Kaluresis independent K homeostasis in dogs: activity after ureter ligation and pancreatectomy

In ureter ligated dogs intravenous administration of KCl stimulates both insulin secretion and activity of a kaluresis independent K homeostatic mechanism (K transfer capacity) that retards the development of hyperkalemia by transferring K to intracellular fluid. If the preparation is K loaded by infusion with 2 mEq KCl/kg/hr until prelethal ECG changes of hyperkalemic cardiotoxicity appear, about 50% of administered K is transferred. An increased proportion--70%--is transferred if the animal is K loaded 70 minutes after pancreatectomy--when serum immunoreactive insulin is fixed at less than 4 uU/ml. That proportion (70%) is unchanged by simultaneous adrenalectomy, but is reduced to less than 40% by propranolol blockade of B receptors. Increased post pancreatectomy K transfer capacity apparently involves K transfer mediated by B receptors that are activated by an extra-adrenomedullary B agonist(s). Findings also indicate that residual post pancreatectomy insulin biological activity mediates K transfer.     

Heparin mediates transmembrane potassium transfer in hyperkalemic dogs

Unheparinized, ureter-ligated control dogs that are potassium loaded, i.e., infused with 2 mEq of KCl/kg until prelethal electrocardiographic changes of hyperkalemic cardiotoxicity appear (end point), transfer 57 +/- 4% (1.7 +/- 0.1 mEq/kg) of administered potassium to intracellular fluid. Heparinized controls transfer 73 +/- 1% (3.2 +/- 0.2 mEq/kg); with simultaneous alpha-adrenoreceptor blockade, that proportion increases to 81 +/- 2% (4.80 +/- 0.7 mEq/kg) and with simultaneous beta-receptor blockade it is 58 +/- 3% (1.1 +/- 0.1 mEq/kg). In potassium loaded, ureter-ligated dogs, heparin increases transmembrane potassium transfer as effectively as does a dosage of atropine large enough to cross the blood-brain barrier and its influence on potassium transfer, like that of atropine, is suppressed by beta-adrenoreceptor blockade.     

Kaluresis independent K-homeostasis: glucagon and B receptor blockade in pancreatectomized dogs

Seventy minutes post pancreatectomy, in dogs that are K loaded - made abruptly hyperkalemic and "life threatened" - by infusion with 2 mEgKC1/kg-/hr until prelethal ECG changes of hyperkalemic cardiotoxicity appear, a kaluresis independent K homeostatic mechanism transfers about 2/3 of administered K to intracellular fluid. Treatment of K loaded pancreatectomized dogs with glucagon or a B receptor blockading dosage of propranolol does not alter the proportion transferred, but treatment with glucagon and propranolol reduces it. It appears that in pancx dogs there is a reciprocal relation between insulin and B receptor mediated K transfer and that glucagon is involved in activity of the kaluresis independent K homeostatic mechanism.     

Insulin tolerance test causes hypokalaemia and can provoke cardiac arrhythmias

We report the observation and analysis of a new adverse event during the insulin tolerance test (ITT) and propose additional safety procedures. An 8-year-old girl with growth hormone insufficiency had a cardiac arrest due to ventricular flutter when she was tested for growth hormone deficiency by the ITT. Severe hypokalaemia (K+ 2.6 mmol/l) was observed after resuscitation. Ergometry ECG revealed catecholaminergic polymorphic ventricular tachycardia, a hereditary arrhythmogenic disease. Consecutive measurements of serum potassium during ITT in 29 short children (21 boys) with growth failure revealed a mean decrease of serum potassium by 1.1 +/- 0.4 mmol/l with the nadir at 30 min after the insulin bolus. Hypokalaemia (serum potassium < 3.5 mmol/l) occurred in all but one child; severe hypokalaemia (serum potassium < 2.9 mmol/l) was measured in every third child. This observation indicates that acute hypokalaemia which is induced by insulin and catecholamine excess occurs frequently in ITT. The case shows that the combination of acute hypokalaemia and the adrenergic counterregulation in ITT is a strong trigger of cardiac arrhythmias, which can become life-threatening if the child has an arrhythmogenic disease. Therefore, we recommend ECG monitoring during ITT to enhance the detection of cardiac arrhythmias. In addition, in the case of a comatose child during ITT the determination of the glucose and potassium level as well as adequate treatment are necessary.     

