Studies have been carried out to compare the losses of NH4+ and of HCO3– from the dog bladder in vivo when: 1) each of these ions was present separately as the salt of a strong electrolyte, and 2) both ions were present together as ammonium bicarbonate. The initial concentration of electrolyte in each experiment was 100 mmoles/liter. After instillation of ammonium chloride (pH 8), [NH4+] fell by a mean of 20 mEq/liter in 8 hr, whereas after instillation of ammonium bicarbonate, [NH4+] fell by a mean of 67 mEq/liter ( P < .001). After instillation of sodium bicarbonate, [HCO3–] fell by only 10 mEq/liter, whereas in the ammonium bicarbonate experiments it fell by 58 mEq/liter ( P < .001). It is proposed that the larger loss of NH4+ and HCO3– which occurred in the ammonium bicarbonate experiments resulted from the simultaneous and rapid diffusion of NH3 and CO2 with continuous regeneration of each nonionic species at the expense of the ionic member of each buffer pair. These observations suggest that nonionic diffusion, under some conditions, may lead to significant transfers of weak electrolytes across the bladder wall.
The authors report the first American case of a factor VIII inhibitor found in a patient with Sjogren's syndrome. The inhibitor was isolated from a patient with no known hematologic disorder who was seen with a compartment syndrome of the left thigh after sustaining a fall from bed. The Sjogren's syndrome had been previously diagnosed via lower lip biopsy. After fasciotomy, signs and symptoms of intra-abdominal hemorrhage developed, and the patient was taken to laparotomy, where no hemorrhage was found. A coagulopathy developed, and the patient's hemoglobin continued to fall. A complete factor analysis revealed a factor VIII inhibitor that was quantified at 40 Bethesda units. After vigorous therapy-which included factor concentrates, immunoglobulins, steroids, antifibrinolytic agents, and blood replacement-the patient's bleeding stopped and she continued to convalesce under hospital care until her ultimate death from respiratory problems. Acquired hemophilia with a factor VIII inhibitor may be associated with Sjogren's syndrome.
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