The Measurement of Bidirectional Sodium Fluxes across the Intestinal Wall in Man Using Whole Gut Perfusion

Abstract

1. Double-tracer studies have been carried out in order to investigate the validity of a whole-gut perfusion technique for the measurement of gut lumen-to-plasma and plasma-to-gut lumen sodium fluxes in man. 2. The use of two tracers permits differentiation between the unabsorbed orally administered sodium in the stools and the sodium which has been absorbed and resecreted. The latter is by no means negligible and may amount to some 30% of the recovered material. 3. The available data do not permit the calculation of the absolute values of the bidirectional fluxes without the introduction of some assumption concerning the reabsorption of the sodium which crosses from the plasma to the gut lumen. It is assumed here that this sodium is absorbed by the gut to the same extent as the orally administered material. Analysis of the kinetics of sodium transfer from mouth to stool direct and via the blood plasma in normal subjects and patients with diarrhoea provided experimental evidence confirming the correctness of this assumption. 4. In eleven normal volunteers the gut lumen-to-plasma flow of sodium averaged 13.0 mmol min−1, implying that the observed absorption averaging 1.65 mmol min−1 represents a relatively small imbalance between the bidirectional fluxes. Although one patient with post-gastrectomy dumping syndrome had high fluxes and another with malabsorption following gut resection gave low values, it is suggested that changes in the fluxes in the same patient are more significant than isolated observations on individuals. 5. Granted the validity of the primary assumption, a considerably simpler technique may be used for clinical and field studies which is sufficiently accurate for most purposes and employs a single tracer.