Hypokalemic myopathy associated with primary aldosteronism and glycyrrhizine-induced pseudoaldosteronism

Enzymatic and histological features of muscular disorders associated with primary aldosteronism and glycyrrhizine-induced pseudoaldosteronism were studied. Among 10 patients with primary aldosteronism and 3 patients with pseudoaldosteronism, 5 patients were admitted to our hospital because of muscular weakness. The serum potassium (K) level was 1.86 +/- 0.21 mEq/l in a myopathy group on admission, a value significantly less than that of the 2.74 +/- 0.10 mEq/l in a non-myopathy group (p less than 0.01). Serum creatine phosphokinase (CPK), glutamate-oxyloacetate transaminase (GOT), and lactate dehydrogenase (LDH) were increased in the myopathy group compared to the non-myopathy group; serum CPK was 1412.6 +/- 902.6 vs. 22.8 +/- 5.0 mU/ml, serum GOT was 186.4 +/- 75.3 vs. 24.2 +/- 5.4 mU/ml (p less than 0.05), and serum LDH was 1133.4 +/- 377.3 vs. 387.6 +/- 42.5 mU/ml (p less than 0.05) in the groups with and without myopathy. Analysis of CPK isozymes revealed that the MM type exceeded 95%. The elevated serum CPK, GOT and LDH rapidly decreased to the normal range and muscular strength completely improved within 6 to 13 days after hospitalization, when the serum K level remained below than normal. Light microscopic finding of damaged muscle showed the diffuse necrosis and vacuolization of muscle fibers. Electron microscopic study clearly demonstrated complete dissolution of myofilaments with disappearance of sarcoplasmic reticulum and T-tubules in the necrotic muscle fibers. These results indicate that muscular lesions may occur in primary aldosteronism and pseudoaldosteronism when the serum K level is decreased to below 2.0 mEq/l. This myopathy is not periodic paralysis but hypokalemic myopathy. The mechanism by which K deficiency causes muscular damage remains unknown.     

Quantitative relationship between plasma potassium levels and QT interval in beagle dogs

The aim of the current study was to establish the quantitative relationship between plasma potassium concentrations and the QT interval of the electrocardiogram in dogs. Furosemide, a potent diuretic, was given at increasing doses (5-60 mg/kg) to five male and five female beagle dogs. Electrocardiogram (ECG) was recorded three times each day, simultaneous to blood sampling for measurement of plasma potassium. Furosemide treatment produced a clear hypokalaemia, which was associated with an increase in QT and corrected QT intervals (QTc) duration. On average, the slopes of the negative linear correlation between potassium plasma levels and QT or QTc were steeper in females than in males. These results show that a decrease in potassium plasma level may explain a concomitant increase in QT duration in a toxicity study in dogs, in particular if potassium values are decreased below 3.3 mmol/L. Correction of QT interval for K+ plasma level has, therefore, been established separately for males and females. A global formula correcting QT for K+ and heart rate simultaneously was established. Hypokalaemia was also associated with changes in the morphology of the T wave recorded in CV5RL, in particular, with a flattening and/or a notching of the wave (appearance of a second peak), biphasic aspect or inversion of polarity. These changes are probably related to an increased heterogeneity of repolarization between different populations of cardiomyocytes. In conclusion, hypokalaemia is quantitatively associated with an increase in QT and QTc duration in dogs. The relationship is apparently stronger for females than for males. A formula may be used to correct QT for potassium plasma level.     

