Total Urine Output Research Articles

A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial of Aminophylline to Prevent Acute Kidney Injury in Children Following Congenital Heart Surgery With Cardiopulmonary Bypass.

Acute kidney injury occurs commonly in children following congenital cardiac surgery with cardiopulmonary bypass and has been associated with increased morbidity and mortality. Aminophylline, a methylxanthine nonselective adenosine receptor antagonist, has been effective in the management of acute kidney injury in certain populations. This study sought to determine whether postoperative administration of aminophylline attenuates acute kidney injury in children undergoing congenital cardiac surgery with cardiopulmonary bypass. Single-center, double-blinded, placebo-controlled, randomized clinical trial. Tertiary center, pediatric cardiovascular ICU. A total of 144 children after congenital heart surgery with cardiopulmonary bypass. Seventy-two patients were randomized to receive aminophylline and 72 patients received placebo. Study drug was administered every 6 hours for 72 hours. The primary outcome variable was the development of any acute kidney injury, defined by the serum creatinine criteria of the Kidney Diseases: Improving Global Outcomes. Secondary outcomes included the development of severe acute kidney injury, time between cardiovascular ICU admission and first successful extubation, percent fluid overload, total fluid balance, urine output, bioelectrical impedance, and serum neutrophil gelatinase-associated lipocalin. The unadjusted rate and severity of acute kidney injury were not different between groups; 43 of 72 (60%) of the treatment group and 36 of 72 (50%) of the placebo group developed acute kidney injury (p = 0.32). Stage 2/3 acute kidney injury occurred in 23 of 72 (32%) of the treatment group and 15 of 72 (21%) of the placebo group (p = 0.18). Secondary outcome measures also demonstrated no significant difference between treatment and placebo groups. Aminophylline administration was safe; no deaths occurred in either group, and rates of adverse events were similar (14% in the treatment group vs 18% in the placebo group; p = 0.30). In this placebo-controlled randomized clinical trial, we found no effect of aminophylline to prevent acute kidney injury in children recovering from cardiac surgery performed with cardiopulmonary bypass. Future study of preoperative aminophylline administration to prevent acute kidney injury may be warranted.

Terminalia arjuna bark extract improves diuresis and attenuates acute hypobaric hypoxia induced cerebral vascular leakage

Ethnopharmacological relevanceTerminalia arjuna (Roxb. ex DC.) Wight & Arn. (T. arjuna) has been widely used in the traditional ayurvedic system of medicine as a cardioprotectant and for acute and chronic renal diseases supporting its ethnopharmacological use. Aim of the studyThe present study aimed at evaluating the diuretic action of an alcoholic extract of T. arjuna and its possible use as a prophylactic to prevent vascular leakage during acute mountain sickness at high altitude. Materials and methodsRats were exposed to hypobaric hypoxia simulated to an altitude of 27,000ft. in a decompression chamber for 12h. T. arjuna bark extract was administered at a single dose of 150mg/kg (p.o.) to male Sprague Dawley rats (200±20g) 30min prior to exposure. Total urine volume was measured during exposure to hypobaric hypoxia. The animals were then investigated for cerebral vascular leakage and serum concentration of sodium, potassium, renin, angiotensin-II, aldosterone and atrial natriuretic peptide (ANP). ResultsT. arjuna ameliorated acute hypobaric hypoxia induced decrease in glomerular filtration rate (p<0.5), increased total urine output (p<0.5) and prevented cerebral vascular leakage in hypoxic rats. T. arjuna treated animals also showed decrease in serum levels of renin (p<0.001) and angiotensin-II (p<0.5) as compared to placebo treated animals. Administration of T. arjuna attenuated acute hypobaric hypoxia induced oxidative stress, improved aldosterone levels and altered electrolyte balance in animals through ANP dependent mechanism. ConclusionResults of the present study indicate towards diuretic potential of hydro-alcoholic extract of T. arjuna bark and provide evidence for its novel application as a prophylactic to attenuate acute hypobaric hypoxia induced cerebral vascular leakage through ANP mediated modulation of renin-angiotensin-aldosterone system.

