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Non-invasive assessment of fluid volume status in the interstitium after haemodialysis
Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
Department of Applied Physics and Electronics, Umeå University and Biomedical Engineering and Informatics, University Hospital of Northern Sweden, Umeå, Sweden .
Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
2000 (English)In: Physiological Measurement, ISSN 0967-3334, E-ISSN 1361-6579, Vol. 21, no 2, 211-220 p.Article in journal (Refereed) Published
Abstract [en]

During dialysis excess fluid is removed from uraemic patients. The excess fluid is mainly located in the skin and subcutaneous tissues. In this study we wished, with two non-invasive techniques, the IM (impression method) and BIA (bioimpedance analysis), to study what mechanical (IM) and electrical cellular membrane (BIA) effects the fluid withdrawal has on these tissues. The IM measures the resistive force of the tissues when mechanically compressed. From the force curve two parameters are calculated, the F(0), indicative of interstitial tissue pressure and the FT corresponding to the translocation of tissue fluid (interstitial movable water).

The BIA phase angle shift (), i.e. geometrical angular transformation of the ratio between reactance and resistance, which has been associated with cellular membrane function, was used as a measurement of electrical cellular membrane effects.

Twenty patients were studied before and after haemodialysis measuring the F(0), FT and . The results showed that the patients lost a median of 3.7 kg during the haemodialysis. F(0) increased until after dialysis, but did not reach significant values, whereas FT increased significantly after dialysis, p < 0.001, as compared with before. After a peak at one hour postdialysis the FT value returned to predialysis values at four hours after termination of dialysis. Also increased from before to after dialysis, p < 0.001, but already after one hour it returned to predialysis values.

It is common knowledge that dialysis alters the dynamics of fluid in the interstitium of the skin and subcutis. We conclude that the impression method is sensitive enough to detect and chronicle these changes. Furthermore, with the BIA, (phase angle) signs of changes in the electrical properties of the tissues, possibly reflecting cellular membrane function, could be detected.

Place, publisher, year, edition, pages
2000. Vol. 21, no 2, 211-220 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-47661DOI: 10.1088/0967-3334/21/2/301OAI: diva2:268557
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-08-09Bibliographically approved
In thesis
1. Water physiology in burn victims
Open this publication in new window or tab >>Water physiology in burn victims
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients who sustain a burn injury of more than 20 - 30 % TBSA will, if untreated, develop burn shock within a couple of hours. Flcid is lost fi·om the vascular compartment due to suction from the interstitium of the wound and due to a generalised increase in vascular permeability. To prevent bum shock intravenous fluids are given during the first two days after a bum in order to ensure adequate organ perfusion. Although organ perfusion will be improved when blood volume is restored, the fluid provided will add to the continuing leak into the tissues. With fluid treatment the patient survives the acute stage, but the resulting oedema interferes with the healing of the burn wound and partially damaged skin may be further compromised.

To describe, follow and understand the development of the general oedema in burn injured patients we used four different techniques. Ethanol dilution was used for measurement of total body water (TBW), iohexol dilution in order to estimate extracellular volume (ECV), bioimpedance analysis (BIA) to register TBW as well as electrical membrane properties and the impression method (IM) for the measurement of visco-elastic properties in non-burned tissues. In order to further examine the non-invasive techniques (BIA and IM) these were used in patients subjected to haemodialysis.

The excess fluid was found to be accumulated in the extracellular space. Interesting alterations in the visco-clastic properties of the skin and cellular electrical membrane properties could also be detected. These alterations were not related to the actual tluid volume in the tissues. Instead, they were related to changes in the fluid equilibrium of the tissues. Still, one week postbum an excess of tissue fluid, altered cellular electrical membrane properties and changed visco-elastic properties of the skin remained.

Albumin supplementation did not influence the amount or distribution of the excess tissue fluid, measured with dilution techniques.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 61 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 633
Total body water, Extracellular fluid, Burn, Bioelectrical impedance, Oedema, Extracellular matrix
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-27560 (URN)12222 (Local ID)91-7219-734-X (ISBN)12222 (Archive number)12222 (OAI)
Public defence
2000-05-27, Berzeliussalen, Universitetssjukhuset, Linköping, 08:30 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2015-06-09Bibliographically approved

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Zdolsek, Hans JoachimSjöberg, Folke
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