Arch Intern Med
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Comparative Study
Treatment of alcoholic acidosis: the role of dextrose and phosphorus.
We have made serial metabolic observations in 18 acute episodes of alcoholic ketoacidosis in ten patients. Data from patients treated with only saline initially were compared to data from patients who received modest amounts of intravenous dextrose (7.0 to 7.5 gm/hr). More rapid improvement in the acidotic state was seen in the latter group (P less than .001). ⋯ Since phosphorus is a critical cofactor necessary for NADH oxidation and the glucose-induced correction of the acidosis was associated with a rapid decline in serum phosphorus from an initial mean of 6.79 +/- .82 mg/100 ml SEM to 0.96 +/- 0.12 mg/100 ml in 24 hours, we propose that glucose enhanced the mitochondrial capacity to oxidize NADH by increasing hepatocyte phosphorus. This effect combined with decline in free fatty acid levels results in reversal of acidosis. Our data suggest that glucose provides the safest, most effective treatment for this disorder; addition of either insulin or bicarbonate is usually unnecessary.
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Comparative Study
Acute myocardial infarction in Newark, N.J. A study of racial incidence.
The incidence of acute myocardial infarction (AMI) among urban blacks appears to be considerably less than that among whites. To evaluate this, all AMIs among Newark, NJ, residents in 1973 were evaluated, using the 1970 census for calculating age, race, and sex-specific rates. Death certificates of patients dead on arrival (DOA) from coronary heart disease (total 517) were also evaluated. ⋯ Although crude rates per 100,000 population were higher for whites than for blacks, age-specific rates by decades from 20 to 80 revealed no differences. Coronary DOA rates were consistently higher among blacks than among whites, reaching approximately a 2:1 ratio in the older decades. The apparent rarity of AMI among Newark blacks is attributable to their relative youth compared to whites (77% under 40 vs 56%) and a higher out-of-hospital coronary death rate.
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Three patients had primary hyperparathyroidism and monoclonal serum immunoglobulins. Although multiple myeloma was suspected in each case, subsequent evaluation was consistent with a "benign monoclonal gammopathy". ⋯ The association between primary hyperparathyroidism and benign monoclonal gammopathy is discussed in terms of possible pathogenetic mechanisms. Primary hyperparathyroidism should be suspected in patients with hypercalcemia and benigh monoclonal gammopathy, as well as in other conditions, like multiple myeloma, that are known to be associated with hypercalcemia.
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Massive cyanide poisoning occurred in a 21-year-old man who had ingested 600 mg of potassium cyanide. The clinical course was marked by acute pulmonary edema and lactic acidosis. Because the poison was unidentified until nine hours after ingestion, the patient received only supported treatment which included diuresis, oxygen, bicarbonate, and assisted ventilation. ⋯ A simple chemical test which can be performed on gastric aspirate is available. Hydroxocobalamin may be used as a nontoxic specific antidote. Nonspecific supportive therapy is of great importance.
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A 56-year old woman, with the diffuse form of bronchioloalveolar cell carcinoma, developed massive bronchorrhea, resulting in severe fluid and electrolyte depletion when her oral intake was compromised. Chemical analysis of the bronchial secretions and the ultrastructural features of the tumor cells support the concept of an active secretory process. The lactic dehydrogenase (LDH) isoenzyme pattern of the fluid is similar to that found in fetal cells. The neoplastic cells may acquire a more primitive LDH pattern.