For patients with short bowel syndrome who undergo ileostomy, nutritional management is essential to prevent complications associated with a high-output stoma (HOS). We report a practical example of ostomic, medical nutrition therapy provided by an intensive nutritional support team (NST). A 42-year-old male with a history of Crohn's disease visited Seoul National University Hospital for treatment of mechanical ileus. He underwent loop ileostomy after extensive small bowel resection. As his remaining small bowel was only 160 cm in length, the stomal output was about 3,000 mL/day and his body weight fell from 52.4 to 40.3 kg. Given his clinical condition, continuous tube feeding for 24 h was used to promote adaptation of the remnant bowel. Thereafter, an oral diet was initiated and multiple, nutritional educational sessions were offered by dietitians. Constant infusion therapy was prescribed and included in the discharge plan. Two months after discharge, his body weight had increased to 46.6 kg and his hydration status was appropriately maintained. This case suggests that the critical features of medical nutritional therapy for ostomy management are frequent assessments of fluid balance, weight history, and laboratory data and after nutritional interventions.
Adult ; Body Weight ; Crohn Disease ; Diet ; Diet Therapy ; Enteral Nutrition ; Humans ; Ileostomy ; Ileus ; Male ; Nutrition Therapy ; Nutritional Support ; Nutritionists ; Ostomy ; Seoul ; Short Bowel Syndrome ; Water-Electrolyte Balance

Maintaining adequate fluid balance is essential for all biological functions in the body. The purpose of this study was to evaluate vulnerability to dehydration by analyzing age, gender, body mass index (BMI), and blood lipid parameters in health checkup examinees who visited Sahmyook Seoul Hospital for comprehensive health checkups. In a binary logistic regression analysis stratified by age and body mass index the odd ratio for dehydration was as high as 3.317 (95% CI: 1.666~6.605) in the 50s age group, 4.224 (95% CI: 2.038~8.755) in the 60s age group, and 4.610 (95% CI: 1.943~10.940) in the above 70s age group compared to 20s reference age group. Aged females showed greater vulnerability to dehydration with significance levels of P<0.01 and P<0.001. Compared to a normal weight (BMI: 18.5~22.9) the odd ratio was higher in males with an under weight (BMI: less than 18.5) (5.130 [95% CI: 1.631~16.132]) and in females with an over weight (BMI: 23.0~24.9) (1.500 [95% CI: 1.065~2.114]). In conclusion, our results showed that vulnerability to dehydration increased with age and was higher in under weight males and over weight females than that in normal weight.
Body Mass Index* ; Dehydration* ; Female ; Humans ; Logistic Models ; Male ; Seoul ; Water-Electrolyte Balance

The kidney collecting duct is an important renal tubular segment for the regulation of body water and salt homeostasis. Water reabsorption in the collecting duct cells is regulated by arginine vasopressin (AVP) via the vasopressin V2-receptor (V2R). AVP increases the osmotic water permeability of the collecting duct cells through aquaporin-2 (AQP2) and aquaporin-3 (AQP3). AVP induces the apical targeting of AQP2 and transcription of AQP2 gene in the kidney collecting duct principal cells. The signaling transduction pathways resulting in the AQP2 trafficking to the apical plasma membrane of the collecting duct principal cells, include AQP2 phosphorylation, RhoA phosphorylation, actin depolymerization and calcium mobilization, and the changes of AQP2 protein abundance in water balance disorders have been extensively studied. These studies elucidate the underlying cellular and molecular mechanisms of body water homeostasis and provide the basis for the treatment of body water balance disorders.
Actins ; Aquaporin 2* ; Aquaporins ; Arginine Vasopressin ; Body Water ; Calcium ; Cell Membrane ; Homeostasis ; Kidney Tubules, Collecting* ; Permeability ; Phosphorylation ; Vasopressins ; Water-Electrolyte Balance Body Water

The kidneys play a key role in the homeostasis of body water and electrolyte balance. Aquaporin-2 (AQP2) is the vasopressin-regulated water-channel protein expressed at the connecting tubule and collecting duct, and plays a key role in urine concentration and body-water homeostasis through short-term and long-term regulation of collecting duct water permeability. The signaling transduction pathways resulting in the AQP2 trafficking to the apical plasma membrane of the collecting duct principal cells, including AQP2 phosphorylation, RhoA phosphorylation, actin depolymerization, and calciumm obilization, and the changes of AQP2 abundance in water-balance disorders have been extensively studied. Dysregulation of AQP2 has been shown to be importantly associated with a number of clinical conditions characterized by body-water balance disturbances, including hereditary nephrogenic diabetes insipidus (NDI), lithium-induced NDI, electrolytes disturbance, acute and chronic renal failure, ureteral obstruction, nephrotic syndrome, congestive heart failure, and hepatic cirrhosis. Recent studies exploiting omics technology further demonstrated the comprehensive vasopressin signaling pathways in the collecting ducts. Taken together, these studies elucidate the underlying molecular mechanisms of body-water homeostasis and provide the basis for the treatment of body-water balance disorders.
Actins ; Aquaporin 2* ; Aquaporins ; Arginine Vasopressin ; Body Water ; Cell Membrane ; Diabetes Insipidus, Nephrogenic ; Electrolytes ; Heart Failure ; Homeostasis* ; Kidney Failure, Chronic ; Kidney* ; Liver Cirrhosis ; Nephrotic Syndrome ; Permeability ; Phosphorylation ; Ubiquitination ; Ureteral Obstruction ; Urine ; Vasopressins ; Water-Electrolyte Balance

