Early fluid therapy guided by optimal urine output threshold in patients with acute pancreatitis / 中华急诊医学杂志

Objective:To investigate the urine output threshold of acute kidney injury in patients with acute pancreatitis(AP) and to guide early fluid therapy.Methods:The clinical data of AP patients from Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) were collected. The 24-h urine output rate [24-h urine output·kg-1·24-h-1, 24-UR mL/ (kg·h) ] and 48-h urine output rate [48-h urine output·kg-1·48-h-1, 48-UR mL/ (kg·h) ] were calculated, and according to the occurrence of acute kidney injury within 7 days (7-AKI), AP patients were divided into the 7-AKI group and non-7-AKI group. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of 24-UR and 48-UR on 7-AKI in AP patients. 24-UR and 48-UR were grouped according to the optimal cut-off value obtained from the ROC curve. Logistic regression was used to analyze the risk factors of 7-AKI, and Kaplan-Meier (KM) survival curve was drawn to analyze the effect of 24-UR and 48-UR on in-hospital mortality of AP patients.Results:A total of 713 AP patients were included, ROC curve analysis showed that the area under the ROC curve (AUC) of 24-UR in predicting 7-AKI in AP patients was 0.76. Based on the maximum Youden index, the cut-off value of 24-UR was 0.795 mL/ (kg·h) , and the AUC of 48-UR was 0.78 and the cut-off value of 48-UR was 0.975 mL/ (kg·h) . Logistic regression analysis showed that 24-UR≤0.795 mL/ (kg·h) was an independent risk factor for 7-AKI compared with 24-UR>0.795 mL/ (kg·h) ( OR: 4.22, 95% CI:1.50-11.85, P=0.006). Similarly, compared with 48-UR>0.975 mL/ (kg·h) , 48-UR0.975 mL/ (kg·h) was an independent risk factor for 7-AKI ( OR: 3.75, 95% CI: 1.45-9.72, P=0.007). The KM survival curve showed that the cumulative in-hospital survival rate in the high 24-UR group was higher than that in the low 24-UR group. Conclusions:24-UR can be used to guide early fluid therapy in AP patients.

Efficacy of Herbmed Plus in urolithic rats: An experimental study

Background: In Ayurveda, several herbs and formulations are available for the treatment of Urolithiasis.However, they are not systematically evaluated for their safety, efficacy, indication and limitations.Herbmed Plus is one such herbal formulation that has been known for the management of urinary tractdisorders. An attempt has been made to evaluate its efficacy on Urolithiasis.Objective: To evaluate the efficacy and safety of Herbmed Plus in urolithic rats.Materials and methods: A total of 60 Wistar albino rats were used for this study. The male and female ratswere divided into five groups: disease control, test (dose 90 mg/kg), standard I (Cystone), standard II(Alkaston insta) and normal control (six in each group). Urolithiasis was induced using ethylene glycol0.75% in drinking water for 28 days. The rats with urinary oxalate crystals were dosed with oral test orstandard treatments for 28 days.Results: All the animals appeared normal and showed no clinical signs of toxicity. None of the groups reported mortality or adverse effect on body weight and food consumption. The treatment with test drugshowed improvement in the SGPT level and urine output (5.4 vs 3.47 mL/24 h). A drastic reduction in numberof crystals were observed in male 0.5 vs 22 and female rats 0 vs 22.7 in test and disease group. The kidneylactate dehydrogenase, alkaline phosphatase, urinary phosphorus and calcium oxalate level decreased in thetest and standard drug groups as compared to disease groups. Microscopy of the urine samples showedreduction in the number of crystals after treatment compared to the urolithic group. Increase in citrate levelsin urine in all the treatment groups indicated anti-urolithiatic activity. The test group showed a 69.70% recovery in males and 47.57% recovery in female rats compared to the disease control group.Conclusion: Herbmed Plus showed a significant reduction in oxalate synthesizing enzymes suggestinganti-urolithiatic activity and anti-inflammatory and regenerative property in cellular injury caused bycrystal deposits

Influence of Co-Administration of Bioflavonoid on Diuretic Activity of Furosemide

