Relation between indoor and outdoor exposure to fine particles near a busy arterial road

Various studies on indoor and outdoor particulate matter in the urban environment in the vicinity of busy arterial roads in the centre of the subtropical city of Brisbane have indicated that the revised United States Environmental Protection Agency National Ambient Air Quality Standards (US EPA NAAQS) for Particulate matter PM2.5 could be exceeded not only outdoors but also indoors. The aim of this work was to investigate outdoor exposure to submicrometer particles and their relationship with indoor exposure in a hypothetical office building located in the vicinity of a busy arterial road. The outdoor exposure values and trends were measured in terms of particle number in the submicrometer size range and were then recalculated to represent mass concentration trends. The results of this study indicate that exposure to PM0.7 particles in ambient air close to a busy road often exceeds the levels of the annual and 24-hour US EPA NAAQS PM2.5 standards. It is likely that exposure to PM2.5 is even higher, and may significantly exceed these standards.

Insemination at the second of two induced oestrous periods in anoestrous dairy cows increases conception rates to first service

AIM

To determine whether mating previously anoestrous cows on their second, rather than first, oestrus post pm-turn could increase conception rates to that service.

METHODS

Cows diagnosed as anovulatory anoestrus were allocated to two groups, starting treatment on Day -17 (OES2) or on Day -7 (OESI) where the date of the planned start of mating = Day 0. All cows were treated with intravaginal progesterone (CIDR device) for 6 days and an injection of 1 mg oestradiol benzoate 24 h after removal of the device. Cows in the OES2 group were also injected with prostaglandin F2alpha on Day 0.

RESULTS

During the first 7 days of mating, 61.8% (207/335) and 88.2% (328/372) of cows in the OES2 and OESl groups, respectively, were inseminated on detection of oestrus (p <0.001). Oestrus without ovulation occurred in 1.5% of cows in the OES2 group and 6.2% of cows in the OESl group during this period (p <0.01). Of those cows inseminated in the first week of mating, conception rates were 54.0% in the OES2 group and 45.5% in the OESl group (p = 0.05). There was no significant difference in median interval from start of mating to conception between the two groups (24 and 22 days for OES2 and OESl, respectively, p >0.05).

CONCLUSION

Mating previously anoestrous cows on their second, rather than first oestrus post partum increased conception rates to that service. However, median intervals from start of mating to conception were not altered.

Combined assessment of myocardial perfusion and left ventricular function with exercise technetium-99m sestamibi gated single-photon emission computed tomography can differentiate between ischemic and nonischemic dilated cardiomyopathy

The purpose of this study was to determine whether exercise technetium-99m sestamibi gated single-photon emission computed tomography (SPECT) accurately distinguishes between patients with ischemic cardiomyopathy and patients with nonischemic left ventricular systolic dysfunction. Noninvasive tests have previously failed to accurately separate patients with ischemic cardiomyopathy from those with nonischemic cardiomyopathy. Technetium-99m gated SPECT imaging offers advantages that have the potential to overcome the limitations of previous studies. Thirty-seven adults with a left ventricular ejection fraction < or = 35%, including 24 patients with nonischemic cardiomyopathy and 13 patients with ischemic cardiomyopathy, were prospectively evaluated using symptom-limited metabolic exercise treadmill testing with technetium-99m sestamibi gated SPECT imaging. Interpretation of myocardial perfusion and regional wall motion was performed, using a 17-segment model. Summed stress, rest, and reversibility perfusion defect scores were determined, and the variance of segmental wall motion scores was computed. Summed stress, rest, and reversibility perfusion defect scores were significantly lower in nonischemic cardiomyopathy patients, compared with those with ischemic cardiomyopathy (summed stress defect score: 6.9 +/- 3.8 vs 32.9 +/- 7.7, respectively, p <0.001). Variability in segmental wall motion was also significantly lower in patients with nonischemic cardiomyopathy compared with those with ischemic cardiomyopathy (variance: 0.3 +/- 0.3 vs 1.2 +/- 0.8, respectively, p <0.001). Thus, assessment of myocardial perfusion and regional ventricular function with exercise technetium-99m sestamibi gated SPECT imaging can reliably distinguish between patients with ischemic cardiomyopathy and patients with nonischemic dilated cardiomyopathy.

