Inhibition of pannexin-1 does not restore electrolyte balance in precystic Pkd1 knockout mice.

Mutations in PKD1 and PKD2 cause autosomal dominant polycystic kidney disease (ADPKD), which is characterized by the formation of fluid-filled cysts in the kidney. In a subset of ADPKD patients, reduced blood calcium (Ca2+) and magnesium (Mg2+) concentrations are observed. As cystic fluid contains increased ATP concentrations and purinergic signaling reduces electrolyte reabsorption, we hypothesized that inhibiting ATP release could normalize blood Ca2+ and Mg2+ levels in ADPKD. Inducible kidney-specific Pkd1 knockout mice (iKsp-Pkd1-/-) exhibit hypocalcemia and hypomagnesemia in a precystic stage and show increased expression of the ATP-release channel pannexin-1. Therefore, we administered the pannexin-1 inhibitor brilliant blue-FCF (BB-FCF) every other day from Day 3 to 28 post-induction of Pkd1 gene inactivation. On Day 29, both serum Ca2+ and Mg2+ concentrations were reduced in iKsp-Pkd1-/- mice, while urinary Ca2+ and Mg2+ excretion was similar between the genotypes. However, serum and urinary levels of Ca2+ and Mg2+ were unaltered by BB-FCF treatment, regardless of genotype. BB-FCF did significantly decrease gene expression of the ion channels Trpm6 and Trpv5 in both control and iKsp-Pkd1-/- mice. Finally, no renoprotective effects of BB-FCF treatment were observed in iKsp-Pkd1-/- mice. Thus, administration of BB-FCF failed to normalize serum Ca2+ and Mg2+ levels.

Examining the significance of arginine vasopressin release to elucidate the often multifactorial etiology of hypotonic hyponatremia: A novel criterion.

Clinical hyponatremia guidelines, protocols and flowcharts are a convenient means for clinicians to quickly establish an etiological diagnosis for hyponatremia, and facilitate its often complex analysis. Unfortunately, they often erroneously attribute multifactorial hyponatremia to a single cause, which is potentially dangerous. In this manuscript, a novel criterion is proposed to quickly determine the physiological relevance of non-osmotic arginine vasopressin (AVP) release, and to add nuance to hyponatremia analysis. While analyzing hypotonic hyponatremia, it is imperative to not only verify whether or not a certain degree of inappropriate AVP release is present, but also to ascertain whether it-in itself-could sufficiently explain the observed hyponatremia, as these two are not always synonymous. Using well-known concepts from renal physiology to combine the electrolyte-free water balance and solute-free water balance, a novel physiological criterion is derived mathematically to easily distinguish three common hyponatremia scenarios, and to further elucidate the underlying etiology. The derived criterion can hopefully facilitate the clinician's and physiologist's interpretation of plasma and urine parameters in a patient presenting with hyponatremia, and warn against the important clinical pitfall of attributing hyponatremia too readily to a single cause.

Fluid Management in Acute Respiratory Failure.

Fluid management in acute respiratory failure is an area of uncertainty requiring a delicate balance of resuscitation and fluid removal to manage hypoperfusion and avoidance of hypoxemia. Overall, a restrictive fluid strategy (minimizing fluid administration) and careful attention to overall fluid balance may be beneficial after initial resuscitation and does not have major side effects. Further studies are needed to improve our understanding of patients who will benefit from a restrictive or liberal fluid management strategy.

[Establishing a prognostic prediction model for patients with septic shock based on the completion time of fluid resuscitation and the negative fluid balance volumes].

