DOCSLIB.ORG

Plasma Renin Activity in Relation to Serum Sodium Concentration and Body Fluid Balance H

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Plasma Renin Activity in Relation to Serum Sodium Concentration and Body Fluid Balance H Plasma Renin Activity in Relation to Serum Sodium Concentration and Body Fluid Balance H. H. NEWSOME AND F. C. BARTTER Endocrinology Branch, National Heart Institute, National Institutes of Health, Bethesda, Maryland 20014 ABSTRACT. The relationship of peripheral tivity decreased (109 to 62 ng/100 ml) during plasma renin activity to changes in body fluid overhydration in spite of a decrease (140 to volume and to serum sodium concentration was 129 mEq/1) in serum sodium concentration. Downloaded from https://academic.oup.com/jcem/article/28/12/1704/2715533 by guest on 29 September 2021 studied in normal subjects and in hypertensive Expansion of intravascular volume in a patient patients during changes in hydration or changes with a defect in renal sodium conservation re- in sodium intake. There was an inverse relation- sulted in suppression of plasma renin activity. ship between renin activity and fluid volume; It thus appears that some factor related to body e.g., renin activity increased (168 to 833 ng/100 fluid balance, perhaps intravascular volume, may ml in normal subjects) following loss of body be more important than serum sodium concentra- fluid (—2.1%) by diuresis. In contrast, the tion in determining plasma renin activity. (J relationship of renin activity to serum sodium Clin Endocr 28: 1704, 1968) concentration could be reversed; e.g., renin ac- INCE the relationship of the renin-an- sodium intake; diuretics were administered S giotensin system to the adrenal cortex during the period of lowest sodium intake. was postulated in 1958 (1) and later con- Changes in water balance. Six normal volunteers firmed (2-6), the regulation of renin se- were placed on a diet containing each day 109 cretion has received increasing attention. mEq of sodium (Na) and 500-800 ml total Several factors have been implicated in water (water content of foodstuffs and water of the control of plasma renin concentration. oxidation, combined). During the'control peri- It has been shown that plasma renin is in- ods a constant amount (1000-1500 ml) of extra water was given to each subject. Dehydration versely related to sodium intake (7) and to was effected by withdrawal of the extra water serum sodium concentration (8). It is clear for 48 to 96 hr. Overhydration was established by that other factors such as fluid balance increasing the daily water intake to 2000 to may be involved (9-11). The present study 3000 ml and by administering Pitressin tannate examines the relative roles of serum sodium in oil intramuscularly twice daily. The subjects remained throughout the study in an air-con- concentration and of body fluid volume in ditioned environment. Normal, moderate phys- the control of plasma renin activity. The ical activity was permitted. Body weight, blood results of the study suggest that changes in hemoglobin and hematocrit, blood urea nitro- body fluid volume may supersede serum gen, and serum sodium, potassium, chloride and sodium concentration as a determinant of carbon dioxide content were determined daily. Peripheral plasma renin activity was measured plasma renin activity. in the venous blood of each subject during periods of normal hydration, dehydration and Materials and Methods overhydration. Plasma renin activity was measured in 15 subjects under various conditions of water and Changes in sodium balance. The 5 normal vol- of sodium balance. Changes in water balance unteers and 4 patients with benign hyperten- were accomplished in 6 normal volunteers by sion were maintained on constant daily water overhydration and dehydration; Pitressin tan- intake and studied while each received high nate in oil was administered during the periods (240 mEq), moderate (109 mEq) and low of overhydration. Changes in sodium balance (9 mEq) amounts of dietary Na. While receiv- were accomplished in 5 normal volunteers and 4 ing 9 mEq of sodium daily, the subjects were patients with hypertension by changing the given Mercuhydrin intramuscularly (1 or 2 ml each day). All other conditions and analyses Received January 5, 1968; accepted August 7. were the same as those of the preceding group. 