A.L. Linton

MEASUREMENT OF BODY WATER AND INTRACELLULAR ELECTROLYTES BY MEANS OF MUSCLE BIOPSY

Abstract A method for estimating the water and electrolyte content of small biopsy specimens of skeletal muscle is described by means of which the total amounts of these are divided into intracellular and extracellular fractions and the corrected chloride content of the specimen is used to calculate the extracellular water. The values thus obtained are believed to be representative of changes in the water and electrolyte content of the whole body. The potassium content of muscle-biopsy specimens taken under general anaesthesia was found to be significantly reduced, but was discounted as being of no practical significance. The muscle-biopsy technique has been useful in the treatment of electrolyte imbalance in disease. The extracellular water content of the biopsy specimens was shown to depend under normal conditions on the sodium content and the intracellular water content on the potassium content; changes in intracellular potassium were balanced osmotically by changes in sodium content. The method is simpler than any method so far described.

Analgesic Nephropathy: Clinical Syndrome and Prognosis

Over a five-year period 86 patients presented to a renal unit with a history of prolonged analgesic abuse and no other obvious cause of renal damage. Anaemia and peptic ulceration were common, and neurological states suggestive of chronic analgesic intoxication occurred in 22 patients. Thirty-two patients died during follow-up, but the prognosis was much better in patients who ceased abuse of compound analgesics, and improvement could occur even in advanced renal failure. While 84 patients had taken mixtures containing both aspirin and phenacetin, papillary necrosis was also found in two patients who had abused only aspirin, and when phenacetin was withdrawn from several leading compound analgesics, renal function continued to deteriorate in patients ingesting those preparations.

Methods of forced diuresis and its application in barbiturate poisoning.

Abstract In a series of 110 cases of severe barbiturate intoxication treated by means of forced diuresis there were only 2 deaths, and no serious side-effects. Comparison of forced diuresis with unassisted renal excretion showed that considerably more barbiturate was removed in unit time with forced diuresis, although the effect was more pronounced with phenobarbitone and cyclobarbitone than with the other intermediate-acting drugs. Study of the methods used to induce and maintain forced diuresis suggested that a simple regimen of fluid infusion was adequate, and that the type of diuretic used was not important, except that alkalinisation was valuable in poisoning with phenobarbitone.

ANALGESIC ABUSE IN PSYCHIATRIC PATIENTS

Abstract Of 181 psychiatric patients interviewed, 16 (8.8%) had consumed a total of more than 1 kg. of aspirin or phenacetin, and a further 26 (14.4%) admitted to daily analgesic ingestion for the previous six months. Compared with non-abusers the 16 analgesic abusers showed a significantly higher incidence of dyspepsia, urinary-tract symptoms, and renal impairment as measured by bacteriuria, pyuria, and creatinine clearance. A further 22 patients known to abuse analgesics exhibited more striking lesions; 4 had died in chronic renal failure and 10 others were uraemic, 14 were anaemic, and 8 had undergone gastric surgery. Psychiatrists are largely unaware, both of the frequency and dangers of analgesic abuse in their patients, and should be on the alert for the syndrome in middle-aged women with chronic neurosis, inadequate personality or reactive depression, especially if known to abuse other drugs or have headaches.

Measurement of blood losses before and after renal transplantation.

There is a significant association between the occurrence of post-halothane jaundice and a previous administration of halothane when the interval between the two halothane anaesthetics is four weeks or less. The risk is in any case small and seems to lie between 1 case in 6,000 (Cardiff data) and 1 case in 22,000 (average of C.S.D. data) repeat halothane anaesthetics within four weeks. In the case of patients who had not had halothane within the previous four weeks the risk is smaller still. From the C.S.D. data it appears to be less than 1 in 600,000. On the assumption that the average consultant anaesthetist administers 1,000 anaesthetics per annum and that if all the patients having second anaesthetics within four weeks were given halothane, in a working life of 30 years he will have administered such repeat halothane anaesthetics to about 2,000 patients. Most therefore of the consultant anaesthetists in the British Isles are likely to complete their professional lives without seeing a single case of halothane jaundice. There seems therefore little reason, on present evidence, to stop halothane anaesthesia. Nevertheless, and in spite of the rarity of jaundice, it is reasonable to avoid halothane when it has been administered to the same patient during the previous four weeks. However, this advice assumes that there is an equally effective and safe alternative with which the anaesthetist is familiar. Otherwise it might mean that by avoiding a rare cause of morbidity or mortality a more common one is introduced.