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1.
The Effect of Hypo-Hydration on Mood and Cognition Is Influenced by Electrolyte in a Drink and Its Colour: A Randomised Trial.
Cousins, AL, Young, HA, Thomas, AG, Benton, D
Nutrients. 2019;(9)
Abstract
Traditionally, it has been thought necessary to lose 2% of body mass due to dehydration to disrupt functioning, although recently, adverse effects have been reported, with a loss of 0.5%-0.7%. It is, however, unclear whether the response to small reductions in mass reflects dehydration as homeostatic mechanisms are thought to be effective. As psychological responses are most commonly reported, it is strange that the possibility of a placebo response has not been considered. Individuals were therefore subject to a temperature of 30 °C for three hours, and mood and cognition were monitored. To consider changes in hydration status, drinks were compared, differing in their ability to rehydrate due to the presence or absence of electrolytes. The possibility of a placebo response was considered by comparing the response to plain or coloured water. Not drinking was disruptive, although a combination of plain water and electrolyte tended to be the most effective means of preventing a decline in mood, indicating a role for rehydration after a loss of 0.66% body mass. There was, however, also evidence of a placebo response: a combination of plain water and electrolyte tended to be better able to prevent a decline in mood than coloured water and electrolyte.
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2.
Diuretics prescribing in chronic kidney disease patients: physician assessment versus bioimpedence spectroscopy.
Khan, YH, Sarriff, A, Adnan, AS, Khan, AH, Mallhi, TH
Clinical and experimental nephrology. 2017;(3):488-496
Abstract
INTRODUCTION The relationship between hypertension and fluid overload in pre-dialysis CKD patients need to be elucidated. Current study aimed to find relationship between fluid overload and hypertension along with prescribed diuretic therapy using bioimpedance spectroscopy (BIS). METHODOLOGY A prospective observational study was conducted by inviting pre-dialysis CKD patients. Fluid overload was assessed by BIS. RESULTS A total of 312 CKD patients with mean eGFR 24.5 ± 11.2 ml/min/1.73 m2 were enrolled. Based on OH value ≥7 %, 135 (43.3 %) patients were hypervolemic while euvolemia was observed in 177 (56.7 %) patients. Patients were categorized in different regions of hydration reference plot (HRP) generated by BIS i.e., 5.1 % in region-N (normal BP and fluid status), 20.5 % in region I (hypertensive with severe fluid overload), 29.5 % in region I-II (hypertensive with mild fluid overload), 22 % in region II (hypertensive with normohydration), 10.2 % in region III (underhydration with normal/low BP) and 12.5 % in region IV (normal BP with severe fluid overload). A total of 144 (46 %) patients received diuretics on basis of physician assessment of BP and edema. Maximum diuretics 100 (69.4 %) were prescribed in patients belonging to regions I and I-II of HRP. Interestingly, a similar number of diuretic prescriptions were observed in region II (13 %) and region IV (12 %). Surprisingly, 7 (4.9 %) of patients in region III who were neither hypervolemic nor hypertensive were also prescribed with diuretics. CONCLUSION BIS can aid clinicians to categorize CKD patients on basis of their fluid status and provide individualized pharmacotherapy to manage hypertensive CKD patients.
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3.
Hemodynamics and Salt-and-Water Balance Link Sodium Storage and Vascular Dysfunction in Salt-Sensitive Subjects.
Laffer, CL, Scott, RC, Titze, JM, Luft, FC, Elijovich, F
Hypertension (Dallas, Tex. : 1979). 2016;(1):195-203
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Abstract
We investigated 24-hour hemodynamic changes produced by salt loading and depletion in 8 salt-sensitive (SS) and 13 salt-resistant (SR) normotensive volunteers. After salt loading, mean arterial pressure was higher in SS (96.5±2.8) than in SR (84.2±2.7 mm Hg), P<0.01, owing to higher total peripheral resistance in SS (1791±148) than in SR (1549±66 dyn*cm(-5)*s), P=0.05, whereas cardiac output was not different between groups (SS 4.5±0.3 versus SR 4.4±0.2 L/min, not significant). Following salt depletion, cardiac output was equally reduced in both groups. Total peripheral resistance increased 24±6% (P<0.001) in SR, whose mean arterial pressure remained unchanged. In contrast, total peripheral resistance did not change in SS (1±6%, not significant). Thus, their mean arterial pressure was reduced, abolishing the mean arterial pressure difference between groups. SS had higher E/e' ratios than SR in both phases of the protocol. In these 21 subjects and in 32 hypertensive patients, Na(+) balance was similar in SR and SS during salt loading or depletion. However, SR did not gain weight during salt retention (-158±250 g), whereas SS did (819±204), commensurate to iso-osmolar water retention. During salt depletion, SR lost the expected amount of weight for iso-osmolar Na(+) excretion, whereas SS lost a greater amount that failed to fully correct the fluid retention from the previous day. We conclude that SS are unable to modulate total peripheral resistance in response to salt depletion, mirroring their inability to vasodilate in response to salt loading. We suggest that differences in water balance between SS and SR indicate differences in salt-and-water storage in the interstitial compartment that may relate to vascular dysfunction in SS.