1704 December 1968 RENIN, SERUM SODIUM AND FLUID BALANCE 1705 TABLE 1. Effect of changes in hydration on renin activity, serum sodium and changes in body weight in six normal subjects Hydration— Norm Under Over Norm Under Over Norm Under Over Under Over Renin activity Serum sodium Changes in body weight Supine Upright mEq/1 % Change ng/100 ml B.S. 145 166 94 140 144 126 -2.14 +3.60 C.J. 145 215 64 141 140 132 -2.58 +2.90 E.J. 101 162 30 140 146 127 -1.64 +3.61 L.C. 91 134 107* 255 401 207 140 144 125 -1.95 +2.91 Downloaded from https://academic.oup.com/jcem/article/28/12/1704/2715533 by guest on 29 September 2021 L.B. 146 143 39 302 878 38 140 148 130 -2.22 +4.91 G.T. 72 450 78 267 743 151 139 147 128 •3.41 +3.61 * Overhydration not optimally achieved due to emesis. Peripheral plasma renin activity was measured The pressor responses obtained in the rats in the venous blood of each subject during the were analyzed statistically by the method of period of high-sodium intake (240 mEq), of Bliss (13). Data analysis was facilitated by use normal sodium intake (109 mEq) and of low of a Honeywell 360 computer. A check for sodium intake (9 mEq). Renin activity was parallelism between dose-response curves of assayed during the period of low-sodium intake standard and unknown was done for each only after administration of Mercuhydrin. sample. Results, expressed in ng of angiotensin in 100 ml of plasma (ng/100 ml plasma + SEM), Albumin infusion. A study was done in a patient represent the amount of angiotensin generated (E.M.) with hypertension, arteriolonephro- from endogenous substrate by endogenous renin sclerosis, and a slightly impaired ability of the in 3 hr of incubation at 37 C. Mean recovery for kidney to conserve sodium on a low-sodium the method, when angiotensin was added to diet. Daily Na intake was 109 mEq for 8 days, plasma from nephrectomized dogs, was 31 + followed by 9 mEq for 8 days. At the end of the 13% (SD). The results presented in this paper period of 9 mEq of Na intake 75 g of human were not corrected for recovery. In an estimate serum albumin (9 mEq Na) was given intra- of precision, values from 5 aliquots of pooled venously. Plasma renin activity, serum Na plasma with a mean potency of 1111 ng/100 ml concentration and urinary Na were measured showed a standard deviation of 34 ng/100 ml. immediately before and after albumin infusion No pressor activity was detected in the plasma and several times thereafter. Body weight was from 3 nephrectomized patients awaiting renal recorded daily. transplants. No pressor activity was detectable when epinephrine (100 /xg/100 ml), norepine- Measurement of plasma renin activity. Blood phrine (100 jug/100 ml), or Pitressin (10 mU/ samples were drawn with the subjects either in 100 ml) had been added to the plasma. the supine position at 8 AM and/or in the up- right position at 12 noon. The subjects were Results kept supine for 8 hr or remained up and about for 4 hr before blood sampling. Changes in water balance. An individual Plasma renin activity was determined by a study on changes in water balance in a nor- modification of Boucher's method (12). The mal subject is shown in Fig. 1, and all the modifications are as follows: data on six normal subjects are summarized in Table 1. During the dehydration period in 1. The material was eluted from the column E.J. (Fig. 1) serum Na concentration in- without acidification with acetic acid, and was frozen immediately in a flask immersed in a creased from 140 to 146 mEq/1, renin activ- slurry of dry ice and acetone. ity increased from 101 to 162 ng/100 ml, 2. The frozen material was lyophilized and while body weight decreased by 1.64%. washed 3 times with 80 % ethanol. With dehydration (Table 1), renin activity 3. Three aliquots of each sample were injected into at least 3 rats and compared in each rat (supine and upright) was increased in every with 3 doses of standard Val-5, angiotensin subject except L.B., at a time when serum amide (Ciba), according to a 6-point bioassay Na concentration had increased or re- design. mained the same and body weight had con- 1706 NEWSOME AND BARTTER Volume 28 HYDRATION J.C.. 0. E.J.,0. No INTAKE 07-12-87 Normal Under Over 06-66-78 April 1966 Nov. 1966 H2O 240 109 9+Hq (mEq/d) INTAKE SERUM 140, PITRESSIN Na mEq/1 135 V... 145 250 No 13 5 200 URINARY mEq/l 125 150 Downloaded from https://academic.oup.com/jcem/article/28/12/1704/2715533 by guest on 29 September 2021 Na 100 50 URINARY IOO l- Na L 0 mEq/d 0 L 63 B.W. 61 55 kg B.W. 59 53 •x/ 1500 si 1000 200 500 s RENIN 0 150 ACTIVITY RENIN 3000 100 ng% ACTIVITY U 20001- 50 1000 ng% \ 0 0 I 3 5 7 I 2 DAYS FIG. 2. Effect of changes in sodium intake on serum FIG. 1. Effect of changes in hydra tion on serum Na, urinary Na, body weight and renin activity sodium (Na), urinary sodium (Na), body weight in the supine and in the upright positions in a nor- (B.W.) and renin activity in the supine position in mal subject. Na depletion was accomplished by an a normal subject.
