Intracellular Cation Exchanges in Acidosis Due to Renal Insufficiency. Effects of Alkali Therapy 1

Abstract

Disturbances in the exchanges of certain intracellular electrolytes which occur in patients with metabolic alkalosis, have been described in the previous paper (1). Clues to the direction and magnitude of these disturbances were obtained by calculating from balance measurements the alterations in body fluids produced by replacement therapy. In the present communication the results are presented of a similar study in patients with metabolic acidosis due to renal insufficiency.Since this study involved the administration of hypertonic solutions of sodium bicarbonate or sodium lactate, it seemed advisable to reassess all of the factors, including those of intracellular transfers, which determine the quantitative effect of such replacement therapy on the total fluid and acid-base equilibrium of these patients. Previous studies have been made of the effects of alkalinizing sodium solutions. Palmer and Van Slyke (2) and later Hartmann and Senn (3) found that the rise in serum bicarbonate was such that the dose of alkali was apparently distributed through a volume equal to two-thirds of the body weight, a fraction which they believed represented the total body water. Since both bicarbonate ions (4, 5) and the major portion of sodium ions are not freely diffusible across the cell membrane, some explanation must be sought for the discrepancy between the value stated above and the now commonly accepted

Muscle Composition in Respiratory Acidosis 1

“…These findings confirm the suspicions of Elkinton, Squires, and Singer in the case of humans with respiratory acidosis (13). Therefore, in the fluid therapy of these states adequate quantities of water and extracellular electrolyte (sodium chloride) should be provided so that complete renal compensation may be effected.…”