As bioflavonoids have a strong affinity to bind with albumin, it is plausible that they may have the ability to displace the diuretic furosemide bound to albumin. In this study we sought to verify this hypothesis by examining the effect of the co-administration of a bioflavonoid with furosemide on the diuretic activity of the latter. Diosmin is a bioflavonoids type of plant chemical found mainly in citrus fruits.For this purpose, we analyzed bioflavonoids by their ability to bind to human serum albumin (HAS) using an in silico method and found that diosmin had a higher affinity to albumin than furosemide. Subsequently, we investigated the effect of the co-administration of diosmin with furosemide on the diuretic activity of the latter in mice.Our results showed that the combination did not produce any significant change in the diuretic activity of furosemide; however, after 3 hours of treatment, the urine volume of the mice that received diosmin along with frusemide was greater than that of mice administered only the same dose of furosemide. There was no significant difference in urine volume between the two groups at the end of 24 hours. A similar trend of increased levels at 3 hours in the combination group and absence of any difference at 24 hours was noted in the case of the urine concentrations of Na+, K+, and 2 Cl Our findings indicate that co-administration of diosmin increased the immediate diuretic effect of furosemide for the first few hours and that this effect subsides within 24 hrs. Therefore, this combination should be used with care, especially during the first few hours of administration

Impact of oliguria during lung surgery on postoperative acute kidney injury / 北京大学学报(医学版)

OBJECTIVE@#To explore the influence of intraoperative urine volume on postoperative acute kidney injury (AKI) and the independent risk factors of AKI.@*METHODS@#This was a retrospective cohort study recruiting patients who received selective pulmonary resection under general anesthesia in Peking University First Hospital from July, 2017 to June, 2019. The patients were divided into the AKI group and the control group according to whether they developed postoperative AKI or not. Firstly, univariate analysis was used to analyze the relationship between perioperative variables and postoperative AKI. Secondly, receiver operating characteristic (ROC) curve was used to explore the predictive value of intraoperative urine output for postoperative AKI. The nearest four cutoff values [with the interval of 0.1 mL/(kg·h)] at maximum Youden index were used as cutoff values of oliguria. Then univariate analysis was used to explore the relationship between oliguria defined by these four cutoff values and the risk of AKI. And the cutoff value with maximum OR was chosen as the threshold of oliguria in this study. Lastly, the variables with P < 0.10 in the univariate analysis were selected for inclusion in a multivariate Logistic model to analyze the independent predictors of postoperative AKI.@*RESULTS@#A total of 1 393 patients were enrolled in the study. The incidence of postoperative AKI was 2.2%. ROC curve analysis showed that the area under curve (AUC) of intraoperative urine volume used for predicting postoperative AKI was 0.636 (P=0.009), and the cutoff value of oliguria was 0.785 mL/(kg·h) when Youden index was maximum (Youden index =0.234, sensitivity =48.4%, specificity =75.0%). Furthermore, 0.7, 0.8, 0.9, 1.0 mL/(kg·h) and the traditional cutoff value of 0.5 mL/(kg·h) were used to analyze the influence of oliguria on postoperative AKI. Univariate analysis showed that, when 0.8 mL/(kg·h) was selected as the threshold of oliguria, the patients with oliguria had the most significantly increased risk of AKI (AKI group 48.4% vs. control group 25.3%, OR=2.774, 95%CI 1.357－5.671, P=0.004). Multivariate regression analysis showed that intraoperative urine output < 0.8 mL/(kg·h) was one of the independent risk factors of postoperative AKI (OR=2.698, 95%CI 1.260－5.778, P=0.011). The other two were preoperative hemoglobin ≤120.0 g/L (OR=3.605, 95%CI 1.545－8.412, P=0.003) and preoperative estimated glomerular filtration rate < 30 mL/(min·1.73 m2) (OR=11.009, 95%CI 1.813－66.843, P=0.009).@*CONCLUSION@#Oliguria is an independent risk fact or of postoperative AKI after pulmonary resection, and urine volume < 0.8 mL/(kg·h) is a possible screening criterium.

Effectiveness of Parkland formula in the estimation of resuscitation fluid volume in adult thermal burns / 中华创伤杂志(英文版)

PURPOSE@#Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons. Though various formulae for fluid infusion are available but consensus is still lacking, resulting in under resuscitation or over resuscitation. Parkland formula is widely used but recently its adequacy is questioned in studies. This study was conducted to see how closely the actual volume of fluid given in our center matches with that of calculated volume by Parkland formula.@*METHODS@#All patients admitted with more than 20% flame burn injury and within 8 h of incident were included in this study. Crystalloid solution for infusion was calculated as per Parkland formula; however, it was titrated according to the urine output. Data on fluid infusion were collected from patient's inpatient records and analyzed.@*RESULTS@#The study included a total of 90 patients, about 86.7% (n = 78) of the patients received fluid less than the calculated Parkland formula. Rate of fluid administered over 24 h in our study was 3.149 mL/kg/h. Mean hourly urine output was found to be 0.993 mL/kg/h. The mean difference between fluid administered and fluid calculated by Parkland formula was 3431.825 mL which was significant (p < 0.001).@*CONCLUSION@#The study showed a significant difference in the fluid infused based on urine output and the fluid calculated by Parkland formula. This probably is because fluid infused based on end point of resuscitation was more physiological than fluid calculated based on formulae.