Load more

Recommended publications
  • Hormones and Fluid Balance During Pregnancy, Labor and Post Partum
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ntegrativ Fysiologi, Box 571, %&'()*+ Sweden </ $.% 4--5="6== 4-52366""162"26 ! !!! 623'$ !;; **; > ? ! !!! 623) In memory of my beloved father Ove I lift up my eyes to the hills -- where does my help come from? My help comes from the Lord, the Maker of heaven and earth. He will not let your foot slip -- He who watches over you will not slumber; indeed, He who watches over Israel will neither slumber nor sleep. The Lord watches over you -- the Lord is your shade at your right hand; the sun will not harm you by day, nor the moon by night. The Lord will keep you from all harm He will watch over your life; the Lord will
    [Show full text]
  • Medicines That Affect Fluid Balance in the Body
    the bulk of stools by getting them to retain liquid, which encourages the Medicines that affect fluid bowels to push them out. balance in the body Osmotic laxatives e.g. Lactulose, Macrogol - these soften stools by increasing the amount of water released into the bowels, making them easier to pass. Older people are at higher risk of dehydration due to body changes in the ageing process. The risk of dehydration can be increased further when Stimulant laxatives e.g. Senna, Bisacodyl - these stimulate the bowels elderly patients are prescribed medicines for chronic conditions due to old speeding up bowel movements and so less water is absorbed from the age. stool as it passes through the bowels. Some medicines can affect fluid balance in the body and this may result in more water being lost through the kidneys as urine. Stool softener laxatives e.g. Docusate - These can cause more water to The medicines that can increase risk of dehydration are be reabsorbed from the bowel, making the stools softer. listed below. ANTACIDS Antacids are also known to cause dehydration because of the moisture DIURETICS they require when being absorbed by your body. Drinking plenty of water Diuretics are sometimes called 'water tablets' because they can cause you can reduce the dry mouth, stomach cramps and dry skin that is sometimes to pass more urine than usual. They work on the kidneys by increasing the associated with antacids. amount of salt and water that comes out through the urine. Diuretics are often prescribed for heart failure patients and sometimes for patients with The major side effect of antacids containing magnesium is diarrhoea and high blood pressure.
    [Show full text]
  • Hormonal and Thirst Modulated Maintenance of Fluid Balance in Young Women with Different Levels of Habitual Fluid Consumption
    nutrients Article Hormonal and Thirst Modulated Maintenance of Fluid Balance in Young Women with Different Levels of Habitual Fluid Consumption Evan C. Johnson 1,2,*, Colleen X. Muñoz 1,3, Liliana Jimenez 4, Laurent Le Bellego 4, Brian R. Kupchak 1,5, William J. Kraemer 1,6, Douglas J. Casa 1, Carl M. Maresh 1,6 and Lawrence E. Armstrong 1 1 Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA; [email protected] (C.X.M.); [email protected] (B.R.K.); [email protected] (W.J.K.); [email protected] (D.J.C.); [email protected] (C.M.M.); [email protected] (L.E.A.) 2 Division of Kinesiology and Health, University of Wyoming, Laramie, WY 82071, USA 3 Department of Health Sciences and Nursing, University of Hartford, West Hartford, CT 06117, USA 4 Hydration & Health Department, Danone Research, Palaiseau 91767, France; [email protected] (L.J.); [email protected] (L.L.B.) 5 Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA 6 Department of Human Sciences, the Ohio State University, Columbus, OH 43210, USA * Correspondence: [email protected]; Tel.: +1-307-766-5282; Fax: +1-307-766-4098 Received: 22 February 2016; Accepted: 11 May 2016; Published: 18 May 2016 Abstract: Background: Surprisingly little is known about the physiological and perceptual differences of women who consume different volumes of water each day. The purposes of this investigation were to (a) analyze blood osmolality, arginine vasopressin (AVP), and aldosterone; (b) assess the responses of physiological, thirst, and hydration indices; and (c) compare the responses of individuals with high and low total water intake (TWI; HIGH and LOW, respectively) when consuming similar volumes of water each day and when their habitual total water intake was modified.