OBJECTIVE: To explore the relationship between the completion time of fluid resuscitation as well as negative fluid balance volumes and the prognosis of patients with septic shock, and to try to construct a prediction model based on the completion time of fluid resuscitation and negative fluid balance volumes, and to verify the predictive efficacy of the model on the prognosis of patients with septic shock. METHODS: Patients with septic shock admitted to Wuxi People's Hospital from April 2020 to April 2023 were selected. The general data (gender, age, body mass index, infection site), pathological indicators on admission, the difference of acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) between admission and 24 hours after fluid resuscitation, the completion time of fluid resuscitation and negative fluid balance volume were recorded. Multivariate Logistic analysis was used to screen the influencing factors of the prognosis of patients with septic shock, and a nomogram model was established. Bootstrap method was used for internal validation of the model. The consistency index, calibration curve and receiver operator characteristic curve (ROC curve) were used to evaluate the accuracy and prediction efficiency of the model. RESULTS: A total of 96 patients with septic shock were enrolled, 38 patients died and 58 patients survived at 28 days. Compared with the survival group, the difference of APACHE II score, SOFA score, the proportion of fluid resuscitation completed within 1 to 3 hours, and the proportion of negative fluid balance volume -500 to -250 mL per day in the death group were lower, and the differences were statistically significant (all P < 0.05). Multivariate Logistic analysis showed that the completion time of fluid resuscitation was a risk factor for the prognosis of patients with septic shock [odds ratio (OR) = 26.285, 95% confidence interval (95%CI) was 9.984-76.902, P < 0.05]. The difference of APACHE II score (OR = 0.045, 95%CI was 0.015-0.131), SOFA score (OR = 0.056, 95%CI was 0.019-0.165) between admission and 24 hours after fluid resuscitation, and negative fluid balance volume (OR = 0.043, 95%CI was 0.015-0.127) were protective factors for the prognosis of patients with septic shock (all P < 0.05). The model validation results showed that the consistency index was 0.681 (95%CI was 0.596-0.924), indicating good discrimination. The calibration curve showed that the calibration curve fitted well with the ideal curve. The ROC curve showed that the sensitivity of the nomogram model for predicting the death of patients with septic shock was 83.7%, the specificity was 97.2%, and the area under the ROC curve (AUC) was 0.931 (95%CI was 0.846-0.985), indicating that the model had good prediction efficiency. CONCLUSIONS: The completion time of fluid resuscitation and negative fluid balance volumes are related to the prognosis of septic shock patients, and the alignment diagram model improve the identification of the risk of death in septic shock patients.

The tale of an endemic shrimp's exceptional osmoregulation and the ancient Athalassic mangrove oasis.

The hyperarid mangrove in the Middle East is characterised by the absence of rivers or freshwater inputs and is one of the most extreme settings of this ecosystem on Earth. Endemic to Qatar's hyperarid mangroves, a Palaemon shrimp is uniquely confined to a sole mangrove site in the Arabian Gulf. Within these mangrove channels, we unveiled brine groundwater sources exceeding 70 ppt salinity, contrasting the local marine standard of 42 ppt. Concurrently, a mysid species typically linked to salt pans and groundwater coexists. Stable isotopic analysis implied the existence of a predator-prey dynamic between this mysid species and the studied shrimp. Then, investigating the endemic shrimp's adaptation to extreme salinity, we conducted osmolarity experiments and phylogenetic studies. Our findings demonstrate that this shrimp transitions from hypo- to hyper-osmoregulation, tolerating salinities from 18 to 68 ppt-an unprecedented osmoregulatory capacity among caridean shrimps. This speciation pattern likely arises from the species osmolarity adaptation, as suggested for other Palaemon congeners. Phylogenetic analysis of the studied Palaemon, along with the mangrove's geological history, suggests a profound evolutionary interplay between the ecosystem and the shrimp since the Eocene. This study proposes the hyperarid mangrove enclave as an Athalassic mangrove oasis-a distinctive, isolated ecosystem within the desert landscape.

Analysis of Fluid Balance and Urine Values in Elite Soccer Players: Impact of Different Environments, Playing Positions, Sexes, and Competitive Levels.

