TOTAL ACID-BASE EQUILIBRIUM OF PLASMA IN HEALTH AND DISEASE
Authors: John P. Peters, A. Maurice Wakeman, Anna J. Eisenman, Carter Lee
Journal: Journal of Clinical Investigation (1929)

In a study of the metabolism of patients with nephrosis and the nephrotic type of glomerular nephritis, the total acid-base equilibrium in the serum has been determined by a procedure described in previous papers of this series (1, 2).Briefly, this consists of the determination of the concentration of base and of most of the important acids of the serum: protein, bicarbonate, chloride and inorganic phosphate.It was hoped that such studies might throw some light on the patho- genesis of edema and especially on the relative influence of individual electrolytic components in the production of edema. NATURE OF THE CLINICAL MATERIALA brief description of the chief characteristics of each patient will suffice for the purposes of the present discussion.It may be assumed that the patients were subjected to careful routine examinations and that relevant findings, when not mentioned, were negative.Case no.29122.A Greek, aged 30, in the four months before admission developed generalized subcutaneous edema, ascites and right sided hydrothorax.There was no history of antecedent infection; his blood pressure was moderately elevated, 154/85 on admission, but rapidly fell to normal.The urine always contained large amounts of albumin and casts, but no red blood cells.Case no.31190.An Italian male, aged 52, in the three weeks before admission developed moderate pitting edema of the lower extremities and back.There was' no history of antecedent infection.His blood pressure on admission was 145/80, but rapidly fell to normal.His urine contained much albuimin and many casts, but 577 RENAL EDEMA few leucocytes or red blood cells.A year after discharge albuminuria persisted; but edema had not returned as long as he continued treatment.His blood pres- sure was 164/88 on one occasion, at other times normal.In 1924 he had become infected with syphilis and his Wassermann was found to be strongly positive.Case no.35628.(Protocol given at length in a previous paper (3)), a Polish male, aged 43, four months before admission, after tonsillitis, developed generalized subcutaneous edema, double hydrothorax and ascites.His blood pressure wat normal.The urine contained much albumin, many casts, moderate numbers of leucocytes and variable numbers of red blood cells.Early in his course in the hospital he had two attacks of sore throat with fever.His edema did not subside until after tonsillectomy, March 17th.Case no.34854.(Protocol of first admission given at length in a previous paper (3)), a Polish male, aged 29, was admitted with generalized subcutaneous edema, double hydrothorax, ascites and splenic enlargement, which had first appeared two years earlier after an attack of polyarthritis and had been aggravated by frequent sore throats which had continued even after tonsillectomy.His blood pressure was 155/95 on admission, but soon fell to normal.His urine contained much albumin, many casts and leucocytes and variable numbers of red blood cells (sometimes gross blood).His course was marked by attacks of sore throat associ- ated with fever and exaggeration of the hematuria.He was discharged in August, but returned the next June, after a prolonged stay in another hospital, temporarily free from edema, but sick and emaciated.After July 10th, symptoms and signs suggesting embolic phenomena appeared with increasing frequency.September 19th and October 8th he had typical apopletic seizures and died shortly after the second.Autopsy revealed a massive cerebral hemorrhage; evidences of old and recent infarcts in several organs; a single, small fresh vegetation on the mitral valve; and large, swollen, kidneys that presented evidences of focal embolic lesions, diffuse glomerular nephritis and tubular degenerative changes.Case 56883.An American male, aged 21, was admitted because of a profuse albuminuria that had developed after a severe attack of "grippe" five years earlier.His blood pressure was normal.The urine contained much albumin and moderate numbers of casts and leucocytes.Case no.50265.A Swiss male, aged 36, with tuberculosis of the upper lobe of the left lung and a chronic discharging right ear, developed edema of the lower extremities six months earlier.His blood pressure was normal.The urine contained large amounts of albumin and many casts, but no red blood cells nor leucocytes.