Further Observations Upon the Changes in the Electrolytes of the Urine Following the Injection of Parathyroid Extract 1

Abstract

From previous studies (1, 2, 3, 4, 5) it now seems clear that one of the most striking changes found in the urine after the injection of parathyroid extract is the immediate increase in the absolute amount and in the concentration cf inorganic phosphate. Goadby and Stacey (6) have also emphasized the increased excretion of phosphate after the administration of parathyroid extract. In agreement with our experience, these observers did not find at any time an increase in the level of inorganic phosphorus in the plasma, but occasionally noted a fall of that level after the excretion of increased amounts of inorganic phosphate in the urine.They were unable to prevent the rise in excretion of urinary phosphorus by lowering the level of inorganic phosphate in the plasma with glucose administered at the time of the parathormone injection. The work of Goadby and Stacey, together with ours, serves to direct attention to the behavior of the kidneys in response to parathyroid extract.In 1934, while studying the phosphate excretion by the kidney, one of us (5) observed that, when urine specimens were taken hourly before and after the administration of parathyroid extract, the pH showed a tendency to shift definitely to the alkaline side during the first hours after the extract was given. In order to examine this effect further it seemed advisable, although the bicarbonate of urine may be roughly estimated from the pH, to determine accurately the bicarbonate content of the urine before and after giving parathyroid extract and to compare the magnitude of any change found with that of the inorganic phosphate.At the same time estimations of pH, sodium, 1 This work was aided by a grant from the council on Pharmacy and Chemistry of the American Medical Association. potassium, ammonium, phosphate, and chloride ions were made. As previous estimations have shown no significant alteration in urinary calcium, in experiments of the duration of the present ones, urinary calcium determinations were not done. EXPERIMENTALThe subjects of the experiment were four male patients; three (G., S., K.) were convalescent from respiratory infections and ready for discharge from the hospital, the fourth, M., was a patient who had been operated upon for hyperthyroidism and who had developed hypoparathyroidism after operation. All patients were fasted and kept in bed for 12 hours before and throughout the duration of the experiment. Each patient was given 100 cc. of water by mouth each hour. Urine specimens in the three convalescent subjects were collected under oil, those of M. were not. The specimens were collected hourly for three hours before and four hours after the intravenous injection of 4 cc. of parathyroid extract (Lilly).The analyses were made by standard methods as follows: pH by the quinhydrone electrode (13)

Effects of Volume Expansion, Purified Parathyroid Extract, and Calcium on Renal Bicarbonate Absorption in the Dog

“…The concentration of ultrafilterable calcium fell, however, and this coupled with the alkalosis (20) could have stimulated PTH secretion. Since PTH has been shown to increase urinary bicarbonate excretion (7)(8)(9)(10), it is possible that the observed decrease in bicarbonate reabsorption was the consequence of the elaboration of PTH and not of volume expansion per se. To resolve this question TPTX animals were studied.…”

“…As early as 1935 Ellsworth and Nicholson (7) noted that the infusion of PTE was followed by a rise in urinary pH, bicarbonate, sodium, and phosphate. They postulated that PTE produced an increase in sodium excretion and secondarily increased phosphate and bicarbonate excretion.…”

“…In past studies it had been shown that the infusion of parathyroid extract (PTE) results in increased bicarbonate excretion (7)(8)(9)(10). Conversely, the infusion of calcium was shown to increase hydrogen ion secretion and the excretion of ammonia (11).…”

Renal Bicarbonate Wasting during Phosphate Depletion A POSSIBLE CAUSE OF ALTERED ACID-BASE HOMEOSTASIS IN HYPERPARATHYROIDISM

“…These observations led Muldowney et al (10) to postulate that parathyroid hormone directly decreases the renal reabsorption of bicarbonate resulting in metabolic acidosis. Support for such a postulate is found in experimental observations that the acute administration of parathyroid extract (PTE)1 produces a rise in urinary pH and an increase in urinary excretion of HCOi- (15)(16)(17)(18). However, Kurtz-man, Karlinsky, and Sager (19) SERUM PHOSPHORUS mg/100 ml FIGURE 1 The relation between the levels of serum bicarbonate production of phosphate depletion.…”

A micropuncture study of the effect of parathyroid hormone on renal bicarbonate reabsorption.

“…1 Abbreviations used in this paper: EFp, excreted fraction of phosphorus; GFR, glomerular filtration rate; PTH, parathyroid hormone; SED, standard error of difference; SNGFR, by the renal tubules (1)(2)(3)(4)(5)(6)(7)(8)(9). Infusion of purified parathyroid extract into intact dogs under normal acidbase conditions causes a transient rise in urinary bicarbonate excretion (7), and when infused into parathyroidectomized bicarbonate-loaded animals, a sustained reduction in tubular reabsorption of bicarbonate results (7)(8)(9).…”