Glenn D. Lubash

Severe Acidosis and Hyperpotassemia Treated with Sodium Bicarbonate Infusion

Four uremic patients with severe acidosis, hyperpotassemia, and electrocardiographic signs of toxicity were treated with intravenous sodium bicarbonate. Serial determinations showed a fall in plasma potassium, a rise in blood pH, and regression of the electrocardiogram toward normal. The mechanisms responsible for these changes are discussed.

Use of a Calcium Chelating Agent(NaEDTA) in Cardiac Arrhythmias

The interrelated effects of digitalis and various cations on cardiac rhythmicity are the subject of much recent interest. This paper presents additional data on this subject that carry important therapeutic implications. The chelating agent, disodium ethylene diamine tetra acetate (NaEDTA), has been used intravenously in 14 instances of supraventricular and ventricular arrhythmia. Digitalis had been administered previously in 13 instances, and various degrees of digitalization were encountered. This report summarizes our experience with NaEDTA as a test of the degree of digitalis therapy and as treatment of the arrhythmias observed.

A Controlled Study of Induced Diuresis in Barbiturate Intoxication

Excerpt Management of the patient comatose from barbiturates rests on maintenance of vital functions with meticulous attention to respiratory toilet (1). Other regimens employed to remove the toxic...

Severe metabolic alkalosis with neurologic abnormalities; report of a case.

EXTREME degrees of hypokalemic and hypochloremic alkalosis are occasionally seen in the adult patient. The case reported below is an example of such a metabolic abnormality, the severity of which i...

Refractory edema treated with calcium chloride in combination with mercurial diuretics

Abstract Data are presented on 12 patients with edema refractory to mercurial diuretics. During 13 periods of hyperchloremic acidosis induced by calcium chloride alone or in combination with acetazoleamide, responsiveness to mercurial diuretics was restored. Calcium chloride has proved to be a safe, effective substitute for ammonium chloride as a source of chloride in this regimen. It may be employed in patients with liver disease.

Separation of plasma protein fractions by continuous-flow paper electrophoresis using a volatile buffer

Abstract A method is described for use of a volatile triethylamine-acetic acid buffer for continuous-flow paper electrophoresis of human plasma. Separation is excellent and contamination is minimal. The properties of the buffer are well suited for additional analytical studies.

Cardiac aspects of renal disease

Abstract The heart and the kidney are interdependent in the maintenance of circulatory homeostasis. It is not surprising, therefore, that cardiac manifestations are frequently seen in the course of renal disease. Cardiac abnormalities may occur concomitant with renal disease if both share the same basic pathologic process. Cardiac manifestations may also appear as a result of abnormalities in renal function leading to altered fluid and electrolyte balance. In advanced stages of the uremic syndrome anatomic changes in the heart often result. The pathogenesis of many cardiac manifestations in uremia, however, remains obscure. Management of the renal disease is similar in all these processes. The principles as outlined may be applied with minimum laboratory facilities. In maintenance of fluid balance, total daily intake should match total daily loss. Daily measurement of intake and output supplemented by determinations of body weight are readily available, valuable clinical guides. Electrolyte management also involves replacement of specific losses. In complex situations, determination of urinary as well as plasma electrolyte concentrations may prove helpful in calculation of daily needs. Electrolyte abnormalities are most serious in their cardiac effects. The resultant electrocardiographic changes represent the sum total of a complex ion relationship. With changing electrolyte patterns, therefore, frequent electrocardiographic observations are necessary. Specific abnormalities are discussed and illustrated with case examples. The dangers of electrolyte abnormalities and overhydration in the oliguric patient and the basic principles of their management are well recognized. The same principles applied in all phases of renal disease can result in gratifying improvement in useful life expectancy.

An Unusual Clinical SignMydriasis Associated with Hyperkalemia and Metabolic Acidosis

Excerpt Muscle paresis or paralysis is infrequently associated with hyperkalemia (1-3). This relationship was noted in the case presented here and was particularly interesting because of associated...