Atypical or Variant stress cardiomyopathy

Sir, We would like to describe atypical or variant type of stress cardiomyopathy (SCM) wherein there is no involvement of the apical segment of the heart, in the background of recent publication in Indian Journal of Anaesthesia.[1] The prevalence of SCM is estimated to be 1.2-2.2%, and the atypical SCM constitutes 40% of these cases.[2] Intravenous administration of catecholamines and adenosine receptor antagonists has been reported in association with reverse SCM.[3] We hereby report a case of a young woman who developed atypical SCM postoperatively. A 23-year-old female with refractory chylous ascites was posted for surgical sealing of chylous leak. She had undergone diagnostic laparoscopy 1 week back, wherein 10 litres (L) of ascitic chylous fluid was removed. She was thin built, malnourished and had recurrence of ascites which was tense. She was given general anaesthesia combined with epidural analgesia (put on pre-induction, under local anaesthesia). On opening the abdomen, there were multiple sites of chylous leak, and the surgery took 7–8 h. She lost around 5–6 L of ascitic fluid, which was replaced with albumin (8 g/L loss). Central venous pressure was maintained between 6 and 10 mmHg. During the surgery, she developed hypotension, which did not respond to intravenous fluids. Noradrenaline, vasopressin and adrenaline were started subsequently. Intraoperatively, there were no electrocardiographic (ECG) changes. At the end of the surgery, she was on only adrenaline 0.16 μg/kg/min. She was extubated and shifted to the Intensive Care Unit. Her total input was 8000 ml of crystalloids and 1000 ml of colloids. Total urine output was 1050 ml and chylous tap was 5600 ml. On the post-operative day 1, she had an episode of sinus tachycardia which soon returned to normal without any intervention. After 2 h, her ECG showed ST elevation in I, aVL, V5-V6 leads and T inversion in V1–V2 [Figure 1]. Echocardiogram showed moderate left ventricular (LV) dysfunction and inferior wall hypokinesia. Troponin levels and emergency coronary angiogram done were normal; hence, a diagnosis of inverted SCM was made. She was treated with carvedilol, heparin and noradrenaline. She was discharged after 4 weeks with normal ECG, echocardiogram [Figure 2] and stable haemodynamics, with no chylous leak.Figure 1: Electrocardiograph 1Figure 2: Electrocardiograph 2Four types of atypical SCM have been described depending on the patterns of LV involvement:[45] (1) inverted/reverse (2) mid-ventricular (3) localised and (4) global type. The difference in the distribution, density and sensibility of adrenergic receptors over the myocardium determines the area of hypokinesis.[46] The area with a highest density of adrenergic receptors being the most affected. The most common of these forms is the inverted type with hyperdynamic apex and akinetic base of the LV.[6] This phenomenon explains why typical SCM occurs more often in older patients where adrenoreceptors density in the apex is reduced because of hormonal change, while atypical variant occurs in younger patients.[24] Inverted SCM is more often associated with either mental or physical stress. It presents with a lower prevalence of T-wave inversion.[4] Release of troponin is higher, which is the consequence of the larger muscle region involved. Natriuretic peptides are more elevated in apical and mid-ventricular patterns, which is evident by more severe symptoms. Younger patients with a poor general condition when undergoing major surgeries can develop SCM perioperatively. Refractory intra-operative hypotension treated with catecholamines might be the cause. This can be atypical in presentation. Increased awareness leads to timely use of intra-operative trans-oesophageal echocardiogram, early diagnosis and proper intervention. As recurrence rate is high, due care is required during future surgeries also. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement We sincerely thank the Department of Anaesthesiology, KIMS, for their support and technical help.

Need for Mechanical Ventilation in Pediatric Scald Burns: Why it Happens and Why it Matters.

Scald burns are the most common thermal injury among children. A small subset of pediatric scald burns are complicated by the need for mechanical ventilation (MV). Studies suggest that 4 to 5% of pediatric scald burns will require MV, and these patients tend to be younger with larger burns. Identifying why pediatric patients with scald burns require MV has remained unclear, and few studies have sought to elucidate possible mechanisms. After institutional review board approval, a retrospective review of all pediatric patients with scald burns admitted to the Burn Center between 2010 and 2013 was conducted. Variables collected included age, sex, weight, height, race, ethnicity, socioeconomic status or type of insurance, hospital length of stay, burn size and location, Department of Child and Family Services (DCFS) involvement, time to intubation from admission, reason for intubation, need for MV, duration of MV, need for operative intervention, 24-hour and 48-hour total fluid intake and urine output, glucose levels, infectious complications, comorbidities, and mortality. Patients who required MV were then compared with those who did not require MV to identify statistically significant differences between groups. The MV patients (n = 6) and nonventilated patients (n = 339) did not show significant differences in regards to gender, body mass index, ethnicity, and type of insurance; however, MV patients were younger and had larger burns. The mean age of MV patients was 8.2 + 5.0 months compared with 40.7 + 45.2 months for non-MV (P = .002). The mean percentage of TBSA burn in MV patients was 17.3 + 9.0% compared with 4.5 + 3.9% for non-MV (P < .001). Burn location was significant, and 66.6% of MV patients had burns on the face or neck compared with 23.6% of non-MV (P = .015). MV patients were more likely to have been victims of child abuse, as DCFS was involved in 67% of MV patients vs. 28% of non-MV patients (P = .036). Fifty percent of patients requiring MV had either a preceding upper respiratory infection, diagnosis of asthma, or congenital defects, compared with 6% of non-MV patients (P = .004). MV patients received more fluids for 48 hours compared with non-MV patients (2275.7 vs. 1332.3 ml, P = .013) and had a higher 48-hour urine output (2.34 vs. 1.34 ml/kg/hr, P = .013). Pediatric scald burns that require MV have an increased mortality risk and length of stay. MV patients were younger with larger burns. They received more fluids than non-MV patients, and child abuse, asthma, and stress hyperglycemia within the first 72 hours of injury were common among MV patients. Importantly, burn size and previous history of asthma were found to be independent predictors of the need for MV.

