Norman M. Keith

SOME EFFECTS OF POTASSIUM SALTS IN MAN

Excerpt During the last few years both the physiologist and the clinician have discovered many new facts regarding the metabolism of potassium. Several factors have stimulated recent studies in thi...

Electrocardiographic changes in uremia associated with a high concentration of serum potassium: Report of three cases

Abstract Serial observations were made in three cases in which severe renal insufficiency and uremia developed. The study included clinical, biochemical, electrocardiographic, and pathologic observations. Consistent observations were a marked increase of the concentration of potassium in the blood serum and the development of an intraventricular conduction defect shortly before death from cardiac failure. These results support the thesis that death in these cases was due to potassium intoxication.

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.

Hypothyroidism and mild myxedema from thiocyanate intoxication

Abstract The patient whose case is reported herein developed hypothyroidism with mild myxedema in the course of prolonged administration of thiocyanate for essential hypertension. Classical cardiac manifestations of myxedema occurred and could be compared with control records made one year previously. Spontaneous, subjective and objective improvement occurred after cessation of thiocyanate therapy. The temporarily enlarged heart receded to dimensions approximating those previously present.

CHRONIC GLOMERULONEPHRITIS FOR FORTY YEARS: REPORT OF CASE

Excerpt The course of chronic glomerulonephritis has been a subject of interest since Bright1considered it in a paper published in 1840. His appraisal of the course was necessarily limited to a per...

The prognosis in acute and chronic nephritis of pregnancy from the standpoint of classification

Abstract The classification of nephritis of pregnancy as acute and chronic and the study of renal function in the individual case is an aid to prognosis. Patients with acute nephritis rarely give a history of previous renal trouble. The presence of albuminuria, the rather sudden rise in blood pressure, and increased edema usually occur during the eighth or ninth month. Tests of renal function show adequate excretion, aside from oliguria, the specific gravity of the urine is high, and the ocular fundi may reveal evidence of acute changes in the vessels and retina. Patients with chronic nephritis often give a history of previous nephritis. Albuminuria, hypertension, and edema are apparent earlier in pregnancy, usually before the seventh month. Tests of renal function often disclose retention of nitrogen and phenolsulphonephthalein. The specific gravity of the urine is fixed or low, and there is definite secondary anemia. Examination of the ocular fundi often reveals changes resulting from previous nephritis. Most pregnant women with acute nephritis recover with little or no demonstrable impairment of renal function. In some cases the disease will progress to the chronic stage. Many pregnant women with a history of nephritis but with no gross impairment of renal function can be carried safely through pregnancy under careful supervision. Chronic nephritis with seriously lowered renal function distinctly increases the hazard to mother and child.