An experience with "research by committee"

The Nursing Research Committee of a community hospital describes the difficulties and unexpected pitfalls encountered during an attempt to conduct "research by committee." The steps of the process, from initial development of a research question through research design and implementation and termination of the project, are related. A retrospective analysis of the difficulties encountered serves as a basis for recommendations to others who might consider research by committee. Although a valid means for conducting research, the experiences of this committee indicate how forces, in their control and beyond their control, might influence completion of a project.

Predictors of referral to cardiac rehabilitation and cardiac exercise self-efficacy

Cardiac rehabilitation (CR) has known benefits after myocardial infarction (MI) or coronary artery bypass surgery (CABG). Yet, only a small percentage of patients are referred for outpatient CR after hospital discharge. This study investigates patient characteristics related to referral to CR and cardiac exercise self-efficacy, a salient predictor of health behavior change and maintenance. Two hundred nineteen patients enrolled in the study. Of the 185 patients who were CR candidates, 74 were referred to CR. Logistic regression analysis was used to identify variables related to CR referral. Results indicate that patient characteristics of having had fewer MIs or CABGs, having attended CR in the past, and being less physically active during leisure time are related to an increased likelihood of being referred to CR. Multiple regression analysis indicates that leisure physical activity is a predictor of cardiac exercise self-efficacy. Implications for nurses who recruit patients for CR are discussed.

A new approach to assessment and documentation of conscious sedation during endoscopic examinations

Assessment and documentation of patient responses to treatment and/or invasive procedures are important facets of nursing care. The purpose of this article is to describe a tool for assessing and quantifying a patient's response to sedation and tolerance of a specific diagnostic and/or therapeutic procedure. Use of the conscious sedation scale will allow the nurse to objectively measure the patient's outcome. This tool will also facilitate better patient care and documentation and substantiate nursing intervention.

Effects of hypertonicity on water intake in the elderly: an age-related failure

Dehydration is a common clinical syndrome associated with many illnesses and treatments in the elderly. Prior studies have shown diminished sensation of thirst during water deprivation. It is currently unclear whether age-related decreases in thirst perception impair the defense against a hyperosmolar challenge. To examine the impact of water ingestion during hyperosmolality, young and old subjects were allowed free access to water during and after an intravenous infusion of 5% hypertonic saline. Cumulative water intake and serum osmolality were compared between seven healthy young (20-28 yrs) and seven healthy old (72-89 yrs) volunteers during and following a two hour hypertonic saline infusion at a rate of 0.06 mlxkg(-1) min(-1). Serum osmolality and water intake were markedly different between the two groups. In the old group, serum osmolality increased by 17 mosmol/kg above baseline despite free access to water. In contrast, serum osmolality increased to only 7 mosmol/kg above baseline in the young group and did not rise further. By ingesting water, the young were able to defend against an additional increase in serum osmolality. The young drank approximately twice that of the old during the infusion period. Healthy older individuals drink less than young despite a significantly increased serum osmolality. This hypodipsia in old individuals increases their susceptibility to hypertonicity.

Urinary cyclic GMP, endothelin, and prostaglandin E2 in normal pregnancy and preeclampsia