Advances in the research of application of urine output monitoring in prevention and treatment of burn shock / 中华烧伤杂志

Fluid therapy is a crucial treatment for patients with extensive burn, which affects patients′prognosis directly. Accurate urine output measurement plays an irreplaceable role in guiding fluid resuscitation in clinic. As one of the best indexes in traditional burn resuscitation, urine output comprehensively reflects systemic circulation. However, it doesn′t fully reflect all the specific chapters of microcirculation and systemic circulation and deficient cellular oxygen metabolism exactly. We need to use urine output combined with other shock parameters to ensure adequate fluid replacement. Currently, the most common way of urine output monitoring is manual measurement. The article reviews the application of urine output monitoring in guiding fluid resuscitation of burn shock.

Remifentanil does not increase urine output during oral surgery, contrary to its effect during other surgeries - a cohort study / Remifentanil não aumenta a diurese durante cirurgia oral, contrariamente ao seu efeito durante outras cirurgias - estudo de coorte

Abstract Background: An increase in urine output by remifentanil injection during laparoscopic procedures and surgeries such as cardiac and gynecological procedures, due to suppression of the stress response to surgery, has been reported. The aim of our prospective, observational, cohort study was to assess the effect of remifentanil analgesia on urine output during dental and minor oral surgery by comparing intraoperative urine output under defined infusion volumes with and without the use of remifentanil. Methods: Dental patients aged 16 years or older, American Society of Anesthesiologists physical status 1, with no renal diseases or abnormal blood values of serum creatinine and BUN, not on treatment with diuretic drugs, and undergoing minor oro-maxillofacial surgery or dental treatment under inhalation general anesthesia were included in this study. Urethral catheterization was performed after anesthesia induction, and urine output was measured every 30 minutes. We measured urine volume (mL) and rate of urine output (mL.kg-1.h-1) intraoperatively, and compared these parameters between patients who did and did not receive remifentanil during the intraoperative period. Results: Eighty-seven patients were categorized into the remifentanil group (n = 43) or remifentanil non-use group (n = 44). Both volume of urine (mL) and rate of urine output (mL.kg-1.h-1) were not significantly different between the two groups (remifentanil group, 372.3 ± 273.5 mL, 1.8 ± 1.1 mL.kg-1.h-1; remifentanil non-use group, 343.3 ± 283.3 mL, 1.9 ± 1.2 mL.kg-1.h-1; p = 0.63; 0.57). Conclusion: Our results show that use of remifentanil during dental and minor oral surgeries does not increase urine output.

Resumo Justificativa: Foi relatado um aumento na diurese após a injeção de remifentanil durante procedimentos laparoscópicos e cirurgias cardíacas e ginecológicas, devido à supressão da resposta ao estresse da cirurgia. O objetivo de nosso estudo prospectivo, observacional e de coorte foi avaliar o efeito da analgesia com remifentanil sobre a diurese durante cirurgia odontológica e oral de pequeno porte e comparar a diurese no intraoperatório sob infusão de volumes definidos, com e sem o uso de remifentanil. Métodos: Pacientes odontológicos ≥ 16 anos, estado físico ASA I, sem doenças renais ou valores sanguíneos anormais de creatinina sérica e ureia, sem tratamento com diuréticos e submetidos à cirurgia bucomaxilofacial de pequeno porte ou tratamento odontológico sob anestesia geral inalatória foram incluídos neste estudo. Cateterismo uretral foi feito após a indução da anestesia e a diurese foi medida a cada 30 min. Medimos o volume de urina (mL) e a taxa de diurese (mL.kg-1.h-1) no intraoperatório e comparamos esses parâmetros entre os pacientes que receberam e que não receberam remifentanil durante o período intraoperatório. Resultados: Foram designados 87 pacientes para os grupos com remifentanil (n = 43) ou grupo sem remifentanil (n = 44). O volume de urina (mL) e a taxa de diurese (mL.kg-1.h-1) não foram significativamente diferentes entre os dois grupos (grupo com remifentanil: 372,3 ± 273,5 mL, 1,8 ± 1,1 mL.kg-1.h-1; grupo sem remifentanil: 343,3 ± 283,3 mL, 1,9 ± 1,2 mL.kg-1.h-1; p = 0,63; 0,57). Conclusão: Nossos resultados mostram que o uso de remifentanil durante as cirurgias odontológicas e de pequeno porte não aumenta a diurese.

