Plasma Potassium and Phosphate Concentrations—Influence by Adrenaline Infusion, β-blockade and Physical Exercise

ABSTRACT. Ljunghall S, Joborn H, Rastad J, Åkerström G (Departments of Internal Medicine, and Surgery, University Hospital, Uppsala, Sweden). Plasma potassium and phosphate concentrations—influence by adrenaline infusion, β-blockade and physical exercise. Acta Med Scand 1987; 221:83–93. Infusion of adrenaline into healthy male subjects reduced the plasma concentrations of both potassium and phosphate to a similar extent, in a dose-dependent manner, an effect which was prevented by the administration of propranolol. Ergometer bicycling until exhaustion, which caused marked accumulation of lactic acid in the blood and reduction of pH, induced great elevations of both plasma potassium and phosphate with close relationships between the raised plasma concentrations and the reduction in pH, also during β-blockade. However, longer-term aerobic exercise, without acidosis, also caused some rise of the potassium and phosphate concentrations. During recovery from anaerobic, but not from aerobic, exercise there was a rapid decrease of the plasma potassium levels while the phosphate values normalized gradually together with pH. From measurements of the ion concentrations both in the femoral effluent of one leg, which carried out maximal isokinetic work, and in the opposite antecubital vein it could be calculated that there was for potassium, but not for phosphate, a post-exercise uptake both in the exercised muscle and in the entire organism, indicating the participation of systemic factors.     

Clodronate Treatment in Patients with Malignancy-associated Hypercalcemia

ABSTRACT. Rastad J, Benson L, Johansson H, Knuutila M, Pettersson B, Wallfelt C, Åkerström G, Ljunghall S (Departments of Surgery and Internal Medicine, University Hospital, Uppsala, Sweden). Clodronate treatment in patients with malignancy-associated hypercalcemia. Acta Med Scand 1987; 221:489–94. The possibility of reducing symptomatic hypercalcemia and of maintaining total serum calcium concentrations <2.8 mmol/1 with clodronate (dichloromethylene bisphosphonate) was evaluated in 28 patients with various types of malignant tumors. Four episodes of hypercal-cemic crisis with mean serum calcium concentrations of 4.43 mmol/1 were controlled within 4–6 days of intravenous clodronate (4 mg/kg BW/day). This was accompanied by a moderate increase in serum creatinine values which, however, returned to pretreatment levels after therapy withdrawal in all but one case. Oral clodronate successfully reduced a mean serum calcium concentration of 3.16 mmol/1 in 22 out of 25 patients after 3–12 days (800–3 200 mg/ day). After reversal of the hypercalcemias oral clodronate controlled the serum calcium concentration for up to 42 weeks in six out of 15 patients After discontinuation of initial therapy five of seven recurrent hypercalcemias were successfully treated with oral or intravenous clodronate. Hypocalcemia and subjective side-effects were uncommon. It is concluded that clodronate is a valuable clinical tool in the management of patients with malignancy-associated hypercalcemia.     

Muscle Water and Electrolytes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

ABSTRACT. Muscle water and electrolytes were determined in percutaneous muscle biopsy material from m. quadriceps femoris in 33 uremic patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for 1–38 months, and in 34 normal subjects. The patients showed increased muscle contents of water, sodium, and chloride relative to fat-free solids (FFS); both intra- and extracellular water contents were increased. The total water content was inversely correlated with the duration of CAPD. The muscle potassium content was increased, both relative to FFS and to magnesium, whereas the intracellular potassium concentration was normal. Despite hypermagnesemia, the muscle content of magnesium was normal and the intracellular concentration was even slightly decreased due to the increase in intracellular water. We conclude that muscle water and electrolyte status is abnormal in CAPD patients, but the alterations appear to be less marked than in uremic patients undergoing other forms of therapy.     

Chediak''s anomaly of leukocytes in malignant lymphoma associated with leukemic manifestations: case report with necropsy

A case of Chediak’s anomaly of leukocytes was described, the fourth reported in the literature.

The patient was an 11-month-old boy who, in addition to Chediak’s anomalyof the leukocytes, presented a leukemic blood picture.

He died five days after admission to the hospital, and necropsy revealeda malignant lymphoma.

We consider it possible that in all the reported cases there were generalizedpathologic changes in the reticulohistiocytic system.

Submitted on December 3, 1957 Accepted on May 15, 1958     

Out-patient antihypertensive drug utilization and stroke mortality: An ecological study

Directly age-standardized rates of out-patient utilization ofantihypertensive drugs (antihypertensives, diuretics and beta-blockers)and stroke mortality in men and women (40–79 years ofage) were compared over 4 years (1987–1990) in a midwestern(Värmland) and a southern (Skäne) province of Swedenand in their 49 (16 + 33) municipalities. In both genders, thestroke mortality and utilization rates of the 3 antihypertensivedrug groups, both combined and separate, were higher in Värmlandand there were positive correlations between these rates whenall 49 municipalities were compared. On the other hand, foreach province and each drug group there were municipalitieswith every possible combination of stroke mortality and antihypertensivedrug utilization rates. In addition, antihypertensive drug utilizationrates were similar in men and women even though the stroke mortalityrates were much lower among the latter. The findings cast doubton the effectiveness of antihypertensive drug treatment in commonpractice.     

Hemodynamics in Diabetic Renal Failure

ABSTRACT. Cardiac performance was assessed by left ventricular catheterization in ten insulin-dependent diabetics with non-dialysis-requiring uremia. None of the patients had a history or clinical signs of ischemic or valvular heart disease or congestive heart failure. Cardiac output at rest was normal in all patients. During exercise, one patient had somewhat low cardiac output and nine showed impaired ability to increase stroke work. This impairment was accompanied by elevation of the left ventricular end-diastolic pressure. The abnormal cardiac performance could not be ascribed to the degree of anemia or uremia or to volume overload. Arterial hypertension possibly contributed. The observations suggest that in diabetic patients with moderate uremia there is also left ventricular dysfunction. Renal transplantation should therefore be considered for these patients earlier than is customary for uremics without diabetes.