Anne M. Perley

ESTIMATION OF TOTAL BODY SODIUM BY ISOTOPIC DILUTION. I. STUDIES ON YOUNG ADULTS

Although the amount of sodium contained within the human body has been determined in a number of fetuses and newborns by direct chemical analysis, no such data are available for the adult. This value has been estimated (by means which are not clear) to be 63 Gm. by Shohl (2), 56 Gm. by Hackh (3), and 105 Gm. by Sherman (4) for a 70 Kg. man. The literature contains reports of the chemical analysis of one adult carcass, but unfortunately values for sodium are not given (5). The importance of sodium in the electrolyte economy of the human body prompted us to undertake a study of the feasibility of determining total body sodium by the isotopic dilution method. In vAtro applications of isotopic dilution analysis are well known, and present no particular difficulties under conditions wherein the system to be studied is a closed one. The method was applied to man for the determination of total body water in 1934 by Hevesy and Hofer (6) who used deuterium, a stable isotope, in their experiments. More recently radioactive hydrogen has been used for the same purpose (7). Although Kaltreider and his co-workers (8) made the suggestion several years ago that they were measuring total body sodium in experiments aimed at determination of extracellular fluid volume, F. D. Moore (9) was the first to emphasize the potentialities of the isotopic dilution method for the measurement of total body sodium and potassium in addition to total body water in man, and re-

ESTIMATION OF TOTAL BODY SODIUM BY ISOTOPIC DILUTION II. STUDIES ON INFANTS AND CHILDREN AN EXAMPLE OF A CONSTANT DIFFERENTIAL GROWTH RATIO

In contrast to the lack of such information on adults, the literature does contain reports of the direct chemical analysis of a number of fetuses and newborn infants for sodium. Data are available, therefore, with which to compare directly results obtained by the isotopic dilution method. Our study of total body sodium in man, for which data on adults are presented elsewhere (2), was consequently broadened to include infants and children. Since it has been known for some time that the sodium content of the infant, on a per kilogram basis, is higher than that of the adult (3), we set out to investigate the possibility that there was some regularity to the process of chemical growth. That a chemical growth pattern, capable of being expressed in simple mathematical terms, does indeed exist, at least with regard to sodium accumulation, will be demon

Cholesterol: treadmill activity accelerates oxidation in rats.

Cholesterol-26-14C was injected intravenously into male and female rats of two different strains. Recovery of radioactivity from the expired air was increased by treadmill activity.

Renal Physiology in Infants and Children. II. Inulin Clearances in Newborn Infant with Extrophy of Bladder

Interest in the renal function of newborn infants has been aroused by recent studies which indicate that the glomerular filtration rate is relatively low during the newborn period. The application of a method devised by one of us 1 to 7 apparently normal full-term infants ranging in age from 4 to 9 days suggested glomerular filtration rates between 20 and 40% of the average normal adult values. McCance and Young 2 have since published an extensive study of renal function of newborn infants, in which are included observations on inulin clearances in 3 infants, aged 6 to 13 days, with meningoceles. Urine collections were made by means of catheterization, and the determined inulin clearances were of the order of 43% of the average adult value. These workers pointed out that the inulin clearances varied considerably with the minute urine volumes. In addition, they observed corresponding changes in urea clearances. Gordon, Harrison, and McNamara, 3 determining urea clearances in premature and full-term infants ranging in age from 7 to 70 days, also obtained values considerably below the normal adult levels. They did not find increases in the urea clearances when the flow of urine, initially 0.05 to 0.20 cc per minute or 0.4 to 1.0 cc per square meter per minute, increased by 25 to 100%. The observations reported here were made on a 24-hour-old infant, weighing 2100 g, who was admitted to the St. Louis Childrens Hospital on July 18, 1941, because of an extrophy of the bladder. The 2 ureteral orifices were visible and readily accessible. Ureteral catheters were inserted easily and a steady flow of urine was obtained. Blockage necessitating irrigation of the catheters was not encountered during the period of the studies to be described and it was felt that accurate collections were made with a minimum of manipulation.