Cyclic GMP, endothelin and prostaglandin E2 (PGE2) all have systemic vasoactive properties (with cyclic GMP acting as a second messenger of nitric oxide). Intrarenally they act as natriuretics and urinary levels reflect intrarenal production. Cyclic GMP and PGE2 also act as important inhibitors of platelet activation and thrombosis. The purpose of this study was to determine if urinary levels of cyclic GMP, endothelin, and PGE2 differ in preeclamptic as compared to normal pregnancies. Parameters were compared in 13 normotensive, nonpreeclamptic pregnancies, and 32 preeclamptic pregnancies. Preeclamptic women had significantly lower levels of urinary cyclic GMP (0.67 +/- 0.12 vs. 2.1 +/- 0.5 nmol/g creatinine), endothelin (0.88 +/- 0.09 vs. 3.75 +/- 1.4 ng/g creatinine), and PGE2 (26 +/- 4 vs. 9 ng/g creatinine) as compared to normals (p < 0.05). Intrarenal production of cyclic GMP, endothelin, and PGE2 are all disturbed in preeclampsia and may have implications in the sodium retention, hypertension, and intrarenal thrombosis and vasospasm of preeclamptic pregnancy.

Tonic synaptic inhibition modulates neuronal output pattern and spatiotemporal synaptic integration

Irregular firing patterns are observed in most central neurons in vivo, but their origin is controversial. Here, we show that two types of inhibitory neurons in the cerebellar cortex fire spontaneously and regularly in the absence of synaptic input but generate an irregular firing pattern in the presence of tonic synaptic inhibition. Paired recordings between synaptically connected neurons revealed that single action potentials in inhibitory interneurons cause highly variable delays in action potential firing in their postsynaptic cells. Activity in single and multiple inhibitory interneurons also significantly reduces postsynaptic membrane time constant and input resistance. These findings suggest that the time window for synaptic integration is a dynamic variable modulated by the level of tonic inhibition, and that rate coding and temporal coding strategies may be used in parallel in the same cell type.

Currents evoked in Bergmann glial cells by parallel fibre stimulation in rat cerebellar slices

1. Whole-cell recordings were obtained from Bergmann glial cells in rat cerebellar slices. 2. The cells had low input resistances (70 +/- 38 M omega; n = 13) and a mean resting potential of -82 +/- 6 mV (n = 12) with a potassium-based internal solution. Electrical and dye coupling between Bergmann glia were confirmed. 3. Stimulation of parallel fibres induced a complex, mostly inward current which could be decomposed pharmacologically. 4. The ionotropic glutamate receptor antagonist, 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX; 10 microM), but not DL-2-amino-5-phosphonopentanoic acid (DL-APV; 100 microM) consistently blocked an early inward current component that may reflect synaptic activation of AMPA/kainate receptors in Bergmann glia. 5. Addition of cadmium ions (100 microM) to inhibit transmitter release blocked most of the CNQX-APV-insensitive current. This component probably reflects electrogenic uptake of the synaptically released glutamate. 6. Tetrodotoxin (TTX; 1 microM) blocked the remaining inward current: a slow component, possibly produced by the potassium ion efflux during action potential propagation in parallel fibres. An initial triphasic component of the response was also TTX sensitive and reflected passage of the parallel fibre action potential volley. 7. The putative glutamate uptake current was further characterized; it was blocked by the competitive uptake blockers D-aspartate (0.5 mM) and L-trans-pyrrolidine-2,4-dicarboxylic acid (PDC; 0.5 mM), and by replacement of sodium with lithium. Monitoring the triphasic TTX-sensitive component showed that this inhibition did not result from changes of action potential excitation and propagation. 8. Intracellular nitrate ions increased the putative uptake current, consistent with the effect of this anion on glutamate transporters. 9. The putative uptake current was reduced by depolarization, consistent with the voltage dependence of glutamate uptake. 10. It is concluded that a large fraction of the current induced by parallel fibre stimulation reflects the uptake of synaptically released glutamate. The uptake current activated rapidly, with a 20-80% rise time of 2.3 +/- 0.7 ms (n = 10), and decayed with a principal time constant of 25 +/- 6 ms (n = 10).

