Phosphorus In The Blood And Urine: A Study Of The Excretion And Retention Of Phosphorus In A Normal Subject And In Patients With Renal Disease

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Abstract
In a normal, fasting individual the level of inorganic P in the plasma is equal to or less than the level in the whole blood. In patients with nephritis in whom there is retention of P the level of inorganic P in the plasma is greater than that in the whole blood. Retention of P associated with retention of creatinine in patients with chronic nephritis offers a fatal prognosis. A mixture of solution of acid sodium phosphate, 9 %, and of solution of alkaline sodium phosphate, 9.6%, in a ratio of 3 parts of the former to 17 parts of the latter, is suitable for intravenous injection into man. It is nontoxic. The intravenous injection of this solution produces an immediate rise followed by a gradual fall in the inorganic P of the blood; the level of P in the plasma is higher than the level in the cells; it causes an increase in the amount of inorganic P excreted in the urine and in the amount of P excreted in the feces; the amount in the urine is much greater than that in the feces. The CO2 combining power of the plasma, the level of serum Ca, and the feces are not appreciably affected by injection of the solution of P. In the normal, fasting subject 50% of the injected P is recovered in the urine within 4 hrs. In cases of nephritis, the urinary response is delayed and the amount of P recovered is decreased as the amount of renal injury is increased. Also, the return of the level of inorganic P in the blood to that preceding injection is slower in patients with nephritis than in the normal subject. In a normal person more P is excreted in the urine than in the feces. The ratio of the total amount of P in the feces to the amount of inorganic P in the urine is between 1:2.5 and 1:2.9. The path of excretion of P is not altered by the ingestion of CaCl2 even though the level of inorganic P in the blood is raised through intravenous injection of solution of phosphate.

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