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THE KIDNEY

Edema

A 55-year-old man with heart failure has developed edema. During the past 2 weeks, his weight has
increased by 4 kg (9 lbs). Assuming that the entire weight gain is the result of the accumulation of fluid,
calculate the following:

This man has gained 4 kg. This represents the accumulation of 4 L of fluid (I kg = 1 L) in the ECF. A
portion of the fluid will accumulate in the interstitial fluid compartments as edema. The composition of this
fluid is the same as that of plasma and has a [Na+] of 145 mEq/L. Recall that the accumulation of the
fluid requires Na+ retention by the kidneys. Therefore the amount of Na+ retained by the kidneys must be
equal to the amount contained in 4 L of fluid having a [Na+] of 145 mEq/L, or 580 mEq of Na+.

Euvolemia

A 21-year-old woman is euvolemic and ingests a diet that contains 200 mEq/day of Na+ on average. What
would the Na+ excretion rate of this woman be over a 24-hour period?

The woman is euvolemic. To maintain Na+ balance, the amount of Na+ ingested in the diet must equal
the amount excreted from the body. Because the kidneys are the primary route for Na+ excretion, the
amount of Na+ excreted daily is nearly equal to the amount ingested in the diet (small amounts of Na+
are lost in perspiration and feces). Therefore the Na+ excretion rate in this woman is approximately 200
mEq/day.