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A diagram to facilitate the understanding and therapy of mixed acid base disorders.

A diagram based on in-vivo relationships between arterial hydrogen ion activity (H+) and carbon dioxide tension (PCO2) in primary abnormalities of acid base homeostasis is presented. It is designed to facilitate the interpretation of pH data by including the 95% confidence limits described in patients with simple metabolic and respiratory acid base disorders. These bands have been formulated from observation of simple acid base abnormalities and indicate the appropriate respiratory or renal compensatory response to the primary pH defect. A plot which falls outside these limits therefore indicates the presence of a mixed acid base disorder. The diagram presents a physiological approach to clinical disorders of pH regulation demonstrating maintenance of intra-cellular fluid homeostasis during primary extracellular fluid disturbances. Diagnostic and therapeutic advantages are further illustrated and discussed in six case reports.

Acid-Base Imbalance

The need for special foods and sugar substitutes by individuals with diabetes mellitus.

The need for special dietary products marketed for use by individuals with diabetes mellitus and the safety and efficacy of certain nutritive sweetener substitutes for sucrose are reviewed. Special foods for individuals with diabetes mellitus are not necessary to achieve the dietary objectives recommended by leading United States and European authorities. They can be achieved conveniently and at minimum expense through enlightened choices of commonly available food items. At present, specific and unique characteristics of food products with special therapeutic properties for diets of diabetic individuals cannot be delineated or defined on rational nutritional grounds. Such terms as "diet", "dietetic", and "diabetic" on food labels have no uniform meaning for consumers, and diabetologists have observed that patients tend to consume such foods without regard to their energy content. Some consumers regard the reduced-calorie and low-calorie prepared food products as convenient in diets for weight reduction and diabetes although their use in dietary management of diabetes has no therapeutic basis other than weight reduction and maintenance. When fed as pure substances to fasted subjects, the nonglucose carbohydrate nutritive sweeteners, fructose, xylitol, and sorbitol, are absorbed relatively slowly and produce less postprandial hyperglycemia and insulin response than sucrose or glucose. Adequate studies of their long-term effectiveness when ingested as part of mixed meals have not been conducted. Although these sucrose substitutes are generally considered safe, the significance of recent information on possible carcinogenicity of oral xylitol in long-term feeding studies has not been fully evaluated. In view of the lack of certain essential information on the long-term effectiveness of various diets in preventing or mitigating the chronic debilitating complication of diabetes, suggestions for future research are included.

Blood Glucose

The influence of cell surface receptor clustering on the thermodynamics of ligand binding and the kinetics of its dissociation.

We show that an equilibrium model for the clustering, by divalent ligand, of homogeneous plasma membrane-bound divalent receptors that do not change conformation predicts Scatchard plots with positive second derivatives (concave up). The result is thermodynamically indistinguishable from predictions based upon receptors that are heterogeneous for ligand, or that change conformation in a negatively cooperative way when ligand binds. A more general formulation of the theory, which allows application to dissociation kinetics, predicts that the dissociation of labeled ligand is accelerated in the presence of excess cold ligand and, moreover, that the accelerated dissociation has at least two components. The theory is briefly illustrated by fitting five different sets of data, at several temperatures for two different systems, with parameter values that are well within physically meaningful ranges. The model presented is the simplest and least ad hoc explanation thus far proposed as the basis for the kinetic phenomena, and raises the possibility that the numerous experiments in which such data are observed are primarily minifestations of cell surface clustering.

Insulin

Effects of quantity and unsaturation of dietary fat on serum components in normal and diabetic Macaca nigra.

Dietary fat affects serum lipids independently of dietary cholesterol. Normal and diabetic monkeys (Macaca nigra) were fed cereal-based, specially formulated diets with either a low fat (LF = 2.5%) or a higher fat (13.2%) content; the latter had varying concentrations of safflower and coconut oil to attain greater polyunsaturation (SFO) or saturation (CCO) in the diets. Dietary cholesterol was less than 0.01%. Serum triglyceride concentrations were greatest when monkeys consumed the LF (higher carbohydrate) diet and lowest when they consumed the SFO diet. Concentrations were greater in diabetic than in normal monkeys fed the LF and SFO diets, but both groups had similar concentrations when fed the CCO diet. Cholesterol levels in diabetic monkeys were only slightly higher than in normals regardless of diet; in both groups, levels were lowest when the LF diet was fed and highest when the CCO diet was fed. The quantity of fat had a greater effect on serum cholesterol than did the degree of polyunsaturation. In both groups, triglyceride concentrations correlated significantly with VLDL protein, and cholesterol levels correlated with LDL protein. Thus the responses of Macaca nigra to dietary fat manipulation depend upon both the diet fat content and composition as well as the normal or diabetic metabolic state of each monkey.

Animals