ACID-BASE EQUIVALENCE OF THE BLOOD IN DISEASES ASSOCIATED WITH HYPERGLOBULINEMIA; WITH SPECIAL REFERENCE TO LYMPHOGRANULOMA INGUINALE AND MULTIPLE MYELOMA

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Abstract
Further data concerning the occurrence of hyperpro-teinemia in lymphogranuloma inguinale, to which the authors had previously called attention, are presented. The serum protein concn. exceeded 8% in 26 of 35 patients with this disease, reaching levels as high as 11.2%. The rise in serum protein was due to increases in the euglobulin and pseudoglobulin I fractions. Electrolyte partitions of the sera of 18 patients with lymphogranuloma inguinale revealed a consistent discrepancy in acid-base equivalence of the blood in those cases presenting marked hyperglobulinemia: there was an apparent excess of determined acid-equivalents over total base, i.e., B[long dash]A appeared to be negative. A fair positive linear correlation could be made out between the degree of increase in serum euglobulin and the degree of excess of acid-equivalents over equivalents of base. A similar discrepancy in acid-base balance was noted in cases presenting marked hyperglobulinemia due to multiple myeloma and, in occasional cases, to other causes. This discrepancy appeared only rarely in acid-base balances carried out on normal subjects, or on patients with lymphogranuloma inguinale, multiple myeloma, etc., with serum proteins within normal limits. Possible causes for the discrepancy in acid-base equivalence found in association with hyperglobulinemia are considered. Changes in pH of the serum, alteration in the organic acid radicles of the blood, the presence of lipid-bound chloride, negative analytical errors in estimating base, loss of Na due to disease are either ruled out or held to be improbable causes. The authors consider the discrepancy to be apparent only and the result of erroneously high values for protein acid-equivalents. The error is thought to be introduced by the application to pathological serum globulin (which contains a large proportion of abnormal euglobulin) of a factor for calculating base bound to globulin which was derived from normal serum globulin. When the factor now in general use for estimating base bound to globulin is applied to sera with definite hyperglobulinemia, a correction is necessary.

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