Osmotic diuresis due to urea as the cause of hypernatraemia in critically ill patients

Hypernatraemia is common in critically ill patients and has been shown to be an independent predictor of mortality. Osmotic urea diuresis can cause hypernatraemia due to significant water losses but is often not diagnosed. Free water clearance (FWC) and electrolyte free water clearance (EFWC) were proposed to quantify renal water handling. We aimed to (i) identify patients with hypernatraemia due to osmotic urea diuresis and (ii) investigate whether FWC and EFWC are helpful in identifying renal loss of free water.

Electrolyte-free water clearance versus modified electrolyte-free water clearance: do the results justify the effort?

Calculation of electrolyte-free water clearance (EFWC) allows for quantification of renal losses of free water and was shown to be helpful in the differential diagnosis of dysnatremias and might help in the correction of the electrolyte disorders. A modified EFWC formula (MEFWC) was described to be more accurate than the conventional one; however, it has never been evaluated clinically.

Modelling Lake Kivu water level variations over the last seven decades

This study aimed at analysing the hydrological changes in the Lake Kivu Basin over the last seven decades with focus on the response of the lake water level to meteorological factors and hydropower dam construction. Historical precipitation and lake water levels were acquired from literature, local agencies and from global databases in order to compile a coherent dataset. The net lake inflow was modelled using a soil water balance model and the water levels were reconstructed using a parsimonious lake water balance model. The soil water balance shows that 370 mm yr−1 (25%) of the precipitation in the catchment contributes to the runoff and baseflow whereas 1100 mm yr−1 (75%) contributes to the evapotranspiration. A review of the lake water balance resulted in the following estimates of hydrological contributions: 55%, 25%, and 20% of the overall inputs from precipitation, surface inflows, and subaquatic groundwater discharge, respectively. The overall losses were 58% and 42% for lake surface evaporation and outflow discharge, respectively. The hydrological model used indicated a remarkable sensitivity of the lake water levels to hydrometeorological variability up to 1977, when the outflow bed was artificially widened.