Endothelin and atrial natriuretic peptide levels following radiocontrast exposure in humans

Radiocontrast exposure is associated with vasoconstriction of the renal vascular bed and, in certain circumstances, with acute renal failure. This may be influenced by the volume of contrast infused or underlying disease, such as diabetes or renal failure. Changes in circulating vascular regulators, such as endothelin and atrial natriuretic peptide (ANP), may play a role in the development and/or prevention of acute renal failure. Nineteen patients undergoing arteriographic procedures were divided into two groups: large-volume contrast (> or = 150 mL; n = 7) and small-volume contrast (< 150 mL; n = 12). Circulating endothelin levels increased significantly (from 12.3 +/- 1.1 pmol/L to 19.4 +/- 2.2 pmol/L; P < 0.05) following large-volume contrast exposure (group 1) but not following small-volume contrast exposure (group 2) (13.9 +/- 1.7 pmol/L to 12.2 +/- 0.09 pmol/L). ANP levels increased significantly in both groups: 43 +/- 15 pg/mL to 75 +/- 21 pg/mL in group 1 and 33 +/- 16 to 106 +/- 39 pg/mL in group 2. Data from an additional eight patients with underlying diabetes mellitus and/or renal insufficiency also were obtained and were considered separately. Endothelin levels were higher at baseline and increased significantly after contrast (25.7 +/- 5 pmol/L to 55.4 +/- 18 pmol/L) despite the relatively small average volume of contrast infused (112 +/- 15 mL). ANP levels were also highest in these patients (211 +/- 43 pg/mL precontrast and 323 +/- 65 pg/mL postcontrast). No group had a significant change in serum creatinine following contrast exposure. In conclusion, large-volume radiocontrast exposure is associated with an increase in both circulating endothelin and ANP levels. Patients with underlying diabetes or renal insufficiency may have higher baseline levels and a greater tendency to increase endothelin after contrast exposure. While an increase in endothelin may contribute to renal vasoconstriction following radiocontrast exposure, simultaneous increases in ANP may serve to offset this response and protect against changes in renal function.

Increased salt retention and hypertension from non-steroidal agents in the elderly

We studied blood pressure and natriuretic responses to acute salt loading, and the effect of non-steroidal anti-inflammatory agents on these responses, in five healthy normotensive women aged 65 to 71 years. Five women aged 25 to 31 years acted as controls. Intravenous saline loading, with and without prior ingestion of ibuprofen, was 15 ml/kg/h for 3 h. Baseline blood pressures were higher in the elderly. Saline infusion without ibuprofen raised systolic blood pressure (SBP) by about 25 mmHg in the older group only. Ibuprofen increased baseline SBP in the elderly (129 +/- 6 vs. 116 +/- 5 mmHg, p < 0.05). Saline loading after ibuprofen again raised blood pressure by about 25 mmHg in the elderly only. The elderly group showed markedly increased sodium excretion during saline loading, but this was reduced by ibuprofen. Ibuprofen had no effect on SBP or sodium excretion in controls. Ageing appears to increase susceptibility to salt retention and hypertension from non-steroidal anti-inflammatory agents.

A direct comparison of the single-channel properties of synaptic and extrasynaptic NMDA receptors

The assumption that synaptic and extrasynaptic glutamate receptors are similar underpins many studies that have sought to relate the behavior of channels in excised patches to the macroscopic properties of the EPSC. We have examined this issue for NMDA receptors in cerebellar granule cells, the small size of which allows the opening of individual synaptic NMDA channels to be resolved directly. We have used whole-cell patch-clamp recordings to determine the conductance and open time of NMDA channels activated during the EPSC and used cell-attached and outside-out recordings to examine NMDA receptors in somatic membrane. Conductance and open time of synaptic channels were indistinguishable from those of extrasynaptic channels in cell-attached patches. However, the channel conductance in outside-out patches was 20% lower than in cell-attached recordings. This change was partially reduced by dantrolene and phalloidin, suggesting that it may involve depolymerization of actin following Ca2+ release from intracellular stores. Our results demonstrate that synaptic and extrasynaptic NMDA receptors have similar microscopic properties. However, NMDA channel conductance is reduced following the formation of an outside-out patch.

