No abstract
The relationship between the formation of ascites and dietary sodium in patients with cirrhosis of the liver is well established (1)(2)(3)(4). Rigid restriction of ingested sodium provides a therapeutic procedure which is effective in arresting the accumulation of ascites in most cases of hepatic cirrhosis. However, the many factors conditioning the response to variations in ingested sodium are incompletely understood. Detailed studies of sodium and water metabolism, therefore, were carried out in a large group of patients with cirrhosis. Marked abnormalities were found which were characterized by extreme renal retention of sodium, as previously emphasized by Farnsworth and Krakusin (3), and by low values of serum sodium. Associated with minimal renal excretion of sodium, a more generalized phenomenon of conservation of sodium, as demonstrated in studies on saliva and sweat, suggests an hormonal relationship. It is not inferred that these abnormalities are primary. Rather it is felt that owing to the formation of excessive ascites they may reflect body mechanisms which are essentially protective in nature. 2Wyeth's "Low Sodium Food"; National Drug's "Protinal"; Squibb's "Melactin." sium were determined by means of the Perkin-Elmer flame photometer; lithium was used as an internal standard. MATERIALS AND METHODS AllFood and feces were prepared for analyses of sodium and potassium by ashing. The total three-day collection of feces or of food, including dietary fluids but not water, was pooled and mixed in a Waring blendor. To an aliquot of 10 gms. was added 1 cc. of 10% H2SO,4 to facilitate ashing. The aliquot was dried at approximately 900 C. for two days and ashed at 3000 C. for one hour and then at 500°C. for five hours. A small amount of black material in addition to the sodium and potassium caused no interference in the determination of the latter substances. The black material could be removed by heating at 800°C., but at such temperatures a progressive loss of sodium and potassium occurred. The residue, redissolved in approximately 10 cc. of warm 0.1 N H2SOI, was filtered into a 100 cc. volumetric flask. The crucible and filter paper were washed five times with warm 0.1 N H2SO and the volume was adjusted to 100 cc. with 0.1 N H2SO4 after the solution of lithium required as an internal standard had been added. All determinations were performed in duplicate, the differences averaging less than 1%. Several recovery determinations of sodium and potassium were done with each group of analyses, and were found to range from 96% to 104%.Serum sodium and potassium were also measured by means of the flame photometer, at a dilution of 1:200 for sodium and 1: 10 for potassium; lithium was used as internal standard. To insure accuracy in the preparation of dilutions of serum, especially in the higher dilutions used in analyses of sodium, the same calibrated pipettes were used throughout, a 0.5 cc. blow pipette for sodium and a 1 cc. delivery pipette for potassium. Since the sera analyzed contained extremely variable con...
Numerous reports have appeared in the literatureJ concerning the failure to produce ascites in animals by ligation of the portal vein. These results have caused some people to minimize the importance of increased portal pressure as a factor in the mechanism of ascites in patients with cirrhosis of the liver. Recently Blakemore-l and Lintons have demonstrated that ascites sometimes disappears following anastomoses between the portal and the general venous circulation. Portal pressures 3 and 4 times the nomal range have been found at operation in patients with cirrhosis accompanied by ascites. However, the exact role of elevated portal pressure in the production of ascites is not clear.The present experiments were undertaken to assess the influence of hypoprotein,emia, increased h'a intake and antidiuretic substances on the production of ascites in rats with elevated portal pressure. I t was found that partial ligation of the portal vein alone produced some ascites in a large percentage od the mts. These animals were demonstrated to have increased portal pressure. The additive effect of the other procedures on ascites will be described in another co'mmunication.Experimental Procedure and Results. Adult rats weighing 200-300 g were operated on under ether anesthesia and the portal vein above the splenic vein was ligated to approximately its original circumference. This was carried out by exteriorizing the portal vein and tying it off completely. Then a small probe was inserted in the loose knot and it _____ _._____ ----__ 1. Eck, N. V., Bozjp.rtci X e d .
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