Polyuria and GDD- why does baseline peeing a lot not necessarily help with removing Gd.
Polyuria is defined as urine output > 3 L/day. Blood volume is typically 4.5 - 5.7 L. This means that individuals can pee out nearly their entire blood volume each day.. That is remarkable. What is remarkable is how the body is able to maintain homeostasis of perhaps 100 or more blood elements so the individual does not die in just a few days of polyuria- and these people live with it... maybe all their lives.
Approximately 5% of individuals with GDD have polyuria,. On the surface following chelation, peeing out half your blood volume or more per day sounds like it should get rid of an enormous amount of Gd that has been remobilized from tissues back into the blood system. And yet, in my clinical experience, individuals with polyuria often do less well than others with standard urine volume.
How is this possible?
My theory is this: to eliminate that amount of fluid per day from the blood system and not lose at the same time tremendous amounts of electrolytes and other blood elements, the kidneys, and specifically the distal convoluted tubules (DCT) have to make shortcuts. The distal convoluted tubule is the portion of the kidney nephron involved in electrolyte homeostasis. As with any flowing system, as the speed picks up short cuts have to be taken (think Lucille Ball and the episode in the chocolate factory). I think that to manage this flow, electrolytes, rather than be carefully selected in individuals, they en bulk get reabsorbed. So at normal flow rates, Calcium , and other necessary cations, are selectively picked out and reabsorbed. At fast flow rates/large volumes, Calcium and cations similar to Calcium, such as Gadolinium , which has a similar ionic radius,, may be treated the same and all reabsorbed, with little selection. This bundling performed to avoid losing important cations when large flow is occurring. In my opinion, Gd may be bundled reabsorbed with Calcium and other important native cations, so in a constant state of polyuria, the host is able to survive. Cations and other important electrolytes and blood elements are non-selectively reabsorbed to avoid electrolyte imbalance and ultimately death.
Ironically therefore, baseline status polyuria, rather than promoting Gd elimination, actually may serve to increase Gd retention.
Note this is different than a normal urine output individual increasing urine output by drinking more when they undergo chelation. This temporary, 1 or 2 day intentional increased fluid intake to generate greater urine output does make perfect sense... At the same time this may suggest that overdoing fluid intake in order to generate massive urine, may have the effect of the bundling effects of cations in the DCT.
The polyuria individual has already, as their status quo, the bundling reabsorption of Gd with Ca. The source of this polyuria is unknown for many of them. This is another important area of research- is it hypothalamus-origin, posterior pituitary, or direct DCT? Or is it a problem of communication between these structures?
This maybe also reminds us of the age old wisdom: everything in moderation.
Richard Semelka, MD.