Water Distribution in Normal Subjects and in Patients With Laënnec's Cirrhosis

Abstract

The development of ascites and edema in patients with Laennec's cirrhosis is believed by some to be due to a deranged hormonal balance which results in salt and water retention (1-5). The present investigation analyzes the components of total body water in 22 control subjects and 15 patients with Laennec's cirrhosis to ascertain the distribution of the retained salt and water. METHODSThe control subjects were patients on the surgical wards for minor procedures which influence water and electrolyte balance minimally. The patients with cirrhosis were admitted for therapeutic operative procedures, observation, or treatment of ascites.Plasma volume was measured by the method of Gibson, Evelyn, and Gregerson using the dye, T-1824, (Evans Blue) (6, 7). Blood volume was calculated from the value of the plasma volume or T-1824 space and the hematocrit. Radioactive sodium was utilized to measure the extracellular space plus the additional space into which sodium presumably passes. Total body water was determined by the dilution of injected deuterium oxide.The patients were in a basal state at the time of the study. After taking a pre-injection blood sample the needle was left in the vein and to it was attached a threeway stopcock, to one arm of which was fastened a syringe containing saline. To the other arm of the stopcock was attached a 50 ml. burette equipped with rubber tubing and adapter which was filled to the adapter with a saline solution containing approximately 70 microcuries of radioactive sodium 1 and 3 ml. of 0.45 per cent dye T-1824 in each 10 ml. The stopcock was opened and about 10 ml. of this solution was allowed to enter by gravity. The exact quantity injected was measured on the burette and the material left in the stopcock and needle washed into the vein with the saline in the syringe. The burette and adapter were then removed, and a weighed 50-ml. syringe con-1 Radioactive sodium received from Brookhaven National Laboratories as the carbonate (Naf?CO,) was first prepared by diluting in sterile saline, neutralizing with the calculated amount of 6 N hydrochloric acid, sterilizing by filtration through an ultrafine sintered glass filter, and boiling on a hot plate for 15 minutes. The 70 microcuries given represents a dosage of about 0.1 roentgen, one-third the accepted tolerance level of 0.3 roentgen per week.taining the deuterium oxide-saline solution 2 was attached.The stopcock was again opened and the deuterium oxide was injected under slight pressure in a period' of about 2 minutes. The deuterium oxide remaining in stopcock and needle was washed into the vein in a manner similar to that of the first solution. The difference between the weights of the full and the empty syringe was taken as the weight of the deuterium oxide solution injected.Ten minutes after the injection of the dye T-1824 and the radioactive sodium, a blood sample was taken for determination of plasma volume. Three hours after the injection a blood sample was taken for measuring sodium and deuterium oxide space. Twenty-four hours a...

Total Body Water and Total Exchangeable Sodium in Edematous States Due to Cardiac, Renal or Hepatic Disease 1

“…The renal and hepatic disease groups, exhibited the theoretical change expected in individuals with straightforward extracellular fluid accumulation of moderate severity. Values of this order of magnitude for patients with cirrhosis of the liver have been reported by others (9).…”

D2O Equilibration Rates in Thermally Injured Animals.

“…Recently several other studies of this response have been reported (4)(5)(6)(7)(8) in both atrial and ventricular musculature of different species. In the experiments on rhythm.…”

“…Some investigators have allowed 3 hours for D20 to equilibrate in certain pathologic states; thus they imply some delay in equilibration (6). Isotopes have facilitated this work; but no isotope is ideal since each has its own peculiar advantages and disadvantages.…”

“…Since 1950, most investigators have assumed that equilibration was co'mplete in 2 or 3 hours regardless of the pathologic state (6). The possibility that sampling a t 3 hours did not allow adequate time for equilibration was suggested by Last et aZ.…”