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4.
Safety of femtosecond laser-assisted cataract surgery: assessment of aqueous humour and lens capsule.
Yu, AY, Lin, CX, Wang, QM, Zheng, MQ, Qin, XY
Acta ophthalmologica. 2016;(7):e534-e540
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Abstract
PURPOSE To investigate the effect of femtosecond laser-assisted cataract surgery (FLACS) on aqueous humour and lens capsule. METHODS This prospective randomized comparative study enrolled 19 eyes that underwent FLACS as the trial group and 20 eyes that underwent conventional phacoemulsification as the control group. The femtosecond laser platform (LLS-fs 3D; LensAR, Orlando, FL, USA) was used to generate capsulotomy (laser energy 8 μJ) and lens fragmentation (laser energy 10 μJ). Morphology of the cutting edge and cells of anterior capsule was assessed by light microscopy. The proteins in the aqueous humour were identified by mass spectrometry (Ultraflex III TOF/TOF; Bruker Dalton, Bremen, Germany). Electrolyte in the aqueous humour was detected by a chemistry analyzer (Aeroset Clinical Chemistry Analyzer; Abbott Laboratories, Abbott Park, IL, USA). RESULTS The cutting edge of anterior capsule was saw-tooth-shaped under magnification of 200× and 400× in the trial group, while it was smooth in the control group. Intact cells were found in the boundary area next to the cutting edge of anterior capsule in both groups. β-Crystallin B1, γ-crystallin S and transferrin were detected in the aqueous humour in the trial group. The concentrations of K+ , Na+ and Cl- in the aqueous humour in the trial group differed significantly from those in the control group (p = 0.02, 0.03 and 0.04, respectively). CONCLUSION Femtosecond laser-assisted cataract surgery (FLACS) causes release of transferrin and crystallin from lens to aqueous humour and results in significant changes in the concentrations of K+ , Na+ and Cl- in aqueous humour. However, these changes due to FLACS have no clinical significance or toxicity.
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The use of balanced HES 130/0.42 during complex cardiac surgery; effect on blood coagulation and fluid balance: a randomized controlled trial.
Schramko, A, Suojaranta-Ylinen, R, Niemi, T, Pesonen, E, Kuitunen, A, Raivio, P, Salmenperä, M
Perfusion. 2015;(3):224-32
Abstract
INTRODUCTION Colloids and crystalloid are used during cardiac surgery for priming of the cardiopulmonary bypass (CPB) circuit. Colloids may decrease postoperative fluid balance because of their high oncotic pressure and low risk of fluid extravasation. On the other hand, colloids have been shown to impair blood coagulation. MATERIALS AND METHODS In a prospective, randomized, double-blinded study, 50 patients scheduled for coronary artery bypass grafting or a valve procedure were planned to be randomized to receive either balanced 6% HES130/0.42 or Ringer-acetate solution for CPB priming. Randomization was stopped prematurely after 35 randomized patients (19 in the HES and 16 in the Ringer groups) because of the published report where HES130/0.42 was associated with impaired renal function. Effects on haemostasis and fluid balance were investigated. RESULTS The rotational thromboelastometry (ROTEM®) parameters and chest tube drainage on the first postoperative morning (1POM) were comparable between the groups (p>0.05). However, patients in the HES group needed more blood and blood product transfusions. The total volume administered into the CPB circuit was lower in the HES than in the Ringer (RIN) group, 2905±1049 mL versus 3973±1207 mL (p=0.011), but there was no statistically significant difference in total fluid balance on the 1POM (5086±1660 mL in the HES group versus 5850±1514 mL in the RIN group, respectively). CONCLUSIONS After complex cardiac surgery, the use of balanced 6% HES130/0.42 solution for CPB circuit priming did not impair haemostasis measured by ROTEM®, but it increased the need for transfusions. Fluid balance after CPB was less positive in the HES group, but, on the 1POM, it was comparable between the groups.
