| Summary: | A mathematical model is formulated to study the transport and redistribution of fluid,
proteins and small ions between the circulating blood, interstitium and cells. To achieve this task,
the human/animal body was schematically divided into two distinct compartments, namely the
plasma and interstitium. Two additional cellular compartments representing the red blood cells
and generalized tissue cells were introduced as sub-compartments embedded in the two
extracellular compartments.
Two major sites of exchange are accounted for to characterize the movement of materials
between these four fluid compartments. The microvascular exchange system (MVES) involves
the movements of fluid, proteins and small ions from plasma into the interstitium across the
capillary membrane as well as the return of these materials from the interstitial space back into
plasma via the lymphatic system. Across the cellular membrane separating the intra- and
extracellular compartments, there are dynamic exchanges of fluid and the three important ions,
NA ⁺ , K ⁺ and CI⁻. These exchanges are assumed to occur by both passive and active mechanisms.
The general model consists of a large set of time-dependent differential-algebraic
equations that must be solved simultaneously to predict both clinically measurable data (e.g.,
plasma and blood volumes, plasma solute concentrations, and osmotic pressures) and
experimentally difficult or impossible to measure variables (e.g., intracellular volumes and small
ion concentrations, cellular transmembrane potentials, and transmembrane fluid shifts). The
solution of these equations is carried out by the use of numerical methods.
To describe mass exchange within the MVES and across the cell membranes, the
transport characteristics of the principle resistances encountered by the exchanging materials
must be known. The set of transport parameters needed to describe fluid and protein exchanges
across the capillary membrane and within the lymphatic system were estimated previously from
human data by other researchers in our group. As part of the present work, the transport
parameters related to the movement of small ions across the capillary membrane (i.e., the
reflection coefficient, OION, and the permeability-surface area product, PSION) were estimated
using data from studies in which animals were successively infused with iso-osmolar saline (NS)
and hyperosmolar saline (HS) solutions. Also, the transport parameters associated with cellular
exchange (i.e., the cell membrane permeabilities for sodium, potassium and chloride, pNa, PK and
pci, as well as the rate of the sodium-potassium pump, RP, were determined from the steady-state
equations that describe cell volume regulation, together with the known normal distribution of
ions between the intra- and extracellular fluids. Additional transport parameters required to
accommodate external infusions of macromolecular species such as dextran were obtained from
the literature.
The validation of the model with these newly introduced parameters was carried out by
comparing model-predicted results with experimental data from animals and humans that had
undergone different resuscitation protocols (i.e., different rates and volumes of fluid
administration using different types of infusates (NS, Ringer's solution (RS), HS or hyperosmotic
saline/dextran solution (HSD)). Considering the physiological complexity of the body, the
model-predicted results compared very well with the experimental data in the majority of cases
simulated.
As a subset of this study, mathematical expressions are developed to describe the
excretion of fluid and small ions by the kidney. The formulation of this renal model is based on
the physiological role of the kidney in maintaining the plasma volume and plasma sodium
concentration at their normal values. Thus, it is assumed that the kidney responds via a negative
feedback to any changes in these two values from their normal set-points. The generalized fourcompartment
model that includes the 'kidney module' was tested using experimental animal and
human data involving infusions of NS or HS solutions, or non-treated hemorrhages. The model
predictions were generally in very good agreement with the measured results for all the cases
simulated.
Finally, the applicability of the model to the study of hemorrhagic shock was exemplified
through a series of simulations that describe the distinct stages in the progression of shock.
Empirical equations were proposed to characterize the release of glucose and other solutes that
occur during the compensatory (hemodilution) phase of hemorrhage, as well as the disturbed
cellular transport that takes place during the decompensatory (hemoconcentration) stage of
shock. The weaknesses and strengths of the model to clarify certain mechanisms related to
hemorrhagic shock were underlined.
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