Regional increase in extracellular potassium can be arrhythmogenic due to nonuniform muscle contraction in rat ventricular muscle

In the ischemic myocardium, extracellular potassium ([K(+)](o)) increases to ≥20 mmol/l. To determine how lethal arrhythmias occur during ischemia, we investigated whether the increased spatial pattern of [K(+)](o), i.e., a regional or a global increase, affects the incidence of arrhythmias. Force, sarcomere length, membrane potential, and nonuniform intracellular Ca(2+) ([Ca(2+)](i)) were measured in rat ventricular trabeculae. A "regional" or "global" increase in [K(+)](o) was produced by exposing a restricted region of muscle to a jet of 30 mmol/l KCl or by superfusing trabeculae with a solution containing 30 mmol/l KCl, respectively. The increase in [Ca(2+)](i) (Ca(CW)) during Ca(2+) waves was measured (24°C, 3.0 mmol/l [Ca(2+)](o)). A regional increase in [K(+)](o) caused nonuniform [Ca(2+)](i) and contraction. In the presence of isoproterenol, the regional increase in [K(+)](o) induced sustained arrhythmias in 10 of 14 trabeculae, whereas the global increase did not induce such arrhythmias. During sustained arrhythmias, Ca(2+) surged within the jet-exposed region. In the absence of isoproterenol, the regional increase in [K(+)](o) increased Ca(CW), whereas the global increase decreased it. This increase in Ca(CW) with the regional increase in [K(+)](o) was not suppressed by 100 μmol/l streptomycin, whereas it was suppressed by 1) a combination of 10 μmol/l cilnidipine and 3 μmol/l SEA0400; 2) 20 mmol/l 2,3-butanedione monoxime; and 3) 10 μmol/l blebbistatin. A regional but not a global increase in [K(+)](o) induces sustained arrhythmias, probably due to nonuniform excitation-contraction coupling. The same mechanism may underlie arrhythmias during ischemia.     

Prolactin secretion in patients with idiopathic diabetes insipidus.

It has been demonstrated that hyperprolactinemia is sometimes present even in patients with idiopathic diabetes insipidus (DI). In this study, we examined the responses of serum prolactin (PRL) to hypertonic saline infusion and TRH injection in 11 patients with idiopathic DI diagnosed by clinical examinations. Serum sodium in these patients (147.5 +/- 3.2 mEq/L) was significantly higher at baseline than in normal subjects (139.7 +/- 2.4 mEq/L). The plasma arginine vasopressin (AVP) level was significantly lower in DI (0.42 +/- 0.24 pg/ml) at baseline than in normal subjects (2.53 +/- 1.03 pg/ml). However, the serum PRL level in both groups did not differ significantly except in one patient with idiopathic DI (35.6 ng/ml). There was no significant correlation between the basal serum sodium and basal serum PRL in either group. After an infusion of hypertonic saline, the serum sodium level gradually increased to 155.6 +/- 3.4 mEq/L in DI and to 146.5 +/- 4.3 mEq/L in the normal subjects. However, this increase did not affect PRL secretion in either group. PRL response to TRH was essentially normal in all patients with idiopathic DI. These results indicate that the secretion of PRL is not generally affected by chronic mild hypernatremic hypovolemia in the patients with idiopathic DI.     

Role of anion gap and different electrolytes in hypertension during pregnancy (preeclampsia)

The present study was designed to determine the changes in serum sodium, anion gap, different antioxidants and free radicals in preeclamptic patients and control subjects. Serum sodium, chloride, bicarbonate, calcium, potassium and magnesium were estimated and anion gap was determined in 100 proteinuric hypertensive and 100 normotensive pregnant women. Mean serum sodium, chloride and bicarbonate level (133.26 ± 13.1, 104.97 ± 11.37, and 22.01 ± 4.66 mEq/l, respectively) were significantly higher in proteinuric hypertensive women as compared to controls (125.85 ± 10.4, 101.90 ± 6.3, 19.34 ± 3.21 mEq/l, respectively) whereas anion gap level (6.28 ± 16.147) was nonsignificantly higher in proteinuric hypertensive as compared to normotensive (4.61 ± 11.84). Total serum sodium concentration increases in preeclamptic subjects, the exact distribution of serum sodium in various compartments of the body are not clear and correlation of serum sodium and anion gap with proteinuria is also not known. The levels of different antioxidants were decreased in preeclamptic patients as compared to the controls while the level of free radicals elevated in preeclamptic subjects as compared to controls. In our study, anion gap level was found to be rather non-significantly higher in proteinuric hypertensive women as compared to normotensive women.     

