Thursday, October 20, 2011

Low Blood Volume, Insensible Loss of Total Body Water, and Insensible Pulmonary Capacity Loss (IPCL)

The quandry is this:

If we are bedridden, how can we show a simultaneous low blood volume? This is my quandry and my question that I will be contemplating.

Such questions arise: Even if we keep strict In's and Outs (I & O), this does not always account for a blood volume loss. So the only factor in the equation that can be missing here is Insensible Loss. For those of you who do not yet know what Insensible Loss is, it includes water loss from things other than by passing urine. This includes but is not limited to sweat and respiratory loss.

My hypothesis is that Insensible Loss is a Primary Factor in patients with dysautonomia. If it were possible to inhale/exhale and gain calculated data on water loss through ambient conditions (e.g., barometric pressure, altitude, humidity, sun shine index (*), and existing/coexisting disease such as chronic obstructive pulmonary disease or asthma), perhaps we could measure Insensible Lung Loss with mathematical sensitivity.

The discussion would involve issues such as the typical pulmonary function tests (PFTS), spirometry, and even perhaps total lung volume (as can be calculated by the Multiple Inert Gas Elimination Techinque, or by using Fuzzy Connectedness with hyperpolarized helium 3 inert gas and magnetic resonance imaging (MRI) of the lung. With He3-MRI of the lung, perhaps it is the pulmonary artery pressure, the wedge pressure, and/or the ventilation/perfusion (V/Q) interactions. Additional parameters include such as hemoglobin, hematocrit, platelet count, sodium level, magnesium level, potassium level, barometric pressure, elevation and altitude.

Findings would result in a new quotient parameter that would be more sensitive in calculating/deriving a proposed Insensible Pulmonary Capacity Loss (IPCL). Blood volume and pulmonary insensible loss would be assessed so that the patient knows what action to take. If it is too hot outside, how do we know when/if a patient should lay down? And should we have been able to predict that if we lay this patient down, we will or will not be able to pick this patient back up?

Clinical applications would include the assessment of other diseases which also show low blood volume. Contracts and similarities would be assessed and the numbers would be run to see any association(s). The ultimate benefit would be a reduction in morbidity and mortality due to hypotension, in cases where low blood volume is a significant clinical finding.

Perhaps this will explain why the patient can not get out of bed to exercise. Perhaps it is not the physical condition, but the pathophysiological condition that defines the patient's abilities. There is no 'will' nor 'attitude' nor 'laziness' that is intended nor implied. The benefit is that the physician or other health care professional can use the science of medicine as well as the art of medicine to provide compassion, aide, and a commitment to simply keeping an open mind.

And perhaps it is just a salient yet common sense approach: if the patient says it is true, perhaps it is. If the physician does not find a problem, that does not mean that the problem does not exist. Perhaps there is a problem that needs to be better understood.

* author proposed that it is sun exposure, not just ambient temperature, that primarily leads to dehydration.

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