    [Show full text]
  • Role of the Renin-Angiotensin-Aldosterone
    International Journal of Molecular Sciences Review Role of the Renin-Angiotensin-Aldosterone System beyond Blood Pressure Regulation: Molecular and Cellular Mechanisms Involved in End-Organ Damage during Arterial Hypertension Natalia Muñoz-Durango 1,†, Cristóbal A. Fuentes 2,†, Andrés E. Castillo 2, Luis Martín González-Gómez 2, Andrea Vecchiola 2, Carlos E. Fardella 2,* and Alexis M. Kalergis 1,2,* 1 Millenium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, 8330025 Santiago, Chile; [email protected] 2 Millenium Institute on Immunology and Immunotherapy, Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330074 Santiago, Chile; [email protected] (C.A.F.); [email protected] (A.E.C.); [email protected] (L.M.G.-G.); [email protected] (A.V.) * Correspondence: [email protected] (C.E.F.); [email protected] (A.M.K.); Tel.: +56-223-543-813 (C.E.F.); +56-223-542-842 (A.M.K.) † These authors contributed equally in this manuscript. Academic Editor: Anastasia Susie Mihailidou Received: 24 March 2016; Accepted: 10 May 2016; Published: 23 June 2016 Abstract: Arterial hypertension is a common condition worldwide and an important predictor of several complicated diseases. Arterial hypertension can be triggered by many factors, including physiological, genetic, and lifestyle causes. Specifically, molecules of the renin-angiotensin-aldosterone system not only play important roles in the control of blood pressure, but they are also associated with the genesis of arterial hypertension, thus constituting a need for pharmacological interventions. Chronic high pressure generates mechanical damage along the vascular system, heart, and kidneys, which are the principal organs affected in this condition.
    [Show full text]
  • Drug Dosing in Patients with Multiple Organ Dysfunction
    Drug Prescribing in Kidney Disease: Initiative for Improved Dosing Drug Dosing in Patients with Multiple Organ Dysfunction Section Leaders: Gary Matzke and Ravindra Mehta Kidney Disease: Improving Global Outcomes www.kdigo.org Areas for Consideration • Patients • Phases of disease • Process of care • Organ interactions • Factors influencing drug disposition and drug dosing • Questions to be addressed Kidney Disease: Improving Global Outcomes www.kdigo.org Areas for Consideration 1. Patients • Multiple Organ Dysfunction Syndrome – Acute – Altered organ function in acutely ill patients e.g. Traumatic brain injury in a 20 yr old previously healthy adult. • Multiple System Organ Failure – Acute on Chronic disease – Altered organ function with pre-existing co-morbidites e.g. pneumonia in 45 yr old patient with multiple sclerosis • Multiple Organ Dysfunction Syndrome – Chronic – Altered organ function secondary to multimorbidity e.g. 55 yr old obese patient with diabetes, hypertension, Hep C cirrhosis and aortic stenosis Clinical practice guidelines rarely account for patients with multiple chronic conditions (JAMA 2010;303:1303-4) Kidney Disease: Improving Global Outcomes www.kdigo.org Epidemiology • As many as 19% of ICU patients develop MODS • MODS is responsible for 50%–80% of ICU deaths. • Patients who develop MODS have a 20-fold increase in mortality rate and a doubled length of stay (LOS) compared with unaffected patients. • Moreover, MODS is the most common diagnosis in ICU patients with a long LOS (>21 days) . Mizock BA Dis Mon 2009;55:476-526 Barie PSSurgical Infections ;10:2009 Proulx F, et al Pediatr Crit Care Med 2009;10:12-22 Kidney Disease: Improving Global Outcomes www.kdigo.org Inflammation is a common feature of MODS MizockKidney Disease:BA Dis MonImproving 2009;55:476-526 Global Outcomes www.kdigo.org Areas for Consideration 2.
