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Osmotic and Nonosmotic Sodium Storage during Acute Hypertonic Sodium Loading
Horacio J Adrogué1,2, Sreedhar Mandayam1,3, Hocine Tighiouart4,5
1Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
American Journal of Nephrology
|June 20, 2019
Summary
The Edelman equation accurately predicts plasma sodium levels in dogs, even with varying sodium and potassium depletions. This study refutes claims that sodium restriction causes progressive osmotic inactivation of retained sodium.
Area of Science:
- Physiology
- Renal Physiology
- Electrolyte Balance
Background:
- The Edelman equation historically predicts plasma [Na+] response to fluid and electrolyte shifts.
- Recent studies questioned its validity, particularly concerning sodium restriction and osmotic inactivation of retained sodium.
Purpose of the Study:
- To examine the validity of the Edelman equation under conditions of variable sodium and potassium stores.
- To challenge recent findings suggesting progressive osmotic inactivation of retained sodium.
Main Methods:
- Evaluated baseline total body water (TBW) and sodium (Na+) space in dogs with normal, moderately depleted, or severely depleted sodium and potassium stores.
- Administered acute hypertonic sodium bicarbonate (NaHCO3) infusion to assess changes in TBW and Na+ space.
Main Results:
- Absence of progressive Na+ space expansion disproved progressive osmotic inactivation of retained sodium.
- In normal and alkalotic dogs, Na+ space matched TBW, indicating fully osmotically active retained sodium.
- Acidotic dogs showed early, nonprogressive osmotic inactivation of retained sodium, linked to bone-sodium depletion.
Conclusions:
- The Edelman equation's validity is affirmed in normal dogs and those with varying sodium and potassium depletions.
- These findings refute recent observations in human volunteers on restricted sodium diets.
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