Validating a Lower Urine Output Criteria in Predicting Death in Critically Ill Patients

Introduction: Urine output provides a rapid estimate for kidney function, and its use has been incorporated in the diagnosis of acute kidney injury. However, not many studies had validated its use compared to the plasma creatinine. It has been showed that the ideal urine output threshold for prediction of death or the need for dialysis was 0.3 ml/kg/h. We aim to assess this threshold in our local ICU population. Methods: This was a secondary analysis of an observational study done in critically ill patients. Hourly urine output data was collected, and a moving average of 6-hourly urine output was calculated over the first 48 hours of ICU admission. AKIuo was defined if urine output ≤ 0.5 ml/kg/h, and UO0.3 was defined as urine output ≤ 0.3 ml/kg/h. Results: 143 patients were recruited into the study, of these, 87 (61%) had AKIuo, and 52 (36%) had UO0.3. The AUC of AKIuo in predicting death was 0.62 (0.51 to 0.72), and UO0.3 was 0.66 (0.55 to 0.77). There was lower survival in patients with AKIuo and UO0.3 compared to those without (p=0.01, and 0.001, respectively). However, only UO0.3 but not AKIuo independently predicted death (HR 2.44 (1.15 to 5.18). Conclusions: A threshold of 6 hourly urine output of 0.3 ml/kg/h but not 0.5 ml/kg/h independently predictive of death. This support previous finding of a lower threshold of urine output criteria for optimal prediction.

Early diagnostic value of neutrophil gelatinase-associated lipocalin and interleukin-18 in patients with sepsis-induced acute kidney injury / 中华危重病急救医学

Objective To evaluate the early diagnosis value of blood neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) in patients with sepsis-induced acute kidney injury (AKI). Methods A prospective case controlled study was conducted. Fifty-six patients with sepsis but without renal disease admitted to intensive care unit (ICU) of Shanxi People's Hospital from April 2014 to April 2015 were enrolled. Blood lactic acid and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score at ICU admission were recorded. The urine output, blood urea nitrogen (BUN), serum creatinine (SCr), NGAL, IL-18 and tumor necrosis factor-α (TNF-α) were continuously monitored for 48 hours. The patients were divided into AKI group and non-AKI group according to the diagnostic criteria of Kidney Disease: Improving Global Outcomes (KDIGO). The changes trend in above parameters between the two groups at different time points were compared. The early diagnostic value of NGAL, IL-18, and SCr for sepsis-induced AKI was evaluated by receiver operating characteristic curve (ROC). Results Compared with non-AKI group, with the time prolongation after ICU admission, the traditional parameters reflecting AKI urine output in sepsis-induced AKI group was decreased gradually, BUN and SCr were gradually increased, and a statistically significant difference was found at 12 hours between the two groups [BUN (mmol/L): 11.8±3.5 vs. 8.2±3.5, SCr (μmol/L): 88.6±11.3 vs. 74.0±11.0, both P < 0.01]; but the new indicators NGAL and IL-18 reflecting AKI had a statistically significant difference at 6 hours [NGAL (μg/L): 426.7±90.7 vs. 382.3±67.9, IL-18 (ng/L): 75.7±9.3 vs. 70.9±7.3, both P < 0.05]. It was shown that in AKI group, NGAL and IL-18 compared with BUN and SCr increased at least 6 hours ahead of schedule. The area under ROC curve (AUC) of 6-hour NGAL and IL-18 in patients with sepsis-induced AKI were 0.821 [95% confidence interval (95%CI) = 0.713-0.931] and 0.719 (95%CI = 0.584-0.853) respectively, superior to SCr (AUC = 0.677, 95%CI = 0.528-0.825). The cutoff value of NGAL was 363.58 μg/L, and the sensitivity and specificity were 88.0% and 86.7% respectively. Conclusions NGAL and IL-18 in the early prediction of sepsis patients with AKI are better than SCr, and NGAL was most sensitive. Therefore, NGAL can be used as an early biomarker for the diagnosis of AKI in patients with sepsis.