The Effect of Ad Libitum Consumption of a Milk-Based Liquid Meal Supplement vs. a Traditional Sports Drink on Fluid Balance After Exercise.

The aim of this study was to compare the effect of ad libitum intake of a milk-based liquid meal supplement against a carbohydrate-electrolyte sports drink following exercise induced fluid loss. Seven male participants (age 22.3 ± 3.4 years, height 179.3 ± 7.9 cm, body mass 74.3 ± 7.3 kg; mean ± SD) completed 4 separate trials and lost 1.89 ± 0.44% body mass through moderate intensity exercise in the laboratory. After exercise, participants consumed ad libitum over 2 h a milk-based liquid meal supplement (Sustagen Sport) on two of the trials (S1, S2) or a carbohydrate-electrolyte sports drink (Powerade) on two of the trials (P1, P2), with an additional 1 hr observational period. Measures of body mass, urine output, gastrointestinal tolerance and palatability were collected throughout the recovery period. Participants consumed significantly more Powerade than Sustagen Sport over the 2 h rehydration period (P1 = 2225 ± 888 ml, P2 = 2602 ± 1119 mL, S1 = 1375 ± 711 mL, S2 = 1447 ± 857 ml). Total urine output on both Sustagen trails was significantly lower than the second Powerade trial (P2 = 1447 ± 656 ml, S1 = 153 ± 62 ml, S2 = 182 ± 118 mL; p < .05) and trended toward being lower compared with the first Powerade trial (P1 = 1057 ± 699 ml vs. S1, p = .067 and vs. S2, p = .061). No significant differences in net fluid balance were observed between any of the drinks at the conclusion of each trial (P1 = -0.50 ±0. 46 kg, P2 = -0.40 ± 0.35 kg, S1 = -0.61 ± 0.74 kg, S2 = -0.45 ± 0.58 kg). Gastrointestinal tolerance and beverage palatability measures indicated Powerade to be preferred as a rehydration beverage. Ad libitum milk-based liquid meal supplement results in similar net fluid balance as a carbohydrate-electrolyte sports drink after exercise induced fluid loss.

Hypertonic Saline in Conjunction with High-Dose Furosemide Improves Dose-Response Curves in Worsening Refractory Congestive Heart Failure.

IntroductionDiuretic responsiveness in patients with chronic heart failure (CHF) is better assessed by urine production per unit diuretic dose than by the absolute urine output or diuretic dose. Diuretic resistance arises over time when the plateau rate of sodium and water excretion is reached prior to optimal fluid elimination and may be overcome when hypertonic saline solution (HSS) is added to high doses of furosemide.MethodsForty-two consecutively hospitalized patients with refractory CHF were randomized in a 1:1:1 ratio to furosemide doses (125 mg, 250 mg, 500 mg) so that all patients received intravenous furosemide diluted in 150 ml of normal saline (0.9%) in the first step (0–24 h) and the same furosemide dose diluted in 150 ml of HSS (1.4%) in the next step (24–48 h) as to obtain 3 groups as follows: Fourteen patients receiving 125 mg (group 1), fourteen patients receiving 250 mg (group 2), and fourteen patients receiving 500 mg (group 3) of furosemide. Urine samples of all patients were collected at 30, 60, and 90 min, and 3, 4, 5, 6, 8, and 24 h after infusion. Diuresis, sodium excretion, osmolality, and furosemide concentration were evaluated for each urine sample.ResultsAfter randomization, 40 patients completed the study. Two patients, one in group 2 and one in group 3 dropped out. Patients in group 1 (125 mg furosemide) had a mean age of 77 ± 17 years, 43% were male, 6 (43%) had heart failure with a preserved ejection fraction (HFpEF), and 64% were in New York Heart Association (NYHA) class IV; the mean age of patients in group 2 (250 mg furosemide) was 80 ± 8.1 years, 15% were male, 5 (38%) had HFpEF, and 84% were in NYHA class IV; and the mean age of patients in group 3 (500 mg furosemide) was 73 ± 12 years, 54% were male, 6 (46%) had HFpEF, and 69% were in NYHA class IV. HSS added to furosemide increased total urine output, sodium excretion, urinary osmolality, and furosemide urine delivery in all patients and at all time points. The percentage increase was 18,14, and 14% for urine output; 29, 24, and 16% for total sodium excretion; 45, 34, and 20% for urinary osmolarity; and 27, 36, and 32% for total furosemide excretion in groups 1, 2, and 3, respectively. These findings were translated in an improvement in the furosemide dose–response curves in these patients.ConclusionThese results may serve as new pathophysiological basis for HSS use in the treatment of refractory CHF.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0254-9) contains supplementary material, which is available to authorized users.

