Fever and sepsis during neutropenia are associated with expansion of extracellular and loss of intracellular water

Abstract

Background and aims: Shifts from intracellular to extracellular water are features of a catabolic reaction to sepsis. Bedside assessment of fluid shifts was carried out in neutropenic patients at high risk of systemic infection.

Methods: Multifrequency bioelectrical impedance analysis was performed in 41 patients with leukemia or high-malignant lymphoma and chemotherapy-induced neutropenia.

Results: Hydration was stable during afebrile periods except for transient intra- and extracellular dehydration after chemotherapy. The risk of over-hydration and dehydration increased 3-fold during fever. Over-hydration was more severe when occurring during fever. Extracellular water was highly variable and tended to increase, and intracellular water was slowly depleted. During sepsis, these alterations were enhanced. Changes in hydration status did not predict subsequent progression to sepsis because it developed more slowly than other symptoms of infection.

Conclusions: Extracellular over-hydration and intracellular dehydration are observed in febrile infection in neutropenia, similar to severe sepsis. If the technical limits of bioelectrical impedance are taken into account, this method may be useful for non-invasive monitoring of these features of metabolic stress.