Robert E. Cooke

The role of potassium in the prevention of alkalosis

Abstract 1.1. Loads of sodium bicarbonate were administered to normal rats in drinking water along with known amounts of potassium and chloride. Alkalosis did not develop after two weeks as long as potassium chloride intake exceeded 0.5 mM/kg./day even though sodium bicarbonate intake amounted to 10 to 30 mM/ kg./day. It was not possible to produce alkalosis in this way in the absence of potassium deficiency, as demonstrated by muscle analysis. 2.2. Sodium bicarbonate, 15 mM per kg., was injected into normal and potassium-deficient rats, and urine was collected for the subsequent twelve hours. Serum and muscle analyses were obtained at the end of that time also. Normal animals excreted 10 mEq. of sodium and 5 mEq. of potassium per kg. of body weight in the twelve-hour period following loading. Essentially no chloride was excreted and alkalosis was not present after twelve hours. Potassiumdeficient animals excreted only 6 mEq. of sodium per kg. and no potassium. Almost 1 mEq. of chloride per kg. of body weight was excreted by the potassium-deficient animals and severe hypochloremic alkalosis was present twelve hours after loading. 3.3. Potassium bicarbonate, 3 mM per kg., was injected twice a day into potassium-deficient rats with hypochloremic alkalosis. No sodium or chloride was administered. After 24 mM per kg. of potassium bicarbonate had been administered, serum bicarbonate concentration fell to normal and serum chloride concentration rose to normal. This correction was associated with relatively little increase in bicarbonate excretion and with essentially no change in urinary pH or titratable acidity. Cation was excreted with organic anion, a large part of which was shown to be citrate.These results suggest that citrate may be substituted for chloride in the renal defense against alkalosis so that sodium is excreted without chloride and without change in urinary pH. Potassium would seem to be essential for the maximal conservation of chloride in this way. 4.4. These findings suggest that potassium deficiency may alter the ratio in which sodium and chloride are reabsorbed from glomerular filtrate. Such an alteration leads to changes not only in extracellular concentrations but also in extracellular volume.

Pathogenesis of the supravalvular aortic stenosis syndrome

Experiences with 15 cases of the syndrome of supravalvular aortic stenosis are described. Clinical and epidemiologic relationships between the syndrome and infantile hypercalcemia suggest the existence of a common prenatal cause for both disorders.

Origin of the galvanic skin response.

Summary The galvanic skin response from a macroelectrode covering the toe pad of the cat was compared with simultaneously recorded potentials arising from individual sweat glands and cells of the surrounding epidermis and dermis of the toe pad skin of the same animal. By direct measurements employing microelectrode technics, the fast negative component of the galvanic skin response was shown to originate in the sweat glands, and to be related to sweat gland activity. The slow positive component of the galvanic skin response was shown to originate in the cells of the epidermal layer of the skin and is therefore unrelated to sweating.

An electron microscopic study of eccrine sweat glands in patients with cystic fibrosis of the pancreas.

Summary Eccrine sweat glands contain an acid mucopolysaccharide-secreting cell in the secretory segment, the mucoid cell. Mucoid cells in cystic fibrosis of the pancreas contain fewer secretory vacuoles than normal. Unidentified dense bodies are present in all cells of the secretory segment in large numbers in cystic fibrosis, but they are also present in small numbers in the normal ones. The eccrine duct is normal in cystic fibrosis. The basic defect in cystic fibrosis of the pancreas is an abnormality in the production of mucopolysaccharide. Those organs secreting mucus evidence morphologic alteration: the mucus-secreting goblet cells obstruct the duct of the pancreas and liver; and the mucus-secreting acini of bronchial, Brunners, submaxillary, and sublingual glands produce obstruction and dilatation of these glands. Glands evidencing no morphologic alteration but demonstrating altered electrolyte secretion are seromucoid glands; that is, the secretory cells liberate low-viscosity material and are ordinarily considered to be serous, but mucopolysaccharide can be demonstrated in the acinar secretory products; the eccrine sweat glands, parotid, and lacrimal glands fall in this class. Various hypotheses are presented to accountfor the defective electrolyte secretion of the seromucoid glands on the basis of altered mucopolysaccharide secretion.