Osmotic and ionic regulation during hypoxia in the medicinal leech, Hirudo medicinalis L.

The concentrations of inorganic and organic ions and osmolality in the blood of the medicinal leech, Hirudo medicinalis, were determined during normoxia and hypercapnic and hypocapnic hypoxia. In normoxic animals, the blood sodium concentration was 124.5 +/- 4.2 mmol/l and the total cation concentration was 132.2 +/- 4.3 mEq/l (mean +/- S.D.). Major anionic compounds were chloride (40.8 +/- 1.6 mmol/l), bicarbonate (8.4 +/- 1.3 mmol/l), and organic anions (42.5 +/- 2.3 mEq/l). Among the latter, malate accounts for 30.4 +/- 2.2 mEq/l. The nature of the remaining anion fraction, which balances cation and anion concentrations in leech blood, remains unknown. Within 96 h of hypercapnic hypoxia, the amount of organic osmolytes in leech tissue increased from the control level of 56.6 +/- 9.1 to 158.3 +/- 19.5 mumol/g dry weight. An even higher amount of organic acids was accumulated within 96 h of hypocapnic hypoxia (218.0 +/- 53.7 mumol/g dry weight). A possible reason for this is that lactate, which is a major end-product of hypocapnic hypoxia, cannot be excreted to the external medium as easily as propionate. The accumulation of blood organic acids generating osmotic stress in the animals was compensated by an equimolar decrease in sodium and chloride ion concentrations. In hypercapnic animals these changes resulted in a constant osmotic concentration of the blood (200 mosmol/kg H2O) during the experimental period. Between 24 and 96 h of hypocapnic hypoxia, however, the increase in the osmotic gradient between animal and medium was correlated with further net water uptake and the obvious deterioration of the volume- and ion-regulatory mechanisms in these animals.     

Oral KCl dietary supplement extends survivability of dogs with Heidenhain pouch gastric fistulas

Supplementing the food of Heidenhain pouch gastric fistula dogs with a KC1 product greatly extends the survivability of these dogs. Since there is a continuous discharge of gastric juice from the pouch to the exterior each time a meal is consumed, clinical signs such as dehydration, anorexia, rough hair coat and lethargy usually occur within a few months after gastric pouch surgery and, unless extensive supportive measures are taken, most dogs will die shortly thereafter. The five dogs which did not receive KC1 supplementation died within 6 months after surgery with a mean survival time of 2.4 +/- 0.9 months. Seven dogs that received a daily oral supplement of 1.5 g KC1 (20 mEq) in their food have, on average, survived more than ten times longer than dogs which received no KC1 supplementation, with a mean survival time of 25.1 +/- 4.4 months. All KC1 supplemented dogs survived for more than 15 months with three dogs currently surviving for 36-40 months. When two dogs experienced decreased serum potassium, sodium and/or chloride levels and showed clinical signs of electrolyte imbalance despite receiving daily oral KC1 supplementation, intervention with intravenous (i.v.) lactated Ringer's solution and increased amounts of oral KC1 supplement reversed these symptoms within 1-2 weeks. Dogs that received only i.v. Ringer's therapy died with 1 week of the onset of clinical signs. Daily oral KC1 supplementation, careful observation of behavior and eating patterns, and routine physical examinations and serum electrolyte measurements can greatly extend the life expectancy of dogs with Heidenhain pouch gastric fistulas.     

