Hypernatremia, azotemia, and dehydration ue to high-protein tube feeding.
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Biomedical subjects
Publications and source records attributed to M H Gault.
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Serial determinations of serum lactic-acid dehydrogenase (LDH), phosphohexose isomerase (PHI), alkaline phosphatase (AP), and glutamic oxaloacetic transaminase (GOT) were carried out in 30 patients with primary and four with secondary neoplasms of the lung. Enzyme values were correlated with the stage of illness, with tumour histology, with chemotherapy and with the extent and site of metastases as determined at autopsy. The activity of the enzymes LDH and PHI was most frequently elevated; their values correlated closely. AP and GOT tended to become elevated only shortly before death. Although, in general, enzyme activity increased with tumour extension and often in relation to chemotherapy, assays provided little assistance in early diagnosis or prognosis except that, in most instances, elevated values of any of the four enzymes indicated the presence of metastases.
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A simple method is described for the assessment of renal function, without collection of urine. Phenolsulfonphthalein (PSP) is injected intravenously in a dosage of 1 mg./kg. body weight, and blood samples are taken at timed intervals. Only one venepuncture is required. The index is based on the rate of decrease in concentration of PSP in the plasma 15 to 35 minutes after injection, during which time this rate is exponential. The methodology and normal range, and the influence of dose, urine flow rate, age and body surface are defined. The extrarenal component of the PSP index and the distribution of PSP in body fluids are discussed.
The plasma phenolsulfonphthalein index (PSPI) was determined in 175 subjects and was compared with levels of blood urea nitrogen (BUN) and serum creatinine, 15-minute urinary excretion of PSP, and clearance of creatinine, PAH and inulin. Statistical analyses indicate that the PSPI measures the same function as the 15-minute urine test when PSP is administered in a dosage of 1 mg./kg. body weight; and that, although the index cannot be used as a precise substitute for PAH clearance, it is equally repeatable and no greater error is associated with its measurement. The PSPI has been found of most value when complete, accurately timed urine collections are unobtainable because of urological abnormality or inability of the patient to co-operate.
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Five patients with bronchogenic carcinoma associated with adrenocortical hyperfunction are described. The clinical features, laboratory studies and autopsy findings are discussed and compared with previously reported cases. Four patients presented most of the typical features of this disorder as previously described, whereas the fifth was atypical in some respects. Typical features included: acute onset of adrenocortical hyperfunction in a middle-aged male, rapid downhill course, slight or absent physical signs of Cushing's syndrome, frequently impaired glucose tolerance, markedly elevated plasma and urinary 17-hydroxycorticosteroids not suppressed by exogenous steroids, absent diurnal variation of plasma corticoids, hypokalemic alkalosis with normal aldosterone excretion, and tumour histology of the oat cell variety. The adrenal glands of two patients were of normal or slightly increased weight, and mean 17-ketosteroid excretion values were normal in three; this contrasts with the marked increase in adrenal weight and 17-ketosteroid excretion in most reported cases.
Recently it has been observed that the activity of certain enzymes in serum and urine may be increased after renal infarction. Although aortography or selective renal angiography should be the diagnostic corner-stone on which one would proceed to embolectomy, it is possible that enzyme assays may serve as laboratory aids to suggest or confirm the diagnosis. This paper reviews the few existing clinical and experimental studies and reports on two patients who had a total of three episodes of renal infarction. Serial determinations after one episode showed increased activity of serum oxaloacetic glutamic transaminase (SGOT) and of lactic acid dehydrogenase (LDH) and alkaline phosphatase in the serum and urine; some elevated serum LDH and SGOT values were recorded after the other two infarctions. The time of onset and duration of these increases are discussed, and the possible difficulty in differentiating renal from myocardial infarction is illustrated.
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Sterile dialysate, free of endotoxin (ET) and other cytokine inducing factors, will probably become a future standard. High-flux dialysis with bicarbonate and reuse has the membrane, the pressures, and bacteriologic potential for ET fragments to pass from dialysate to the blood side of the membrane with activation of monocytes and production of cytokines. Ultrafiltration through polysulfone filters has been shown to remove bacteria, ET, and its fragments and other cytotoxic inducing factors. The authors found that in spite of sterile, ET-free, reverse osmosis (RO) water, ET was usually present at the dialyzer inlet and arose from the RO storage tank water with bacteria < 30 CFU/ml, in spite of repeated disinfection. The authors now remove bacteria, ET, and fragments from RO tank water with a 5 mu cellulose filter followed by ultrafiltration with a Fresenius F-80 polysulfone dialyzer inserted between the wall RO delivery port and each delivery system. At the dialyzer inlet, monthly bacterial counts were < 30 cfu/ml, and ET values (n = 38) were not detectable in 89% and < 0.5 EU/ml in 11%. The F-80 filters were used for 180+ dialyses along with the 5 mu filters, which replaced the frequently endotoxin contaminated 10 mu filters in the Monitral-S delivery systems. The costs did not increase.