Body Water and Electrolyte Composition in Acute Renal Failure

Body water and electrolyte contents have been measured by means of muscle biopsy analysis in 11 patients with untreated acute renal failure and in one patient during the diuretic recovery phase of his illness. Patients with acute oliguric renal failure show two main types of imbalance. One group shows evidence of a reduction in extracellular sodium and chloride with normal intracellular water and electrolytes. These findings are thought to be due to a combination of excess urinary salt loss during the development of oliguric renal failure, and inadequate replacement of extrarenal electrolyte losses. A second group shows overhydration of both extra- and intracellular phases, associated with an excess of sodium and chloride. The intracellular potassium concentration is reduced, owing to the intracellular water excess. The patient studied during the diuretic recovery phase of acute renal failure showed a marked loss of sodium and chloride, which emphasizes the necessity to replace urinary electrolyte losses at this stage of the illness. It is often extremely difficult to assess fluid and electrolyte balance in patients presenting with acute renal failure, and muscle biopsy analysis or isotope dilution studies may be required before accurate replacement therapy is possible.     

A clinical approach to common electrolyte problems: 2. Potassium imbalances.

A clinical approach to potassium imbalances is presented. Hypokalemia is rarely due solely to a reduced intake of potassium; instead, it usually results from a potassium flux into the cells or increased loss of the element, at times combined with a decreased intake. The clinician must seek the cause of the intracellular flux or the source of the gastrointestinal or renal loss. The causes of gastrointestinal losses are generally self evident. Renal potassium wasting, though, generally results from increased mineralocorticoid activity, an increased rate of urinary flow or of sodium delivery to the distal nephron, or both, hypomagnesemia or a combination of these factors. Hyperkalemia may be factitious, but usually it is caused by a flux of potassium from the cells or a decrease in the renal loss of potassium, the latter being mediated by a reduction in renal function, mineralocorticoid activity, or the rate of urinary flow or sodium delivery, or both. In both hypokalemia and hyperkalemia, treatment must be guided by the specific clinical circumstances.     

The effects of lactose on human erythrocytes

Human erythrocytes suspended in isotonic lactose solution lost potassium and continued to lose potassium even when resuspended in isotonic sodium chloride. The same phenomenon was observed when the cells were suspended in an isotonic solution of the sodium salt of glutamate, a nonpenetrating anion. The presence of 5 mEq per liter of sodium chloride in the lactose or sodium glutamate suspensions greatly reduced the initial potassium loss and the potassium loss when the cells were resuspended in sodium chloride solution. Salts of nonpenetrating anions were less or not effective in blocking lactose damage. The results indicate that absence of penetrating anions in the suspending media is the initiating condition of lactose damage. Chloride and consequently potassium are lost from the erythrocyte. Changes in cellular ionic pattern and/or changes in the cell membrane result in a nontransient damage manifested by continued potassium loss by lactose-treated cells resuspended in isotonic NaCl.     

Effects of impermeant medium ions on the composition of rabbit renal cortical slices

When incubated in isosmotic oxygenated medium in which chloride was completely replaced by gluconate, rabbit renal cortical slices lost chloride with sodium, potassium and water before reaching a new steady-state composition after 15-30 min. When corrected for extracellular space, there was an electroneutral loss of alkali metal cations (Na + K) with chloride, accompanied by isosmotic loss of water from the cells. The losses of chloride and water were independent of medium pH over the range of 6.4-8.2, and were the same with potassium rather than sodium as the dominant medium cation. Incubation in isosmotic sodium chloride medium restored tissue composition of slices transferred from gluconate medium. This recovery was not dependent specifically upon medium chloride, for slice water content also recovered when nitrate rather than chloride was substituted for medium gluconate. With sodium completely replaced by n-methyl d-glucamine (nmdG+), cells in slices lost far more sodium and potassium than chloride before reaching a new steady-state composition after some 30 min. However, the loss of water was as predicted from the total losses of measured inorganic ions. With sodium and chloride completely replaced by nmdG+ and gluconate, there was a greater loss of water than found with unilateral substitutions. Again, the combined loss of diffusible inorganic cations exceeded the loss of chloride but the water loss was that expected for isosmotic loss accompanying the measured losses of ions. These results reveal that both gluconate and nmdG+ behave as impermeant ions in this tissue preparation. It is suggested that, in the absence of medium sodium, sodium-hydrogen exchange is inhibited. Retained hydrogen ions are buffered on charged cellular non-diffusible solutes and the associated hydroxyl (or bicarbonate) ions are lost from the cells accompanied by the inorganic univalent cations lost in excess of chloride in nmdG+ medium.     