Evaluation of the Diuretic Activity and Phytochemical Screening of Different Solvent Fractions of the Rhizomes of &lt;i&gt;Rumex abyssinicus&lt;/i&gt; Jacq (Polygonaceae) in Rats

Rumex abyssinicus J. (Polygonaceae) is a widely spread medicinal plant used traditionally to treat a variety of diseases, including hypertension. Previous study confirmed the diuretic effect of the aqueous and 80% methanol crude extracts of the plant, of which the 80% methanol extract produced a better diuresis. The aim of this study was to investigate which solvent fraction(s) of the 80% methanol extract would be responsible for the diuretic effect of the plant. Diuretic activity was examined in adult male rats, which were orally administered with aqueous, methanol and ethyl acetate fractions of 80% methanol extract of R. abyssinicus at doses of 250, 500 and 750 mg/kg; furosemide (10 mg/kg) or vehicle. Total urine output and electrolyte content of the urine was computed over 24 h period and compared with the standard and negative controls. Phytochemical composition of the fractions was also investigated using standard tests. The methanol (p<0.01) and ethyl acetate (p<0.001) fractions induced a significant diuresis at the lower dose (250 mg/kg) compared to the aqueous fraction, which produced a notable effect only at its higher dose. Both fractions also increased urinary electrolyte excretion significantly (p<0.001) at their highest doses. Whilst the ethyl acetate fraction increased urine output comparably to that of furosemide, the methanol fraction showed the highest saluretic effect. These findings collectively indicate that an increase in urine volume is observed with decreasing polarity of the fractions. This suggests that the diuretic activity of the plant might be mostly due to active principles contained in the less polar fractions. Keywords: Rumex abyssinicus , Furosemide, Diuretic Activity, Electrolytes, Solvent Fractions

Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns.

Background:Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP) can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT) with LiDCOrapid system can improve well-being of both HDP parturient and their babies.Methods:Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer's solution (LR), parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume (ΔSV) provided via LiDCOrapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events.Results:The severity of HDP was similar between two groups. The total LR infusion (P < 0.01) and urine output (P < 0.05) were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group (P < 0.01). There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased (P < 0.05), and the incidences of neonatal hypercapnia and hypoxemia were statistically increased (P < 0.05) than in the GDFT group.Conclusions:Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide potential benefits to stable HDP parturient and their babies.

Urinary proteomics in renal pathophysiology: Impact of proteinuria.

Urinary differential proteomics is used to study renal pathophysiological mechanisms, find novel markers of biological processes and renal diseases, and stratify patients according to proteomic profiles. The proteomic procedure determines the pathophysiological meaning and clinical relevance of results. Urine samples for differential proteomic studies are usually normalized by protein content, regardless of its pathophysiological characteristics. In the field of nephrology, this approach translates into the comparison of a different fraction of the total daily urine output between proteinuric and nonproteinuric samples. Accordingly, alterations in the level of specific proteins found by this method reflect the relative presence of individual proteins in the urine; but they do not necessarily show alterations in their daily excretion, which is a key parameter for the understanding of the pathophysiological meaning of urinary components. For renal pathophysiology studies and clinical biomarker identification or determination, an alternative proteomic concept providing complementary information is based on sample normalization by daily urine output, which directly informs on changes in the daily excretion of individual proteins. This is clinically important because daily excretion (rather than absolute or relative concentration) is the only self-normalized way to evaluate the real meaning of urinary parameters, which is also independent of urine concentration.

