Third Space Fluid Accumulation Research Articles

Commentary on A Patient with Third-Space Fluid Loss.

The “third space” describes body compartments that sequester fluid that does not freely equilibrate with the plasma. Tay et al. describe a patient with third-space fluid accumulation in the pleural and peritoneal spaces. Interpretation of biochemical parameters measured in both fluids was important in determining the underlying diagnosis. However, it is equally important to recognize the limitations of the criteria used to assess pleural and peritoneal effusions so that the correct conclusions can be drawn in complex cases such as this. Light criteria have stood the test of time as a vital component of pleural fluid analysis, capably separating effusions into transudates and exudates. In this case, Light criteria classify the effusion as a transudate. A limitation of Light criteria is the false classification of approximately 20%–30% of transudates as exudates. However, the criteria have a high negative predictive value for the identification of exudates, and so it is highly likely that this patient’s effusion is indeed a transudate.

Haematological and Clinical Findings Especially Third Space Fluid Accumulation Observed in Major Dengue Outbreaks of Pakistan

Introduction: Dengue fever is a mosquito-borne disease caused by the bite of female aedes mosquito. It is a flavivirus and belongs to the family of arboviruses. According to WHO estimate about 50 million people are afflicted with dengue each year. The outbreak of dengue fever has serious implications on public health and should be dealt efficiently.
 Aims & Objectives: The purpose of this study was to observe the haematological parameters, frequency of third space fluid accumulation (TSFA) and its association with these parameters so that this fatal complication can be detected early to improve patient management.
 Place and duration of study: It was a cross-sectional study conducted in Haematology Department KEMU, in collaboration with Dengue Unit, Mayo Hospital Lahore between December 2021 to February 2022.
 Material & Methods: This was a cross-sectional study conducted at Hematology Department King Edward Medical University Lahore. The patients of dengue fever diagnosed on serology were included in our study. The complete blood counts, ALT and third space fluid accumulation on radiological examination was noted in all patients. The data was analyzed using SPSS version 20 and association among the variables was seen.
 Results: Total 200 patients were included with mean age 35.03 ± 15 years and male to female ratio of 2.07:1. TSFA was seen in (60) 30% patients, and showed positive correlation with increased hematocrit, low platelet count, increased lymphocyte, and monocyte count. The results were compared with previous outbreaks in 2008 and 2012.
 Conclusion: Haematological parameters are helpful in disease monitoring and predicting the development of complications especially third space fluid accumulation which has high mortality rate. Early follow-up of haematological findings with clinical correlation can help to prevent the disease complications and increase overall survival.

Timing, predictors, and progress of third space fluid accumulation during preliminary phase fluid resuscitation in adult patients with dengue

Fluid leakage remains the hallmark of dengue hemorrhagic fever (DHF). The applicability of currently recommended predictors of DHF for adults with dengue is questionable as these are based on studies conducted in children. One hundred and two adults with dengue were prospectively followed up to investigate whether home-based or hospital-based early phase fluid resuscitation has an impact on clinical and hematological parameters used for the diagnosis of early or critical phase fluid leakage. In the majority of subjects, third space fluid accumulation (TSFA) was detected on the fifth and sixth days of infection. The quantity and quality of fluids administered played no role in TSFA. A reduction in systolic blood pressure appeared to be more helpful than a reduction in pulse pressure in predicting fluid leakage. TSFA occurred with lower percentage rises in packed cell volume (PCV) than stated in the current recommendations. A rapid reduction in platelets, progressive reduction in white blood cells, percentage rises in Haemoglobin (Hb), and PCV, and rises in aspartate aminotransferase and alanine aminotransferase were observed in patients with TSFA and therefore with the development of severe illness. Clinicians should be aware of the limitations of currently recommended predictors of DHF in adult patients who are receiving fluid resuscitation.

Ovarian Hyperstimulation Syndrome: A Potentially Fatal Complication of Early Pregnancy

We present the case of a patient who presented to the Emergency Department (ED) 48 h after successful in vitro fertilization with abdominal pain, hypotension, and free fluid on an ED-focused abdominal sonogram for trauma study. This presentation is typical of Ovarian Hyperstimulation Syndrome (OHSS), a diagnosis that may be unfamiliar to many Emergency Physicians. With the increasing frequency of in vitro fertilization procedures, this disease process is becoming more common. Numerous complications can occur with OHSS, including third-space fluid accumulation, hemoconcentration, renal failure, and thromboembolic phenomena. Vigilance is required as these patients are at increased risk of ovarian torsion, ovarian rupture with internal hemorrhage, ectopic pregnancy, and infection. This case report provides an overview of clinical features and emergent management of OHSS.

The role of inflammatory cytokines in Meigs’ syndrome

BACKGROUND: Inflammatory cytokines are known to induce capillary leakage and third-space fluid accumulation in numerous gynecologic and nongynecologic disorders. This study aimed to assess their role in Meigs’ syndrome. CASE: Evaluation of serum, peritoneal, and pleural fluids retrieved from a patient suffering from Meigs’ syndrome revealed high interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor (TNF)-α levels. After surgical removal of the ovarian tumor and with resolution of ascites and hydrothorax, serum levels of IL-1β, IL-6, and IL-8 declined, whereas tumor necrosis factor-α levels remained high. CONCLUSION: The correlation between these inflammatory cytokines and the clinical course of Meigs’ syndrome suggests their involvement in the formation of ascites and hydrothorax in this disorder.

Human pharmacokinetics of marcellomycin.

In conjunction with two phase I clinical trials, we have investigated the pharmacokinetics of marcellomycin (MCM), a new class II anthracycline antibiotic, in nine patients with normal renal and hepatic functions and no third-space fluid accumulation. MCM was infused IV over 15 min at a dosage of 27.5, 40, or 50 mg/m2. Plasma and urine samples were collected up to 72 h. MCM and metabolites were assayed by thin-layer chromatography and quantified by specific fluorescence. The disappearance of total MCM-derived fluorescence from plasma followed first-order kinetics and lacked the rebound in total fluorescence that has been described for the structurally similar agent, aclacinomycin A. After 40-50 mg/m2, the peak MCM concentration in plasma was 1.67 +/- 0.61 microM; MCM disappeared from plasma in a triexponential fashion and was undetectable by 48 h after infusion. The area under the plasma concentration-time plot (AUC), including the infusion time, was 1.11 +/- 0.39 microM X h; plasma clearance of MCM was 1.50 +/- 0.88 l/min/m2. Five other fluorescent compounds were consistently observed in plasma. M2 was a contaminant present in the parent drug. P1 and P2 were conjugates of MCM and M2, respectively. G1 and G2 were aglycones. The peak concentrations of the metabolites were 25% or less or the peak concentration for MCM, but their persistence resulted in higher AUCs than that for MCM. For the dosage of 27.5 mg/m2, fewer data were available; but the pharmacokinetics of MCM and metabolites appeared to be similar to that at higher dosage. Urinary excretion of total fluorescence amounted to 8.0% +/- 1.6% of the total dose at 40-50 mg/m2, and to 7.0% +/- 2.3% at 27.5 mg/m2. No correlation was detected among the various pharmacokinetic parameters and toxicities encountered in these patients.