Body water compartments in patients with obstructive jaundice

Abstract

To elucidate the pathogenesis of renal dysfunction associated with obstructive jaundice, body water compartments were measured using a multi-isotope dilution technique in ten patients with biliary tract obstruction and in ten control subjects matched for age, sex, weight, height and body surface area. Expressed as a fraction of body-weight, total body water was reduced in jaundiced patients (41.8 versus 46.2 per cent, P less than 0.02). Extracellular water volume was also reduced in patients with jaundice (20.3 versus 24.3 per cent, P less than 0.003) owing to a reduction of the interstitial space (16.1 versus 19.5 per cent, P less than 0.004) and, to a lesser degree, of the plasma volume (4.2 versus 4.8 per cent, P = 0.1). There was a close correlation in jaundiced patients between plasma volume and the creatinine clearance rate (r2 = 0.56, P less than 0.02) and between plasma volume and extracellular volume (r2 = 0.77, P less than 0.0001). Extracellular volume in such patients also correlated with the percentage weight loss (r2 = 0.42, P = 0.04). Obstructive jaundice is associated with a contracted extracellular water compartment, although extracellular water, as a percentage of body-weight, increased in proportion to the body-weight lost. Reduction of the interstitial volume and a marginally reduced plasma volume may be determinant factors in the pathogenesis of the renal and haemodynamic disturbances observed in patients with biliary tract obstruction.

Preoperative Assessment of Body Fluid Disturbances in Patients with Obstructive Jaundice

“…Previous studies have proposed that patients with obstructive jaundice present with hemodynamic and body fluid disturbances [23][24][25]. Our group also demonstrated that extracellular water volume was reduced in the presence of obstructive jaundice [6,7]. Both studies were performed using the same multiisotope dilution technique.…”

“…In fact, reactance values are inversely related to extracellular water status [9,15], which seems to be altered in these patients. Previous studies [7] showed that TBW decreased significantly in patients with biliary tract obstruction. In the present study, TBW was also lower in these patients.…”

“…In a previous study the authors showed a difference in ECW between OJ patients and the control group of 4.0 Ϯ 2.5% of body weight [7]. Assuming a 95% confidence interval (type I error) and a power of 95% (type II error), with a two-tailed test 11 patients and healthy subjects would be required in each group.…”

“…Only one comprehensive clinical study [7] has been carried out to determine the body water compartment status in patients with obstructive jaundice. In this multiisotope dilution study, our group observed that patients had a significant reduction of the ECW compartment.…”

Prediction of renal dysfunction in patients with obstructive icterus

“…Nedostaci studija na ljudima koje povezuju opstruktivni ikterus i renalnu disfunkciju su razlike u stepenu bilijarne opstrukcije, prisustvo ikterusa ili prisustvo udruženih bolesti (srčana insuficijencija, hronične bolesti jetre, terapija diureticima ili nesteroidnim antinflamatornim lekovima) ili tretmana koji mogu da utiču na renalnu funkciju, a koje je veoma teško ustanoviti [17,18].…”