Ionophore characteristics of heliomycin]

A highly purified product, identified as a well-known antibiotic geliomycin, has been derived by gradient extraction of the mycelium from Streptomyces robefuscus isolated from soil specimens as a result of purposeful search for a producer of hydrophobic ionophore antibiotics. The ionophore properties of geliomycin are highly labile and inducible. Cationic or anionic nature and the angle of the function performed depend on the concentration, type of electrolyte, protocol of measurements, and some additives used for the preparation of geliomycin electrodes to measurements. Stable development of the cationic function was detected for potassium chloride. The lability of ionophore properties was the highest with ammonium chloride as the electrolyte. Ammonium acetate and potassium and sodium chlorides notably increased the stability of geliomycin electrodes. Selective activity of geliomycin towards potassium ion is a more permanent characteristic. The results permit a conclusion about the inducibility of ionophore properties of geliomycin, which may play an important role in the vital activity of the producer and manifest as a regulatory factor in maintenance of water and acid base balance.     

Nutritional interrelationships of electrolytes and amino acids

Evidence for interactions between amino acid and electrolyte metabolism is reviewed. Variations in dietary sodium, potassium, and chloride concentrations affect acid-base balance and also influence the severity of the lysine-arginine antagonism. High dietary levels of Na and K salts of metabolizable organic acids alleviate, whereas excessive dietary chloride exacerbates, the antagonism. Potassium deficiency causes depletion of intracellular potassium and increased intracellular accumulation of basic amino acids. These variations in electrolytes, which alter acid-base balance, also influence the metabolism of glutamic acid and the excretion of nitrogen. It is hypothesized that basic amino acids as well as glutamic acid and glutamine may have an important role in metabolic regulation of acid-base balance.     

Sodium, potassium, calcium, magnesium, zinc, citrate and chloride content of human prostatic and seminal fluid

The ionic composition of human prostatic fluid varied greatly between individuals, reflecting the secretory activity of the gland and the presence or absence of prostatic inflammatory disease. In normal prostatic fluid the major anion was citrate, while chloride concentrations were lower. Their counterions were mainly sodium and potassium, together with calcium, magnesium and zinc. Prostatic secretions from men with prostatitis comprised mainly sodium and chloride. The electrolytes were closely correlated to each other (except for sodium, which was essentially invariant at about 145 nm). The molar changes per mole of citrate were about 0.52, potassium; -0.53, chloride; 0.17, calcium; 0.14, magnesium; and 0.09, zinc. The pH was also associated with citrate, decreasing from 8.0 to 6.2 as the citrate increased. These various ionic changes can be explained as responses to citrate secretion, without the need to propose specific transport mechanisms for the other ions measured. The marked effect of prostatic inflammation on the composition of prostatic fluid can be seen as being due mainly to decreased secretion rather than active modification.     