Effect of hydration status and fluid availability on ad-libitum energy intake of a semi-solid breakfast

This study investigated the effects of hydration status and fluid availability on appetite and energy intake. Sixteen males completed four 24 h trials, visiting the laboratory overnight fasted on two consecutive days. Standardised foods were provided during the 24 h and on day two an ad-libitum semi-solid porridge breakfast was provided. Water intake during the 24 h (0 or 40 mL⋅kg−1) and fluid provision during the ad-libitum breakfast were manipulated so subjects were euhydrated with (EU-F) and without fluid (EU-NF) available at breakfast; and hypohydrated with (HYPO-F) and without fluid (HYPO-NF) available at breakfast. Blood samples (0 and 24 h), urine samples (0–24 h) and subjective responses (0, 24 and 24.5 h) were collected. HYPO trials decreased body mass by ~1.8%. Serum and urine osmolality increased and plasma volume decreased during HYPO trials (P < 0.001). Total urine output was greater during EU than HYPO trials (P < 0.001). Ad-libitum energy intake was not different between trials: 2658 (938) kJ (EU-F), 2353 (643) kJ (EU-NF), 2295 (529) kJ (HYPO-F), 2414 (954) kJ (HYPO-NF), (P = 0.131). Fluid intake was ~200 mL greater during HYPO-F than EU-F (P < 0.01). There was an interaction effect for thirst (P < 0.001), but not hunger or fullness. These results demonstrate that mild hypohydration produced by inadequate fluid intake and fluid availability during eating does not influence ad-libitum energy intake of a semi-solid breakfast, at least in healthy young males.

Effects of protein addition to carbohydrate–electrolyte solutions on postexercise rehydration

Background/ObjectiveThis study aimed to examine the effects of the addition of whey or casein protein, the two major proteins in milk, to carbohydrate–electrolyte (CE) solutions on postexercise rehydration. MethodsTen young men aged 20.7 ± 1.4 years with an average VO2max of 60.7 mL/kg/min ran for 60 minutes at 65% VO2max on three occasions followed by 4 hours' recovery. During recovery, the participants consumed either CE solution with 66 g/L carbohydrate (CHO), or CE plus whey protein solution (CW trial, 44 g/L CHO, 22 g/L whey), or CE plus casein protein solution (CC trial, 44 g/L CHO, 22 g/L casein); the solutions were matched for energy and electrolyte content. ResultsThe participants lost 2.36 ± 0.32% of their pre-exercise body weight after the exercise. Total urine output after recovery was greater in the CE and CC trials than CW trial (CE vs. CW vs. CC: 1184 ± 378 mL vs. 1005 ± 214 mL vs. 1256 ± 413 mL; p < 0.05). Fluid retention after ingestion of CW solution was greater than CE and CC solutions (CE vs. CW vs. CC: 46.9 ± 16.5% vs. 54.9 ± 9.2% vs. 45.8 ± 17.3%; p < 0.05). Lower urine specific gravity and urine osmolality were observed by the end of recovery in the CE trial compared with CW trial (p < 0.05). No difference was found in the changes in plasma volume in all trials. ConclusionThese results suggest that during the 4 hours' recovery after a 60-minute run, the CW solution was more effective for rehydration compared with the CE or CC solution.

Bladder Oxidative Stress in Sleep Apnea Contributes to Detrusor Instability and Nocturia

Obstructive sleep apnea is associated with voiding symptoms in humans and animals, and yet its effects on the urinary tract are poorly understood. We examined bladder structure and function, markers of oxidative damage and the redox survival pathway in a rat model of obstructive sleep apnea to identify changes. To model obstructive sleep apnea we used a rat oxycycler system to create cyclical interruption in breathing oxygen, thereby producing intermittent hypoxemia. Male Sprague Dawley® rats were divided into an obstructive sleep apnea, a sham treated and a control group of 8 each. After 8-week exposure to obstructive sleep apnea conditions we assessed daytime and nighttime rat voiding behavior in metabolic cages. Cystometrograms were done and bladder tissue was processed for biochemical assays, enzyme-linked immunosorbent assay and transmission electron microscopy. Increased urinary frequency and total urine output developed in rats exposed to obstructive sleep apnea conditions. Cystometric changes included detrusor instability, bladder noncompliance and increased spontaneous contractions. These changes were associated with bladder oxidative stress characterized by significant increases in tissue levels of malondialdehyde and advanced oxidation protein products. Obstructive sleep apnea activated cell survival signaling manifested by increased expression of PI3K and phosphorylated Akt1. Transmission electron microscopy revealed marked ultrastructural damage to subcellular elements. Intermittent hypoxia in obstructive sleep apnea causes oxidative stress with ultrastructural and functional changes in the bladder. Sleep apnea related nocturia/voiding symptoms could be the result of these direct changes. Untreated sleep apnea has significant health consequences. Identifying urinary oxidative stress products in patients with nocturia may be useful as an economical noninvasive biomarker to identify undiagnosed obstructive sleep apnea.

