Water content of the endothelial glycocalyx layer estimated by volume kinetic analysis

• Main Author: Robert G. Hahn
• Format: Article
• Language: English
• Published: SpringerOpen 2020-07-01
• Series: Intensive Care Medicine Experimental
• Subjects: Glycocalyx; Physiology; Pharmacokinetics; Plasma volume; Analysis; Ringer’s solution
• Online Access: http://link.springer.com/article/10.1186/s40635-020-00317-z

Abstract Background The water volume of the endothelial glycocalyx layer has been estimated at 0.7 to 1.7 L using tracer methods of unclear value. The present study attempts to measure this fluid volume by analyzing the kinetics of a crystalloid fluid load. Methods An intravenous infusion of approximately 1 L of Ringer’s acetate was administered to 35 healthy volunteers, and the central volume of distribution of the water volume was calculated from the urinary excretion and frequent measurements of the fluid-induced hemodilution using mixed-effects modeling software. Comparisons were made with the plasma volume derived from three published anthropometric regression equations based on isotope measurements. In a second analysis, up to 2.5 L of Ringer’s was administered to 60 volunteers selected from a cohort of 160 to have as similar hematocrits as possible to the volunteers whose data were used to create the anthropometric equations. Results Volume kinetics showed that the infused crystalloid fluid occupied a larger central fluid space than was estimated with the isotope measurements. The first analysis of the 35 subjects indicated a mean difference of 0.51 L in males and 0.49 L in females. The second, larger analysis showed a mean excess volume of 0.43 L, which was approximately 15% of the circulating plasma volume. Conclusions A crystalloid fluid load expands a 0.4–0.5 L larger central fluid space than the circulating plasma volume. The excess volume is probably located in the glycocalyx layer.