武夷山甜槠生态系统的养分平衡研究（英文）

本文通过比较大气降水的养分输入与由地表径流和地下渗流的养分输出,对武夷山甜槠林生态系统的养分平衡进行了研究。结果表明：在1993年4月至1994年4月期间,通过大气降水进入甜槠林的养分元素以N最高,为34.207kg·hm-2,其余依次为Ca(22.99kg·hm-2)、S(12.722kg·hm-2)、Na(6.679kg·hm-2)、K(3.558kg·hm-2)和Mg(2.057kg·hm-2),以P的输入最低,仅1.779kg·hm-2;由地表径流和地下渗流的养分输出总量N、P、K、Ca、Mg、S、Na分别为5.68、1.016、7.345、3.430、0.620、0.534、0.576kg·hm-2,以K的输出量最高,S的输出最少。其中,通过地下渗流的养分损失占输出总量的85.97％～96.38％,而地表径流的养分输出仅占总输出的3.62％～14.03％;在该系统中,N、Ca和S有大量的积累(分别为28.527、19.560和12.188kg·hm-2),Mg和Na有少量积累(分别为 1.437和6.103kg·hm-2),P基本上处于平衡状态(0.763kg·hm-2),而K则为净的输出损失(-3.787kg·hm-2)。岩石风化对于该生态系统K的补偿可能起重要作用,而其他养分元素仅通过降水输入即可得到补充。     

Potassium loading effect on potassium balance in athletes during prolonged restriction of muscular activity

Negative potassium balance during hypokinesia (decreased number of kilometers taken/day) is not based on the potassium shortage in the diet, but on the impossibility of the body to retain potassium. To assess this hypothesis, we study the effect of potassium loading on athletes during prolonged hypokinesia (HK). Studies were done during 30 d of a pre-HK period and during 364 d of an HK period. Forty male athletes aged 23–26 yr were chosen as subjects. They were divided equally into four groups: unloaded ambulatory control subjects (UACS), unloaded hypokinetic subjects (UHKS), loaded hypokinetic subjects (LHKS), and loaded ambulatory control subjects (LACS). For the simulation of the hypokinetic effect, the LHKS and UHKS groups were kept under an average running distance of 1.7 km/d. In the LACS and LHKS groups, potassium loading tests were done by administering 95.35 mg KC1 per kg body weight. During the pre-HK and HK periods and after KC1 loading tests, fecal and urinary potassium excretion, sodium and chloride excretion, plasma potassium, sodium and chloride concentration, and potassium balance were measured. Plasma renin activity (PRA) and plasma aldosterone concentration was also measured. Negative potassium balance increased significantly (p < -0.01) in the UHKS and LHKS groups when compared with the UACS and LACS groups. Plasma electrolyte concentration, urinary electrolyte excretion, fecal potassium excretion, PRA, and PA concentration increased significantly (p ≤ 0.01) in the LHKS and UHKS groups when compared with LACS and UACS groups. Urinary and fecal potassium excretion increased much more and much faster in the LHKS group than in the UHKS group. By contrast, the corresponding parameters change insignificantly in the UACS and LACS groups when compared with the base line control values. It was concluded that urinary and fecal potassium excretion increased significantly despite the presence of negative potassium balance; thus, negative potassium balance may not be based on potassium shortage in the diet because of the impossibility of the body to retain potassium during HK.     

Influence of lithium on biliary electrolyte and bile acid excretion in young and adult rats

The influence of a three-day lithium treatment on the biliary electrolyte and bile acid output was determined in 20- and 105-day-old rats. The osmolarity of bile and the biliary concentrations of cations (Na+, K+, Ca++, H+) and chloride were higher in untreated young rats than in adults, although bile flow and bile acid excretion rates of the young and adult animals were comparable. Lithium increased the biliary excretion of sodium, potassium and calcium and decreased the excretion of chloride and bicarbonate ions in both age groups. In contrast, lithium treatment reduced bile acid excretion only in adult rats. The lithium-induced alterations in biliary ion elimination may be caused by an intracellular replacement of sodium and/or potassium. These results indicate that after lithium treatment cation loss occurs in the young as well as in the adult organism not only via urine and faeces but also via bile.     

