The Role of the Colon in the Pathogenesis of Hyperchloraemic Acidosis in Ureterosigmoid Anastomosis

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Abstract
1. The composition of urine-faeces mixture in seven patients with ureterosigmoid anastomosis has been studied by a dialysis in vivo method using cellulose bags. Urine—faeces dialysate obtained from these patients contained much greater amounts of both bicarbonate and total ammonia than has been reported for faecal dialysate in normal subjects. 2. Total ammonia concentrations in urine– faeces specimens obtained by catheter suggest that urine excreted by the kidneys in these patients becomes increasingly acid with increasing systemic acidosis. The highly alkaline nature of urine-faeces mixtures, especially in acidotic patients, indicates rapid alkalinization of the mixture in the colon. It appears that colonic secretion of bicarbonate is a direct consequence of the acidity of urine excreted by the kidney and draining into the colon. 3. The study suggests that the development of hyperchloraemic acidosis in patients with ureterosigmoid anastomosis is due to bicarbonate secretion by the colonic mucosa, with concomitant chloride absorption. With the development of metabolic acidosis, rapid alkalinization of the urine still occurs in the colon, but during further retention of the urine-faeces in the colon some reabsorption of bicarbonate occurs, probably in part by ionic diffusion since chloride concentration in the lumen increases. 4. Evidence suggestive of non-ionic diffusion of ammonia was found in only one patient. It seems probable that higher rates of urea breakdown in other patients mask the expected relationship between total ammonia and bicarbonate.

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