The effect of cyproheptadine on carbohydrate metabolism

Cyproheptadine administration has previously been demonstrated to stimulate appetite. The present study demonstrates a depression of blood glucose by cyproheptadine. while the exact mechanism has not been determined, tentative suggestions are presented.

EVIDENCE OF ALLERGY IN PATIENTS WITH CYSTIC FIBROSIS OF THE PANCREAS

Abstract Review of the records of 135 patients with cystic fibrosis of the pancreas revealed that nineteen had evidence of atopic allergy. The diagnosis of cystic fibrosis was easily overlooked in patients with classical manifestations of atopic allergy, such as asthma, nasal polyps, hay fever, urticaria, eczema, positive skin tests, and familial allergy. Optimal therapy for many of these patients included treatment of the allergic problem as well as the usual regiment for cystic fibrosis. Forty-seven patients with atopic bronchial asthma had no evidence of the sweat chloride abnormality characteristic of cystic fibrosis of the pancreas. The nature of the relationship between cystic fibrosis of the pancreas and atopic allergy is not clear.

Potassium deficiency and adrenocortical hormones in the etiology of metabolic alkalosis

D ARROW and co-workers 1 in 1948 reported a series of experiments defining an interesting electrolyte syndrome which correlated changes between intracellular cations and extracellular anions. With reference particularly to states of potassium deficiency, they noted an association between a loss of potassium and gain of sodium by the cells, with a decrease in the chloride and increase in the bicarbonate in the extraeellular fluids. This syndrome is diagrammed in Fig. 1. Darrows findings created immediate excitement; in subsequent years many publications on this topic have appeared, all of which have been confirmatory to his original observations.

Ethics and law on behalf of the mentally retarded.

Although in theory society has guaranteed the rights of the dependent through protective statutes and institutions, in actual day-to-day operation, many of these protective aspects are misused to protect the rights of the normal and to disenfranchise the mentally retarded. Nowhere is the abuse more flagrant than in the care of the institutionalized retarded.

A structured approach to the use of physician extenders in well-child evaluations*

Systems analysis techniques were used to develop a new method for data acquisition in well-child evaluations. This method, a departure from tradition, was designed to increase physician efficiency, yet maintain an acceptable patient-physician relationship in providing high-quality care. Results of well-child examinations on 104 children using the new method were compared with those obtained by physicians examining children in the traditional manner. More information was obtained by the new method, with significant reduction in time expenditure by the physician. High acceptance with a frequent preference for the new method was expressed by parents and clinic staff.

Physician productivity and medical care

Summary Both the shortage of health services and the rapidly escalating costs of medical care are likely to be improved by increases in physician productivity. The most promising efforts to improve productivity appear to be in the use of various types of assistants at all levels in the health care system. Some progress has been made in defining tasks and training. It is unclear how best to structure the administrative setting in which these personnel would function. However, current expectations about health care, particularly among the urban poor, are unlikely to be met unless new organizations for ambulatory care are developed and implemented. Physicians will need training in how best to use assistants and also in ways of improving productivity in general. Making house staff familiar with, or perhaps even dependent upon, assistants in ambulatory care would seem to be an important addition to training programs. For planning and evaluation in the area of productivity and costs, considerable expertise is required in several disciplines. It seems very clear that training for health services research must be stimulated and sufficient funds made available to train adequate numbers of investigators. There is no reason to accept less well-prepared professionals here than for biologic research. Good principles of financial management require that some small percentage of the vast federal expenditures for health care be devoted to expanded support for both research and training of investigators to maintain adequate study programs of health services effectiveness, quality, and acceptability, as well as productivity.