再水合溶液能有效改善急性脱水女举重运动员的运动表现

本研究旨在探讨女子举重运动员急性脱水后口服4种不同组成的溶液,对液体存留率、胃肠道舒适度、血液值和无氧动力的影响。本研究以12位大学生女子举重运动员为对象,采交叉、平衡次序设计;研究参与者于脱水2%体重后分别补充相当于1.5倍脱水量的低渗透压电解质液(HES)、等渗透压电解质液(IES)、运动饮料(SB)或纯水(W),补充时间为脱水后立即、再水合期的30 min、60 min及90 min。再水合期间记录胃肠舒适分数、测量体重(计算液体存留率),并采集静脉血以测量血液渗透压、葡萄糖及钠、钾与氯离子,于脱水前与再水合期120 min时进行Wingate无氧动力测验。研究结果显示:补充HES、IES及运动饮料(SB)于再水合期90 min时的胃肠道舒适分数显著低于补充纯水(W)、而补充3种溶液于再水合期60 min时的血糖值则显著高于补充纯水(W),补充HES于再水合期120 min时的血钾值显著高于补充运动饮料(SB)及纯水(W);但补充4种溶液后的无氧动力与液体存留率并无显著差异。本研究证实举重运动员急性脱水后补充4种不同口服再水合溶液并不会影响再水合后的无氧动力,但补充含有糖类及电解质的溶液能有较佳的胃肠道舒适度,并血糖与血液电解质有维持的效果。     

A study of passive potassium efflux from human red blood cells using ion-specific electrodes

Summary Using ion-specific electrodes, the potassium leakage induced by ouabain in human erythrocytes can be measured continuously and precisely near physiological conditions. Upon small additions of isotonic sucrose solution to a suspension of red cells in physiological saline the passive potassium efflux increases proportionally to the chloride ratio. The same result is obtained upon addition of hypertonic sucrose solution, suggesting that neither osmolarity nor intracellular concentrations have any influence on the passive potassium efflux. The independence of the potassium efflux and osmolarity can be verified by addition of a penetrating substance like glucose to the cell suspension. Adding water or hypertonic sodium chloride solution shows that the potassium efflux increases slightly in more concentrated salt solutions. Inasmuch as it can be interpreted as a pure ionic strength effect, this result supports the hypothesis of independence of potassium efflux and intracellular concentrations. The results of this investigation together with other studies show that the passive permeability of the human red blood cell to potassium depends uniquely on the membrane potential near physiological conditions, while it depends on parameters such as pH or concentrations for large membrane potentials. This suggests that two different mechanisms of transport might be involved: one would control the permeability under normal conditions; the other would represent a leak through the route normally used by anions and become important only under extreme conditions.     

Ion Exchange Properties of the Canine Carotid Artery

Properties of the ion exchange mechanisms in the arterial wall were investigated by comparing water and electrolyte contents, and by measuring the steady-state entry of ²²Na, ⁴²K, and ²⁶Cl under similar in vitro conditions. Overnight incubation of freshly dissected slices at 2°C resulted in an accumulation of sodium, chloride, and water and a loss of potassium. Subsequent incubation at 37°C in a physiological solution resulted in a reversal of these processes. Loss of water, sodium, and chloride at 37°C could also take place into a potassium-free solution. Under all conditions studied the quantity of fast exchanging electrolyte (half time less than 3 min) exceeded that contained in the inulin and sucrose spaces. The excess could not be attributed to connective tissue adsorption. A kinetic model was applied to the flux data which incorporated two simultaneous processes: bulk diffusion and a reversible reaction. The assumption that the cell membrane behaved as a discrete barrier for the exchange of all cell electrolyte was relaxed in this approach. A theory based upon the physicochemical properties of proteins, ions, and water in biological systems provided a physical basis for the kinetic model, and for interpreting the ion exchange properties of the vascular wall.     