Gastrointestinal Replacement Solution

The mean sodium concentration of 61 gastrointestinal aspirations in peritonitis was 103 mEq/l. (S.D. 16·66), of 16 aspirations in vagotomy 88 mEq/l. (S.D. 19·49), of 12 aspirations in perforated duodenal ulcer 81 mEq/l. (S.D. 19·49), and of 15 aspirations in intestinal obstruction 89 mEq/l. (S.D. 19·49). The mean potassium concentrations were 9, 9·9, 13, and 8·8 mEq/l. respectively, and the mean chloride concentrations 122, 131, 125, and 112 mEq/l. respectively. It is suggested that a gastrointestinal replacement solution should contain 100 mEq of sodium, 12 mEq of potassium, and 122 mEq of chloride per litre; 50 g. of dextrose or 100 g. of fructose may be added to provide energy.     

Electrolyte changes of serum and muscle,and related mortalities in maturingAnguilla rostrata migrating down the St. Lawrence Estuary (Canada)

This study was made to investigate changes in serum and muscle ion concentrations and related mortalities in maturingAnguilla rostrata migrating down the St. Lawrence Estuary. Mortalities take place in the freshwater portion of the St. Lawrence. Electrolyte concentrations of moribund eels taken in freshwater were compared to those of freshwater and salt water controls. Moribund eels had a much lower serum osmolality (270 mOsm/kg) than the controls (328 and 358 mOsm/kg). This resulted from low sodium (125 mEq/l) and particularly low chloride (69 mEq/l) contents in the moribund eels compared to the freshwater controls (153 and 117 mEq/l) and the salt water controls (179 and 137 mEq/l). There was also a general decrease in muscle ion concentrations in moribund eels though the percentage water was similar to that of the freshwater controls (64.0 and 63.7%). The changes measured between the freshwater controls and the salt water controls in nature are similar to those measured onAnguilla anguilla in laboratory. These results suggest that mortalities are related to failure by some of the maturing eels to maintain their mineral balance in freshwater. Hypothesis is made that maturing eels migrating long distances in freshwater or retarded by physical or chemical barriers, start to excrete sodium and chloride under hormonal control before they have reached brackish water. In the conditions that prevail in the St. Lawrence Estuary, this results in mineral unbalance and possibly in mortalities.     

Serum potassium during exercise in Hereford calves: influence of physical conditioning

We determined how rapidly serum potassium concentration ([K+]) increased, its magnitude, and how quickly it decreased during and after a 3.5-min exercise bout at maximal speed capability in eight Hereford steers, before and after physical conditioning. Serum [K+] values rose rapidly after the start of exercise and declined rapidly to within 7% of preexercise values 5 min after exercise ceased. Before physical conditioning, serum [K+] increased from an average of 4.19 meq/l at rest to 6.71 meq/l at the highest treadmill speed the animals could sustain (1.8-2.4 m/s at a 3 degrees incline). After physical conditioning, the serum [K+] increase at comparable treadmill speeds was approximately 5% lower than before conditioning (average of 6.37 meq/l); however, the animals could now exercise from 0.6 to 0.8 m/s faster than before conditioning, and their maximal serum [K+] rose to an average of 7.47 meq/l, a 10% increase over preconditioned maximal values. We conclude that higher speeds and accompanying increases in serum [K+] attained by conditioned animals may place them at greater risk of cardiotoxicity than before conditioning.     

