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.

Evaluation of somatosensory pathway by short latency evoked potentials in patients with end-stage renal disease maintained on hemodialysis.

Somatosensory evoked potentials and peripheral nerve conduction velocity were studied on 10 patients with end-stage renal failure maintained on hemodialysis treatment. None of the patients had symptomatic neuropathy and the only abnormal finding on neurological examination was absent ankle jerk in 7 of the 10 patients. Nerve conduction velocities and intercomponent conduction times of the somatosensory evoked potential were determined using electrical stimulation of nerve trunks and mechanical stimulation of the finger. Nerve ending conduction times was determined using a combination of the two stimuli and found to be abnormal in 8 patients. All 10 patients had slowed sensory conduction velocities at some segment of the tested peripheral nerve. Intercomponent time differences in the somatosensory evoked potentials could not be defined in the majority of our patients due to the absence of many of the components, making it impossible to distinguish whether the changes in somatosensory evoked potentials were due to impaired peripheral input, or to changes in the somatosensory pathway.

Clearance of lidocaine by hemodialysis.

Because little has been known regarding the dialyzability of lidocaine, we studied the clearance of this drug by hemodialysis. The dialysance of lidocaine was found to range between 10.6 to 21.3 ml/min. Lidocaine-urea extraction ratio averaged 11%. Because of the low therapeutic and even toxic plasma levels, the amount of drug removed by dialysis is negligible. Therefore, dose adjustment is unnecessary during dialysis, and dialysis appears to be of little help in the treatment of lidocaine toxicity.

Chronic hemodialysis in end-stage lupus nephritis: changes of clinical and serological activities.

The available data on the clinical and serological activities of systemic lupus erythematosus (SLE) in dialysis patients with end-stage lupus nephritis are limited. The clinical and serological parameters in 12 such patients prior to, at the onset of, and an average of 31 months after the institution of hemodialysis were retrospectively compared. One of the patients died of cardiopulmonary arrest within 1 week after institution of hemodialysis. All patients were clinically and serologically active prior to the onset of end-stage renal disease (ESRD). With the onset of ESRD, 2 of the 10 patients exhibited complete clinical and serological remission, and 2 patients showed clinical remission with persistent serological activity. After an average of 31 months on dialysis, the number of patients in total remission rose to 4 of 11, and the number of clinically inactive but serologically active patients was 1 of 11. Significant clinical and serological activities persisted in 6 of the 11 dialysis patients, requiring low dose steroid therapy in 3. The authors conclude that the clinical and serological activities of SLE decrease with the onset of ESRD and the institution of dialysis, leading to complete or partial remission in the majority of patients.

Reassessment of fistula puncture site blood loss.

Fistula puncture site blood loss during and after hemodialysis was measured in 12 patients with end-stage renal disease. It was found to be 0.74 +/- 0.32 ml per dialysis and 115.4 +/- 49.9 ml per year in patients with Cimino A-V fistulas. Puncture site blood leak in patients with heterologous grafts was 1.77 +/- 0.36 ml per dialysis and 276.1 +/- 56.1 ml per year. The values obtained in this study are 5 to 10 folds less than those found in the original reports. Recent advances in dialytic technology are probably responsible for the observed improvement. The results also suggest that Cimino A-V fistulas are superior to the heterologous graft.

Dialysis-induced changes in muscle strength.

Little is known about the acute effects of hemodialysis on muscle strength. Rapid changes in hemodynamic and biochemical parameters are known to occur during dialysis and may alter muscle performance. Ten patients maintained on chronic hemodialysis had measurements of quadriceps muscle and handgrip strength performed before and after dialysis. In seven of these patients maximum static inspiratory and expiratory pressures (PI max and PE max respectively) were similarly determined. Quadriceps muscle strength improved in 6 patients, decreased in 3 and remained unchanged in 1. Handgrip strength increased in 5 patients, decreased in 3, and remained unchanged in 1. PI max decreased in 6 patients and increased in 1, and PE max decreased in 4 patients and increased in 3. No significant correlation was found between the changes in strength of the tested muscle groups and the serum concentrations of sodium, potassium, calcium, phosphorus, urea nitrogen, and creatinine, changes in blood pressure of fluid balance. The dialysis-induced changes in biochemical parameters may exert opposing effects on neuromuscular performance. This may explain the diversity of the results obtained in this study.