Effect of Hypertonic Solutions on Metabolism and Excretion of Electrolytes

Effects of Injection of Hypertonic Glucose on Metabolism of Water and Electrolytes in Patients With Edema 1

“…The accelerated excretion of potassium in the face of declining serum values in the hydropenic subjects of this report has been observed under similar conditions in normal subjects and may have been a result of cellular dehydration, in keeping with previously expressed views on this subject (1,(30)(31)(32). The precise nature of the relationship of dehydration to excretion of potassium is, however, obscure.…”

“…Changes in the volume of the extracellular fluid and the concentration of serum sodium in edematous patients were similar to those noted in normal subjects following similar glucose loads (1). But the renal response to these distortions of the internal environment differed markedly in the two groups (Table I, Figure 1).…”

“…In Figures 2 and 3 the excretion rates of glucose and of total solutes are plotted against urine flow, both for the patients of this study and for the normal subjects of a previous report (1). The excretion of water per unit of excreted glucose or total solutes was considerably increased by hydration in the normal subject, but was slightly, if at all, changed by hydration in our edematous patients.…”

“…This does not, of course, imply that there is no intrinsic tubular mechanism for sodium transport which may be influenced by the character and flow of tubular urine, as has been pointed out (22,24). However, such observations as the failure of a sulfate diuresis to sweep out sodium chloride (25,26), the variable response to urea loads (1,2,6,23), and the cutback in sodium excretion in some diabetic patients despite continued massive glycosuria (18,27,28), suggest that the osmotic influence of the injected solute within the renal tubule may be only one of several determinants. This view is, on the whole, consonant with that expressed in greater detail by Wolf (29).…”

“…Balance data were calculated using methods and assumptions previously described from this department (1,8). Changes in extracellular volume were estimated from alterations in the chloride balance after assuming an initial extracellular volume of 35% of the body weight.…”