    [Show full text]
  • Effect of Aging on Plasma Renin and Aldosterone in Normal Man PETER WEIDMANN, SYLVIANNE DE MYTTENAERE-BURSZTEIN, MORTON H
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Kidney International, Vol. 8, (1975), p. 325—333 Effect of aging on plasma renin and aldosterone in normal man PETER WEIDMANN, SYLVIANNE DE MYTTENAERE-BURSZTEIN, MORTON H. MAXWELL and JosE DE LIMA Nephrology and Hypertension Service, Department of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine, Los Angeles, California Effect ofaging on plasma renin and aldosterone in normal man. sential hypertension has been diagnosed more com- Theinfluence of aging on the renin-angiotensin-aldosterone system monly in older than young adults [1—4], and the syn- was evaluated by comparing young (20 to 30 yr) with elderly (62 to 70 yr) healthy subjects. Despite comparable body sodium-fluid drome of hyporeninemic hypoaldosteronism has been balance in the two age groups, serum renin concentration, plasma described almost exclusively in patients older than 50 renin activity and aldosterone concentrations were lower in the elderly. The age-related decreases in circulating renin and aldo- yr of age [5]. sterone concentrations were slight while subjects were supine and The possibility that aging may influence renin and receiving normal sodium intake; when upright and during sodium aldosterone metabolism has been considered pre- depletion, they were more pronounced. Inverse renin-blood pres- sure interrelations were noted during two of four study conditions viously, but the available data on the relationship be- involving normal sodium intake or mild sodium depletion (r = tween age and the function of the renin-angiotensin-al- —0.44and —0.47, respectively), but not during progressive sodium dosterone system in normotensive healthy adults are depletion.
    [Show full text]
  • Knowledge Acquisition Test
    KNOWLEDGE ACQUISITION TEST 1. What are the essential components of an effective handover report using ISBAR? a) Background, situation, assessment b) Symptoms, assessment, recommendation c) Introduction, assessment, response d) Background, situation, allergies 2. At handover you are told that one of your patients has been admitted with dehydration secondary to a gastro-intestinal infection. Which charts will you immediately review? a) Fluid balance, pathology, patient history b) Neurological, stool, fluid balance c) Falls risk assessment. stool, general observations d) Fluid balance, medications, neurological 3. A postoperative client is diagnosed with hypervolaemia. Which of the following should the nurse assess for this client? a) Concentrated haemoglobin and haematocrit levels b) Decreased urine output c) Distended neck veins d) Poor skin turgor 4. A client is diagnosed as being in the early stages of hypovoleamic shock. The nurse will expect to see all of the following signs and symptoms EXCEPT: a) Urine output less than 30 mL per hour b) Unconsciousness c) Hypotension d) Tachycardia 5. Which cues are most relevant to the assessment of hypervolaemia? a) Blood pressure, pulse, pain b) Blood pressure, oxygen saturation, colour c) Colour. Urine output, respiratory rate d) Blood pressure, pulse, urine output This resource was created as part of an ATLC Project titled Examining the impact 1 of simulated patients and information and communication technology on nursing students' clinical reasoning 6. Identify which of the following is not a true statement: a) Oliguria can be caused by hypotension b) Hypertensive can be caused by excessive IV fluids. c) Third space fluid shift can cause tachycardia d) Pre- operative bowel preps can cause hypervoleamia 7.
