Arnold E. Osterberg

THE TOLERANCE FOR POTASSIUM IN SEVERE RENAL IN-SUFFICIENCY: A STUDY OF TEN CASES

The concentration of potassium in the serum of a patient who has developed severe renal insufficiency may be normal, increased, or diminished, and nq, satisfactory explanation for these widely varied concentrations has been advanced. Naturally the finding of an increased content of potassium in the serum of a nephritic patient suggests caution in the administration of potassium salts. On the other hand there are certain undernourished patients who have nephritis and are suffering from lack of potassium and therefore require an increased intake. It is also recognized that many patients who have renal edema can tolerate a considerable daily dose of potassium salts over a period of months without evidences of toxic effects. It is therefore obvious that there are other factors, in addition to renal retention, which play a role in the distribution of the potassium ion in uremic patients. Observations of potassium tolerance, both in normal. subjects and in patients who had adrenal insufficiency, have been made by Zwemer and Truszkowski (1), Wilder and his co-workers (2), and Jaffe and Byron (3). The effects of a small and of a considerable dose of potassium salts were studied by Greene, Levine and Johnston (4), and by Winkler and his associates (5) in renal disease and by Thomson (6) and Sharpey-Schafer (7) in cardiac disease. The doses employed by Winkler and Sharpey-Schafer were frequently large and sometimes proved impractical and even dangerous. We therefore gave normal subjects and patients who had renal disease a uniform and smaller dose of 5.0 grams of potassium bicarbonate by mouth and were gratified to find that this amount could usually be tolerated and also revealed information as to the individuals tolerance. Our procedures and results in normal subjects have already been reported (8). The present communication deals with the results of the same procedures carried out in 10 patients who had definite renal. insufficiency. Distinct alterations in potassium tolerance were observed in all of the 10 patients and form the basis of this paper.

ACINAR CELL CARCINOMA OF PANCREAS: REPORT OF CASE IN WHICH FUNCTION OF CARCINOMATOUS CELLS WAS SUSPECTED

Excerpt We are reporting a case of acinar cell carcinoma of the pancreas in which values for enzymatic activity in the serum were many times greater than those usually encountered in cases of carci...

Treatment of the hemorrhagic tendency in jaundice; with special reference to vitamin k

Evidence has been presented to show that oral administration of a fat soluble vitamin and bile salts will increase the concentration of prothrombin and thereby reduce the clotting time of the blood, as measured by both direct and indirect methods. It appears that the vitamin alone will not accomplish this result if bile is excluded from the intestine, while bile or bile salts have some definite effect, presumably because these substances facilitate absorption of the vitamin which is already present in the intestinal tract. The question naturally arises as to why bile alone cannot be used in the preoperative and postoperative treatment. The first reason is, of course, that the prothrombin time may continue to rise postoperatively, even when bile is flowing freely into the intestine. As Warner, Brinkhous and Smith (23) have shown, the administration of Vitamin K greatly accelerates the restoration of prothrombin in such cases. The second is the inadequate food intake which is common to most jaundiced patients and which may of itself lead to depletion of the amount of Vitamin K in the digestive tract. The third factor has to do with the ability of the liver itself to convert the protective material into prothrombin. There is considerable clinical evidence to show that in the presence of injury of the liver larger amounts of Vitamin K are required to achieve the desired effect. Presumably, the chemical laws governing mass action are operative in this connection. A good deal of future experience will be needed before a definite statement as to the indications for and the limitations of this treatment can be established, but for the present it may be said that it offers considerable hope for the ultimate control of the hemorrhagic diathesis in jaundiced persons.

Pancreatic secretion in man after administration of different stimulants: a comparative study.

Parallel determinations of values for volume of duodenal contents and for bicarbonate, amylase, trypsin and lipase in the duodenal contents have been made in man after stimulation with Vitamin A administered intramuscularly, cooked starch, casein and olive oil administered intraduodenally, prostigmine methylsulfate and mecholyl chloride administered subcutaneously, secretin administered intravenously and secretin and mecholyl chloride injected in combination. Vitamin A and starch did not produce a measurable stimulation of the fractions of duodenal contents. Mecholyl chloride appeared to stimulate the various fractions of duodenal contents more uniformly than, and as potently as did casein, fat and prostigmine methylsulfate and for this reason appeared to be preferable to foods and prostigmine methylsulfate as a stimulant.

The effect of atropine sulfate, morphine sulfate, pilocarpine hydrochloride, prostigmine methylsulfate, sodium salt of dehydrocholic acid and secretin on the gastric and duodenal secretions of normal persons when fasting

The method of continuous aspiration of gastric and duodenal contents has been applied in the study of volume and pH of the gastric and duodenal contents.