Water-electrolyte metabolism and renal function under action of hyperbaric factors

INTRODUCTION. Numerous studies in the field of hyperbaric physiology and diving medicine note changes in the water-electrolyte metabolism as well as renal function of men and animals in conditions of high pressure of gas and water environments. Despite undeniable water part in the process of body saturation-desaturation from indifferent gas as well as in processes of maintaining osmotic homeostasis, the role of water-electrolyte metabolism and renal functions in adaptation processes to hyperbaric conditions remains under-researched.

OBJECTIVE. To determine mechanisms and patterns of changes in the water-electrolyte metabolism and renal functions under the action of hyperbaric factors.

MATERIALS AND METHODS. Review work of scientometric databases was conducted: eLibrary.ru, RSCI, Scopus, PubMed, Cochrane, Google Scholar, www.academickeys.com, Ulrichsweb, www.research4life.org, www.lens.org, www.cabi.org, rucont.ru, www.ebsco.com, www.mendeley.com, OpenCitations.net, unpaywall.org, xueshu.baidu.com, www.wikidata.org, na.neicon.ru, keepers.issn.org. the search was done by keywords and phrases in Russian and English: a diver, water-electrolyte metabolism, excretory system, renal functions, diuresis, kidney, nitrogen toxic effect, hyperoxia, hypoxia, decompression sickness, oxygen toxic effect. 155 literary sources of 1975–2023 were analyzed, 53 works of which were included in the review, met the criteria for inclusion and exclusion. In this case, at least 80 % of works, included in the review, have been published for the past 10 years.

RESULTS. Most analyzed works contain information on an increase in diuresis in most subjects in the course of diving. Apart from it, there is an increase in the excretion of sodium and potassium in the urine, correlated with the amount of urine produced. Hypernatremia and an increase in tissue hydration are often revealed in the hyperbaric conditions, cause by oxygen toxic effect, supersaturation of body tissues with indifferent gases and nitrogen toxic effect. Renin-angiotensin-aldosterone system (RAAS) and its main component aldosterone play a key role in changes of the water-electrolyte metabolism in the hyperbaric conditions. The role of antidiuretic hormone is interesting because a lot of “non-classical” effects are uncovered in it that could be manifested in hyperbaric conditions and have never been associated with the action of high pressure on the regulation of the water-electrolyte metabolism.

DISCUSSION. Staying in conditions of increased pressure of the gas and water environment is subject to numerous and sometimes divergent changes in the water-electrolyte metabolism and renal functions. The loss of water and electrolytes by the body, recorded by bioimpendance methods in the course of hyperbaric factors, might result in dehydration. This, in turn, can increase the risk of developing specific divers’ disease, primarily such as decompression sickness. The studied literature does not provide clear guidelines on water-electrolyte balance correction in divers. Some works present data showing the possibility and usefulness of liquid intake (drinks) or pharmacological drugs, affecting divers’ water-electrolyte metabolism.

CONCLUSION. Analysis of literature data shows that specific changes of water-electrolyte metabolism and functions of excretory system emerge in the conditions of hyperbaric factors. In most subjects, these changes involve increased diuresis, hypernatremia and reduced tissue hydration. In cases where the effect of the adverse hyperbaric factor led to the development of pathological changes, tissue hyperhydration and increasing concentration of potassium in the blood as well as reduction of sodium in the urine were observed. This could indicate the possibility of forming the specific phenomenon “pressure diuresis” in hyperbaric conditions. All changes, occurring in the body under the action of hyperbaric factors, should be considered in terms of individual resistance to these factors and primarily to decompression sickness. Studies of divers’ water-electrolyte metabolism and renal function in the conditions of adverse hyperbaric factors are relevant with a view to developing the system of correction measures and prevention of the revealed violations.

marine medicine, diver, pressure diuresis, decompression sickness, water-electrolyte metabolism, nitrogen toxic effect, oxygen toxic effect, hypoxic hypoxia

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