Exercise can disrupt the fluid balance, hindering performance and athlete health. Limited data exist on fluid balance responses in varying climates, sexes, and ages. This study aimed to measure and compare fluid balance and urine values among elite soccer players during training at high and low temperatures, examining the differences between sexes, playing positions, and competitive levels within men's soccer. During the 2022-2023 competitive season, a descriptive observational study was conducted on 87 soccer players from an elite Spanish soccer team. The study found that none of the groups exceeded weight loss values of 1.5% of their body mass. Additionally, the soccer players studied experienced higher weight loss, fluid intake, and a higher sweat rate (SR) during summer training compared to winter training. During the summer, male U23-21 soccer players exhibited higher levels of weight loss, fluid intake, and a higher SR compared to female soccer players or the U19-17 male category. No significant differences were found between playing positions. In conclusion, differences in the fluid balance were observed based on the climatic conditions, competitive level, and sex.

[Clinical significance of negative fluid balance and infection management in the treatment of acute respiratory distress syndrome caused by severe novel coronavirus infection].

OBJECTIVE: To explore the clinical significance of negative fluid balance and infection management in the treatment of acute respiratory distress syndrome (ARDS) caused by severe novel coronavirus infection. METHODS: A retrospective survey was conducted. Patients with ARDS caused by severe novel coronavirus infection who were hospitalized in the department of critical care medicine of the Third Affiliated Hospital of Gansu University of Chinese Medicine and received non-invasive ventilator assisted ventilation were selected as the research objects. The fluid intake and output of all patients were accurately counted every day, and the fluid intake of the next day was adjusted according to the output of the previous day. According to the fluid negative balance, and whether the hospital infection management measures were complied with during the treatment and inspection of the patients, 45 patients with a negative fluid balance of more than 200 mL/d and strict management of nosocomial infection were taken as the observation group, and 48 patients with a negative fluid balance of less than 200 mL/d and no strict management of nosocomial infection were taken as the control group. The general data, weaning success rate, endotracheal intubation rate, mortality, as well as laboratory indicators such as white blood cell count (WBC), procalcitonin (PCT), C-reactive protein (CRP) after treatment were compared between the two groups. RESULTS: There were no significant differences in gender (male: 51.1% vs. 52.1%), age (years old: 66.31±15.92 vs. 67.50±13.59), acute physiology and chronic health evaluation II (APACHE II: 18.98±4.81 vs. 18.54±4.35) between the observation group and the control group (all P > 0.05), indicating that the baseline data were balanced and comparable. Compared with the control group, the weaning success rate of the observation group significantly increased [53.3% (24/45) vs. 31.2% (15/48), P = 0.031], endotracheal intubation rate significantly decreased [22.2% (10/45) vs. 43.8% (21/48), P = 0.028], mortality significantly reduced [20.0% (9/45) vs. 41.7% (20/48), P = 0.024], laboratory indicators WBC, PCT and CRP levels were significantly reduced [WBC (×109/L): 8.085±4.136 vs. 16.898±7.733, CRP (mg/L): 82.827±52.680 vs. 150.679±74.625, PCT (µg/L): 3.142±2.323 vs. 7.539±5.939, all P < 0.01]. CONCLUSIONS: Fluid negative balance and infection management have significant clinical significance in the treatment of severe novel coronavirus infection with ARDS.

[Features of water-electrolyte balance in persons of the older age group].

Age-related changes have a great influence on the regulation of water and electrolyte homeostasis in the body, which is regulated by a complex interaction of environmental factors, drinking behavior, the secretion of a number of hormones and hormone-like substances, as well as the innervation and functional state of the kidneys. It is well known that the changes that are part of physiological aging underlie fluid and electrolyte imbalances, exacerbated by the presence of age-related diseases, medications, or a number of external factors such as malnutrition, fluid intake, and the presence of dementia. This review considers literature data on the effect of normal aging on the development of pathology of the water-sodium balance, including dehydration of senile patients, hyponatremia, hypernatremia, changes in the secretion of antidiuretic hormone and the activity of elements of the renin-angiotensin-aldosterone system.

Assessment of the components of fluid balance in patients with septic shock: a prospective observational study.