    [Show full text]
  • Fluid Balance
    Fluid Balance What is fluid balance? Fluid balance is the recording of intake and output of fluid, and the balancing of them both. Why do we maintain fluid balance? To help aid a patient’s recovery by avoiding dehydration and other unwanted complications. How will we do it? Nurses will ask you regularly how much you have had to drink and will ask you to pass urine into a measuring pot so they can record the amount of fluid on your fluid chart. If you are having diarrhoea or vomiting, you may be also asked to provide a sample of this so the fluid loss can be accurately recorded and a specimen sent for testing. How can you help? Use the provided measuring pots and inform staff when you have passed urine, or if you have had any diarrhoea or vomiting. Please ask staff for additional measuring pots, if needed. If you require any further information, please speak to your nurse. Urine Colour Chart 1 2 3 4 5 6 7 8 There’s a saying that 1-3 is healthy wee, but 4-8 you need to hydrate! That’s true for many healthy individuals, but it may not be true for everyone. Some medications (including chemotherapy), certain foods or dyes in food can cause quite startling colours in urine including: brown, orange, pink, red, blue or green. Dark coloured urine may be ‘normal’ for people with liver or kidney problems and it may be that your doctor has advised you to strictly limit your fluid intake. BUT… If dark coloured urine is simply because you’re not drinking enough liquid or because of something you have eaten: Try to drink 2 litres (8-10 cups) per day
    [Show full text]
  • Effect of Varying Water Intake on Renal Function in Healthy Preterm Babies
    Arch Dis Child: first published as 10.1136/adc.60.7.614 on 1 July 1985. Downloaded from Archives of Disease in Childhood, 1985, 60, 614-620 Effect of varying water intake on renal function in healthy preterm babies M G COULTHARD AND E N HEY Department of Child Health, Princess Mary Maternity Hospital, Newcastle upon Tyne SUMMARY Renal control of water and electrolyte homeostasis was studied in 10 healthy babies (gestation 29 to 34 weeks; birthweight 1-19 to 2-19 kg) while water intake was varied. Glomerular filtration rate and urine flow were estimated daily from spot plasma and urine samples for six days using a constant inulin infusion, and simultaneous sodium, potassium, osmolar, and free water clearances were calculated. The infusion was started at an average age of 14 hours. Each baby received a total fluid intake of 96 ml/kg daily on study days 1, 2, and 5, and about 200 ml/kg on study days 3, 4, and 6. Daily sodium intake was kept constant at 3 mmollkg. At the end of the first study day the babies were undergoing a diuresis, but thereafter their estimated daily water balances remained stable regardless of intake. Glomerular filtration remained stable; alterations in urine flow reflected a change in the percentage of filtrate excreted. Plasma electrolytes and osmolality were stable throughout, and on study days 2 to 6 the urinary excretion rates of sodium, potassium, and other osmoles remained the same regardless of urine flow. The delivery of sodium to the distal tubule was estimated to be between 17 and 20% of the copyright.
    [Show full text]
  • Aging Kidney and Fluid Balance
    Aging Kidney and Fluid Balance Rasheeda Hall MD, MBA, MHS Disclosures • Current funding: – NIA GEMSSTAR (R03AG050834) – Duke CTSA Scholar (UL1TR001117) – Duke Claude D. Pepper Older Americans Independence Center (P30 AG028716) • Other financial relationships: None • Conflicts of interest: None Significance • Aging kidney is not synonymous with chronic kidney disease (CKD) • CKD is common in adults aged > 65 • Alterations in Kidney Fluid Balance and Urine Production are predominant factors in development of urinary incontinence in older adults Topic Outline • Aging Kidney – Fluid Balance – Urine Production • CKD – Management NIDDK website – Complications Current Fluid Balance Urine Production Knowledge CKD Management CKD Complications Aging Kidney • Creatinine Clearance (CrCl) can decline by 0.75ml/min/year in older adults without kidney disease or other comorbidities. • Not all older adults experience this decline in CrCl. • Independent of CrCl, kidney physiology changes with aging. Current Fluid Balance Urine Production Knowledge CKD Management CKD Complications Water and Sodium • Excess Water loss – Maximum urine osmolality declines with age – Kidney tubule response to Antidiuretic hormone (ADH) is muted – Risk of Dehydration • “Sodium Wasting” – Independent of Volume status – Impaired response by Loops of Henle – Caused by a decline in Aldosterone levels Current Fluid Balance Urine Production Knowledge CKD Management CKD Complications Regulation of Urine Formation Hormone Effect of Aging on Secretion Renin-Angiotensin-Aldosterone Decreased Atrial Natriuretic Hormone (ANH) Increased Antidiuretic Hormone (ADH) Decreased* *Decreased Nocturnal Secretion Renin ANH Angiotensin Sodium and Water Aldosterone Excretion Urine Flow ADH At Night Current Fluid Balance Urine Production Knowledge CKD Management CKD Complications Nocturnal Urine Production Circadian Rhythm of ADH secretion typically yields lower urine production at night; however, this changes with older age.