Norepinephrine infusion increases urine output in children under sedative and analgesic infusion / Infusão de noradrenalina aumenta o débito urinário de crianças recebendo drogas sedoanalgésicas

Objective: to evaluate the effects of early norepinephrine (NE) infusion in children submitted to mechanical ventilation (MV) requiring continuous sedative and analgesic infusion. Methods: double-blinded, randomized, placebo-controlled trial enrolling children (1 month to 12 years of age) admitted to a Brazilian PICU and expected to require MV and continuous sedative and analgesic drug infusions for at least five days. Children were randomized to receive either norepinephrine (NE) (0.15 mcg/kg/min) or normal saline infusion, started in the first 24 hours of MV, and maintained for 72 hours. We compared hemodynamic variables, fluid intake, renal function and urine output between groups. Results: forty children were equally allocated to the NE or placebo groups, with no differences in baseline characteristics, laboratorial findings, PRISM II score, length of MV, or mortality between groups. The average norepinephrine infusion was 0.143 mcg/kg/min. The NE group showed higher urine output (p = 0.016) and continuous increment in the mean arterial pressure compared to the baseline (p = 0.043). There were no differences in the remaining hemodynamic variables, fluid requirements, or furosemide administration. Conclusion: early norepinephrine infusion in children submitted to MV improves mean arterial pressure and increases urine output. These effects were attributed to reversion of vasoplegia induced by the sedative and analgesic drugs. .

Objetivo: avaliar os efeitos da infusão de noradrenalina (NA) em crianças submetidas a ventilação mecânica (VM) requerendo infusão contínua de sedoanalgesia. Métodos: estudo duplo cego, randomizado e placebo controlado envolvendo crianças de 1 mês a 12 anos, admitidas em uma UTI pediátrica brasileira com a expectativa de necessidade de VM e sedoanalgesia por, no mínimo, 5 dias. As crianças foram randomizadas a receber infusão de NA (0,15 mcg/kg/min) ou solução salina, iniciadas nas primeiras 24 horas de VM e mantidas por 72 horas. Comparamos as variáveis hemodinâmicas, oferta hídrica, função renal e débito urinário entre os dois grupos. Resultados: 40 crianças foram alocadas aos grupos NA e placebo, sem diferenças nas características basais, achados laboratoriais, escore PRISM II, tempo de VM ou mortalidade. A infusão média de NA foi 0,143 mcg/kg/min. O grupo NA apresentou maior débito urinário (p = 0,016) e aumento constante da pressão arterial média quando comparado aos níveis basais (p = 0,043). Não se observou diferenças nas demais variáveis hemodinâmicas, reposição hídrica ou no uso de furosemida. Conclusão: infusão precoce de NA em crianças submetidas a VM em uso sedoanalgesia promove aumento na pressão arterial média e aumento da diurese. Esses efeitos são atribuídos à reversão da vasoplegia induzida pelas drogas sedativas e analgésicas. .

Acute hypotensive and diuretic activities of Artemisia herba alba aqueous extract in normal rats

Objective:To evaluate the effect of Artemisia herba alba (A. herba alba) intravenous injection on cardiovascular and renal function in normal rats. Methods:The effect of intravenous injection of A. herba alba extract at the different doses of 50, 100 and 200 mg/kg was investigated in normal rats. Diuresis, heart frequency and electrolytes concentrations were analyzed. Results: Intravenous bolus injection of A. herba alba at the different doses of 50, 100 and 200 mg/kg produced a dose dependent reduction in arterial blood pressure (P Conclusions: We conclude that the aqueous A. herba alba extract possesses a potent acute hypotensive effect on normal rats. In addition, A. herba alba perfusion may affect renal function to increase urine and electrolytes excretion.

Overview of the Formation, Components, Color, and Abnormal Findings of Urine

Urine production is vital for the removal of certain waste products produced by metabolism in the body and for the maintenance of homeostasis in the body. The kidneys produce urine by the following three precisely regulated processes: filtration, reabsorption, and secretion. Urine is composed of water, certain electrolytes, and various waste products that are filtered out of the blood through the glomeruli. The physical features of urine are evaluated carefully to detect any abnormal findings that may indicate underlying diseases in the genitourinary system. A change in urine color may indicate an underlying pathological condition, although many of the causes of abnormal urine color are benign effects of medications and foods. A characteristic and specific odor may be the result of a metabolic disease rather than a concentrated specimen or a simple urinary tract infection. Although transient changes in urine output and nocturia are usually benign conditions, persistent abnormal findings require further work-up, with a thorough medical history taking. This article presents many of the conditions that physicians may encounter and will help them in the diagnosis and in establishing a treatment plan.

Prognostic indicators in patients with snakebite: Analysis of two-year data from a township hospital in central Myanmar.

