Hyponatraemia and Sick Cells

Flear, C. T. G.; Singh, Charanjit

doi:10.1093/bja/45.9.976

Cited by 113 publications

(53 citation statements)

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“…We believe that our data support either (1) movement of water from the ECF into a hyperosmolal gut lumen, or (2) accumulation or generation of solutes within cells, as likely causes of the observed postprandial hyperosmolality and hypernatraemia. There need be no alterations in cell membrane permeability to account for our observations; hence there would not be a redistribution of normally constrained intracellular osmoles, such as organic phosphate (Flear & Singh 1973), and indeed this did not alter in our experiments (see Table 1). Percentage plasma water content, measured by refractometry, also did not change, probably because of a fall in plasma volume as well as water content after food.…”

Section: Discussionmentioning

confidence: 67%

Changes in Plasma Solutes after Food

et al. 1985

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Summary: In experiments on 8 healthy young male volunteers, the ingestion of a large meal was found to cause plasma osmolality to rise from 288.8 + 0.8 (mean + s.e. mean) to 295.6 + 0.9 mmol/kg at 4 hours (P <0.001). There was an accompanying rise in plasma sodium (Na) from 141.9 + 0.8 to 144.6 + 0.8 mmol/l, also at 4 hours (P < 0.01), but little change in other plasma electrolytes. Serum total amino acids rose slightly, non-esterified fatty acid fell minimally and changes in blood glucose concentrations were unremarkable. Thirst was experienced at plasma osmolality of 294.8 + 0.7 mmol/kg. Repeating the experiment either without food, or with the salt content of the meal only, was without effect on plasma Na, other solutes or osmolality. Postprandial hypersomolality and hypernatraemia is probably due to movement of water from the vascular compartment to the gut, or into cells. Plasma osmolality is best measured in the fasting state. IntroductionIn health, plasma osmolality is tightly controlled by well-defined homeostatic mechanisms (Baylis 1983). We postulated, however, that absorption of solutes produced within the gastrointestinal tract after large meals, by digestion of food, might increase plasma osmolality. This paper reports our investigation of this hypothesis. Relative hyperosmolality after meals was confirmed, but it appeared to be due to net loss of water from the extracellular fluid (ECF), rather than the addition of absorbed exogenous 'osmoles' to the ECF.

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Section: Discussionmentioning

confidence: 67%

Changes in Plasma Solutes after Food

et al. 1985

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“…The increased presence of certain cytokines (interleukine-1b and tumour necrosis factor-a) was found to be inversely correlated with the amount of FFM in patients with rheumatoid arthritis (Roubenoff & Rall, 1993) and the authors suggested that rheumatoid cachexia is at least partly driven by in¯ammation. Flear & Singh (1973) suggested that cell membrane function may be changed by disease, which may causē uid shifts. The pathogenesis of tissue injury in IBD involves an imbalance between increased reactive oxidative compounds production and reduced antioxidant defences, resulting in oxidative stress (Grisham, 1994;Lih-Brody et al, 1996).…”

Section: Discussionmentioning

confidence: 99%

Gender specific alterations of body composition in patients with inflammatory bowel disease compared with controls

Geerling¹,

Lichtenbelt

Stockbrügger³

et al. 1999

Eur J Clin Nutr

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Objective: To assess body hydration and the distribution of the body water compartments in de®ned populations of patients with in¯ammatory bowel disease (IBD) compared with those of matched healthy controls. Subjects: Fifty-two patients with IBD at time of diagnosis (20 patients with Crohn's disease (CD-new) and 32 patients with ulcerative colitis (UC-new)), 40 patients with long-standing CD (CD-long) and 2 matched healthy control groups (n 52 and n 40) were recruited for the study. Methods: Total body water (TBW) and extracellular water (ECW) were measured by deuterium oxide and bromide dilution, respectively. Intracellular water (ICW) was calculated as TBW-ECW. In addition, hydration of fat-free mass (FFM) and the ECW:ICW ratio were calculated. FFM, body fat (BF) and % body fat (%BF) were assessed by dual energy X-ray absorptiometry. Results: In female IBD patients, the ECW:ICW ratio was signi®cantly (P`0.05) higher than in controls (CDnew: 0.89 AE0.11 vs 0.79 AE0.08, P`0.01; UC-new: 0.85 AE0.15 vs 0.77 AE0.10, P`0.05; CD-long: 0.86 AE0.14 vs 0.80 AE0.10, P`0.05). In these female patients, the ICW:FFM ratio was signi®cantly (P`0.05) lower than in controls. Fluid shifts were especially pronounced in female patients with recently diagnosed CD. In male patients with recently diagnosed UC and in those with long-standing CD, body weight, body mass index, BF and %BF were signi®cantly (P`0.05) lower than in controls. No differences in body hydration or body water distribution were observed between male patients and controls. Conclusions: An altered body water distribution and body hydration was observed in female IBD patients, especially in female patients with recently diagnosed CD. Sponsorship: This study was ®nancially supported by a grant from Novartis Nutrition Ltd, Switzerland.

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“…The acute loss of solute, according to Flear,9. IO is categorized by a larger than normal osmolal gap, obtained by subtracting the calculated plasma osmolality from the measured plasma osmolality.…”

Section: Discussionmentioning

confidence: 99%

“…Suggested mechanisms include inappropriate secretion of ADH and potassium depletion, S-8 while Flear 9 • 10 has postulated a 'sick cell' syndrome in which damaged cell membranes allow the escape of unidentified organic solutes which are normally confined to the cell.…”

Section: Adh Secretionmentioning

confidence: 99%

Body Space Measurements in the Hyponatraemia of Carcinoma of the Bronchus: Evidence for the Chronic ‘Sick Cell’ Syndrome?

1992

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, Middlesex HAS DAD and 2Department 0/ Chemical Pathology, Bristol Royal Infirmary, Bristol BS2 8HW, UK SUMMARY. Body space measurements using simultaneous multiple isotope dilution techniques were made in both hyponatraemic and normonatraemic patients with carcinoma of the bronchus and wasting, and compared with those in a group of normal volunteers. Both groups of patients showed osmolal loss from cells. The significance of these findings in relation to the development of hyponatraemia is discussed.

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Hyponatraemia and Sick Cells

Cited by 113 publications

References 0 publications

Changes in Plasma Solutes after Food

Changes in Plasma Solutes after Food

Gender specific alterations of body composition in patients with inflammatory bowel disease compared with controls

Body Space Measurements in the Hyponatraemia of Carcinoma of the Bronchus: Evidence for the Chronic ‘Sick Cell’ Syndrome?

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