The Contribution of Plasma Urea to Total Osmolality During Iatrogenic Fluid Reduction in Critically Ill Patients

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The Contribution of Plasma Urea to Total Osmolality During Iatrogenic Fluid Reduction in Critically Ill Patients

Nihlén, Sandra (author): Uppsala universitet,Anestesiologi och intensivvård

Frithiof, Robert (author): Uppsala universitet,Anestesiologi och intensivvård

Titze, J. (author): Program in Cardiovascular and Metabolic Disorders, Duke- NUS Medical School, Singapore, Singapore;Division of Nephrology and Hypertension, University Clinic Erlangen, Erlangen, Germany;Division of Nephrology, Duke University Medical Center, Durham, NC, USA

Kawati, Rafael (author): Uppsala universitet,Anestesiologi och intensivvård

Rasmusson, J. (author): Department of Anesthesiology and Intensive Care, Gävle County Hospital, Gävle, Sweden

Rylander, Christian, 1960 (author): Uppsala universitet,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för anestesiologi och intensivvård,Institute of Clinical Sciences, Department of Anesthesiology and Intensive care,Anestesiologi och intensivvård

Pikwer, Andreas (author): Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD)

Castegren, Markus, 1976- (author): Karolinska Institutet,Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Perioperative Medicine and Intensive Care, Karolinska University Hospital and FyFa, Karolinska Institutet, Stockholm, Sweden

Belin, A. (author): Uppsala universitet,Anestesiologi och intensivvård

Hultström, Michael, 1978- (author): Uppsala universitet,Anestesiologi och intensivvård

Lipcsey, Miklós (author): Uppsala universitet,Anestesiologi och intensivvård

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2021-10-29
2022
English.
In: Function. - : Oxford University Press (OUP). - 2633-8823. ; 3:1

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Journal article (peer-reviewed)

Abstract Subject headings

Hyperosmolality is common in critically ill patients during body fluid volume reduction. It is unknown whether this is only a result of decreased total body water or an active osmole-producing mechanism similar to that found in aestivating animals, where muscle degradation increases urea levels to preserve water. We hypothesized that fluid volume reduction in critically ill patients contributes to a shift from ionic to organic osmolytes similar to mechanisms of aestivation. We performed a post-hoc analysis on data from a multicenter observational study in adult intensive care unit (ICU) patients in the postresuscitative phase. Fluid, electrolyte, energy and nitrogen intake, fluid loss, estimated glomerular filtration rate (eGFR), and estimated plasma osmolality (eOSM) were registered. Contributions of osmolytes Na+, K+, urea, and glucose to eOSM expressed as proportions of eOSM were calculated. A total of 241 patients were included. eOSM increased (median change 7.4 mOsm/kg [IQR-1.9-18]) during the study. Sodium's and potassium's proportions of eOSM decreased (P P < .01, respectively), whereas urea's proportion increased (P < .001). The urea's proportion of eOSM was higher in patients with negative vs. positive fluid balance. Urea's proportion of eOSM increased with eOSM (r = 0.63; adjusted for eGFR r = 0.80), but not nitrogen intake. In patients without furosemide and/or renal replacement therapy (n = 17), urea's proportion of eOSM and eOSM correlated strongly (r = 0.92). Urea's proportion of eOSM was higher in patients not surviving up to 90 d. In stabilized ICU patients, the contribution of urea to plasma osmolality increased during body water volume reduction, statistically independently of nitrogen administration and eGFR. The shift from ionic osmolytes to urea during body fluid volume reduction is similar to that seen in aestivating animals. [GRAPHICS] .

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Medicinska och farmaceutiska grundvetenskaper -- Cell- och molekylärbiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Basic Medicine -- Cell and Molecular Biology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

Keyword

critical care
fluid therapy
water-electrolyte balance
osmolar
concentration
urea
intensive-care-unit
septic shock
mortality
water
saps-3
Cell Biology
Physiology

Publication and Content Type

ref (subject category)
art (subject category)

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By the author/editor: Nihlén, Sandra; Frithiof, Robert; Titze, J.; Kawati, Rafael; Rasmusson, J.; Rylander, Christ ...; show more...; Pikwer, Andreas; Castegren, Marku ...; Belin, A.; Hultström, Micha ...; Lipcsey, Miklós; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Basic Medicine; and Cell and Molecul ...

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Anesthesiology a ...

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By the university: University of Gothenburg; Uppsala University; Karolinska Institutet

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