BACKGROUND: The optimal amount for initial fluid resuscitation is still controversial in sepsis and the contribution of non-resuscitation fluids in fluid balance is unclear. We aimed to investigate the main components of fluid intake and fluid balance in both survivors and non-survivor patients with septic shock within the first 72 hours. METHODS: In this prospective observational study in two intensive care units, we recorded all fluids administered intravenously, orally, or enterally, and losses during specific time intervals from vasopressor initiation: T1 (up to 24 hours), T2 (24 to 48 hours) and T3 (48 to 72 hours). Logistic regression and a mathematical model assessed the association with mortality and the influence of severity of illness. RESULTS: We included 139 patients. The main components of fluid intake varied across different time intervals, with resuscitation and non-resuscitation fluids such as antimicrobials and maintenance fluids being significant contributors in T1 and nutritional therapy in T2/T3. A positive fluid balance both in T1 and T2 was associated with mortality (p = 0.049; p = 0.003), while nutritional support in T2 was associated with lower mortality (p = 0.040). The association with mortality was not explained by severity of illness scores. CONCLUSIONS: Non-resuscitation fluids are major contributors to a positive fluid balance within the first 48 hours of resuscitation. A positive fluid balance in the first 24 and 48 hours seems to independently increase the risk of death, while higher amount of nutrition seems protective. This data might inform fluid stewardship strategies aiming to improve outcomes and minimize complications in sepsis.

Effects of different salinity reduction intervals on osmoregulation, anti-oxidation and apoptosis of Eriocheir sinensis megalopa.

Eriocheir sinensis megalopa has a special life history of migrating from seawater to freshwater. In order to investigate how the megalopa adapt themselves to the freshwater environment, we designed an experiment to reduce the salinity of water from 30 ppt to 0 at rates of 30 ppt, 15 ppt, 10 ppt, and 5 ppt per 24 h to evaluate the effects of different degrees of hyposaline stress on the osmotic regulation ability and antioxidant system of the megalopa. Experimental results related to osmotic pressure regulation show that the gill tissue of megalopa in the treatment group of 30 ppt/24 h rapid reduction of salinity was damaged, while in the treatment group of 5 ppt/24 h it was intact. At the same time, the experiment also found that in each treatment group with different salinity reduction rates, compared with the control salinity, the NKA activity of megalopa increased significantly after the salinity was reduced to 20 ppt (p < 0.05). In addition, two genes involved in chloride ion transmembrane absorption have different expression patterns in the treatment groups with different salinity reduction rates. Among them, Clcn2 was significantly highly expressed only in the rapid salinity reduction intervals of 30 ppt/24 h and 15 ppt/24 h (p < 0.05). Slc26a6 was significantly highly expressed only in the slow salinity reduction intervals of 10 ppt/24 h and 5 ppt/24 h (p < 0.05). On the other hand, the results of antioxidant and apoptosis related experiments showed that in all treatment groups with different rates of salinity reduction, the activities of T-AOC, GSH-PX, and CAT basically increased significantly after salinity reduction compared to the control salinity. Moreover, the activities of T-AOC and CAT were significantly higher in the 10 ppt/24 h and 5 ppt/24 h treatment groups than in the 30 ppt/24 h and 15 ppt/24 h treatment groups. Finally, the experimental results related to apoptosis showed that the expression trends of Capase3 and Bax-2 were basically the same in the treatment groups with different salinity reduction rates, and their expressions were significantly higher in the 10 ppt/24 h and 5 ppt/24 h treatment groups than in the 30 ppt/24 h and 15 ppt/24 h treatment groups. In summary, the present study found that megalopa had strong hyposaline tolerance and were able to regulate osmolality at different rates of salinity reduction, but the antioxidant capacity differed significantly between treatment groups, with rapid salinity reduction leading to oxidative damage in the anterior gills and reduced antioxidant enzyme activity and apoptosis levels.

A Murine Model for Measuring Sebum Production That Can Be Used to Test Therapeutic Agents for the Management of Acne Vulgaris.