Effect of a 12-Week Conditioning Period on Nitrogen Balance in Horses

Fourteen horses were used in two 12-week experiments. Horses were fed to meet crude protein needs for exercising horses and participated in light-to-moderate exercise. Total feces and urine output were measured in 4-day collections at the beginning and the end of each experiment. Fecal nitrogen (FN) and urine nitrogen (UN) were used to calculate nitrogen balance and digestibility. Nitrogen intake (NI) was higher in the end collection (P = .001). Fecal nitrogen expressed as a daily amount or as a percentage of NI was not different (P = .63 and .39, respectively). Nitrogen digestibility was not different (P = .39); however, the amount of nitrogen absorbed (NA) was lower in the initial collection (P = .001). Urine nitrogen was lower in the end collection when expressed as a total loss per day (P = .041), percent of NI (P = .001), or as a percent of NA (P = .001). Daily nitrogen retention (NR), NR expressed as a percentage of NI and as a percentage of NA, was higher in the end collection (P = .001). The improvement in NR in the end collection is due to the reduction in UN loss. This suggests more efficient use of dietary protein because there was no difference in FN loss; but without a significant change in body weight or body condition score, it cannot be concluded that the additional retained nitrogen was because of a need to support additional muscle mass.

Effect of beverage flavor on body hydration in Hong Kong Chinese children exercising in a hot environment.

The purpose of the current study was to examine the effect of flavor on voluntary drinking and thermoregulatory responses in Chinese boys and girls exercising intermittently in a hot environment. Fourteen boys and girls (9 to 11 years old) performed four 3-hour intermittent exercise sessions (20-min walking sessions at 50% VO2peak followed by a 25-minute rest period) in a hot and humid environment (~30 °C ambient temperature and ~70% relative humidity). The participants consumed 1 of 4 beverages ad libitum in a randomized sequence by using a Latin-square principle: unflavored water (W), orange-flavored water (OF), lemon-flavored water (LF), and grape-flavored water (GF). No differences were observed in the total fluid intake (W vs. OF vs. LF vs. GF: Boys, 441 ± 114 vs. 493 ± 106 vs. 387 ± 83 vs. 568 ± 146 ml; Girls, 613 ± 131 vs. 923 ± 204 vs. 825 ± 157 vs. 790 ± 166 ml), urine and sweat output, and physiological perceptual variables among trials and between sexes. The results suggested that Chinese children can maintain body fluid balance while exercising moderately in a hot and humid environment by ad libitum drinking. The flavor of the beverages had no impact on the voluntary drinking and the state of hydration in the current study.

DIURETIC ACTIVITY OF DIFFERENT EXTRACTS OF BARK OF SYZYGIUM CUMINI (LINN.) SKEELS

The present study was undertaken to evaluate the diuretic activity of different extracts of bark of Syzygium cumini (Linn. ) Skeels in Wistar albino rats. Animals were se lected randomly and divided into five groups of six animals each. The test extracts w ere administered orally at a dose of 5 00 mg/kg body weight . F urosemide which was administered at a dose of 1 0 mg/kg body weight i.p. to the rats was used as standard d rug . The diuretic activity was evaluated by determination of urine volume and urinary electrolyte concentrations of sodium, potassium and chloride ions. The findings revealed that the methanol and aqueous extract of Syzygium cumini possesses diuretic activity. Both the extracts have shown an increase in total urine output and increased the excretion of the electrolyte concentrations of sodium and potassium ions significantly. The study concluded that Syzygium cumini