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Effects of insulin detemir and NPH insulin on renal handling of sodium, fluid retention and weight in type 2 diabetic patients.
Hendriksen, KV, Jensen, T, Oturai, P, Feldt-Rasmussen, B
Diabetologia. 2012;(1):46-50
Abstract
AIMS/HYPOTHESIS In type 2 diabetic patients, insulin detemir (B29Lys(ε-tetradecanoyl),desB30 human insulin) induces less weight gain than NPH insulin. Due to the proposed reduction of tubular action by insulin detemir, type 2 diabetic patients should have increased urinary sodium excretion, thereby reducing extracellular volume and body weight when changed from NPH insulin to insulin detemir. METHODS In a randomised, open-labelled, two-way crossover study of 24 patients with type 2 diabetes, patients were first treated with NPH insulin or insulin detemir for 8 weeks. Thereafter, they were changed to the other insulin for 8 weeks. In a third 1 week period, they were changed back to the first insulin. RESULTS At the end of 8 weeks, body weight was reduced by 0.8 ± 0.2 kg (mean ± SEM) on insulin detemir compared with NPH insulin (p < 0.01). After insulin detemir treatment, we also observed a significant reduction of lean body mass (0.8 ± 0.2 kg, p < 0.05) and a non-significant reduction of extracellular volume (0.8 ± 0.5 l/1.73 m², p = 0.14). The weight loss occurred after as early as 1 week (0.8 ± 0.2 kg, p < 0.001), with a simultaneous and transient increase of urinary sodium excretion (p = 0.07). CONCLUSIONS/INTERPRETATION Insulin detemir induces significant and sustained weight loss, which is first observed at 1 week after changing from NPH insulin. The initial weight loss seems to be related to changes in fluid volume and may reflect changed insulin action in the kidneys.
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On-ice sweat rate, voluntary fluid intake, and sodium balance during practice in male junior ice hockey players drinking water or a carbohydrate-electrolyte solution.
Palmer, MS, Logan, HM, Spriet, LL
Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2010;(3):328-35
Abstract
This study evaluated the repeatability of hydration and sweat measurements taken during on-ice hockey practices with players drinking only water, and determined whether having only a carbohydrate-electrolyte solution (CES) to drink during practices decreased fluid intake or affected other hydration and (or) sweat measures. All testing was conducted on elite players of an Ontario Hockey League team (+/-SE; mean age, 17.6 +/- 0.3 years; mean height, 182.9 +/- 1.4 cm; mean body mass, 83.0 +/- 1.7 kg). Players were studied 3 times over the course of 6 weekly on-ice practices (+/-SE; mean playing time, 1.58 +/- 0.07 h; mean temperature, 11.4 +/- 0.8 degrees C; mean relative humidity, 52% +/- 3%). There was strong repeatability of the measured hydration and sweat parameters between 2 similar on-ice practices when players drank only water. Limiting the players to drinking only a CES (as opposed to water) did not decrease fluid intake during practice (+/-SE; mean CES intake, 0.72 +/- 0.07 L.h-1 vs. mean water intake, 0.82 +/- 0.08 L.h-1) or affect sweat rate (1.5 +/- 0.1 L.h-1 vs. 1.5 +/- 0.1 L.h-1), sweat sodium concentration (72.4 +/- 5.6 mmol.L-1 vs. 73.0 +/- 4.4 mmol.L-1), or percent body mass loss (1.1% +/- 0.2% vs. 0.9% +/- 0.2%). Drinking a CES also improved sodium balance (-2.1 +/- 0.2 g.h-1 vs. -2.6 +/- 0.3 g.h-1) and provided the players with a significant carbohydrate (43 +/- 4 g.h-1 vs. 0 +/- 0 g.h-1) during practice. In summary, a single field sweat test during similar on-ice hockey practices in male junior hockey players is sufficient to evaluate fluid and electrolyte balance. Also, a CES does not affect voluntary fluid intake during practice, compared with water, in these players. The CES provided some salt to offset the salt lost in sweat, and carbohydrate, which may help maintain physical and mental performance in the later stages of practice.