Acne vulgaris (acne) effects nearly 90% of all Western teenagers, and the only pharmaceutical class of agents to treat severe forms of this skin condition are the retinoids, which are well-described teratogens. Yet about 50% of the patients receiving this class of therapeutics are women of child-bearing age, in their peak years of reproductive potential. On this basis, there is a significant unmet medical need for agents to treat severe forms of acne that do not carry this liability. As a means to assess potential agents of this type, here we describe methods for estimating the relative amount of sebum that a mouse produces based on the water retention on fur following a thorough wetting procedure. We have shown that a compound that is clinically effective in reducing sebum production demonstrates activity in this model. The method is therefore useful for evaluating therapeutic candidates for reducing sebum production, which would in turn be useful for treating acne. We have broken the entire procedure down into two phases/two protocols, as listed below. © 2024 Wiley Periodicals LLC. Basic Protocol 1: Pre-wash wet weight measurement Basic Protocol 2: Post-wash wet-weight measurement.

Refeeding syndrome and psychopharmacological interventions in children and adolescents with Anorexia Nervosa: a focus on olanzapine-related modifications of electrolyte balance.

This study aims to investigate the potential correlation between the use of olanzapine, a psychopharmacological intervention commonly prescribed in Anorexia Nervosa treatment, and the occurrence of Refeeding Syndrome. Despite the acknowledged nutritional and biochemical impacts of olanzapine, the literature lacks information regarding its specific association with Refeeding Syndrome onset in individuals with Anorexia Nervosa. This is a naturalistic, retrospective, observational study, reporting the occurrence of Refeeding Syndrome in children and adolescents with Anorexia Nervosa, treated or untreated with olanzapine. Dosages and serum levels of olanzapine were assessed for potential associations with the occurrence of Refeeding Syndrome and specific variations in Refeeding Syndrome-related electrolytes. Overall, 113 patients were enrolled, including 46 (41%) who developed a Refeeding Syndrome. Mild (87%), moderate (6.5%), and severe (6.5%) Refeeding Syndrome was described, at a current average intake of 1378 ± 289 kcal/day (39 ± 7.7 kcal/kg/die), frequently associated with nasogastric tube (39%) or parenteral (2.2%) nutrition. Individuals receiving olanzapine experienced a more positive phosphorus balance than those who did not (F(1,110) = 4.835, p = 0.030), but no difference in the occurrence of Refeeding Syndrome was documented. The mean prescribed doses and serum concentrations of olanzapine were comparable between Refeeding Syndrome and no-Refeeding Syndrome patients.    Conclusion: The present paper describes the occurrence of Refeeding Syndrome and its association with olanzapine prescriptions in children and adolescents with Anorexia Nervosa. Olanzapine was associated with a more positive phosphorus balance, but not with a different occurrence of Refeeding Syndrome. Further, longitudinal studies are required. What is Known: • Refeeding Syndrome (RS) is a critical complication during refeeding in malnourished patients, marked by electrolyte (phosphorus, magnesium, potassium) imbalances. • Olanzapine, an atypical antipsychotic with nutritional and biochemical impacts, is used in Anorexia Nervosa (AN) treatment, however data concerning its association with RS are lacking. What is New: • The study observed RS in 46/113 (41%) young patients with AN. • Olanzapine-treated individuals showed a higher improvement in serum phosphate levels than untreated ones, although no impact on the occurrence of Refeeding Syndrome was observed.

Fluid Status Vulnerability in Older Adults.