960

Introduction: Previous studies have shown conflicting results with various dosing strategies on the ability of albumin to improve urine output in hypoalbuminemic critically ill patients without significant renal or hepatic impairment. This study was conducted to evaluate the short term (24 hour) effects of a dosing strategy using bolus administration of both albumin and the diuretic. Methods: This was a retrospective cohort study of patients receiving 25% albumin as an adjunct to diuresis while in an intensive care unit. Eligible patients received a diuretic alone, followed by a diuretic-albumin combination within 24-96 hours. Other inclusion criteria included age ≥ 18 years of age, hypoalbuminemia, and intermittent bolus dosing of both 25% albumin and diuretic. Exclusion criteria included significant renal impairment, diagnosis of liver disease, or use of 25% albumin for other reasons than as an adjunct to diuresis. Baseline demographics were recorded, in addition to the doses of diuretic and albumin. Patients served as their own control, and serial measurements were recorded after the receipt of medications at every 8 hour intervals for the following: total volume in, urine output, central venous pressure (CVP), albumin level, and serum creatinine. The primary end point was total urine output at 24 hours with each dosing strategy. Results: 900 25% albumin orders were screened for inclusion, with 11 patients identified meeting the strict inclusion criteria. The cohort was made up mostly of medical ICU patients admitted for severe sepsis with respiratory failure. Renal function, CVP, and diuretic dose were similar between the two groups at the time of diuretic administration. The total volume in during the 24 hour monitoring period was also similar between the two time points. Urine output at 24 hours was not significantly different between when the patients received the diuretic alone (3439 mL ± 986 mL) and the diuretic in combination with albumin (3277 mL ± 930 mL) (p = 0.753). For those patients who had a CVP measurement available, the CVP was higher at the 8 (mean difference 5.3 mm Hg± 4.1 mmHg; p=0.025) and 16 hour mark (mean difference 4.0 mm Hg ± 3.0 mm Hg; p=0.021) in the diuretic-albumin group as compared with diuretic alone; however, this difference was no longer present at 24 hours. After simple regression analysis, only the dose of diuretic was found to be a significant predictor of urine output at 24 hours in the diuretic alone group (p=0.005, R² 0.61), while total fluid volume in was the only variable found to be a significant predictor of urine output at 24 hours in the diuretic-albumin group (p=0.001, R² 0.71). Conclusions: The use of 25% albumin as a bolus with intermittent dosing of diuretics in the intensive care unit is not associated with improved urine output. The optimal dosing strategy, and utility of, using albumin as an adjunct to diuresis in hypoalbuminemic critically ill patients without significant renal or hepatic impairment requires further study.

Ovariectomy lowers urine levels of unconjugated (+)-catechin, (-)-epicatechin, and their methylated metabolites in rats fed grape seed extract.

Abstract Steroid hormones modulate expression of enzymes that metabolize xenobiotics, including dietary supplements. Half of the human population undergoes menopause, yet the effect of this age-related loss of ovarian steroid hormones on the metabolism of dietary supplements has yet to be determined. Grape seed extract (GSE) is a dietary supplement comprised of monomeric and oligomeric catechins and has health benefits in models of age-related diseases. We hypothesized that surgically-induced loss of ovarian hormones would increase methylation, glucuronidation, and/or sulfation of the grape seed polyphenols (+)-catechin and (-)-epicatechin. Fourteen-week-old spontaneously hypertensive rats (SHRs) were ovariectomized (OVX) or sham-OVX. At 17 weeks of age, SHRs were gavaged with vehicle (water) or GSE (300 mg/kg body weight) once daily for 6 days. Urinary excretion of (+)-catechin, (-)-epicatechin, and their metabolites was analyzed by liquid chromatography-mass spectrometry. Although total urinary output of (+)-catechin, (-)-epicatechin, and their methylated metabolites was unaffected by OVX, the amounts of (+)-catechin, (-)-epicatechin and their methylated metabolites that were not conjugated with glucuronic acid or sulfate were lowered by OVX. Specifically, urine from OVX SHRs administered GSE contained 30% higher proportions (91.8% vs. 62.3%) of glucuronidated (+)-catechin and (-)-epicatechin and glucuronidated methyl (+)-catechin and methyl (-)-epicatechin than urine from sham-OVX SHRs. However, there were no differences in urinary levels of total methylated or sulfated catechins in OVX SHRs. This is the first quantitative characterization of metabolites of grape seed polyphenols in a model of menopause; it indicates that ovariectomy causes either an increase in expression and/or activity of select uridine 5'-diphospho-glucuronosyltransferase(s).

Protective activity profile of herbomineral medicine in early diabetic nephropathy rats: Restoration of kidney antioxidants, hemodynamics and suppression of proinflammatory mediators