Influence of Eosinophile Cells of Hypophysis on Kidney Function

White, Heinbecker and Rolf 1 reported that removal of the glandular division of the hypophysis in dogs resulted in a reduction of 50% or more in inulin and diodrast clearances and in maximal tubular excretion of diodrast at high plasma levels. These changes indicate a depression of renal blood flow and of renal tubular excretory capacity and were in evidence within 7 days after the removal of the glandular hypophysis. They have persisted under observation for a period of 2 years. It can be stated, therefore, that the glandular hypophysis exercises a humoral influence on the kidney. Evidence that the eosinophile cells of the hypophysis are responsible for this influence is presented in this paper. Observations on the urea clearance of 5 patients with acromegaly revealed values of 130, 83, 135, 231, and 100%, respectively, of the normal standard. Three of these values are definitely above the upper limit of normal. An eosinophil tumor was found at autopsy in the first of these patients. The kidneys weighed 420 g. Microscopically the glomeruli and tubules were slightly hypertrophied. There was generalized arteriosclerosis of the renal vessels. Some increase in kidney size is a usual finding in acromegaly. Since eosinophil cell hyperplasia or eosinophil tumor formation has been found in all cases of acromegaly 2 coming to autopsy, the increase in renal function and in renal size observed in this disease perhaps may be attributed to hyperfunction of the eosinophil cells of the glandular hypophysis. The degree of secretory activity of the hypophysial tumor should be reflected in the extent of increase in renal function. Winternitz and Waters 3 and White, Heinbecker and Rolf 4 have shown that in dogs a single remaining kidney fails to hypertrophy after removal of the glandular division of the hypophysis.

The use of sulfamerazine in infants and children

Summary A study of the absorption, methods of administration, therapeutic effectiveness, and toxicity of sulfamerazine in an unselected group of 135 infants and children with infections revealed the following pertinent data: 1. Sulfamerazine is rapidly absorbed from the gastrointestinal tract and rather slowly excreted by the kidney. Accordingly, adequate blood concentrations are easily attained by the oral administration of 0.05 Gm. per kilogram of body weight every eight hours (three-quarters of the total daily dosage usually employed with sulfathiazole and sulfadiazine). Sulfamerazine thus possesses an advantage over the other sulfonamide drugs in that they must be given in larger total dosage with more frequent doses to attain comparable blood levels. 2. High blood concentrations are easily and rapidly produced by the subcutaneous administration of sodium sulfamerazine. The absorption of sulfamerazine from the gastrointestinal tract, although more rapid and complete than is the absorption of the other sulfonamide drugs, does not lead to values sufficiently high to obviate the need for parenteral administration of the drug when very high values are desired. 3. Sulfamerazine was observed to pass into the spinal fluid to the extentof from 52 to 83 per cent of the whole blood value and 41 to 73 per cent of the plasma value, while the concentration in pleural and ascitic fluid equaled that in the plasma. 4. From a purely clinical evaluation, the therapeutic effectiveness of sulfamerazine is entirely comparable to that of sulfapyrazine, sulfadiazine and, sulfathiazole. 5. The toxic reactions encountered were relatively frequent but, for the most part, were mild, and no serious reactions occurred. On the basis of our past experience, the frequency of toxic reactions was definitely greater with the use of sulfamerazine than with sulfapyrazine and certainly as great as with sulfadiazine.

Treatment of hyperthyroidism withradioactive iodine

Summary 1. A case of diffuse toxic goiter in an 11-year-old female is reported in which radioactive iodine therapy resulted in satisfactory relief of signs and symptoms of the disease. 2. Details of the patients response to therapy are presented. 3. Radioiodine uptake curves of thethyroid gland obtained at the time of treatment and again twenty-one months later are presented.