Body Fluid Shifts, Sodium and Potassium Metabolism in Patients Undebgoing Thoracic Subgical Pbocedubes

Aronstam, Elmore M.; Schmidt, Claude H.; Jenkins, Edward D.

doi:10.1097/00000658-195303000-00002

Cited by 13 publications

(2 citation statements)

References 7 publications

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“…These collections of fluid may be as great as 4 to 5 per cent of body weight (37,41,42,46), an amount probably sufficient to result in sodium retention in normal man. Numerous observations suggest that the total extracellular fluid volume may actually be enlarged postoperatively (13,31,32,(49)(50)(51)(52), and indeed in the present study the inulin space, when measured, was increased after surgery. 4 However, such conclusions are based upon an increase in the volume of distribution of a variety of substances presumed to remain in the extracellular compartment, an assumption which may not apply to the same extent postoperatively as preoperatively.…”

Section: Discussionsupporting

confidence: 75%

Mechanism of Postoperative Limitation in Sodium Excretion: The Role of Extracellular Fluid Volume and of Adrenal Cortical Activity1

Randall¹,

Papper²

1958

J. Clin. Invest.

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Decreased renal excretion of sodium is a wellknown feature of the immediate postoperative state (1-3). The mechanisms responsible have, however, not been clearly defined. While increased adrenal cortical secretion such as is generally associated with major surgical procedures (4-9) has been causally implicated by many investigators (1,3,(10)(11)(12)(13), there is considerable evidence that the changes in sodium excretion are independent of variations in the supply of adrenal cortical hormones (14-18).The extracellular fluid volume, or more precisely that portion of it which is physiologically "effective," has been shown to be a major determinant of renal sodium excretion in normal individuals (19-21). Therefore variation in this volume warrants consideration as a possible etiological factor in the decreased postoperative excretion of sodium. The observations that fluid sequestration occurs in and about the traumatized tissues both in animals and in man indeed suggests that a dislocation of the body fluids may occur in the surgical patient and result in a contraction of the effective extracellular fluid volume.The present study was designed to investigate the effect of isotonic expansion of the extracellular fluid volume on the postoperative response to the administration of sodium chloride. The data indicate that the usually observed impairment in natriuretic response is corrected by isotonic extracellular fluid volume expansion. In addition, studies in a patient with Addison's disease suggest that decreased natriuresis postoperatively occurs independently of enhanced adrenal cortical hormone secretion.1 An abstract of this paper appeared in the J. clin. Invest. 1958, 37, 923. 2 Present address: Travis Air Force Base, Calif. METHODSFive young males without cardiovascular, renal, hepatic or endocrine disease were studied before and after orthopedic surgical procedures of sufficient extent to produce major surgical trauma (Table I). One patient (No. 3, A and B) was studied before and after two Moore arthroplasties performed five weeks apart. Orthopedic patients were chosen for study in order to avoid the complicating factors of major gastrointestinal losses of fluids and electrolytes and to allow continued oral intake in the postoperative period. Commencing on the fifth or sixth day before surgery and continuing through the third postoperative day the patients were provided a daily diet containing approximately 43 mEq. of sodium and in addition received nonenteric coated sodium chloride tablets four times daily so that the total sodium intake was 197 mEq. per day. On the day of surgery sufficient isotonic saline solution was given intravenously to maintain the total intake, including the sodium content of the citrated blood, at 197 mEq. Blood loss during surgery was replaced so that in no instance was significant hypotension observed. Oral intake of fluid and food was usually re-instituted by evening of the day of surgery. The daily intake of fluids was recorded in five studies and it was possible to weigh three...

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Section: Discussionsupporting

confidence: 75%

Mechanism of Postoperative Limitation in Sodium Excretion: The Role of Extracellular Fluid Volume and of Adrenal Cortical Activity1

Randall¹,

Papper²

1958

J. Clin. Invest.

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“…The fall in plasma sodium which commonly occurs in the first few days postoperatively appears to be greater after cardiac surgery than after other traumatic procedures. This postoperative hyponatraemia has been attributed by some authors solely to water retention related to altered secretion of antidiuretic hormone (Aronstam et al, 1953 ;Goodyer and Glenn, 1955 ;D'Angelo et al, 1958). The mechanism underlying the hyponatraemia, however, is obscure, and Wilson (1959) suggested that, as well as antidiuretic hormone, altered secretion of adrenocortical hormones, especially aldosterone, may also be implicated in this postoperative electrolyte disturbance.…”

Section: Discussionmentioning

confidence: 98%