title: Hypertonicity: Pathophysiologic Concept and Experimental Studies.
abstract: Disturbances in tonicity (effective osmolarity) are the major clinical disorders affecting cell volume. Cell shrinking secondary to hypertonicity causes severe clinical manifestations and even death. Quantitative management of hypertonic disorders is based on formulas computing the volume of hypotonic fluids required to correct a given level of hypertonicity. These formulas have limitations. The major limitation of the predictive formulas is that they represent closed system calculations and have been tested in anuric animals. Consequently, the formulas do not account for ongoing fluid losses during development or treatment of the hypertonic disorders. In addition, early comparisons of serum osmolality changes predicted by these formulas and observed in animals infused with hypertonic solutions clearly demonstrated that hypertonicity creates new intracellular solutes causing rises in serum osmolality higher than those predicted by the formulas. The mechanisms and types of intracellular solutes generated by hypertonicity and the effects of the solutes have been studied extensively in recent times. The solutes accumulated intracellularly in hypertonic states have potentially major adverse effects on the outcomes of treatment of these states. When hypertonicity was produced by the infusion of hypertonic sodium chloride solutions, the predicted and observed changes in serum sodium concentration were equal. This finding justifies the use of the predictive formulas in the management of hypernatremic states.
authors.affiliation: Department of Medicine, Division of Nephrology, University of New Mexico School of Medicine.
authors.forename: Christos
authors.initials: C
authors.lastname: Argyropoulos
authors.affiliation: Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh Medical School.
authors.forename: Helbert
authors.initials: H
authors.lastname: Rondon-Berrios
authors.affiliation: George Washington University.
authors.forename: Dominic S
authors.initials: DS
authors.lastname: Raj
authors.affiliation: University of Toledo.
authors.forename: Deepak
authors.initials: D
authors.lastname: Malhotra
authors.affiliation: Department of Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria.
authors.forename: Emmanuel I
authors.initials: EI
authors.lastname: Agaba
authors.affiliation: Department of Medicine, Division of Nephrology, University of New Mexico School of Medicine.
authors.forename: Mark
authors.initials: M
authors.lastname: Rohrscheib
authors.affiliation: Department of Medicine, Division of Nephrology, University of New Mexico School of Medicine.
authors.forename: Zeid
authors.initials: Z
authors.lastname: Khitan
authors.affiliation: Raymond G. Murphy VA Medical Center, Albuquerque, New Mexico.
authors.forename: Glen H
authors.initials: GH
authors.lastname: Murata
authors.affiliation: The Joan C Edwards College of Medicine of Marshall University, Huntington, WV.
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Shapiro
authors.affiliation: University of New Mexico School of Medicine.
authors.forename: Antonios H
authors.initials: AH
authors.lastname: Tzamaloukas
keywords: hypertonicity; osmolality; osmolarity; osmolytes; serum sodium concentration