Water and ion balance in the tissues of the dehydrated cockroach, Periplaneta americana

Cockroaches dehydrated for 8 days lost nearly 50% of their haemolymph volume and approx 25% of their tissue water. Haemolymph osmolality and sodium, potassium, and chloride concentrations in the haemolymph and tissue water were all regulated within narrow limits. It is confirmed that sodium and potassium ions are sequestered within the fat body during periods of dehydration. The increase in sodium and potassium ions in the fat body is shown to arise from ionic regulation of haemolymph and other tissues. During periods of rehydration, sodium and potassium concentrations decrease in the fat body and haemolymph volume and ionic concentrations return to near original levels. A small proportion of the surplus haemolymph chloride ions is shown to be associated with the cuticle during times of water deprivation.     

Cell volume regulation in liver

The maintenance of liver cell volume in isotonic extracellular fluid requires the continuous supply of energy: sodium is extruded in exchange for potassium by the sodium/potassium ATPase, conductive potassium efflux creates a cell-negative membrane potential, which expelles chloride through conductive pathways. Thus, the various organic substances accumulated within the cell are osmotically counterbalanced in large part by the large difference of chloride concentration across the cell membrane. Impairment of energy supply leads to dissipation of ion gradients, depolarization and cell swelling. However, even in the presence of ouabain the liver cell can extrude ions by furosemide-sensitive transport in intracellular vesicles and subsequent exocytosis. In isotonic extracellular fluid cell swelling may follow an increase in extracellular potassium concentration, which impairs potassium efflux and depolarizes the cell membrane leading to chloride accumulation. Replacement of extracellular chloride with impermeable anions leads to cell shrinkage. During excessive sodium-coupled entry of amino acids and subsequent stimulation of sodium/potassium-ATPase by increase in intracellular sodium activity, an increase in cell volume is blunted by activation of potassium channels, which maintain cell membrane potential and allow for loss of cellular potassium. Cell swelling induced by exposure of liver cells to hypotonic extracellular fluid is followed by regulatory volume decrease (RVD), cell shrinkage induced by reexposure to isotonic perfusate is followed by regulatory volume increase (RVI). Available evidence suggests that RVD is accomplished by activation of potassium channels, hyperpolarization and subsequent extrusion of chloride along with potassium, and that RVI depends on the activation of sodium hydrogen ion exchange with subsequent activation of sodium/potassium-ATPase leading to the respective accumulation of potassium and bicarbonate. In addition, exposure of liver to anisotonic perfusates alters glycogen degradation, glycolysis and probably urea formation, which are enhanced by exposure to hypertonic perfusates and depressed by hypotonic perfusates.     

Post-exercise rehydration in man: effects of electrolyte addition to ingested fluids

This study examined the effects on water balance of adding electrolytes to fluids ingested after exercise-induced dehydration. Eight healthy male volunteers were dehydrated by approximately 2% of body mass by intermittent cycle exercise. Over a 30-min period after exercise, subjects ingested one of the four test drinks of a volume equivalent to their body mass loss. Drink A was a 90 mmol·l^–1 glucose solution; drink B contained 60 mmol·l^–1 sodium chloride; drink C contained 25 mmol·l^–1 potassium chloride; drink D contained 90 mmol·l^–1 glucose, 60 mmol·l^–1 sodium chloride and 25 mmol·l^–1 potassium chloride. Treatment order was randomised. Blood and urine samples were obtained at intervals throughout the study; subjects remained fasted throughout. Plasma volume increased to the same extent after the rehydration period on all treatments. Serum electrolyte (Na⁺, K⁺ and Cl^–) concentrations fell initially after rehydration before returning to their pre-exercise levels. Cumulative urine output was greater after ingestion of drink A than after ingestion of any of the other drinks. On the morning following the trial, subjects were in greater net negative fluid balance [mean (SEM);P<0.02] on trial A [745 (130) ml] than on trials B [405 (51) ml], C [467 (87) ml] or D [407 (34) ml]. There were no differences at any time between the three electrolyte-containing solutions in urine output or net fluid balance. One hour after the end of the rehydration period, urine osmolality had fallen, with a significant treatment effect (P=0.016); urine osmolality was lowest after ingestion of drink A. On the morning after the test, subjects were in greater net negative sodium balance (P<0.001) after trials A and C than after trials B and D. Negative potassium balance was greater (P<0.001) after trials A and B than after C and D. Chloride balance was positive after drink D and a smaller negative balance (P<0.001) was observed after drink B than after A and C. These results suggest that although the measured blood parameters were similar for all trials, better whole body water and electrolyte balance resulted from the ingestion of electrolyte-containing drinks. There appeared, however, to be no additive effect of including both sodium and potassium under the conditions of this experiment.     

