/pdf/interrelations-between-serum-sodium-concentration-serum-1694rr1li6.pdf

Interrelations Between Serum Sodium Concentration, Serum Osmolarity and Total Exchangeable Sodium, Total Exchangeable Potassium and Total Body Water

Maintenance of a constant volume in the face of extracellular and intracellular osmotic perturbations is a critical problem faced by all cells. Most cells respond to swelling or shrinkage by activating specific metabolic or membrane-transport processes that return cell volume to its normal resting state. These processes are essential for the normal function and survival of cells. This article will outline the cellular and molecular events underlying cell-volume homeostasis and discuss their relevance to medical practice. Fundamentals of Cell-Volume Regulation Meeting Osmotic Challenges Water is in thermodynamic equilibrium across the plasma membrane. In other words, the osmotic concentrations of cytoplasmic . . .

Regulation of Cell Volume in Health and Disease

Changes in plasma potassium concentration during acute acid-base disturbances☆

Clinically apparent cerebral edema is a rare and often fatal complication of diabetic ketoacidosis. To determine whether subclinical brain swelling occurs more commonly, we obtained cranial CT scans in six children with diabetic ketoacidosis treated with fluid resuscitation and continuous low-dose insulin therapy. Control scans were obtained before hospital discharge. Compared with the scans during convalescence, the early scans of all six children showed a narrowing of the brain's ventricular system, compatible with brain swelling. Average changes in diameter were 1.3 +/- 0.1 mm for the third ventricle and 3.7 +/- 0.8 mm for the lateral ventricles (P less than 0.01). In addition, a narrowing of the subarachnoid spaces was subjectively noted during a blind reading of the early scans. Although no single scan was overtly indicative of cerebral edema, the data suggest that subclinical brain swelling may be a common occurrence during treatment of diabetic ketoacidosis in children. Sequential CT scans of the brain may provide a means of evaluating modifications of standard therapy aimed at preventing cerebral edema.

Subclinical Brain Swelling in Children during Treatment of Diabetic Ketoacidosis

The mammalian brain is composed of four distinct fluid compartments: blood, cerebral spinal fluid, interstitial fluid surrounding glial cells and neurons, and intracellular fluid. Maintenance of the ionic and osmotic composition and volume of these fluids is crucial for the normal functioning of the brain. Small changes in intracellular or extracellular solute composition can dramatically alter neuronal signaling and information processing. Because of the rigid confines of the skull and complex brain architecture, changes in total brain volume can cause devastating neurological damage. As a result, it is not surprising to find that the composition and volume of brain intracellular and extracellular fluids are controlled tightly under both normal conditions and in various disease states. Osmotic and ionic balance in the central nervous system is regulated by solute and water transport across the blood-brain barrier, the choroid plexus, and the plasma membrane of glial cells and neurons. Despite its clinical and physiological significance, however, little is known about the underlying cellular and molecular mechanisms by which the central nervous system's osmotic and ionic balance is maintained. In this review, the current understanding of osmoregulation in the mammalian brain and its role in various disease processes such as hyponatremia, renal failure, and hypernatremia will be summarized. A detailed understanding of brain osmoregulatory processes represents a fundamental physiological problem and is required for the treatment of numerous disease states, particularly those encountered in the practice of nephrology.

/pdf/regulation-of-solute-and-water-balance-and-cell-volume-in-2va5eidnjx.pdf

Regulation of solute and water balance and cell volume in the central nervous system.

Osmotic volumes of distribution; idiogenic changes in osmotic pressure associated with administration of hypertonic solutions.

showed the essential equality of total body water and water available for the dilution of a load of osmotically active solute (NaCl). Eggleton (2) sought to check these findings by measuring chloride only, in similar experiments. Since the volume of distribution calculated from the ratio of chloride load to concentration increment of chloride in plasma water was approximately 50% of the body weight as opposed to 63 % (‘total body water’) found for urea, it was concluded that some of the body cells are not in osmotic equilibrium with extracellular fluid. Whatever the validity of this conclusion, it does not follow from the latter studies and, as the measurements of volumes of distribution and the discussion presented here will show, these results are to be expected if the organism actually behaved as a perfect osmometer. As the present work was being prepared for press, a paper by Conway and McCormack (3) appeared containing a theoretical analysis fully in accord with that given here. after injection was analysed for sodium and potassium (internal standard flame photometry), urea (S), chloride (g), sulfate (IO), water (I I), calcium (r2), magnesium ( 3) = I and inorganic phosphate (14). Plasma water concentrations of sodium, potassium, chloride, and sulfate were corrected by Donnan factors: TN~,K = 0.95; f-Cl = 1.05; rso4 = I.10. The quantity of solute injected (load) divided by the corrected concentration increment of the substance in plasma water was used to define the volume of distribution. In the case of urea, a 45-minute precontrol plasma level was used to correct for metabolic production.

Apparent and osmotic volumes of distribution of sodium, chloride, sulfate and urea.

Sodium Concentration Deficit: Nomogram for Replacement

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Osmotic volumes of distribution; idiogenic changes in osmotic pressure associated with administration of hypertonic solutions.

Apparent and osmotic volumes of distribution of sodium, chloride, sulfate and urea.

Sodium Concentration Deficit: Nomogram for Replacement