There is a growing body of evidence about physiological changes with age that impact fluid and electrolyte balance. It is important that infusion nurses have knowledge in managing care for geriatric patients so they can identify these changes when they are exhibited. Knowing how to minimize the effect of these changes on the health of older adults is critical. The infusion nurse with knowledge of geriatric-focused care can avoid complications and critical illness in older adults. In addition, it is important to provide specific patient education that is grounded in geriatric best practices. This information will assist older adults to better protect themselves from dehydration, kidney injury, and other complications associated with fluid balance, such as delirium. This article reviews the literature on specific changes with aging that predispose older adults to adverse complications with fluid imbalance. New technology in geriatrics that can improve management of fluid status, such as dehydration and electrolyte monitors, are also discussed. This review included searches of the Medline®/PubMed® Database using MeSH terms (National Library of Medicine). Search terms included the following: aging-biological; aging kidney; water-electrolyte imbalance; dehydration; hypo-hypernatremia; hypo-hyperkalemia; delirium; wearable technology; and hydration monitors.

Sweat Characteristics and Fluid Balance Responses During Two Heat Training Camps in Elite Female Field Hockey Players.

We examined the sweat characteristics and fluid balance of elite female field hockey players during two heat training camps. Fourteen elite female field hockey players from the Australian national squad participated in two heat training camps held ∼6 months apart, following winter- (Camp 1) and summer-based training (Camp 2). Daily waking body mass (BM) and urine specific gravity (USG) were collected, along with several markers of sweat and fluid balance across two matches per camp. There was a 19% mean reduction in estimated whole-body sweat sodium concentration from Camp 1 (45.8 ± 6.5 mmol/L) to Camp 2 (37.0 ± 5.0 mmol/L; p < .001). Waking urine specific gravity ≥ 1.020 was observed in 31% of samples, with no significant differences in mean urine specific gravity or BM between camps (p > .05), but with substantial interindividual variation. Intramatch sweat rates were high (1.2-1.8 L/hr), with greater BM losses in Camp 1 (p = .030), resulting in fewer players losing ≥2% BM in Camp 2 (0%-8%), as compared with Camp 1 (36%-43%; p = .017). Our field data suggest that elite female field hockey players experience substantial sweat losses during competition in the heat regardless of the season. In agreement with previous findings, we observed substantial interindividual variation in sweat and hydration indices, supporting the use of individualized athlete hydration strategies.

Multi-omics data integration shines a light on the renal medulla.

The renal medulla maintains salt and water balance and is prone to dysregulation because of high oxygen demand. Challenges in obtaining high-quality tissue have limited characterization of molecular programs regulating the medulla. Haug et al. leveraged gene expression, chromatin accessibility, long-range chromosomal interactions, and spatial transcriptomics to build a reference set of medullary tissue marker genes to define the medullary role in kidney function, exemplifying the strength and utility of multi-omic data integration.

Recent advances in understanding the kidney circadian clock mechanism.

Circadian rhythms are endogenous biological oscillations that regulate various physiological processes in organisms, including kidney function. The kidney plays a vital role in maintaining homeostasis by regulating water and electrolyte balance, blood pressure, and excretion of metabolic waste products, all of which display circadian rhythmicity. For this reason, studying the circadian regulation of the kidney is important, and the time of day is a biological and experimental variable that must be considered. Over the past decade, considerable progress has been made in understanding the molecular mechanisms underlying circadian regulation within the kidney. In this review, the current knowledge regarding circadian rhythms in the kidney is explored, focusing on the molecular clock machinery, circadian control of renal functions, and the impact of disrupted circadian rhythms on kidney health. In addition, parameters that should be considered and future directions are outlined in this review.

Fluid assessment, fluid balance, and fluid overload in sick children: a report from the Pediatric Acute Disease Quality Initiative (ADQI) conference.

