INTRACELLULAR CATION EXCHANGES IN ACIDOSIS DUE TO RENAL INSUFFICIENCY. EFFECTS OF ALKALI THERAPY 1

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Abstract
The exchanges of intracellular Na and K were calculated by the balance technic in 8 patients with acidosis due to severe renal insufficiency, during the admn. of sodium bicarbonate. On 4 of the patients acid-base data were obtained. Na entered the intracellular phase in all of the patients in amts. ranging from 29-108% of the Na retained. K entered the intracellular phase in the 4 polyuric patients to whom it was given. In the anuric patients to whom no K was given because of an elevated extracellular concn. of the ion, no significant exchange occurred of intracellular K in excess of N. The metabolic acidoses as measured by the buffer base or bicarbonate were corrected in whole or in part in all of the patients. It is concluded that measurements of the whole blood buffer base give a better index than the CO2 content of changes in this type of acid-base disturbance; that shift of Na into cells, as well as excretion of Na and balance of chloride, determine the effect of administered alkali on the acidosis; and that because of the unpredictability of these factors the therapeutic dosage can only be roughly estimated ahead of time.