W. V. Consolazio

A record case of the tetralogy of Fallot, with comments on metabolic and pathologic studies☆

Abstract Clinical, metabolic, and pathologic studies of a patient with advanced morbus caeruleus (tetralogy of Fallot) are reported. The patient died at the age of 19, and had been cyanosed since the age of 2. He was proficient scholastically, and, until a year before death, suffered a minimum of handicap from his malady. He was thought to have had rheumatic fever at the age of 9 and subacute bacterial endocarditis during his last year of life. A colon bacillus abscess of the cerebrum was immediately responsible for death. The metabolic investigations revealed a profound variation from the normal in the acid-base equilibrium of the body, and changes in renal function. As much as 75 per cent of the blood in the cardiac chambers was thought to traverse a right-to-left shunt. The oxygen saturation of the arterial blood varied between 62 and 58 per cent. These are critical levels for human existence. The oxygen capacity was about 35 volumes per cent. The carbon dioxide content of the arterial blood was less than 33 volumes per cent. The arterial pH s was less than 7.29. A profound, uncompensated acidosis was attributed to the increased concentration of undetermined acids and failure of the respiratory center to maintain the usual balance between free and combined carbon dioxide. The functional insufficiency of the kidneys was attributed to anoxemia, venous congestion, and acidosis.

Electrolyte Balance of the Blood in Ménière's Disease

Mygind and Dederding 1 associated the pathogenesis of Ménières disease with a disturbance of water and salt equilibria. From their investigations they concluded that a dehydrating and an acid-forming diet was indicated in the treatment of this condition. Two years later Furstenberg, Lashmet and Lathrop 2 extended these observations, showed evidence which indicated that sodium was the offending ion and recommended a regime with a low sodium diet and intermittent periods of ammonium chloride ingestion. This regime, where employed, has been successful, 3 , 4 but we believe from our data that a lowering of the sodium content of the body fluids is not its mode of action. In this communication blood studies from 14 patients with Ménières disease are presented. The diagnosis was confirmed by one or more clinicians and satisfied most of the criteria discussed by Crowe. 5 In all of the patients the concentration of serum total base, sodium and potassium was determined and in 4 the concentration of serum protein and hydrogen ion also. Eight patients were seen during periods of acute symptoms and bloods were taken at such times. In 6 patients, bloods were taken after the institution of a low sodium regime or during periods of freedom from symptoms after admission to the hospital. The results are given in Table I. It is observed that the concentrations of serum sodium and total fixed base are within the range for normals. The average concentration of serum sodium is slightly less in the patients with acute symptoms than in those without acute symptoms. The concentration of potassium is somewhat higher in the patients with acute symptoms.