BACKGROUND: The impact of disorders of fluid balance, including the pathologic state of fluid overload in sick children has become increasingly apparent. With this understanding, there has been a shift from application of absolute thresholds of fluid accumulation to an appreciation of the intricacies of fluid balance, including the impact of timing, trajectory, and disease pathophysiology. METHODS: The 26th Acute Disease Quality Initiative was the first to be exclusively dedicated to pediatric and neonatal acute kidney injury (pADQI). As part of the consensus panel, a multidisciplinary working group dedicated to fluid balance, fluid accumulation, and fluid overload was created. Through a search, review, and appraisal of the literature, summative consensus statements, along with identification of knowledge gaps and recommendations for clinical practice and research were developed. CONCLUSIONS: The 26th pADQI conference proposed harmonized terminology for fluid balance and for describing a pathologic state of fluid overload for clinical practice and research. Recommendations include that the terms daily fluid balance, cumulative fluid balance, and percent cumulative fluid balance be utilized to describe the fluid status of sick children. The term fluid overload is to be preserved for describing a pathologic state of positive fluid balance associated with adverse events. Several recommendations for research were proposed including focused validation of the definition of fluid balance, fluid overload, and proposed methodologic approaches and endpoints for clinical trials.

Effect of Personalized Sodium Replacement on Fluid and Sodium Balance and Thermophysiological Strain During and After Ultraendurance Running in the Heat.

PURPOSE: To investigate the effect of personalized sweat sodium replacement on drinking behavior, sodium and water balance, and thermophysiological responses during and after ultraendurance running in hot conditions. METHODS: Nine participants (7 male, 2 female) completed two 5-hour treadmill runs (60% maximum oxygen uptake, 30°C ambient temperature), in a double-blind randomized crossover design, consuming sodium chloride (SODIUM) capsules to replace 100% of previously assessed losses or placebo (PLACEBO). Fluid was consumed ad libitum. RESULTS: No effect of SODIUM was observed for ad libitum fluid intake or net fluid balance (P > .05). Plasma sodium concentration increased in both trials, but to a greater extent in SODIUM at 2.5 hours (mean [SD]: 4 [4] mmol·L-1 vs 1 [5] mmol·L-1; P < .05) and postexercise (4 [3] mmol·L-1 vs 1 [5] mmol·L-1; P < .05). Plasma volume change was not different between trials (P > .05) but was strongly correlated with sodium balance in SODIUM (r = .880, P < .01). No effect of sodium replacement was observed for heart rate, rectal temperature, thermal comfort, perceived exertion, or physiological strain index. During the 24 hours postexercise, ad libitum fluid intake was greater following SODIUM (2541 [711] mL vs 1998 [727] mL; P = .04), as was urinary sodium excretion (NaCl: 66 [35] mmol, Pl: 21 [12] mmol; P < .01). CONCLUSIONS: Personalized sweat sodium replacement during ultraendurance running in hot conditions, with ad libitum fluid intake, exacerbated the rise in plasma sodium concentration compared to no sodium replacement but did not substantially influence overall body-water balance or thermophysiological strain. A large sodium deficit incurred during exercise leads to substantial renal sodium conservation postexercise.

Safety and Efficacy of Albumin for Pump Priming in Cardiac Surgery: A Meta-Analysis.

OBJECTIVES: To assess the efficacy and safety of albumin as pump priming fluid in cardiac surgery. DESIGN: Meta-analysis of randomized controlled trials. SETTING: Each study was conducted in a surgical center or intensive care unit. PARTICIPANTS: Adult and pediatric patients undergoing cardiac surgery with cardiopulmonary bypass who received circuit priming fluids. INTERVENTIONS: Extracorporeal circuit priming with either albumin or crystalloid. MEASUREMENTS AND RESULTS: Fourteen eligible randomized controlled trials with 741 patients were included in the present meta-analysis. Albumin prime had lower bleeding (CI -202.20 to -142.88 mL, p < 0.00001) and showed a greater advantage in preserving platelet counts (CI 14.85-21.48 × 103 mm-3, p < 0.00001), maintaining colloid osmotic pressure and sustaining negative fluid balance. No significant differences were found in the remaining study outcomes. CONCLUSIONS: Albumin was shown to be safe and efficacious in extracorporeal circulation perfusion. However, its clinical advantages were not clearly highlighted, as there were no significant differences in the number of deaths, length of hospital stay, or intensive care unit duration. The results should be interpreted cautiously, as most included studies were small in scale, and the total number of participants was limited.