Background: Rural people seek medical treatment for snakebite at peripheral health care facilities. Hence, identification of the characteristics, which can be used at peripheral levels of health care as reliable predictors of mortality, are required. Methods: Hospital records of 101 patients (70 males and 31 females) with age ranging from 3 to 80 years, admitted to Nahtogyi township hospital in central Myanmar during January 2005 to December 2006 were reviewed retrospectively. Binary logistic regression was used for estimating odds ratio (OR) and 95% Confidence Interval (CI) for various prognostic indicators of mortality. Results: Almost all snakebites were on extremities; more in legs (62%) than hands (37%). Most (52.5%) bites occurred in the morning (4 am to noon). Mean (SD) time for bite-to-hospital and bite-to-injection of anti-snake venom (ASV) was 134.6 (78.6) and 167 (187.8) minutes respectively. Eleven cases (10.9%) had died. Case fatality ratio (CFR) was significantly higher in 39 patients with un-clotted blood as compared to 62 patients with clotted blood (25.6% vs 1.6%, p <0.0005). Significantly higher CFR was observed in 49 patients who received ASV in >2 hours after the bite compared to 52 cases who received ASV within two hours (9.9% vs 0.9%, p <0.0001). Odds ratio of fatality were higher among those who had urine output of <400 ml in the first 24 hours (OR 26.4; 95% CI 2.4 to 288.3), un-clotted blood (OR 4.6; 95% CI 0.3 to 66.7), bite-to-injection time of >2 hours (OR 4; 95% CI 0.1 to 219.8) bite-to-hospital time of >2 hours (OR 3.1; 95%CI 0.1 to 136.3) and bites in the morning (OR 2; 95% CI 0.3 to 16.0). Conclusions: Clinical parameters could be used by healthcare providers to identify snakebite patients for referral, who may have fatal outcome.

GABA in the central amygdaloid nucleus modulates the electrolyte excretion and hormonal responses to blood volume expansion in rats

We investigated the involvement of GABAergic mechanisms of the central amygdaloid nucleus (CeA) in unanesthetized rats subjected to acute isotonic or hypertonic blood volume expansion (BVE). Male Wistar rats bearing cannulas unilaterally implanted in the CeA were treated with vehicle, muscimol (0.2 nmol/0.2 µL) or bicuculline (1.6 nmol/0.2 µL) in the CeA, followed by isotonic or hypertonic BVE (0.15 or 0.3 M NaCl, 2 mL/100 g body weight over 1 min). The vehicle-treated group showed an increase in sodium excretion, urinary volume, plasma oxytocin (OT), and atrial natriuretic peptide (ANP) levels compared to control rats. Muscimol reduced the effects of BVE on sodium excretion (isotonic: 2.4 ± 0.3 vs vehicle: 4.8 ± 0.2 and hypertonic: 4.0 ± 0.7 vs vehicle: 8.7 ± 0.6 µEq·100 g-1·40 min-1); urinary volume after hypertonic BVE (83.8 ± 10 vs vehicle: 255.6 ± 16.5 µL·100 g-1·40 min-1); plasma OT levels (isotonic: 15.3 ± 0.6 vs vehicle: 19.3 ± 1 and hypertonic: 26.5 ± 2.6 vs vehicle: 48 ± 3 pg/mL), and ANP levels (isotonic: 97 ± 12.8 vs vehicle: 258.3 ± 28.1 and hypertonic: 160 ± 14.6 vs vehicle: 318 ± 16.3 pg/mL). Bicuculline reduced the effects of isotonic or hypertonic BVE on urinary volume and ANP levels compared to vehicle-treated rats. However, bicuculline enhanced the effects of hypertonic BVE on plasma OT levels. These data suggest that CeA GABAergic mechanisms are involved in the control of ANP and OT secretion, as well as in sodium and water excretion in response to isotonic or hypertonic blood volume expansion.

Changes of Serum ADH Level during Matoidectomy under General Anesthesia / 대한마취과학회지

