Studies on acidosis and dyspnea in renal and cardiac disease / Francis W. Peabody, Boston.

  • Peabody, Francis Weld, 1881-1927
Date:
1914
Catalogue details

Licence: In copyright

Credit: Studies on acidosis and dyspnea in renal and cardiac disease / Francis W. Peabody, Boston. Source: Wellcome Collection.

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    December 7: The patient’s condition up to 6 p. m., December 6, was unchanged. At that time her mental condition was somewhat clouded. In spite of venesection and enteroclysis, her condition became worse during the early part of the evening and at 11 p. m. she became unconscious. Death occurred at 2:50 a. m. The preceding case is thus one of pure chronic nephritis terminating in uremia. During the whole of her stay in the hospital the excretion of urine was very small. The non-protein nitrogen in the blood was markedly increased and rose progressively. In the last two tests there was no output of phenolsulphonephthalein in two hours. The urine examination shows a high ammonia percentage, which would suggest acidosis. It is interesting, however, that the hydrogen-ion concentra¬ tion of the urine was at all times low. There was nothing in the diet or medication to account for this unusually low acidity. Analyses of the alveolar air showed a progessively falling carbon dioxid content. The ph. of the blood was determined on the last two days and on both occasions shows evidence of marked acidosis. Indeed the deter¬ mination December 6, of blood taken six hours before death, shows evidence of a true shift in the reaction of the blood toward the acid side. It is to be noted that at no time during the course of the dis¬ ease was dyspnea noticed. DISCUSSION OF FOREGOING CASES The foregoing cases confirm the work of von Jaksch,22 who, from results obtained by a rather crude titration method, was the first to describe the acidosis of uremia. More recent investigators, using more accurate methods, have added little that is of essential importance. Straub and Schlayer,23 studying the carbon dioxid tension in samples of the alveolar air, obtained by the Haldane method, found a decreased tension in eight cases of uremia. Slightly low values were found in a number of cases showing only moderate uremic symptoms. The lowest tension occurred in the most advanced cases. These authors go so far as to assume a causal relationship between the acidosis and the uremic condition. Cases of nephritis without evidence of uremia showed normal carbon dioxid tension. Similar results were obtained by Porges and Leimdorfer,24 who also made determinations of the carbon dioxid of the alveolar air. Poulton and Ryffel25 found the alveolar carbon dioxid tension between 14 and 25 mm. in four cases of uremia. The urea-content of the blood was high, and the lactic acid in the blood slightly increased. The blood of these patients took 22. Von Jaksch: Ztschr. f. klin. Med., 1888, xiii, 350. 23. Straub and Schlayer: Miinchen. med. Wchnschr., 1912, lix, 569. 24. Porges and Leimdorfer: Ztschr. f. klin. Med., 1913, lxxvii, 464. 25. Poulton and Ryffel: Proc. Physiol. Soc., June 28, 1913, published in the Jour. Physiol., 1913, xlvii, p. xlvii. /