The role of serum fructosamine as a screening test for gestational diabetes mellitus

The serum fructosamine concentration indicates the degree of glycation of serum proteins, particularly albumin, and reflects an average blood glucose level over the previous 1-3 weeks. Serum fructosamine, glycated haemoglobin (HbA1c), total serum protein, serum albumin, fasting plasma glucose and oral glucose tolerance test (OGTT) have been measured in 127 healthy control subjects, 102 type 1 and 152 type 2 diabetes mellitus patients and 106 nondiabetic pregnant women. Fructosamine concentration of 2.24 +/- 0.16 and 3.21 +/- 0.41 mmol/l (mean +/- S.D.) has been found in control subjects and diabetics respectively (P less than 0.001). During the second trimester a significantly lower fructosamine level (1.92 +/- 0.21 mmol/l) has been found in pregnant women, most likely due to the low serum albumin concentration (31.35 +/- 3.97 g/l). None of them had a fructosamine level above the normal limit of 2.55 mmol/l. On the other hand, 12 pregnant women showed a disturbed OGTT with normal fructosamine. If the serum fructosamine concentration was adjusted for 40 g/l albumin, then a mean fructosamine of 2.16 +/- 0.24 mmol/l was found in patients with gestational diabetes. Our results show that serum fructosamine has a similar diagnostic value as HbA1c for non-pregnant adults, but neither can replace OGTT for the diagnosis of gestational diabetes.     

The influence of water salinity and stage in life history on ion concentration of fish blood serum

(1) The Na, K, Ca, Mg concentration of blood serum have been studied in nearly 60 fish species from various waterbodies (the Neva, Lake Dal'nee, the Volga, Lake Baikal, the White Sea, the Black Sea, the Barents Sea etc.). In fishes (Cyprinidae, Percidae, Siluridae etc.) from fresh water (Lake Dal'nee, the Baikal, the Neva) with low 0.18–0.24 mEq/1 Na concentration Na content in blood serum was lower than in closely related species from fresh water (the Volga, Lyutoga River) with larger Na concentration–nearly 0.5–1 mEq 1. Blood serum of marine teleosts Na concentration (156–210 mEq/1) was higher than in migrating and freshwater species (90–174) mEq/1) and it did not depend on seawater salinity: Barents Sea–465, White Sea–255, Black Sea–227 mEq/1.
(2) Rather a considerable specific variation of ion concentration was found in blood serum of fishes from different families living in the same water body (Lake Baikal: Cyprinidae 90–95 mEq/1, Percidae 114 mEq/1, Salmonidae 126–129 mEq/1 etc.; the Volga: Siluridae 139 mEq/1, Percidae 142–150 mEq/1, Clupeidae 174 mEq/1).
(3) No relation has been detected between K, Ca and Mg concentrations in blood serum of fishes and the concentrations of these ions in the environment.
(4) Na concentration in the blood serum of sockeye salmon juveniles (101 mEq/1) migrating seaward was less than in adult fishes (132 mEq/1) returning to the lake to spawn. Na concentration in the blood of non-migrating salmonids ( Oncorhynchus nerka adult residual 104 mEq/1, Salvelinus alpinus juvenile 140 mEq/1, adult residual 141 mEq/1) changed insig- nificantly during life history. Notable hypopotassemia was observed in spawning time in Salmonidae.
(5) The comparison of blood serum ion concentration in males and females of fishes from different taxonomic groups (Acipenseridae, Salmonidae, Cyprinidae) showed no significant variation.     

X-ray micro analyses of cations (Na, K, Ca) and anions (S, P, Cl) in uterine secretions during blastocyst implantation in the rat

The mass changes of sodium, potassium, and calcium ions in the rat uterine secretion at blastocyst delay, activation, and attachment have been estimated with X-ray microanalyses of samples of uterine secretions absorbed by small Sephadex beads. A quantification of the ions was attempted by using a standardized coat of gold on the beads as a reference element for normalization of the ion peaks and by fitting the normalized values into corresponding linear regression equations obtained from measurements of step-wise dilutions of a control rat serum. The concentrations of sodium observed at delay, activation, and attachment were 117, 201, and 203 mEq/l, respectively, and those of potassium were 6, 18, and 19 mEq/l, respectively. Calcium values were about 2 mEq/l and decreased at attachment. Among the anions, only the chloride concentration increased at activation and attachment.     