The purpose of this study was to determine the effects of beverage temperature and composition on weight retention and fluid balance upon voluntary drinking following exercise induced-dehydration. Eight men who were not acclimated to heat participated in four randomly ordered testing sessions. In each session, the subjects ran on a treadmill in a chamber maintained at 37degrees C without being supplied fluids until 2% body weight reduction was reached. After termination of exercise, they recovered for 90 min under ambient air conditions and received one of the following four test beverages: 10degrees C water (10W), 10degrees C sports drink (10S), 26degrees C water (26W), and 26degrees C sports drink (26S). They consumed the beverages ad libitum. The volume of beverage consumed and body weight were measured at 30, 60, and 90 min post-recovery. Blood samples were taken before and immediately after exercise as well as at the end of recovery in order to measure plasma parameters and electrolyte concentrations. We found that mean body weight decreased by 1.8-2.0% following exercise. No differences in mean arterial pressure, plasma volume, plasma osmolality, and blood electrolytes were observed among the conditions. Total beverage volumes consumed were 1,164 +/- 388, 1,505 +/- 614, 948 +/- 297, and 1,239 +/- 401 ml for 10W, 10S, 26W, and 26S respectively (P > 0.05). Weight retention at the end of recovery from dehydration was highest in 10S (1.3 +/- 0.7 kg) compared to 10W (0.4 +/- 0.5 kg), 26W (0.4 +/- 0.4 kg), and (0.6 +/- 0.4 kg) (P < 0.005). Based on these results, carbohydrate/electrolyte-containing beverages at cool temperature were the most favorable for consumption and weight retention compared to plain water and moderate temperature beverages.
Arterial Pressure ; Beverages ; Body Weight ; Dehydration ; Drinking ; Electrolytes ; Fluid Therapy ; Hot Temperature ; Humans ; Male ; Osmolar Concentration ; Plasma ; Plasma Volume ; Retention (Psychology) ; Sports ; Water ; Water-Electrolyte Balance

PURPOSE: The purpose of the study was to evaluate the accuracy of two different fluid intake measurement methods (fluid only vs. all dietary intake) in measuring fluid balance compared to body weight change among patients with cancers. METHODS: A total of 60 cancer patients in an urban cancer center in South Korea participated in the study. Adult patients who were over 18 years old; having 24-hr I&O order; and taking either normal regular diet or soft blend diet were included. Demographic information and disease related information were also gathered. The data were analyzed using SPSS 18.0 program. RESULTS: Measuring 'fluid only' for oral intake was a more accurate measure than measuring 'all dietary intake' (p=.026 vs. p=.094). Both methods had positive correlations with the amount of weight change (r=.329, p=.010; r=.303, p=.019). Measuring body weight was a more accurate and efficient way of evaluating the fluid balance than 24 hr cumulative I&O. CONCLUSION: Developing clinical manual for selecting proper patients who needs fluid balance monitoring is imperative. Administering weight check and/or 24 hr cumulative I&O should be considered thoroughly based on solid nursing evidence in future.
Adult ; Body Fluids ; Body Weight ; Body Weight Changes ; Diet ; Humans ; Nutrition Assessment ; Republic of Korea ; Water-Electrolyte Balance

PURPOSE: The purpose of this study was to identify differences between intake and output balance and body weight changes and to identify factors related to differences in critically ill patients. METHODS: The participants for this descriptive correlational study were 65 medical surgical ICU patients. The data were collected from patient medical records. RESULTS: Mean age of the patients was 63.80 years (+/-15.21). Body weight changes for 48 hours averaged 281.54g (+/-2210.48). I&O balance for 48 hours corrected for insensible loss averaged 398.1mL. Differences ranged from 45mL to 7,535mL. In the distribution of absolute difference between body weight change and intake and output balance, only 40% of the patients were within less than 1,000mL. Factors relating to accurate measure of intake and output were ventilation methods, respiration patterns, and edema status. CONCLUSION: Although mean values of weight change and I&O balance for all patients were very close, the range of differences was very wide indicating that, for many patients, intake and output is not an appropriate indicator of body fluid balance. Therefore, because of the frequency fever and/or hyperventilation, nurses need to use caution when using intake and output balance only to estimate current body fluid status for critically ill patients.
Body Fluids ; Body Weight ; Body Weight Changes ; Critical Illness ; Edema ; Fever ; Humans ; Hyperventilation ; Critical Care ; Intensive Care Units ; Respiration ; Ventilation ; Water-Electrolyte Balance

