Since the use of NH₄CI – the standard agent for short duration acid loading – may be hazardous in patients with hepatic disease, the acute renal response to another acidifying agent, orally administered CaCl₂ (2 mEq/kg body weight), was compared to that obtained with NH₄CI (1.9 mEq/kg body weight) in normal subjects during a 5- to 6-hour test. Urine pH decreased in all subjects to less than 5.20, and there were no significant differences in the maximal renal responses to either agent. Both in terms of acidification of the blood and as a stimulus to lowering of urine pH and excretion of acid, CaCl₂ can adequately replace NH₄CI as an acidifying agent in a short duration test and can be used in clinical settings in which NH₄CI is contraindicated.

Red blood cell transketolase activity, before and after addition of thiamine pyrophosphate, was the same in 17 cirrhotic patients and in 31 normal volunteers and chronically ill noncirrhotic patients receiving an adequate thiamine intake. Blood lactate and pyruvate levels and L/P ratios were higher in the cirrhotics. Thiamine supplementation did not alter these results. PaO₂ was lower in the cirrhotic group. pHa and PaCO₂ were not different from controls. Although thiamine dependent enzymes were not evaluated in ether tissues, the red blood cell data suggest that these patients can utilize thiamine normally. Factors other than thiamine deficiency (circulatory changes, hyperventilation, cellular damage) may explain the alteration in lactate-pyruvate metabolism observed in these patients.