BACKGROUND: Markedly reduced urine have been commonly observed during mastoidectomy under general anesthesia. The aim of study was to evaluate the surgery-related mechanism of reduced urine during mastoidectomy. METHODS: 11 patients undergoing mastoidectomy were studied. Blood samples were drawn from CVP line inserted through right internal jugular vein just before drilling (Pre-D); at 15 min after drilling (D-15); at the time closest to the inner ear (CHP-1); at 15 min (CHP-2) and 30 min (CHP-3) after CHP-1 and just before emergence (End). MAP, HR, temperature, CVP, and urine output (UO) were recorded at each period. 0.9% normal saline with room temperature was used to irrigate surgical field. Serum ADH, and the osmolalities (serum and urine) were measured. In 6 patients, serum TSH and FSH were measured, simultaneously. RESULTS: There were no significant hemodynamic changes during procedure. UO was decreased in 50% during and after the drilling. No differences showed in UO between before and after the drilling of CHP. Plasma ADH level after the CHP was increased 2-3 fold than before. Serum osmolality was unchanged throughout the periods, while the urine osmolality was significantly increased after the period of CHP. FSH was not changed during the periods and TSH was decreased slightly than in Pre-D. CONCLUSIONS: The reduced urine output during mastoidectomy may be influenced by the drilling-related vibration, which may affect the supraoptico-hypophyseal tract, resulting in ADH release. The irrigated isotonic saline with higher osmolality (308 mOsm/kgH2O) than plasma osmolality may partly contributed to the increased ADH.

Effects of Arginine Vasopressin(AVP) Infusion on the Patients with Catecholamine-dependent Septic Shock / 결핵

BACKGROUND: A decreased level of serum arginine vasopressin(AVP) and an increased sensitivity to an exogenous AVP is expected in patients with septic shock who often require a high infusion rate of catecholamines. The goal of the study was to determine whether an exogenous AVP infusion to the patients with septic shock would achieve a significant decrement in infusion rate of catecholamine vasopressors while maintaining hemodynamic stability and adequate urine output. METHODS: Eight patients with septic shock who require a high infusion rate of norepinephrine had received a trial of 4-hour AVP infusion with simultaneous titration of norepinephrine. Hemodynamic parameters and urine output were monitored during the AVP infusion and the monitoring continued up to 4 hours after the AVP infusion had stopped. RESULTS: Mean arterial pressure showed no significant changes during the study period(p=0.197). Norepinephrine infusion rate significantly decreased with concurrent AVP administration(p=0.001). However, beneficial effects had disappeared after the AVP infusion was stopped. In addition, hourly urine output showed no significant changes throughout the trials(p=0.093). CONCLUSION: Concurrent AVP infusion achieved the catecholamine vasopressor sparing effect in the septic shock patients, but there was no evidence of the improvement of renal function. Further study may be indicated to determine whether AVP infusion would provide an organ-protective effect to the septic shock patients.

ANTI-SHOCK EFFECT OF RAPID INFUSION OF 7.5% SODIUM CHLORIDE ON HEMORRHAGIC SHOCK IN DOGS / 解放军医学杂志

Objective To observe the anti-shock effect of rapid infusion of 7.5% sodium chloride(NaCl) in dog with hemorrhagic shock. Methods Five mongrel dogs were bled to mean arterial pressure(MAP) of 5.33～6.70kPa, and this pressure was maintained for 1 hour. Each dog received 7.5% NaCl (4ml/kg) intravenously, the infusion time was 2 min. The observation time was 4 hours. Results During the infusion period, the blood pressure was obviously lower than that of the shock period(P

Effect of Positive End-Expiratory Pressure on the Concentration of Sodium and Potassium in Plasma and Urine, Plasma Creatinine and Urine Output in Mechanically Ventilated Patients / 대한구급학회지

BACKGOUND: It has been suggested that the addition of positive end-expiratory pressure (PEEP) to the patients with ventilator support leads to an impairment on renal hemodynamics and water- and sodium-retaining hormonal systems, such as plasma renin activity (PRA), plasma aldosterone, urinary antidiuretic hormone (ADH). METHODS: To evaluate the effects of 5 cmH2O and 10 cmH2O PEEP on renal function, we measured the plasma concentration of sodium (Na+), potassium (K+) and creatinine, urinary excretion of Na+, K+ and urine output in eight normovolemic male patients requiring ventilator support. Also changes in mean arterial pressure, pulse rate, arterial oxygen tension (PaO2) and carbon dioxide tension (PaCO2) during the experimental period were measured in these patients. RESULTS: Both 5 and 10 cmH2O PEEP showed no significant effect on the mean arterial pressure, heart rate, PaO2, and PaCO2. Both 5 and 10 cmH2O PEEP showed no significant effect on the plasma concentration of sodium, potassium and creatinine. 5 cmH2O PEEP showed no significant effect on the urinary excretion of sodium, potassium and urine output, but 10 cmH2O PEEP showed significant effect on the urinary excretion of sodium (19% decrease, p<0.05), and urine output (12.5% decrease, p<0.05) respectively. CONCLUSIONS: 10 cmH2O PEEP was revealed to decrease urinary sodium excretion along with urinary output and this phenomenon was likely to relate with water- and sodium-retaining hormonal systems. These results suggested that it was preferable to apply high PEEP cautiously in patients with impaired renal function.

