Transfers of Potassium in Renal Insufficiency 1

Elkinton, J. R.; Tarail, R.; Peters, John P.

doi:10.1172/jci102080

Cited by 70 publications

(21 citation statements)

References 29 publications

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“…Their rates of potassium excretion were quite comparable with that of the control subject (R. E.) on a low potassium diet. Furthermore, most patients with severe renal disease have a lower rather than a higher rate of excretion of the ion (35). It is necessary, therefore, to consider the ways in which the abnormal conditions influence the excretion of potassium by the normal kidney.…”

Section: Discussionmentioning

confidence: 99%

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Potassium Deficiency and the Role of the Kidney in Its Production 12

Tarail¹,

Elkinton²

1949

J. Clin. Invest.

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Section: Discussionmentioning

confidence: 99%

“…In the meantime it is certain that the most important contraindication is inadequate renal function due to any cause (35 (46). A high concentration of potassium in serum, therefore, contraindicates potassium therapy even though the cells may be depleted of the ion.…”

Section: Potassium Deficiency and Role Of Kidney In Producingmentioning

confidence: 99%

Potassium Deficiency and the Role of the Kidney in Its Production 12

Tarail¹,

Elkinton²

1949

J. Clin. Invest.

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“…This is particularly true in those patients with renal failure and a tendency toward potassium accumulation (20)(21)(22). It may be predicted with assurance that such subjects would be harmed by therapy with potassium cycle exchanger, since toxic levels of this cation would be reached that much sooner.…”

Section: Discussionmentioning

confidence: 99%

Acidifying and Non-Acidifying Carboxylic Resin Mixtures Used Alone and With Acth or Cortisone

Peters¹,

Danowski²,

Greenman³

et al. 1951

J. Clin. Invest.

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Evidence has been presented indicating that a sufficient intake of a carboxylic cation exchanger in the potassium cycle increases the stool output of sodium in absolute as well as in relative terms (1)(2)(3)(4). Two other findings accompanying the use of this form of the resin are noteworthy: a) a significant proportion of the potassium taken with or as part of the resin can be retained in the body and b) ingestion of this particular resin does not produce acidosis. Its efficiency in removing sodium is probably not as great, however, as that of either the hydrogen or the ammonium forms of the resin, each of which interferes with potassium absorption and induces a metabolic acidosis. The first half of this paper deals with findings observed during the simultaneous administration of the two types of resin in equal proportions, i.e., potassium cycle mixed with either the hydrogen or the ammonium cycle, as well as in mixtures in which the acidifying resin predominated.The second half of this report describes results obtained during the use of resin mixtures with ACTH or cortisone or both. The expanding recourse to adrenal cortical effects in the therapy of a wide variety of disease states (5-7) has further emphasized that prolonged therapy is frequently not possible because of two particularly undesirable concomitants, i.e., sodium retention and potassium depletion. It seems probable that these side effects by necessitating interruption or intermittency of treatment deprive patients of benefits which might be otherwise obtainable. The combined resin and steroid or hormone studies herein presented describe attempts at prevention or deferment of such deviations in cation metabolism. MATERIALS AND METHODSEqual parts of the acidifying and non-acidifying exchange resins were administered in capsules for a daily total of 24 to 60 g. to hospitalized children or adults during 16 periods three to seven days in length. Mixtures preponderating in the acidifying resin, i.e., 75 to 80% in the ammonium or hydrogen cycle, were given in eight subsequent studies in four patients. In the final group of experiments four parts of ammonium or hydrogen form resin and one part of the potassium resin were administered to patients undergoing treatment with adrenocorticotrophic hormone or cortisone. In all three groups of studies control periods were included when possible. The experimental procedures and other pertinent information have been described earlier (1, 2). The dietary regimens employed, the results of blood and serum analyses, and the available balance data are presented in tabular form. To assist interpretation the findings have been expressed statistically wherever possible and presented in graphic form. RESULTS

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“…Precipitous flaccid paralysis, sensory disturbances and respiratory failure, altogether analogous to the sequence of events in familial periodic paralysis, may occur in these disturbances of potassium metabolism characterized by either deficit or plethora of the ion. The preponderance of evidence indicates that such gross clinical derangements are observed in but a minority of instances of abnormality in the metabolism of potassium (1)(2)(3)(4)(5)(6)(7)(8)(9). Review of existing data, furthermore, fails to disclose a clinical, chemical, or physiologic difference which could account for the capricious incidence of serious manifestations in this minority of patients.…”

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The Ultrafiltrability of Potassium and Sodium in Human Serum

Tarail¹,

Hacker²,

Taymor³

1952

J. Clin. Invest.

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One of the puzzling clinical aspects of the metabolism of electrolytes is the genesis of symptoms and signs of potassium depletion and potassium intoxication (1-3). Precipitous flaccid paralysis, sensory disturbances and respiratory failure, altogether analogous to the sequence of events in familial periodic paralysis, may occur in these disturbances of potassium metabolism characterized by either deficit or plethora of the ion. The preponderance of evidence indicates that such gross clinical derangements are observed in but a minority of instances of abnormality in the metabolism of potassium (1-9). Review of existing data, furthermore, fails to disclose a clinical, chemical, or physiologic difference which could account for the capricious incidence of serious manifestations in this minority of patients.The extensive metabolic studies of Jantz (10) in nine cases of familial periodic paralysis seem to afford a clue to the solution of this problem. He found that episodes of paralysis could be consistently related to a profound reduction in the ultrafiltrable fraction of plasma potassium. Although this finding has not been confirmed or negated, such an explanation might in part account for paralytic phenomena which occasionally supervene in patients without familial periodic paralysis, who develop disturbances of potassium metabolism.The present investigation comprises an analysis of the diffusibility in vitro of potassium and sodium of sera obtained from a group of normal subjects and an analogous preliminary survey of patients with derangements of electrolyte metabolism. The normal subjects were 24 medical students of the freshman class of Boston University School of Medicine. Patients in various states of electrolyte imbalance and dehydration were studied from the wards of Boston City Hospital. Normal subjects came to the laboratory following an overnight fast. Blood was withdrawn, using minimal stasis, under mineral oil, and serum was separated anaerobically within one hour of clot format A portion of serum from the centrifuged blood was aspirated from beneath its thin protective coat of oil into Lavietes' ultrafiltration chambers (11). Anaerobic ultrafiltration transpired through cellophane membranes at room temperature for about 48 hours. Technical details and equipment were identical with those described by Lavietes (11). Both original serum and ultrafiltrate were analyzed simultaneously. Serum residue was not analyzed.Sodium and potassium were determined on the Barclay flame photometer using lithium as the internal standard (12). All fluids were analyzed in duplicate-ie., two separate dilutions of 1 to 50 and 1 to 100 for potassium and 1 to 200 and 1 to 400 for sodium. Each unknown solution was "bracketed" by two knowns, and serum and corresponding ultrafiltrate were read together. Final values were averages of the results of two or more readings of each unknown solution. Average readings of duplicate dilutions were within 2% of one another. Before each group of determinations, the accuracy and precision o...

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Transfers of Potassium in Renal Insufficiency 1

Cited by 70 publications

References 29 publications

Potassium Deficiency and the Role of the Kidney in Its Production 12

Potassium Deficiency and the Role of the Kidney in Its Production 12

Acidifying and Non-Acidifying Carboxylic Resin Mixtures Used Alone and With Acth or Cortisone

The Ultrafiltrability of Potassium and Sodium in Human Serum

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