Effects of oral and intravenous rehydration on ratings of perceived exertion and thirst

The purpose of this investigation was to compare the effects of oral and intravenous saline rehydration on differentiated ratings of perceived exertion (RPE) and thirst. Eight men underwent three randomly assigned rehydration treatments following a 2- to 4-h exercise-induced dehydration bout to reduce body weight by 4%. Treatments included 0.45% saline infusion (i.v.), 0.45% saline oral ingestion (ORAL), and no fluid (NF). Following rehydration and rest (2 h total), subjects walked at 50% VO2max for 90 min at 36 degrees C (EX). Central RPE during ORAL was lower (P < 0.05) than i.v. and NF throughout EX. Local RPE during NF was higher (P < 0.05) than i.v. and ORAL at minutes 20 and 40 of EX and overall RPE during NF was higher (P < 0.05) than ORAL at minutes 20 and 40 of EX. Significant correlations were found between overall RPE and mean skin temperature for i.v. (r = 0.72) and NF (r = 0.75), and between overall RPE and thirst ratings for i.v. (r = 0.70). Thirst ratings were not different among trials at postdehydration. Following rehydration, thirst was higher (P < 0.05) during NF than i.v. and ORAL and lower (P < 0.05) during ORAL than i.v. at all subsequent time points. Results suggest that oral rehydration is likely to elicit lower RPE and thirst ratings compared with intravenous rehydration.

Development of the Conscious Sedation Scale: establishing content validity and reliability

The purpose of this study was to determine content validity and reliability of the Consciousness Sedation Scale (CSS), an instrument developed as a documentation tool for patient response during invasive procedures using intravenous conscious sedation. Instrument items were developed to reflect goals of conscious sedation recommended by the Association of Operating Room Nurses. Content validity of the parameters and grades was established at Content Validity Index (CVI) .875. Cronbach's coefficient alpha of .69 indicated insufficient reliability of discriminatory items between grades. Further refinement of the tool was indicated.

Extrarenal potassium homeostasis with maximal exercise in end-stage renal disease

Serum potassium levels rise substantially during vigorous exercise as a result of the release of potassium from contracting muscle cells. Widespread use of erythropoietin has allowed for increased exercise capacity in patients with ESRD, raising the concern for severe exertional hyperkalemia. The aim of this study was to determine whether ESRD is associated with alterations in potassium and the neurohumoral mediators of extrarenal potassium disposal with maximal exercise. Eight stable hemodialysis patients (aged 37 +/- 16 yr, mean +/- SE) and eight healthy control subjects (aged 44 +/- 13 yr) exercised to exhaustion, using a graded cycle ergometer. There were no significant differences in exercise performance between groups as assessed by peak work rate, maximal oxygen consumption, and rate pressure product. Although the baseline potassium level was higher in the dialysis group (5.0 +/- 0.2 mEq/L) than in control subjects (4.5 +/- 0.1 mEq/L), both groups had a similar pattern of increase during exercise (with an increment of approximately 1 mEq/L) and a similar return to baseline after exercise. However, the dialysis patients had higher basal norepinephrine levels (820 +/- 104 versus 441 +/- 56 pg/mL, P < 0.01) and a greater response to exercise (3122 +/- 429 versus 1696 +/- 424 pg/mL, P < 0.01), higher basal insulin levels (11 +/- 1 versus 7 +/- 1 microU/mL, P < 0.05), higher insulin post-exercise levels (19 +/- 3 versus 11 +/- 1 microU/mL, P < 0.05), and higher basal aldosterone levels (621 +/- 250 versus 109 +/- 13 pg/mL, P < 0.05) with an increase response to exercise (1100 +/- 350 versus 350 +/- 17 pg/mL, P < 0.05). In summary, despite higher basal potassium, dialysis patients have normal potassium responses to maximal exercise. More vigorous insulin, catecholamine, and aldosterone levels may contribute to the maintenance of extrarenal potassium homeostasis in ESRD.