    [Show full text]
  • Measuring and Managing Fluid Balance Headaches, Fatigue in This Article
    Keywords: Fluid balance/Input/Output/ Nursing Practice Dehydration/Overhydration Review ●This article has been double-blind Fluid balance peer reviewed Assessing hydration status and measuring fluid balance can ensure optimal hydration Measuring and managing fluid balance headaches, fatigue In this article... 5 key and dry skin. Severe dehydra- What fluid balance is and how fluid moves around the body points Fluid balance is tion can lead to Causes and signs and symptoms of dehydration and 1the balance of hypovolaemic overhydration the input and shock, organ output of fluids in failure and death How to assess fluid balance, including clinical assessment the body to allow The three How to keep an accurate fluid balance chart metabolic pro- 4elements to cesses to function assessing fluid To assess fluid balance and Author Alison Shepherd is tutor in nursing, balance, including what fluid balance is, 2balance, hydration status department of primary care and child health, and how and why it is measured. It also dis- nurses need to are: clinical Florence Nightingale School of Nursing and cusses the importance of measuring fluid know about fluid assessment, body Midwifery, King’s College London. balance accurately, and the health implica- compartments in weight and urine Abstract Shepherd A (2011) Measuring and tions of dehydration and overhydration. the body and how output; review of managing fluid balance. Nursing Times; fluid moves fluid balance 107: 28, 12-16. What is fluid balance? between these charts; and review Ensuring patients are adequately hydrated Fluid balance is a term used to describe the compartments of blood chemistry is an essential part of nursing care, yet a balance of the input and output of fluids in Dehydration is Fluid balance recent report from the Care Quality the body to allow metabolic processes to 3defined as a 5recording is Commission found “appalling” levels of care function correctly (Welch, 2010).
    [Show full text]
  • Renal & Electrolyte Disturbances
    Renal & Electrolyte Disturbances 20% 6% 80% 186 RENAL I. INTRODUCTION AACN-CCRN/CCRN-E 6% Chronic Renal Failure Acute Renal Failure Life Threatening Electrolyte Disturbances II. RENAL PHYSIOLOGY Major Functions of the Kidney 1. Excretion of Metabolic Wastes 2. Urine Formation 3. Acid-Base Balance Regulation 4. Electrolyte Regulation 5. Fluid Regulation 6. Blood Pressure Regulation 7. Erythropoietin Secretion/Anemia Regulation Renal Assessment 1. Blood Work Blood Urea Nitrogen Creatinine Serum Electrolytes Hgb & Hct Serum Albumin Serum Osmolality Blood Urea Nitrogen: BUN: 5.0 – 25 mg/dL Urea is formed in the liver along with C02 as a waste by product of protein metabolism. It is carried by the blood and excreted by the renal system. Elevated BUN levels are significant for either increased protein catabolism or decreased renal excretion of urea. Situations, which would increase protein catabolism, include high protein diets, GI bleeding (protein from blood is broken down), DKA, burns and cancer. Any pre-renal (shock state, poor renal perfusion) or intra-renal failure (nephrotoxic medications or kidney diseases) will decrease the GFR and therefore urea excretion. The elevation of the metabolic waste products can cause fatigue, muscle weakness, and seizures. Volume status of the patient can also affect the BUN. Treatment is related to the cause of the elevation, which would include hydration, stopping protein catabolism, and/or dialysis. 187 Creatinine: 0.6 – 1.5 mg/dL slightly lower in females, children and elderly Creatinine is a waste product of creatinine phosphate breakdown. Creatinine phosphate is a high-energy compound found in skeletal muscle tissue and is released during muscle breakdown.
    [Show full text]