The concentration of potassium in the serum of a patient who has developed severe renal insufficiency may be normal, increased, or diminished, and nq, satisfactory explanation for these widely varied concentrations has been advanced. Naturally the finding of an increased content of potassium in the serum of a nephritic patient suggests caution in the administration of potassium salts. On the other hand there are certain undernourished patients who have nephritis and are suffering from lack of potassium and therefore require an increased intake. It is also recognized that many patients who have renal edema can tolerate a considerable daily dose of potassium salts over a period of months without evidences of toxic effects. It is therefore obvious that there are other factors, in addition to renal retention, which play a role in the distribution of the potassium ion in uremic patients.Observations of potassium tolerance, both in normal. subjects and in patients who had adrenal insufficiency, have been made by Zwemer and Truszkowski (1), Wilder and his co-workers (2), and Jaffe and Byron (3). The effects of a small and of a considerable dose of potassium salts were studied by Greene, Levine and Johnston (4), and by Winkler and his associates (5) in renal disease and by Thomson (6) and Sharpey-Schafer (7) in cardiac disease. The doses employed by Winkler and Sharpey-Schafer were frequently large and sometimes proved impractical and even dangerous. We therefore gave normal subjects and patients who had renal disease a uniform and smaller dose of 5.0 grams of potassium bicarbonate by mouth and were gratified to find that this amount could usually be tolerated and also revealed information as to the individual's tolerance. Our procedures and results in normal subjects have already been reported (8). The present communication deals with the results of the same procedures carried out in 10 patients who had definite renal. insufficiency.Distinct alterations in potassium tolerance were observed in all of the 10 patients and form the basis of this paper.
SELECTION OF PATIENTSThe chief consideration in the selection of our patients was demonstrable renal insufficiency. Eight of the 10 patients were deliberately chosen because the degree of renal incompetence was marked and we desired particularly to learn the tolerance for potassium of patients who had a minimal amount of functioning renal tissue. The degree of renal insufficiency of these 8 patients was indicated by the increase in the concentrations of urea and creatinine in the blood from 147 to 340 mgm. and from 5.6 to 19.2 mgm. per 100 ml., respectively. The diagnosis in 6 patients was chronic glomerulonephritis; in the 4 remaining, respectively, it was subacute glomerulonephritis, chronic pyelonephritis, bilateral congenital hydronephrosis, and multiple myeloma with chronic diffuse nephritis. Death occurred in 9 of our patients in 2 weeks to 8 months after the test was done. One patient, J. W., with the least degree of renal incompetence, was alive and active when this...
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