Comparison of the Blood Loss during and after Spinal Surgery under Hypotensive Anesthesia and Effects of Furosemide on the Urine Output during Hypotensive Anesthesia for Spinal Surgery / 대한마취과학회지

BACKGROUND: The induced hypotensive anesthesia may produce serious complications related to central nervous system, heart, liver, kidney and eyes. In this study, the blood loss during and after operation were compared to evaluate the delayed effect of hypotension on postoperative bleeding and also, the urine output was measured in control group and furosemide treated group, to investigate the effect of furosemide on the protection of kidney function. METHODS: Forty patients undergoing spinal surgery were evaluated and the hypotension was induced by the combination of hydralazine, esmolol and propranolol under enflurane anesthesia. During hypotensive anesthesia, the systolic arterial blood pressure was maintained between 65 to 75 mmHg. I compared the arterial blood gas analysis, plasma protein, albumin and calcium level, blood urea nitrogen (BUN), creatinine and complete blood count (CBC) before, durng and after hypotensive anesthesia. And also, the volume of blood loss and the units of transfused blood were measured intraoperatively and postoperatively. To investigate the effect of furosemide on the protection of kidney function, patients were randomly divided to contol group (n=20) and furosemide group (n=20). In furosemide goup, 0.1 mg/kg was administered intravenously and the urine output was measured during and after hypotensive anesthesia in both groups. RESULTS: The systolic arterial blood pressure during hypotensive anesthesia was maintained between 65 to 75 mmHg as planned in all forty patients. The average blood loss during and after operation were 769+/-541 and 786+/-397 ml, respectively and the average total blood loss was 1555+/-784 ml. The average units of transfused packed red cell during and after operation were 2.6+/-0.8 and 1.9+/-0.4 units, respectively, and the average total transfused units were 2.3+/-0.8 units. In both control and furosemide treated groups, all forty patients showed oliguria during first two hours after starting hypotensive anesthesia but urine outputs were recovered after the end of hypotensive anesthesia in both groups. During and after hypotensive anesthesia, pH was slightly but significantly decreased. Plasma protein, albumin, calcium and BUN were decreased during and after hypotensive anesthesia compared with before hypotensive anesthesia values. During and after hypotensive anesthesia, platelet count was decreased significantly but white cell count was increased. Severe oliguria was noted during hypotensive anesthesia in both groups and no serious complication related to hypotensive anesthesia was found. CONCLUSIONS: In this study, the volume of blood loss after anesthesia was almost same as that during anesthesia. And the administration of furosemide 0.1 mg/kg did not prevent oliguria during hypotensive anesthesia.

A Reduction of Plasma Antidiuretic Hormone (ADH) during Mastoidectomy with General Anesthesia: Preliminary Study / 대한마취과학회지

BACKGROUND: It has been said that anesthesia and surgery tend to increse 'stress hormone' followed by reduction of GFR and urine flow. We have been noticed a polyuria during mastoidectomy with anesthesia. We hypothesized that a reduction of ADH secretion related to operative procedure might be a cause of a transient polyuria. METHODS: In 41 patients who were in ASA class I, mean arterial pressure (MAP), heart rates (HR), temperature, central venous pressure (CVP) were measured at before induction, just before drilling with irrigation, 30 minutes and 60 minutes after drilling with irrigation, and on arrival in recovery room by groups (room temperatured irrigating fluid and warm fluid were used in group 1 and group 2) during procedures. In 7 of 41, blood samples for antidiuretic hormone (ADH) and plasma osmolalities (Posm) were withdrawn at the same time points. In all patients, fluid were administered with 4 ml/kg/hour throughout the procedures. RESULTS: In group 1, mean urine volume were 5.0 and 6.4 ml/min during anesthesia and drilling with irrigation that was significantly more than in group 2 (3.6 and 4.2 ml/min). In 7 patients, ADH concentration was decreased during surgery compared to pre-induction level, while the Posm were in normal ranges. None of the MAP, HR and CVP showed significant changes. ADH concentrations were not significantly correlated to Posm. CONCLUSIONS: We suggest that a reduction of ADH secretion may have a major role in transient polyuria during mastoidectomy, which might be related to the mechanism that; 1) lowered temperature of hypothalamo-pituitary system by cold irrigating fluid may induce a transient ischemic changes of pituitary gland, 2) absorption of hypoosmolar irrigating fluid to central circulation may reduce central osmotic pressure.