The effect of Shakrino, a herbomineral medicine (HMM)) on early diabetic nephropathy in rats was evaluated. The occurrence of early diabetic nephropathy (DN) in rats treated with streptozotocin was revealed by hyperglycemia, depleted liver glycogen, decreased glucose uptake by peripheral tissue, impaired renal function, increased lipid peroxidation and decreased antioxidants in kidney. These changes were associated with increased total urine output, urinary albumin excretion rate, urinary albumin to creatinine ratio, increased relative kidney weight, increased arterial blood pressure, decreased glomerular filtration rate and urinary creatinine in DN rat. HMM treatment (200 and 400mg/kg, p.o., 4 weeks) lowered blood glucose, glycosylated haemoglobin, creatinine, blood urea nitrogen, lipid profiles, serum albumin and total urine output, urinary albumin excretion rate, urinary albumin to creatinine ratio, relative kidney weight, increased urinary creatinine and GFR, and also restored depleted antioxidants, decreased malonolaldehyde formation in kidney of DN rats. Histoarchitecture study showed dense mesangial matrix in glomeruli of DN rats, which were improved by HMM treatment. The protective effect of HMM may be due to the presence of antioxidants like gallic acid, quercetin, β-sitosterol, Jamboline, ellagic acid, gymnemic acid B, α-amyrin and polyphenols.

Comparison of 7.2% hypertonic saline - 6% hydroxyethyl starch solution and 6% hydroxyethyl starch solution after the induction of anesthesia in patients undergoing elective neurosurgical procedures

OBJECTIVE:The ideal solution for fluid management during neurosurgical procedures remains controversial. The aim of this study was to compare the effects of a 7.2% hypertonic saline - 6% hydroxyethyl starch (HS-HES) solution and a 6% hydroxyethyl starch (HES) solution on clinical, hemodynamic and laboratory variables during elective neurosurgical procedures.METHODS:Forty patients scheduled for elective neurosurgical procedures were randomly assigned to the HS-HES group or the HES group. After the induction of anesthesia, patients in the HS-HES group received 250 mL of HS-HES (500 mL/h), whereas the patients in the HES group received 1,000 mL of HES (1000 mL/h). The monitored variables included clinical, hemodynamic and laboratory parameters. Chictr.org: ChiCTR-TRC-12002357RESULTS:The patients who received the HS-HES solution had a significant decrease in the intraoperative total fluid input (p<0.01), the volume of Ringer's solution required (p<0.05), the fluid balance (p<0.01) and their dural tension scores (p<0.05). The total urine output, blood loss, bleeding severity scores, operation duration and hemodynamic variables were similar in both groups (p>0.05). Moreover, compared with the HES group, the HS-HES group had significantly higher plasma concentrations of sodium and chloride, increasing the osmolality (p<0.01).CONCLUSION:Our results suggest that HS-HES reduced the volume of intraoperative fluid required to maintain the patients undergoing surgery and led to a decrease in the intraoperative fluid balance. Moreover, HS-HES improved the dural tension scores and provided satisfactory brain relaxation. Our results indicate that HS-HES may represent a new avenue for volume therapy during elective neurosurgical procedures.

Anaesthesia for laparoscopic kidney transplantation: Influence of Trendelenburg position and CO 2 pneumoperitoneum on cardiovascular, respiratory and renal function

Background:Laparoscopic donor nephrectomy is a routine practice since 1995. Until now, the recipient has always undergone open surgery for transplantation. In our institute, laparoscopic kidney transplantation (LKT) started in 2010. To facilitate this surgery, the patient must be in steep Trendelenburg position for a long duration. Hence, we decided to study the effect of CO2 pnuemoperitoneum and Trendelenburg position in chronic renal failure (CRF) patients undergoing LKT.Methods:A total of 20 adult CRF patients having mean age of 31.7±10.36 years and body mass index 19.65±3.41 kg/m2 without significant coronary artery disease were selected for the procedure. Cardiovascular parameters heart rate (HR), mean arterial pressure (MAP), Central venous pressure (CVP) and respiratory parameters (ETCO2, peak airway pressure) were noted at the time of induction, after induction, 15 min after creation of pnuemoperitoneum, 30 min after Trendelenburg position, 15 min after decompression of pnuemoperitonuem and after extubation. Arterial blood gas analysis was carried out after induction, 15 min after creation of pnuemoperitoneum, 30 min after Trendelenburg position and 15 min after clamp release. Total duration of surgery, anastomosis time, time for the establishment of urine output and total urine output were noted. Serum creatinine on the 1st and 7th post-operative day were recorded.Results:Significant increase in HR was observed after creation of CO2 pneumoperitoneum and just before extubation. Significant increase in the MAP and CVP was noted after creation of pneumoperitoneum and after giving Trendelenburg position. No significant rise in the ETCO2 and PaCO2 was observed. Significant increase in the base deficit was observed after the clamp release, but none of the patients required correction.Conclusion:LKT performed in steep Trendelenburg position with CO2 pneumoperitoneum significantly influenced cardiovascular and respiratory homeostasis; however, measured parameters remained within clinically acceptable range without affecting early function of the transplanted kidney.