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Sodium replacement and plasma sodium drop during exercise in the heat when fluid intake matches fluid loss.
Anastasiou, CA, Kavouras, SA, Arnaoutis, G, Gioxari, A, Kollia, M, Botoula, E, Sidossis, LS
Journal of athletic training. 2009;(2):117-23
Abstract
CONTEXT Sodium replacement during prolonged exercise in the heat may be critically important to maintaining fluid and electrolyte balance and muscle contractility. OBJECTIVE To examine the effectiveness of sodium-containing sports drinks in preventing hyponatremia and muscle cramping during prolonged exercise in the heat. DESIGN Randomized crossover study. PATIENTS OR OTHER PARTICIPANTS Thirteen active men. INTERVENTION(S): Participants completed 4 trials of an exercise protocol in the heat (30 degrees C) consisting of 3 hours of exercise (alternating 30 minutes of walking and cycling at a heart rate of 130 and 140 beats per minute, respectively); a set of standing calf raises (8 sets of 30 repetitions); and 45 minutes of steep, brisk walking (5.5 km x h(-1) on a 12% grade). During exercise, participants consumed fluids to match body mass loss. A different drink was consumed for each trial: carbohydrate-electrolyte drink containing 36.2 mmol/L sodium (HNa), carbohydrate-electrolyte drink containing 19.9 mmol/L sodium (LNa), mineral water (W), and colored and flavored distilled water (PL). MAIN OUTCOME MEASURE(S): Serum sodium, plasma osmolality, plasma volume changes, and muscle cramping frequency. RESULTS During both HNa and LNa trials, serum sodium remained relatively constant (serum sodium concentration at the end of the protocol was 137.3 mmol/L and 136.7 mmol/L, respectively). However, a clear decrease was observed in W (134.5 +/- 0.8 mmol/L) and PL (134.4 +/- 0.8 mmol/L) trials compared with HNa and LNa trials (P < .05). The same trends were observed for plasma osmolality (P < .05). Albeit not significant, plasma volume was preserved during the HNa and LNa trials, but a reduction of 2.5% was observed in the W and PL trials. None of the volunteers experienced cramping. CONCLUSIONS The data suggest that sodium intake during prolonged exercise in the heat plays a significant role in preventing sodium losses that may lead to hyponatremia when fluid intake matches sweat losses.
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Dehydration rates and rehydration efficacy of water and sports drink during one hour of moderate intensity exercise in well-trained flatwater kayakers.
Sun, JM, Chia, JK, Aziz, AR, Tan, B
Annals of the Academy of Medicine, Singapore. 2008;(4):261-5
Abstract
INTRODUCTION The aim of this study is to investigate the amount of water loss and percentage dehydration experienced during 1 hour of paddling on the kayak ergometer so as to help coaches and athletes tailor a suitable and adequate rehydration regime. Also, rehydration efficacy between water and a well established, commercially available sports drink (Gatorade, Quaker Oats company, USA) was investigated in this cross-over study. MATERIALS AND METHODS Ten national flatwater kayakers were monitored in a controlled setting while paddling the kayak ergometer for 1 hour at an intensity sustainable for long distance marathon. They rehydrated themselves ad libitum with provided beverage. Post-void towel-dried body mass was measured before and after the exercise with percentage dehydration calculated. Body core temperature (tympanic temperatures), ratings of perceived exertion and thirst index were monitored every 15 minutes. The amount of fluid consumed, urine output and urine specific gravity were obtained after exercise. RESULTS The results [mean +/- standard deviation (SD)] showed that kayakers underwent 1.10 +/- 0.52% dehydration while rehydrating with water as compared to 0.72 +/- 0.38% while rehydrating with Gatorade. Also, athletes on water rehydration had higher rating of perceived exertion (RPE) at the 30th and 60th minute mark of the exercise. Overall, athletes undergoing water rehydration lost significantly more body mass (0.70 +/- 0.39 kg) as compared to rehydrating with Gatorade (0.46 +/- 0.27). CONCLUSION Although the hydration efficacy of Gatorade proved superior to that of water, the athletes' hydration habits with either fluids did not provide adequate hydration. It is recommended that specific strategies be developed to address dehydration and rehydration issues of kayakers in Singapore.
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Achieving euvolemia in peritoneal dialysis.
Engel, B, Davies, SJ
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 2007;(5):514-7