TOTAL ACID-BASE EQUILIBRIUM OF PLASMA IN HEALTH AND DISEASE

Abstract

Renal edema was studied in suitable cases from this series. The findings summarized are: The concentrations of base and the most important acids (protein, bicarbonate, chloride and inorganic phosphate) in the serum, together with N and Cl metabolism of patients with nephrosis and nephrotic types of glomerular nephritis, have been determined. Neither the level of protein nor the electrolyte pattern permits differentiation between nephrosis and the nephrotic type of the glomerular nephritis. Serum protein deficiency was the only consistent finding. This is the only abnormality that can be related definitely to the presence or absence of edema. The latter was observed regularly when total protein concentration was below 4%, and in no instance when protein exceeded 5%. Organic acids and inorganic phosphates usually remained unaltered. Bicarbonate changes appear to be merely secondary responses to disturbances of base, chlorides and protein. Hyperchloremia was frequently observed, chloride deficiency never. This, together with a tendency to develop excessive chloride retention, with little diuretic response after NH4Cl, forces the conclusion that the patient with hydropige-nous nephritis has especial difficulty in excreting chlorides. Base was extremely variable but more often low than high, an indication that water is excreted with as much or more difficulty than Na.