Hemodialysis clearance of cimetidine.

Hemodialysis clearance of cimetidine was determined in three patients and was found to range between 41.34 to 75.91 ml/min. Notwithstanding its substantial dialyzability, the amount of cimetidine removed by four hours of hemodialysis constituted only 8% to 14% of the administered dose. Accordingly, major dose adjustment on the days of dialysis treatment, as suggested in the available literature, may not be necessary.

Nephrotoxicity of paraquat in man.

Renal function studies were performed in three cases of paraquat poisoning. Acute renal failure was observed in all three cases. Glomerular filtration rate improved for two patients who survived three weeks, illustrating the reversible nature of paraquat-induced acute renal failure. A mild to moderate transient proteinuria was observed during the first and second weeks following paraquat ingestion. Renal glucosuria, marked amino aciduria, and increased fractional excretion of phosphorus, sodium, and uric acid were observed. These findings, which have not been previously described in man, are indicative of proximal tubular dysfunction and parallel observations previously made in experimental animals.

Cimetidine in the management of metabolic alkalosis induced by nasogastric drainage.

Metabolic alkalosis resulting from nasogastric drainage is a well recognized and potentially serious clinical problem. In the postoperative patient with acute renal failure, the management of the metabolic alkalosis is particularly difficult, and established modalities of therapy are sometimes ineffective and can be hazardous to the patient. In this article, we report on the successful use of cimetidine (an H2-receptor antagonist) as an adjunct in the treatment of severe metabolic alkalosis in a postsurgical renal failure patient. To our knowledge, this is the first reported successful use of cimetidine in the treatment of metabolic alkalosis due to gastric acid loss.

Transabdominal access to the thoracic aorta for aortofemoral bypass grafting.

When acute thrombosis of the abdominal aorta occurs in a comatose patient, direct examination of the intraabdominal organs becomes mandatory. Once a laparotomy has been performed, media calcinosis of the infrarenal aorta is a contraindication to its use as an inflow source. We describe a technique for exposing the thoracic aorta through the abdomen, which obviates the need for a thoracoabdominal incision in such critically ill patients.

Peritoneal dialysis clearance of cimetidine.

Peritoneal dialysis clearance of cimetidine was determined in two patients undergoing peritoneal dialysis treatment. The peritoneal dialysis clearance of cimetidine was approximately 10 ml./min. under optimal dialyzing conditions. The average cimetidine to creatinine extraction ratio was 0.45, which represents significant peritoneal dialyzability. The amount of cimetidine removed, however, constituted only a small fraction of the total administered dose. Therefore, only minor dose adjustments may be necessary during peritoneal dialysis treatment.

Hemodialyzability of acetazolamide.

Because the dialyzability of acetazolamide is not known, we undertook a study to determine the in vivo dialysance of this drug and found it to average 22 ml per minute. The quantity of the drug removed by four hours of dialysis was approximately 30% of the dose administered intravenously one half hour before dialysis. Accordingly, considerable amounts of the drug are removed by dialysis, despite its high intraerythrocytic distribution and plasma protein binding properties. Therefore, hemodialysis may be effective in the management of acetazolamide overdose, particularly when complicated by the presence of renal failure. The dialysance can vary under different dialyzing conditions. An acetazolamide/urea nitrogen extraction ratio of 0.16 established in this study can be used to predict the acetazolamide dialysance in various dialyzing conditions.

Thyroid function studies in the nephrotic syndrome.

Total serum and urinary thyroxine (T4), triiodothyronine (T3), and thyroxine-binding globulin (TBG) as well as serum free T4, thyroid-stimulating hormone (TSH), and T3 resin uptake (T3RU) were measured in seven patients with the nephrotic syndrome. The nephrotic syndrome was defined by proteinuria exceeding 3 g/24 h. All patients were clinically euthyroid. Most values for total serum T4, free T4, T3, T3RU, TBG, and TSH were within normal limits. However, the mean serum T3 and TBG values were significantly lower in patients compared with the control group. The values (mean +/- 2 SD) for urinary T4 were 24.3 +/- 20.3 in the patient group and 1.5 +/- 0.7 microgram/24 h in the control group. Urinary T3 values for patients and the control group were 2100 +/- 856 and 848 +/- 253 ng/24 h respectively. Urinary TBG was 2.1 +/- 1.8 mg/24 h in the patients and undetectable in the control group. There was no correlation between daily urinary T3 and T4 and urinary TBG. There was a weak correlation between daily urinary protein excretion and urinary T4 (r = 0.5).