Evidence for a C-terminal turn in PBAN. An NMR and distance geometry study

The solution conformation of the pheromone biosynthesis activating neuropeptide (PBAN) of the moth Helicoverpa zea has been determined using homonuclear two-dimensional nuclear magnetic resonance techniques and distance geometry-restrained energy minimization. The insect peptide hormone showed a random distribution of conformers in aqueous solution, whereas in a less polar medium of trifluoroethanol and water, a reordering process was observed. In particular, the C-terminal region (Phe-Ser-Pro-Arg-Leu-NH2) adopts a type I' beta-turn conformation, residues 20-27 are in a helix conformation, and residues 1-19 exhibit a high degree of flexibility. Direct observation of the C-terminal beta-turn configuration of PBAN is consistent with a previous report that showed a rigid, cyclic analog of the C-terminal pentapeptide of PBAN retained pheromonotropic activity [Nachman, R.J., Kuniyoshi, H., Roberts, V.A., Holman, G.M. & Suzuki, A. (1993). Biochem. Biophys. Res. Commun. 661-666]. Furthermore, our results show no interaction between the C-terminal turn and the rest of the polypeptide chain, thus providing further evidence that the C-terminal turn is indeed the important conformation recognized by the PBAN receptor.

Aldosterone responses to hyperkalemia in healthy elderly humans

Plasma aldosterone levels are reported to be lower in healthy elderly individuals compared with young individuals, a difference exaggerated by sodium depletion or upright posture. The aim of this study was to determine the aldosterone response to increases in serum potassium with advancing age. In the Clinical Research Center, six healthy young (20 to 35 yr of age) and six healthy elderly (65 to 85 yr of age) subjects underwent evaluation of their aldosterone responses to potassium infusion (0.5 mEq/kg over 45 min). Both young and elderly subjects had similar basal serum potassium levels (4.3 +/- 0.2 versus 4.4 +/- 0.1 mEq/L), similar sodium and potassium excretion amounts and similar increase in serum potassium levels during infusion (to 5.0 +/- 0.2 versus 5.1 +/- 0.1 mEq/L). However, elderly subjects had lower basal levels of plasma aldosterone and a blunted aldosterone response to potassium infusion (P < 0.05, analysis of variance). Advancing age is characterized by relative hypoaldosteronism in the basal state as well as in response to hyperkalemia. This may contribute to an increased susceptibility to hyperkalemia if other potassium regulatory systems fail.

Potassium homeostasis and hyperkalemic syndromes

Acute hyperkalemia can be a life-threatening consequence of a variety of pathologic, pharmacologic, and iatrogenic disorders. Recognition and prompt therapy often reverse the electrophysiologic complications within minutes. Therefore, physicians must have a thorough understanding of potassium homeostasis. The causes of hyperkalemia, intracellular-to-extracellular shifts of potassium, excess exogenous potassium loads, and pseudohyperkalemia are discussed.

Reduced renal response to low-dose dopamine infusion in the elderly

BACKGROUND

Increasing age is associated with a number of changes in renal function, including a diminished capacity to excrete salt and water loads and an increased susceptibility to acute renal failure. Dopamine is a renal autocoid important in diuresis and natriuresis and may also serve to protect against ischemic renal injury. The aim of this study was to assess the renal response to a low-dose dopamine infusion in healthy young vs elderly individuals.

METHODS

Five healthy young (28 +/- 2 yr) and elderly (68 +/- 3 yr) subjects underwent evaluation of renal function and blood pressure before, during, and after a 3-hour infusion of dopamine (1 microgram/kg/min) in the Clinical Research Center of Beth Israel Hospital.

RESULTS

Renal plasma flow, estimated by clearance of para-aminohippurate clearance, was significantly lower in the elderly than in the young subjects, but both groups increased estimated renal plasma flow by approximately 30% during dopamine infusion. Endogenous creatinine clearance was also significantly lower in the elderly. During dopamine infusion, creatinine clearance rose significantly only in the young. Both young and old had a similar natriuretic response to dopamine although urine flow and free water clearance were significantly lower in the old. Neither group had significant changes in blood pressure or heart rate.