Hyperosmotic instillation of rat stomach.

Instillation of equally hyperosmotic solutions (1000 m0sm/kg) of NaCl, KCl, MgCl₂, or dextrose depressed the electrical potential difference and the spontaneous acid secretion of rat stomachs. Luminal osmolality declined only slightly after hyperosmotic dextrose instillation, but loss of luminal chloride followed hyperosmotic salt instillation. Comparable losses of luminal sodium or potassium were observed. These changes result from a hyperosmotic alteration of ion transport through the gastric mucosa.     

Ion channels in urinary bladder.

Urinary epithelia separate urine from interstitial fluid. In the mammal, this tight epithelium has a limited transport capacity but is capable of moving sodium from urine to blood through an aldosterone-sensitive cellular pathway. In lower vertebrates, absorption of ions and water from the urine can contribute significantly to fluid and electrolyte homeostasis. Transepithelial ion transport and maintenance of cellular composition are interdependent, requiring a balance between movements across the apical and basolateral plasma membranes through a variety of pathways including electrodiffusion through ion channels. A variety of such channels has been identified in urinary epithelia. Apical membranes contain amiloride-sensitive, highly selective sodium channels of low conductance (approximately 5-10 pS). There is evidence that in mammalian bladders trypsin-like enzymes in the urine continually degrade these channels, decrease in cation selectivity being followed by loss of the channels from the membrane. New channels stored in the cytoplasm appear to provide a source for replenishment of the membrane. Other channels of higher conductance and lower selectivity have also been described in both mammalian and amphibian bladders, but their physiological significance remains to be established. Basolateral membranes contain potassium channels. In the mammalian bladder, in which chloride appears to be distributed at electrochemical equilibrium, chloride conductance exceeds potassium conductance and patch clamp studies have revealed a chloride channel of conductance approximately 60 pS detectable immediately on patch excision and active at normal membrane potentials. In the amphibian bladder, a variety of findings indicates the presence of a basolateral membrane chloride conductance, but patch clamp data are not yet available.     

Metabolic Studies,Aldosterone Secretion Rate,and Plasma Renin after Carbenoxolone Sodium

A formal metabolic study of carbenoxolone sodium (Biogastrone) 300 mg./day has been performed for 17 days on a woman with gastric ulcer who in a previous 21-day trial, on a 52-mEq sodium diet, showed weight gain, retention, and rise in plasma sodium and chloride concentrations, as well as hypokalaemia without change in potassium balance. In the present trial sodium intake was restricted to 26 mEq/day; while plasma electrolyte changes of lesser degree still occurred, there was no retention of water, sodium, or chloride. Aldosterone secretion in the control period was 202 μg./24 hours, and fell to 74 μg./24 hours after carbenoxolone, but plasma renin was unchanged.These results suggest that the mineralocorticoid effects of carbenoxolone (and presumably of liquorice and its other derivatives) are due to an intrinsic aldosterone-like action, and that, with sodium deprivation, aldosterone secretion is suppressed by a mechanism which is not renin-mediated—possibly hypokalaemia.     

Electrophysiology of bull spermatozoa : Correlations with motility

The bioelectric characterization of bull spermatozoa was based on the establishment of a standard, for comparison with cells subjected to manipulation of the ionic environment. In addition to potassium and sodium, chloride concentration was also found to have an effect on bull spermatozoa membrane potential and motility. The chloride effect on potential was similar in magnitude to that of sodium but smaller than that of potassium. Potential difference in potassium, sodium and chloride supplemented media was related to the amplitude of the flagellar wave.