Vasopressin, angiotensin II (AngII), and aldosterone are essential hormones in the regulation of body fluid homeostatsis. We examined the effects of AngII or aldosterone on the regulation of body water balance. We demonstrated that 1) short-term treatment with AngII in the primary cultured inner medullary collecting duct cells played a role in the regulation of AQP2 targeting to the plasma membrane through AT1 receptor activation. This potentiated the effects of dDAVP on cAMP accumulation, AQP2 phosphorylation, and AQP2 plasma membrane targeting; 2) pharmacological blockade of the AngII AT1 receptor in rats co-treated with dDAVP and dietary NaCl-restriction (to induce high plasma endogenous AngII) resulted in an increase in urine production, a decrease in urine osmolality, and blunted the dDAVP-induced upregulation of AQP2; 3) long-term aldosterone infusion in normal rats or in rats with diabetes insipidus was associated with polyuria and decreased urine concentration, accompanied by decreased apical but increased basolateral AQP2 labeling intensity in the connecting tubule and cortical collecting duct; and 4) in contrast to the effects of dDAVP and AngII, short-term aldosterone treatment does not alter the intracellular distribution of AQP2. In conclusion, angiotensin II, and aldosterone could play a role in the regulation of renal water reabsorption by changing intracellular AQP2 targeting and/or AQP2 abundance, in addition to the vasopressin.
Aldosterone* ; Angiotensin II* ; Angiotensins* ; Animals ; Aquaporin 2 ; Body Fluids ; Body Water ; Cell Membrane ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Osmolar Concentration ; Phosphorylation ; Plasma ; Polyuria ; Rats ; Up-Regulation ; Vasopressins ; Water-Electrolyte Balance

In newborn infants with mechanical ventilation in the first few days of life, fluid balance must be closely monitored because inadequate therapy related to overload may result in serious complications such as patent ductus arteriosus and pulmonary edema. Very low birth weight infants have significant change in body water balance in early neonatal period secondary to a large insensible water loss (IWL) and immaturity of renal function. Consequently these infants tend to have a high incidence of fluid overload so that fluid restriction with high humidification is effective during especially the first week of life. In infants with bronchopulmonary dysplasia, diuretics such as furosemide may act directly to improve lung mechanics by reabsorption of lung fluid, but chronic use may cause electrolyte imbalance, nephrocalcinosis and hearing deficit. In the early phase of perinatal asphyxia with oliguria, fluid restriction to amount equal to urine output and IWL is critical in order to prevent volume excess and potassium should not be given to avoid hyperkalemia. Blood components should always be infused through transfusion set with standard filter. To minimize adverse reactions of transfusion, basic rules must be observed. Moreover, storage of blood cells in small aliquots, using leukocyte removal filters and irradiation of blood can be helpful to prevent multiple donor exposure, cytomegalovirus infection, alloimmunization, and graft-versus-host rejection.
Asphyxia ; Blood Cells ; Body Water ; Bronchopulmonary Dysplasia ; Cytomegalovirus Infections ; Diuretics ; Ductus Arteriosus, Patent ; Fluid Therapy* ; Furosemide ; Hearing ; Humans ; Hyperkalemia ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Leukocytes ; Lung ; Mechanics ; Nephrocalcinosis ; Oliguria ; Potassium ; Pulmonary Edema ; Respiration, Artificial* ; Tissue Donors ; Water Loss, Insensible ; Water-Electrolyte Balance

OBJECTIVE: To determine the differences in water balance between preterm small for gestational age (SGA) and appropriate for gestational age(AGA) infants, we compared the difference in initial physiologic weight loss during the first five days of life and studied associated factors influencing the initial physiologic weight loss in preterm SGA and AGA infants. METHODS: We retrospectively analyzed water and electrolyte balance in 51 preterm low birth weight infants of whom 20 were preterm SGA infants(gestational age, 30.4+/-1.6weeks:birth weight, 970+/-180g) and 31 preterm AGA infants(30+/-1.7 weeks:1437+/-276g) matched by gestation. RESULTS: The percent weight loss was significantly lower in SGA than in AGA infants(p=0.01). The percent weight loss on the fifth day of life were 12.1+/-5.3% in SGA and 15.8+/-4.3% in AGA infants, respectively(p=<0.01). SGA infants had significantly lower urine output on the second and third day of life compared to AGA infants. Diuresis started on the second day of life in AGA infants and on the fifth day of life in SGA infants. CONCLUSION: The initial physiologic weight loss in SGA infants occurred in a smaller degree compared with AGA infants. This was associated with lower urine volume and the delay in onset of diuresis in SGA infants. These differences in water balance in SGA and AGA infants should be considered in the management of preterm low birth weight infants on mechanical ventilation.
Body Weight Changes* ; Body Weight* ; Diuresis ; Gestational Age ; Humans ; Infant* ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Respiration, Artificial ; Retrospective Studies ; Water-Electrolyte Balance ; Weight Loss