CONCLUSIONS

Resistance to the actions of dopamine on creatinine clearance in the elderly may reflect an inability to respond to endogenous dopamine at times of physiologic stress with resulting susceptibility to azotemia.

Hypotensive response to atrial natriuretic peptide administration is enhanced with age

BACKGROUND

Plasma levels of atrial natriuretic peptide (ANP) increase with age. To test the hypothesis that the cardiovascular response to ANP is age dependent and to examine the role of the increased levels of ANP in the hypotensive response to orthostatic challenge, we compared the hemodynamic response of young and elderly subjects to ANP infusion and orthostatic challenge.

METHODS

Blood pressure, heart rate, forearm cutaneous resistance, plasma ANP, and plasma norepinephrine were measured in the supine position and following upright tilt before and after a 60-minute infusion of atrial natriuretic peptide (0.05 microgram/kg/min) in 7 young (27 +/- 4 years) and 5 elderly (74 +/- 4 years) normotensive, healthy subjects.

RESULTS

Prior to ANP infusion, the response to upright tilt was similar in both groups. Infusion of ANP produced similar steady state plasma levels of ANP in both groups (young: 435 +/- 49 pg/ml; elderly: 429 +/- 32 pg/ml). Supine systolic blood pressure decreased by 4 +/- 2 mmHg in the young subjects and by 18 +/- 8 mmHg in the elderly subjects after infusion (p < .08). In contrast, changes in supine heart rate, forearm cutaneous resistance, and plasma norepinephrine were similar in both groups (delta heart rate: young +5 +/- 3 beats/min, elderly +4 +/- 2 beats/min; delta forearm cutaneous resistance: young -38 +/- 9%, elderly -40 +/- 6%; delta norepinephrine: young +55 +/- 11%, elderly: +43 +/- 13%). ANP infusion abolished the vasoconstrictor response normally associated with orthostatic challenge in both groups, despite a significant release of catecholemines and an enhanced heart rate response. This resulted in significant systolic blood pressure reduction in both young (-7 +/- 2 mmHg, p < .05) and elderly subjects (-16 +/- 4 mmHg, p < .05). The drop in systolic blood pressure in response to upright tilt and ANP infusion was four times larger in the elderly subjects (change from pre-ANP level: young -8 +/- 3 mmHg, elderly -32 +/- 5 mmHg, p < .005).

Increased susceptibility to thiazide-induced hyponatremia in the elderly

Hyponatremia is a common cause of morbidity in the elderly, and thiazide diuretics are often implicated. Eleven healthy young volunteers, eight healthy old volunteers, and five elderly patients with a history of thiazide-induced hyponatremia were studied to determine susceptibility to thiazide-induced hypoosmolality in age. Each of the healthy subjects ingested a water load (20 mL/kg) after 3 days of hydrochlorothiazide (HCTZ) (100 mg/day) or placebo. Although there were no differences in minimum Uosm between young and old, the healthy old had lower hourly free water clearances (CH2O) as compared with the young and a greater decline in serum osmolality in response to water loading (P < 0.05). HCTZ impaired minimum urine osmolality and CH2O and delayed recovery of serum osmolality after the water load in both healthy young and old (P < 0.005, placebo versus HCTZ), but the impairment in the latter two parameters was greater in the healthy elderly (P < 0.05, young versus old). Vasopressin levels were not different between healthy young and old (1.9 +/- 0.3 versus 2.0 +/- 1.0 pm with placebo; 3.0 +/- 0.7 versus 4.4 +/- 1.0 with HCTZ). Five of the young subjects were restudied after the addition of ibuprofen (400 mg thrice daily) to the thiazide and placebo regimens. Creatinine clearance was not changed, but free water clearance and serum osmolality after water loading were significantly reduced to a degree similar to that seen in the elderly subjects on the thiazide regimen (P < 0.05), suggesting an important role for renal prostaglandins in the defense against hyponatremia.