulfate administration for seizure prophylaxis in patients with pregnancy-related hypertensive disorders.