The Effect on Serum Ionic Magnesium of Exchange Transfusion with Citrated as Opposed to Heparinized Blood

Serum Mg++ levels before, during, and after replacement transfusion were determined in 20 newborn infants. In 10 infants exchanged with acid-citrate-dextrose (ACD) blood, the level fell from 1.75 ± 0.16 mEq./l. to 0.99 ± 0.16 mEq./l. By contrast, levels in 10 infants exchanged with two types of heparinized blood were unchanged: the pre-exchange values were 1.59 ± 0.11, and the postexchange levels were 1.59 ± 0.08 mEq./l. Mean values for donor bloods were 0.42 ± 0.07 mEq./l. with ACD blood, and 1.45 ± 0.03 mEq./l. with heparinized blood. In vitro studies involving the addition of known amounts of citrate to standard Mg++ solutions demonstrated that the citrate caused a reduction of ionic magnesium. It is proposed that the fall in serum Mg++ when ACD blood is used for exchange transfusion is the combined result of Mg++ binding by the citrate, and the dilution effect of the relatively large proportion of anticoagulant to blood (1:3) used with the ACD mixture.     

Dispersion of cell-to-cell uncoupling precedes low K+-induced ventricular fibrillation

We hypothesize that hypokalemia-related electrolyte imbalance linked with abnormal elevation of intracellular free Ca2+ concentration can cause metabolic disturbances and subcellular alterations resulting in intercellular uncoupling, which favor the occurrence of malignant arrhythmias. Langendorff-perfused guinea pig heart (n = 44) was subjected to a standard Tyrode solution (2.8 mmol/l K+) followed by a K+-deficient solution (1.4 mmol/l K+). Bipolar ECG of the left atria and ventricle was continuously monitored and the incidence of ventricular fibrillation was evaluated. Myocardial tissue sampling was performed during stabilization, hypokalemia and at the onset of fibrillation. Enzyme activities of succinic dehydrogenase, glycogen phosphorylase and 5-nucleotidase were determined using in situ catalytic histochemistry. The main gap junction protein, connexin-43, was labeled using mouse monoclonal antibody and FITC conjugated goat antimouse antibody. Ultrastructure was examined by transmission electron microscopy. The free Ca2+ concentration was measured by the indo-1 method in ventricular cell cultures exposed to a K+-free medium. The results showed that sustained ventricular fibrillation appeared within 15-30 min of low K+ perfusion. This was preceded by ectopic activity, episodes of bigeminy and tachycardia. Hypokalemia induced moderate reversible and sporadically irreversible subcellular alterations of cardiomyocytes and impairment of intercellular junctions, which were heterogeneously distributed throughout myocardium. Patchy areas with decreased enzyme activities and diminished immunoreactivity of connexin-43 were found. Furthermore, lack of external K+ was accompanied by an increase of intracellular Ca2+. The prevention of Ca2+ overload by either 1 mmol/l Ni2+ (Na+/Ca2+ inhibitor), 2.5 micromol/l verapamil, 10 micromol/l d-sotalol or 10 micromol/l tedisamil was associated with the protection against fibrillation. The results indicate that hypokalemia induces Ca2+ overload injury and disturbances in intercellular coupling. Dispersion of these changes throughout the myocardium may serve as the basis for microreentry circuits and thus favor fibrillation occurrence.     

Acid Production in Diabetic Acidosis; a More Rational Approach to Alkali Replacement

The production of organic acids in severe diabetic acidosis was studied to determine the contribution of various acids and to reassess alkali requirements. In 11 patients the mean total concentration of determined organic acids was 16 mEq/l., while the mean estimated base deficit was 24 mEq/l. Acetoacetic and β-hydroxybutyric acids accounted for 75% of measured organic acid. In 10 patients the mean amount of sodium bicarbonate administered for correction of the acidosis was 185 mEq, while the mean requirement was 394 mEq.These findings imply that the methods commonly used to determine the base deficit and the alkali requirements in patients with diabetic acidosis may be invalid. The prompt administration of alkali should be limited, and we suggest that the blood pH should be restored only to 7·25.