Hidden sources of fluids, sodium and potassium in stabilised Swedish ICU patients

Nihlén, Sandra; Kawati, Rafael; Rasmusson, Johan; Rylander, Christian; Pikwer, Andreas; Castegren, Markus; Belin, Anton; Lipcsey, Miklós

doi:10.1097/eja.0000000000001354

Cited by 8 publications

(12 citation statements)

References 21 publications

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“…The sample size was calculated for the original study. 6 The proportion of missing data for key variables was less than 10%, but for the composite variables Prop Na+/eOSM , Prop K+/eOSM , Prop Urea/eOSM , and Prop Glucose/eOSM missing data was 28%. Given the explorative nature of the study and that data was missing at random, calculations were based on the original data set.…”

Section: Methodsmentioning

confidence: 90%

“…In this posthoc analysis on data from our previous retrospective observational study 6 on stable ICU patients in the post resuscitative phase, we included adult patients >18 yr of age who spent at least 7 d in a participating ICU during 2018. Patient inclusion was consecutive at all participating ICUs and terminated when reaching our preset goal number of patients.…”

Section: Methodsmentioning

confidence: 99%

“… 3 , 4 Fluid volume reduction is commenced in ICU patients after the initial resuscitation phase. 5 We have shown that almost all stabilized patients were treated with fluid volume reduction at some point during their ICU stay 6 and estimated plasma osmolality (eOSM) increased during the fluid volume reduction phase. 6 …”

Section: Introductionmentioning

confidence: 99%

“…Yet, recent reports suggest that there is a coordinated response to dehydration in rodents and humans that include a gradual switch from ionic osmolytes in form of sodium, to organic osmolytes in form of glucose and urea. 13 , 14 The postresuscitative phase in critically ill patients, where water loss and nutrition below metabolic needs are common, 6 has previously been compared to torpor, 15 a condition related to aestivation. Moreover, physiological adaptation to body water loss is characterized by catabolic exploitation of muscle energy and nitrogen for body water conservation.…”

Section: Introductionmentioning

confidence: 99%

“…We conducted a posthoc study on data from a multicenter study on ICU patients in the post resuscitative phase to test this hypothesis. 6 …”

Section: Introductionmentioning

confidence: 99%

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The Contribution of Plasma Urea to Total Osmolality During Iatrogenic Fluid Reduction in Critically Ill Patients

et al. 2021

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Hyperosmolality is common in critically ill patients during body fluid volume reduction. It is unknown whether this is only a result of decreased total body water, or an active osmole-producing mechanism similar to that in aestivating animals where muscle degradation increases urea levels to preserve water. We hypothesized that fluid volume reduction in critically ill patients contributes to a shift from ionic to organic osmolytes similar to mechanisms of aestivation. We performed a post-hoc analysis on data from a multicenter observational study in adult ICU patients in the post-resuscitative phase. Fluid, electrolyte, energy and nitrogen intake, fluid loss, estimated glomerular filtration rate (eGFR) and estimated plasma osmolality (eOSM) were registered. Contributions of osmolytes Na+, K+, urea and glucose to eOSM expressed as proportions of eOSM were calculated. 241 patients were included. eOSM increased (median change 7.4 mOsm/kg (IQR −1.9–18) during the study. The of sodium's and potassium's proportions of eOSM decreased (P < 0.05 and P < 0.01 respectively), whereas the urea's proportion increased (P < 0.001). Urea's proportion of eOSM was higher in patients with negative vs. positive fluid balance. The urea's proportion of eOSM increased with eOSM (r = 0.63; adjusted for eGFR r = 0.80), but not nitrogen intake. In patients without furosemide and/or renal replacement therapy (n = 17), urea's proportion of eOSM and eOSM correlated strongly (r = 0.92). Urea's proportion of eOsm was higher in patients not surviving to 90 days. In stabilized ICU patients the contribution of urea to plasma osmolality increased during body water volume reduction, statistically independently of nitrogen administration and eGFR. The shift from ionic osmolytes to urea during body fluid volume reduction is similar to that seen in aestivating animals. ClinicalTrials.org Identifier: NCT03972475

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Section: Methodsmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…We conducted a posthoc study on data from a multicenter study on ICU patients in the post resuscitative phase to test this hypothesis. 6 …”

Section: Introductionmentioning

confidence: 99%

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The Contribution of Plasma Urea to Total Osmolality During Iatrogenic Fluid Reduction in Critically Ill Patients

et al. 2021

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Dextrose 5% versus normal saline as maintenance fluid therapy in patients with septic shock (DEMANDS): a randomized controlled trial

Fayed,

Elsayed Osman,

Megahed

et al. 2024

Alexandria Journal of Medicine

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Fluid administration and fluid accumulation in intensive care units—Protocol for an international inception cohort study (FLUID‐ICU)

Molin,

Wichmann,

Schønemann‐Lund

et al. 2024

Acta Anaesthesiol Scand

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IntroductionFluid accumulation is associated with adverse outcomes in critically ill patients admitted to the intensive care unit (ICU). Fluid administration in the ICU may be a clinically relevant source of fluid accumulation in ICU patients. However, the extent is unknown, and no standard definition exists. We aim to provide epidemiological data on fluid accumulation, risk factors, use of fluid removal strategies, patient outcomes and describe current fluid administration practices in the ICU.MethodsWe will conduct an international 14‐day inception cohort study including a minimum of 1000 acutely admitted adult ICU patients. Data will be collected from medical records and laboratory reports at baseline and daily from ICU admission to discharge with a maximum of 28 days. Follow‐up will be performed on day 90 after inclusion. The primary outcome is the number of patients with fluid accumulation. Secondary outcomes include the number of days with fluid accumulation, use of active fluid removal, days alive without life support at day 28, days alive and out of hospital day 90, and all‐cause mortality at day 90. Furthermore, we will assess risk factors for fluid accumulation and its association with 90‐day mortality and report on the types of fluid administration.ConclusionThis international inception cohort study will provide contemporary epidemiological data on fluid administration and fluid accumulation in adult ICU patients.

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Hidden sources of fluids, sodium and potassium in stabilised Swedish ICU patients

Cited by 8 publications

References 21 publications

The Contribution of Plasma Urea to Total Osmolality During Iatrogenic Fluid Reduction in Critically Ill Patients

The Contribution of Plasma Urea to Total Osmolality During Iatrogenic Fluid Reduction in Critically Ill Patients

Dextrose 5% versus normal saline as maintenance fluid therapy in patients with septic shock (DEMANDS): a randomized controlled trial

Fluid administration and fluid accumulation in intensive care units—Protocol for an international inception cohort study (FLUID‐ICU)

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