Phosphate-binding properties and electrolyte content of aluminum hydroxide antacids.

The phosphate-binding capacities of 19 liquid and solid aluminum hydroxide gel antacids were determined in vitro under varying pH conditions. The resulting data provide a basis explaining the phosphate-binding characteristics observed when patients are treated with long-term aluminum hydroxide therapy. No antacid, liquid or solid, showed significant binding at pH 1.0. Maximum phosphate binding (expressed as phosphorus; P) was observed at pH 2.0 and 3.0 for most antacids and decreased markedly at alkaline pH. The liquid antacids showed a significantly greater phosphate-binding capacity than did tablets or capsules (p less than 0.01). At pH 2.0, the liquid antacids bound a mean of 22.3 mg P/5 ml. At pH 8.0 binding was reduced to a mean of 7.3 mg P/5 ml. Significant interbrand differences were observed. At pH 2.0, the solid antacids bound a mean of 15.3 mg P/tablet or capsule. At pH 8.0, binding was reduced to a mean of 5.8 mg P/tablet or capsule. Interbrand differences, while substantial, were less than those observed among the liquid antacids. Variations in sodium and potassium content were clinically insignificant for most of the antacids in this study, while the differences in phosphate-binding properties were sufficient to warrant attention in the patient with renal failure.

Spontaneous perforation of the colon in a hemodialysis patient.

Spontaneous perforation of the colon by a barium stereoraceous fecaloma occurred two weeks after an upper gastrointestinal x-ray without intervening constipation or symptoms of intestinal obstruction. This patient is chronically uremic as have been a high percentage of the few previously reported similar cases. Renal failure and the associated factors in the management of uremia such as antacids, barium examinations, inactivity, changes in diet and finally abnormalities of the colonic mucosa due to uremia may all predispose these patients to an increased risk for this unusual serious complication.

Granulomatous interstitial nephritis complicating jejunoileal bypass.

Granulomatous interstitial nephritis occurred in a patient five years after jejunoileal bypass surgery was performed. Calcium oxalate crystals were present in the kidney. This finding was associated with renal failure and to our knowledge has not been previously reported. Hepatic granulomas were also present.

T and B lymphocytes in uremic patients with type B hepatitis infection.

Peripheral T and B lymphocytes were measured in (1) hepatitis B surface antigen (HBsAg)-positive, (2) HBsAg-negative uremic patients on chronic hemodialysis (CHD) therapy, and (3) patients with type B chronic active viral hepatitis (CAVH). When compared to normals, a decrease in the absolute number of T and B lymphocytes was detected in both CHD groups. CAVH patients had a decrease in the total number of T lymphocytes. When expressed as percentage of T lymphocytes, normals and HBsAg-negative CHD patients had similar values, while a decrease was detected in both HBsAg-positive CHD and CAVH patients. Also, in the latter two groups, hepatitis B virus infection resulted in an increase in the total number and percentage of null cells.

Barbiturate intoxication. Morbidity and mortality.

The complications encountered in caring for 185 patients intoxicated with barbiturates were reviewed. The population consisted of 142 patients with long-acting barbiturate concentrations of 8 mg per 100 ml or greater, 20 patients with short-acting barbiturate concentrations of 3 mg per 100 ml or greater and 23 consecutive patients with short-acting barbiturate intoxication referred for monitoring. Pneumonia was the major cause of morbidity and mortality and correlated best with the initial depth of coma and the use of an endotracheal tube in treatment. Cardiovascular instability manifested by pulmonary edema was the next leading cause of morbidity and mortality and correlated best with the initial depth of coma and the quantity of intravenous fluid administered. In retrospect, use of eliminative measures such as dialysis would probably not have altered the outcome in most of the patients who died and attempts at forced diuresis may have contributed to several deaths. Particular emphasis should be placed on the problems of sepsis and fluid therapy in the management of these patients.

Evidence for pulmonary microembolization during hemodialysis.

The generation of microaggregates during the extracorporeal circulation of heparinized blood through two types of hemodialyzers was demonstrated by increased screen filtration resistance. Arterial blood deoxygenation and widening of the alveolar-arterial oxygen difference occurred following either unfiltered or inadequately filtered dialysis. These changes were consistent with pulmonary microembolization. The blood gas abnormalities and the increased screen filtration resistance were reversed or improved when venous line microemboli filters were used.

Hypocalcemic tetany due to sodium phosphate ingestion in acute renal failure.

The ingestion of a sodium phosphate laxative preparation (Phosphosoda, Fleed) in a patient who had acute renal failure resulted in hypocalcemic tetany primarily due to severe hyperphosphatemia. Hypernatremia and a marked anion gap were present and attributable in part to the sodium phosphate ingestion of this preparation in the presence of renal failure.